Chapter 20 PREPU questions
A 48-year-old male client diagnosed with type 2 diabetes presents with the following:• Blood glucose level of 46 mg/dL (2.55 mmol/L)• Very lethargic• Has cool, clammy skin.Select the most appropriate intervention. Administer scheduled dose of insulin Encourage the client to sit up and drink 12 ounces of orange juice Place sugared breath mints in the client's mouth Administer injectable glucagon
Administer injectable glucagon
Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia? Muscle spasms and headache Difficulty problem solving and muscle spasms Altered cerebral function and muscle spasms Altered cerebral function and headache
Altered cerebral function and headache
The nurse is caring for a client with type 1 diabetes mellitus and hypoglycemia who is experiencing adrenergic symptoms. Which finding(s) does the nurse expect? Select all that apply. Tremors Palpitations Seizures Anxiety Diaphoresis
Anxiety Palpitations Tremors Diaphoresis
Which comorbidities place a client with diabetes at risk for the development of foot ulcers? Select all that apply. Previous incidents of diabetic ketoacidosis with blood glucose levels of 400 mg/dL (22.2 mmol/L) Diabetic renal problems with severely decreased GFR Bilateral distal loss of pain sensation Smoking history averaging 2 packs/day Motor neuropathy related to improperly fitted shoes
Bilateral distal loss of pain sensation Motor neuropathy related to improperly fitted shoes Smoking history averaging 2 packs/day
The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply. Thirst Anorexia Weight loss Fine moist skin Blurred vision
Blurred vision Weight loss Thirst
The nurse is caring for a client exhibiting polyuria, polydipsia, polyphagia, nocturia, weight loss, and fatigue. Arterial blood gases show a pH of 7.22. For which condition does the nurse suspect? Hyperglycemic hyperosmolar nonketotic syndrome Hypoglycemia Diabetic ketoacidosis Hypocalcemia
Diabetic ketoacidosis
A client with diabetes was visiting the endocrinologist for an annual checkup. The client's blood work reveals an increased level of albumin in the urine. This predisposes the client to which potential complication? Kidney stones Diabetic nephropathy Renal cancer Hyperglycemia
Diabetic nephropathy
A newly diagnosed adolescent with type 1 diabetes read online that diabetes is the leading cause of blindness among Americans. Which statement would be the most accurate information to share with the client along with preventive measures? Reassure her that only type 2 diabetes is a risk factor for blindness. Tell her to expect that she will begin to lose her eyesight by the time she is 25. Tell her there is about a 50 percent chance that she will suffer some diabetes-related sight loss by the time she is 50. Explain that almost all people with diabetes do experience some degree of vision loss.
Explain that almost all people with diabetes do experience some degree of vision loss.
A newly diagnosed adolescent with type 1 diabetes read online that diabetes is the leading cause of blindness among Americans. Which statement would be the most accurate information to share with the client along with preventive measures? Tell her to expect that she will begin to lose her eyesight by the time she is 25. Reassure her that only type 2 diabetes is a risk factor for blindness. Tell her there is about a 50 percent chance that she will suffer some diabetes-related sight loss by the time she is 50. Explain that almost all people with diabetes do experience some degree of vision loss.
Explain that almost all people with diabetes do experience some degree of vision loss.
A young adult has been experiencing some extreme fatigue, changes in vision, and unexpected weight loss, leading the health care provider to suspect hyperglycemia. Which clinical manifestations correlate with a diagnosis of diabetes? Select all that apply. Fruity mouth odor Sweat smelling like honey Ravenous hunger Frequent thirst Excess urination
Frequent thirst Excess urination Ravenous hunger
Diabetic retinopathy, leading to acquired blindness, usually results from which physiologic abnormality? Glaucoma Infections Dehydration Hemorrhages
Hemorrhages
The nurse is assessing a client with type 1 diabetes mellitus who is experiencing hypoglycemia. Which additional finding(s) may contribute to this condition? Select all that apply. Vomiting Hypersomnia Infection Inadequate food intake Hyperinsulinemia
Hyperinsulinemia Inadequate food intake Vomiting Infection
The nurse is caring for a client on repaglinide therapy for type 2 diabetes mellitus. Which mechanism of action does the nurse associate with this medication?
Increased insulin secretion from pancreas
The diagnosis of type 1 diabetes would be confirmed by which principle? Insulin is present in large amounts for use by the body. Small amounts of insulin are produced daily. Insulin is produced but unavailable for use in the body. Insulin is not available for use by the body.
Insulin is not available for use by the body.
The nurse screening for diabetes mellitus at a health fair does not have enough supplies for all of the clients attending. Which client should be given screening priority? Female age 37, white Female age 28, two children Male age 65, hypertension Female age 30, history gestational diabetes Male age 45, BMI 37
Male age 45, BMI 37
A client is brought to the emergency department with a suspected diagnosis of DKA (diabetic ketoacidosis). Select the assessment data (or diagnostic data) to confirm the diagnosis. Select all that apply. Low serum bicarbonate Positive urine ketones High arterial pH Hypoglycemia Negative serum ketones
Low serum bicarbonate Positive urine ketones
A client has been experiencing elevated blood glucose levels. The nurse anticipates that which assessment data correlates with hyperglycemia? Moist mucous membranes Hypertension Polydipsia Fasting blood sugar (FBS) 120 mg/dL (6.66 mmol/L)
Polydipsia
The nurse is caring for a client with suspected type 1 diabetes mellitus. For which finding(s) should the nurse monitor? Select all that apply. Polydipsia Polyphagia Polyuria Weight gain Hyperactivity
Polydipsia Polyuria Polyphagia
A client is diagnosed with diabetic ketoacidosis (DKA) in the emergency department. Which clinical manifestations will the client likely exhibit? Ankle edema, headache, stomach bloating, and high blood pressure Weakness, severe dehydration, and hemiparesis. Headache, difficulty with problem solving and disturbed behavior, and seizures Polyuria, polydipsia, vomiting, and fatigue
Polyuria, polydipsia, vomiting, and fatigue
Infections are common in people with diabetes. Which infection is thought to be related to a neurogenic bladder? Urinary incontinence Pyelonephritis Urinary retention Nephrotic syndrome
Pyelonephritis
The nurse is preparing to administer short-acting insulin to a client with type 1 diabetes mellitus. Which insulin should the nurse administer to the client? Regular Insulin glargine Ultralente NPH
Regular
An adolescent male with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which response by his mother is most accurate? "I know it's not fun, but you're even more susceptible to complications when you're young if you don't stay on top of your diabetes." "Even though you might save some time and energy by doing this, remember that high blood sugars cause a lot of pain and will cause you to gain weight." "Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road." "You need to be vigilant now if you want to be free of diabetes when you grow up."
"Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road."
A client's primary care provider has prescribed an oral glucose tolerance test (GTT) as a screening measure for diabetes. Which instruction should the client be given? "You will drink a sugar solution and then your blood sugar will be measured at specified intervals." "You will be given a sugary drink and then have blood glucose measured once 2 hours later." "Your blood sugar will be checked when fasting and then 2 hours after you eat a meal." "You will have a sample taken to measure how much sugar is attached to your red blood cells."
"You will drink a sugar solution and then your blood sugar will be measured at specified intervals."
A client's primary care provider has prescribed an oral glucose tolerance test (GTT) as a screening measure for diabetes. Which instruction should the client be given? "You will have a sample taken to measure how much sugar is attached to your red blood cells." "You will be given a sugary drink and then have blood glucose measured once 2 hours later." "You will drink a sugar solution and then your blood sugar will be measured at specified intervals." "Your blood sugar will be checked when fasting and then 2 hours after you eat a meal."
"You will drink a sugar solution and then your blood sugar will be measured at specified intervals."
The nurse is caring for a client with type 1 diabetes mellitus experiencing blurred vision. Which condition contributes to this finding?
Hyperosmolar state
The nurse knows that a client with diabetes admitted for a lower limb infection likely is experiencing which pathophysiologic principle listed below? Select all that apply. Hyperglycemia may provide an environment that enhances the growth of microorganisms. Infections happen to all age-groups and people and the client with diabetes has the same risk for developing an infection as other clients without diabetes. Any exercise that creates diaphoresis in their feet can cause a fungal infection in clients with diabetes. Clients with chronic diabetes may have vascular problems that impair circulation and therefore cells needed for adequate inflammatory response can't reach the site. Many clients with diabetes have sensory deficits and ignore minor trauma just because they can't feel it in their feet.
Many clients with diabetes have sensory deficits and ignore minor trauma just because they can't feel it in their feet. Clients with chronic diabetes may have vascular problems that impair circulation and therefore cells needed for adequate inflammatory response can't reach the site. Hyperglycemia may provide an environment that enhances the growth of microorganisms.
A client with type 1 diabetes has been deemed to be a candidate for the use of a continuous subcutaneous infusion of insulin (insulin pump). Which educational points should the nurse address in anticipation of this treatment regimen? Select all that apply. Educating the client about the potential complications of pump use Educating the client about the necessity of frequent blood glucose checks Teaching the client how to load and maintain the insulin pump Teaching the client when to supplement the pump with oral antihyperglycemics Teaching the client how to supplement the pump with subcutaneous injections of short-acting insulin
Teaching the client how to load and maintain the insulin pump Educating the client about the necessity of frequent blood glucose checks Educating the client about the potential complications of pump use
A woman with a diagnosis of type 2 diabetes has been ordered a hemoglobin A1C test for the first time by her primary care provider. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the client? Hemoglobin synthesis by the bone marrow is inversely proportionate to blood glucose levels, with low A1C indicating hyperglycemia. The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell. The high metabolic needs of red cells and their affinity for free glucose indicate the amount of glucose that has been available over 6 to 12 weeks. Insulin is a glucose receptor agonist on the hemoglobin molecule and high glucose suggests low insulin levels.
The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.
The nurse is teaching a client with diabetes about the signs and symptoms of hypoglycemia. The client asks, "Why will I get headache, disturbed behavior, coma, and seizures if it's my pancreas that's impaired?" Which response is the best explanation? Hypoglycemia causes ketone breakdown. Hepatic glycogenolysis The brain relies on blood glucose as its main energy source. Insulin produces a rebound hyperglycemia.
The brain relies on blood glucose as its main energy source.
The health care provider is assessing a new client who is reporting nonintentional weight loss. The provider should consider which potential diagnosis? Adult-onset eating disorder, such as anorexia Adrenal tumor Primary hypertension Type 2 diabetes
Type 2 diabetes
A client with diabetes has laboratory results that indicate the presence of microalbuminuria. Which priority self-care measures should the client's care team prescribe for this client? diet, exercise, and prescriptions to lower blood pressure below 140/80 mm Hg use of over-the-counter herbal products for natural diuretic properties decreased oral sugar intake to less than 5 tsp/day increased fluid intake to at least 2000 ml/day
diet, exercise, and prescriptions to lower blood pressure below 140/80 mm Hg
A newly diagnosed type 2 diabetic client has been prescribed metformin. When explaining the actions of this medication, the nurse should include which statement? This medication: blocks the action of intestinal brush border enzymes that break down complex carbohydrates. inhibits hepatic glucose production and increases the sensitivity of peripheral tissues to the actions of insulin. increases insulin sensitivity in the insulin-responsive tissues—liver, skeletal muscle, and fat—allowing the tissues to respond to endogenous insulin more efficiently. acts like a hormone released into the circulation by the gastrointestinal tract after a meal, especially one high in carbohydrates, which amplify the glucose-induced release of insulin.
inhibits hepatic glucose production and increases the sensitivity of peripheral tissues to the actions of insulin.
