Ch 64 NCLEX

Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes?

"Change positions slowly when moving from sitting to standing."

The nurse in the endocrine clinic is reviewing type 1 and type 2 diabetes with a group of nursing students. Which explanation by the students indicates their understanding of the types of diabetes?

Those with type 2 diabetes make insulin, but in inadequate amounts.

The nurse is teaching a client with newly diagnosed type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching?

"I will begin exercising for at least an hour a day."

A client with typically well controlled diabetes has a glycosylated hemoglobin (HbA1C) level of 9.4%. Which response by the nurse is most appropriate?

"Have you been doing something differently?

The nurse is providing discharge teaching to a client with type 2 diabetes and peripheral neuropathy. Which statement by the client indicates a need for further teaching about injury prevention?

"I can break in my shoes by wearing them all day."

The nurse is teaching a client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective?

"I must inspect my shoes for foreign objects before putting them on."

The nurse is teaching a client about the manifestations and emergency management of hypoglycemia. Which response by the client indicates a correct understanding of what to do if the client feels hungry and shaky?

"I will eat three graham crackers."

The clinic nurse is providing teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet?

"If I become hypoglycemic, I could become unconscious."

A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response?

"Let's tackle it piece by piece. What is most scary to you?"

A client with type 2 diabetes controlled with Metformin is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse's best response about why the client needs to take insulin?

"Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily."

The intensive care nurse is caring for a client admitted in a hyperglycemic-hyperosmolar state. Which of these prescriptions made by the primary health care provider will the nurse question?

1 ampule Sodium Bicarbonate IV now

A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client will need to be monitored for hypoglycemia at which time?

11:00 a.m.

Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites?

55-year-old client who has hypoglycemic unawareness

Which of these clients with diabetes will the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit?

A client who needs blood glucose monitoring and insulin before each meal

Which is the best referral that the community health nurse can suggest to a client who has been newly diagnosed with diabetes?

American Diabetes Association (ADA)

A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL (6.0 mmol/L), and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action will the nurse take next?

Ask the client about current dietary intake and medication use.

Which nursing action will the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes?

Assist the client with washing the feet and applying moisturizing lotion.

A client newly diagnosed with diabetes is not ready to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family?

Causes and treatment of hypoglycemia Insulin administration

A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The client's vital signs are: T 98.4°F (36.9°C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action will the nurse take first?

Check the blood glucose.

The nurse has just taken change-of-shift report on a group of clients on the medical-surgical unit. Which client does the nurse assess first?

Client taking glyburide (Diabeta) who is dizzy and sweaty

The nurse working on a medical surgical endocrine unit has just received change-of-shift report. Which client will the nurse see first?

Client with type 1 diabetes whose insulin pump is beeping "occlusion"

The nurse is performing an admission assessment on a 52-year-old client admitted with type 2 diabetes.Physical AssessmentDiagnostic FindingsProvider PrescriptionsLungs clearGlucose 179 mg/dL (9.9 mmol/L)Regular insulin 8 units if blood glucose 250 to 275 mg/dL (13.9 to 15.3 mmol/L)Right great toe mottled and cold to touchHemoglobin A1c 6.9%Regular insulin 10 units if glucose 275 to 300 mg/dL (15.3 to 16.7 mmol/L)Client states wears eyeglasses to readAfter completing the above assessment, which complication of diabetes does the nurse report to the primary health care provider?

Decreased peripheral perfusion

The nurse in the endocrine clinic is providing education for a client who has just been diagnosed with diabetes. Which factor is most important for the nurse to assess before providing instruction to the client about the disease and its management?

Educational and literacy level

Which physiologic actions result from normal insulin secretion? a. Increased liver storage of glucose of glycogen b. Increased gluconeogenesis c. Increased cellular uptake of blood glucose d. Increased breakdown of lipids (fats) for fuel e. Increased production and release of epinephrine f. Decreased storage of free fatty acids in fat cells g. Decreased blood glucose levels h. Decreased blood cholesterol levels

Increased liver storage of glucose of glycogen increased cellular uptake of blood glucose decreased blood glucose levels decreased blood cholesterol levels

The laboratory values of a client who has diabetes mellitus include a fasting blood glucose level of 82 mg/dL (mmol/L) and a hemoglobin A1c (A1C) of 5.9%. What is the nurse's interpretation of these findings?

The values indicate that the client has managed his or her disease well.

The nurse caring for four clients with diabetes has these activities to perform. Which activity is appropriate to delegate to unlicensed assistive personnel (UAP)?

Perform a blood glucose check on a client who requires insulin.

An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. When the cardiac monitor shows ventricular ectopy, which assessment will the nurse make?

Potassium level

A client recently admitted with new-onset type 2 diabetes will be discharged with a meter for self-monitoring of blood glucose (SMBG) levels. When is the best time for the nurse to explain to the client the proper use of the glucose monitor?

While performing the test in the hospital