chapter 45

The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician? 1. Lantus insulin 20U BID 2. Administering regular insulin 30 minutes prior to meals 3. 5 units of Humalog/10 units NPH daily 4. Metformin (Glucophage) 1000 mg per day in divided doses

Correct Answer: 1 Rationale 1: Lantus insulin is usually prescribed in once-a-day dosing so an order for BID dosing should be validated with the physician. Rationale 2: Regular insulin is administered 30 minutes before meals. Rationale 3: Humalog and NPH insulin can be mixed. Rationale 4: Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day.

The nurse understands that which following drug falls under the classification of biguanides? 1. Metformin HCI (Glucophage) 2. Repaglinide (Prandin) 3. Tolbutamide (Orinase) 4. Acarbose (Precose)

Correct Answer: 1 Rationale 1: Metformin HCI is the only drug that falls within the classification of biguanides. Rationale 2: Repaglinide falls within the classification of meglitinides. Rationale 3: Tolbutamide falls within the classification of sulfonylureas. Rationale 4: Acarbose falls within the classification of alpha-glucosidase inhibitors.

The nurse has finished teaching a client with diabetes mellitus how to administer insulin. The nurse evaluates that learning has occurred when the client makes which statement? 1. "I should only use a calibrated insulin syringe for the injections." 2. "I should check my blood sugar immediately prior to the administration." 3. "I should use the abdominal area only for insulin injections." 4. "I should provide direct pressure over the site following the injection."

Correct Answer: 1 Rationale 1: To ensure the correct insulin dose, a calibrated insulin syringe must be used. Rationale 2: There is no need to check blood glucose immediately prior to the injection. Rationale 3: Insulin injections should also be rotated to the arm and thigh, not just the abdominal area. Rationale 4: There is no need to apply direct pressure over the site following an insulin injection.

The nurse makes a home visit to a client with diabetes mellitus. During the visit, the nurse notes that the client's 3-month supply of insulin vials that were delivered a week ago are not refrigerated. What is the best action by the nurse at this time? 1. Instruct the client that the insulin should be stored away from direct sunlight or excessive heat. 2. Have the client discard the vials. 3. Instruct the client to label each vial with the date when opened. 4. Tell the client this is too much insulin to have on hand.

Correct Answer: 1 Rationale 1: Unopened vials can be stored at room temperature but should be stored away from direct sunlight or direct heat. Rationale 2: There is no need to discard the vials. Rationale 3: Writing the date of opening on the vial is good practice but does not address the need to refrigerate additional vials. Rationale 4: There is no indication that this is too much insulin to have on hand.

A nurse has provided education regarding type 2 diabetes mellitus to a newly diagnosed client. Which statements would the nurse interpret as indicating need for additional education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Well, at least the medications I will be on will help me lose weight." 2. "I can take an oral medication and will never have to inject myself." 3. "I can increase my body's ability to use the insulin I make by exercising regularly." 4. "I have several lifestyle changes to make." 5. "I don't run the risk of blindness and kidney disease like type 1 diabetics."

Correct Answer: 1,2,5 Rationale 1: Some of the medications used for type 2 diabetes cause weight gain. Rationale 2: As type 2 diabetes progresses, the cells that produce insulin may fail, causing the need for insulin. Some medications especially designed to treat type 2 diabetes are injected. Rationale 3: The activity of insulin receptors can be increased by physical exercise. Rationale 4: Lifestyle changes can help the type 2 diabetic avoid complications. Rationale 5: If type 2 diabetes is poorly managed, these complications can occur.

A client, newly diagnosed with type 1 diabetes, says, "I have heard this is a bad disease. What complications could I have?" How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Problems with arteries can occur that may cause such problems as heart disease, stroke, kidney disease, or blindness." 2. "Let's not talk about that now, but rather focus on keeping you healthy." 3. "You could have nerve problems that lead to numbness or tingling in your feet or hands." 4. "One of the most serious complications is diabetic ketoacidosis." 5. "You may experience inability to think and difficulty with memory."

Correct Answer: 1,3,4 Rationale 1: Arterial damage can lead to the problems listed. Rationale 2: The client is interested in this topic today, and the topic should be addressed. Rationale 3: Neuropathy may occur, causing numbness, tingling, or loss of sensation in the limbs. Rationale 4: DKA is one of the most serious complications of type 1 diabetes. Rationale 5: While these symptoms may occur related to CVA, they are not primary complications of type 1 diabetes.

The client receives metformin (Glucophage). What will the best plan by the nurse include with regard to patient education with this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. It decreases sugar production in the liver. 2. It inhibits absorption of carbohydrates. 3. It stimulates the pancreas to produce more insulin. 4. It reduces insulin resistance. 5. It increases energy use.

Correct Answer: 1,4 Rationale 1: Metformin (Glucophage) decreases sugar production (gluconeogenesis) in the liver. Rationale 2: Metformin (Glucophage) does not inhibit the absorption of carbohydrates. Rationale 3: Metformin (Glucophage) reduces insulin resistance. Rationale 4: Metformin (Glucophage) reduces insulin resistance. Rationale 5: Metformin (Glucophage) does not increase energy use.

The client has type 1 diabetes mellitus and receives insulin for glycemic control. The client tells the nurse that she likes to have a glass of wine with dinner. What will the best plan by the nurse for client education include? 1. The alcohol could cause pancreatic disease and decrease insulin production. 2. The alcohol could predispose you to hypoglycemia. 3. The alcohol could cause serious liver disease. 4. The alcohol could predispose you to hyperglycemia.

Correct Answer: 2 Rationale 1: Alcohol can cause pancreatic disease, but the client's pancreas is not producing any insulin currently. Rationale 2: Alcohol can potentiate hypoglycemic effects in the client. Rationale 3: Alcohol can cause liver disease, but the more immediate concern is hypoglycemia. Rationale 4: Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client.

A client with diabetes mellitus type 1 is found unresponsive in the clinical setting. Which nursing action is a priority? 1. Call a code. 2. Treat the client for hypoglycemia. 3. Call the physician STAT. 4. Assess the client's vital signs.

Correct Answer: 2 Rationale 1: Assessment for ABCs should precede calling a code; there is no information that the client is not breathing. Rationale 2: When a client with diabetes mellitus type 1 is found unresponsive, the nurse should focus on and treat for hypoglycemia, as this is more likely than hyperglycemia. Rationale 3: This is an emergency situation where the nurse must act before calling the physician. Rationale 4: Vital signs should be taken after the client is treated for hypoglycemia.

Insulin is released when 1. blood glucose stays the same. 2. blood glucose increases. 3. blood glucose decreases. 4. glucagon increases.

Correct Answer: 2 Rationale 1: Insulin would not be released if blood glucose stays the same. Rationale 2: Insulin is released when blood glucose increases. Rationale 3: Glucagon is released when glucose decreases. Rationale 4: Glucagon increases when insulin is not needed.

The mechanism of action of regular insulin is to 1. stimulate the pancreas to produce insulin. 2. promote entry of glucose into the cells. 3. promote the entry of glucose into the bloodstream. 4. stimulate the pancreas to secrete more insulin.

Correct Answer: 2 Rationale 1: Oral hypoglycemic drugs, such as glipizide, stimulate the pancreas to produce insulin. Rationale 2: The action of regular insulin is to promote entry of glucose into the cells, thereby lowering glucose. Rationale 3: Insulin would not promote glucose into the bloodstream. Rationale 4: Oral hypoglycemic drugs, such as glipizide, stimulate the pancreas to secrete insulin.

The nurse teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes? 1. The 38-year-old client who smokes one pack of cigarettes per day 2. The 42-year-old client who is 50 pounds overweight 3. The 50-year-old client who does not get any physical exercise 4. The 56-year-old client who drinks three glasses of wine each evening

Correct Answer: 2 Rationale 1: Smoking is a serious health concern but is not a specific risk factor for diabetes. Rationale 2: Obesity increases the likelihood of developing diabetes mellitus due to overstimulation of the endocrine system. Rationale 3: Exercise is important, but a lack of exercise is not as big of a risk factor as obesity. Rationale 4: Consuming alcohol is associated with liver disease but is not as high a risk factor for diabetes as obesity.

The physician orders insulin lispro (Humalog), 10 units for the client. When will the nurse administer this medication? 1. Thirty minutes before meals 2. Five minutes before a meal 3. When the meal trays arrive on the floor 4. Fifteen minutes after meals

Correct Answer: 2 Rationale 1: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating, not 30 minutes before meals, to prevent hypoglycemia. Rationale 2: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given 5 to 10 minutes before the client eats. Rationale 3: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given just before the client eats, not when meal trays arrive on the floor, to prevent hypoglycemia. Rationale 4: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating, not 15 minutes after meals, to prevent hypoglycemia.

A client with diabetes mellitus is taking oral agents and is scheduled for a diagnostic test that requires him to be NPO (nothing by mouth) and to have contrast dye. What is the best plan by the nurse with regard to giving the client his oral medications? 1. Notify the diagnostic department and request orders. 2. Notify the physician and request orders. 3. Administer the oral agents immediately after the test. 4. Administer the oral agents with a sip of water before the test.

Correct Answer: 2 Rationale 1: The radiologist in the diagnostic department might give orders, but it would be best to check with the client's physician first. Rationale 2: It is best to notify the client's physician and request orders. Rationale 3: Some oral medications should not be given for up to 2 days after receiving IV contrast. Rationale 4: The client should not receive the medication during NPO (nothing by mouth) status unless directed by the physician. Some oral medications should not be given for 2 days before receiving IV contrast.

The client has been diagnosed with type 1 diabetes mellitus. He asks the nurse what this means. What is the best response by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The exocrine function of your pancreas is to secrete insulin, and it is not working." 2. "Without insulin you will develop ketoacidosis (DKA)." 3. "The endocrine function of your pancreas is to secrete insulin, but it isn't working." 4. "Your alpha cells should be able to secrete insulin, but cannot." 5. "It means your pancreas cannot secrete insulin."

Correct Answer: 2,3,5 Rationale 1: The endocrine, not the exocrine, function of the pancreas is to secrete insulin. Rationale 2: A consequence of diabetes mellitus type 1 is that, without insulin, severe metabolic disturbances, such as diabetic ketoacidosis (DKA) will result. Rationale 3: The endocrine function of the pancreas is to secrete insulin. Rationale 4: Insulin is secreted by the beta, not the alpha, cells of the pancreas. Rationale 5: One function of the pancreas is to secrete insulin.

A nurse is reviewing the blood work of a client who has recently begun treatment for type 2 diabetes. Which results would indicate that the client is on target with therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. HBA1C level is 8.4%. 2. HBA1C level is 6.3%. 3. Fasting blood glucose is 130 g/dL. 4. Fasting blood glucose is 100 g/dL. 5. Fasting blood glucose is 68 g/dL.

Correct Answer: 2,4 Rationale 1: This level is too high. Rationale 2: Target level is 6.5% or less. Rationale 3: This is too high. Rationale 4: Goal is 110 g/dL. Rationale 5: A FBG of 68 g/dL is too low.

A client has been prescribed exenatide (Byetta). What medication education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Drink an 8-ounce glass of water with this pill." 2. "You should take this medication twice each day." 3. "You may experience dryness of the mouth while taking this drug." 4. "You may develop diarrhea while taking this drug." 5. "This drug will help you secrete more insulin."

Correct Answer: 2,4,5 Rationale 1: Exenatide is an injectable drug. Rationale 2: Exenatide is often injected twice daily. Rationale 3: This is not an expected adverse reaction. Rationale 4: Diarrhea is an expected adverse effect of this drug. Rationale 5: One of the actions of this drug is to increase secretion of insulin.

The mother of a 4-year-old boy states, "I can't believe my son has type 1 diabetes. We eat well and I was so careful during the pregnancy. What could have caused this?" How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "There must have been something you were exposed to during your pregnancy that caused it." 2. "Are there others in your family who have type 1 diabetes?" 3. "He must have been allowed to eat too much sugar." 4. "We are not certain what causes type 1 diabetes." 5. "It is thought to be a combination of factors."

Correct Answer: 2,4,5 Rationale 1: There is no known factor that would cause type 1 diabetes if the mother was exposed. Rationale 2: There is a genetic factor associated with type 1 diabetes. Rationale 3: This is not a therapeutic statement and supports the urban myth that diabetes is caused by sugar ingestion. Rationale 4: The specific factors that cause type 1 diabetes are still undiscovered. Rationale 5: It is thought that type 1 diabetes is caused by a number of interrelated factors.

Which sign or symptom is most typical of an untreated client with type 1 diabetes? 1. Increased energy 2. Weight gain 3. Fatigue 4. Decreased hunger

Correct Answer: 3 Rationale 1: Clients with type 1 DM do not experience increased energy; a typical sign/symptom is fatigue. Rationale 2: Clients with type 1 DM typically experience weight loss as opposed to weight gain. Rationale 3: Fatigue is a typical sign/symptom of type 1 DM due to sustained hyperglycemia. Rationale 4: Clients with type 1 DM typically experience polyphagia—increased hunger—as opposed to decreased hunger.

What is the primary function of the islets of Langerhans in the pancreas? 1. Secretion of enzymes 2. Acting as exocrine 3. Secretion of glucagon and insulin 4. Absorption of insulin

Correct Answer: 3 Rationale 1: Secretion of enzymes relates to the exocrine function, which is to release enzymes for chemical digestion of nutrients. Rationale 2: Other cells of the pancreas are responsible for exocrine function. Rationale 3: The cluster of cells within the pancreas (islets of Langerhans) is responsible for the endocrine function, which is to release insulin and glucagon. Rationale 4: These are secretory cells, not absorptive cells.

The client has type 1 diabetes mellitus and receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse? 1. "I know it is tough, but you will get used to the shots soon." 2. "Have you talked to your doctor about taking pills instead?" 3. "Insulin can't be in a pill because it is destroyed in stomach acid." 4. "Insulin must be injected because it needs to work quickly."

Correct Answer: 3 Rationale 1: Telling the client he will get used to the shots does not answer his question and is condescending. Rationale 2: The nurse should answer the client's question, not refer him back to the physician. Rationale 3: Insulin must be injected because it is destroyed in stomach acid if taken orally. Rationale 4: Insulin must be injected because it is destroyed in stomach acid if taken orally; the onset of action is not the issue here.

The physician orders intravenous (IV) insulin for the client with a blood sugar of 563. The nurse administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation by the nurse reveal? 1. The nurse used the correct insulin. 2. The nurse should have contacted the physician prior to administration. 3. The nurse should have used regular insulin (Humulin R). 4. The nurse could have given the insulin subcutaneously.

Correct Answer: 3 Rationale 1: The nurse did not use the correct insulin as it was not regular insulin. Rationale 2: There was no need to contact the physician; regular insulin is the only insulin that can be given intravenously (IV). The physician should be contacted now. Rationale 3: Regular insulin is the only insulin that can be given intravenously (IV). Rationale 4: The nurse cannot give the insulin subcutaneously when it is ordered to be given intravenously (IV).

The client injects his insulin as prescribed but then gets busy and forgets to eat. What is the nurse's most likely assessment finding? 1. The client will be very thirsty. 2. The client will need to urinate. 3. The client will have moist skin. 4. The client will complain of nausea.

Correct Answer: 3 Rationale 1: Thirst is a sign of hyperglycemia; the client would experience hypoglycemia if he did not eat. Rationale 2: Increased urination is a sign of hyperglycemia; the client would experience hypoglycemia if he did not eat. Rationale 3: Moist skin is a sign of hypoglycemia, which the client would experience if he injected insulin and did not eat. Rationale 4: Nausea is a sign of hyperglycemia; the client would experience hypoglycemia if he did not eat.

The diabetes educator would teach a patient that different types of insulin have different onsets of action. Arrange these types of insulin in order of the onset starting with the quickest onset. 1. Insulin detemir (Levemir) 2. Insulin glulisine (Apidra) 3. Insulin lispro (Humalog) 4. Regular insulin (Humulin R) 5. Insulin isophane (NPH)

Correct Answer: 3,2,4,5,1

A patient who has recently been diagnosed with type 1 diabetes mellitus will require insulin therapy. The patient states, "I guess I will have to give up the half bottle of wine I drink at dinner." Which information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Wine is not permitted on your diet." 2. "You can drink as much wine as you would like but avoid hard liquor." 3. "Limit your wine to a time when you are eating a complete meal." 4. "Limit your wine to one glass a day." 5. "Milk is a better choice for you so substitute it for wine."

Correct Answer: 3,4 Rationale 1: Wine does not have to be eliminated from this patient's diet. Rationale 2: The amount of wine permitted is not unlimited. Rationale 3: Alcoholic beverages should be consumed along with a complete meal. Rationale 4: Alcoholic beverages should be limited to one per day. Rationale 5: Large amounts of milk would also interfere with the patient's glucose control.

A patient was prescribed chlorpropamide (Diabinese) for treatment of type 2 diabetes mellitus. One week after therapy was initiated, the patient comes to the clinic with report of nausea, flushing, and palpitations. The nurse prioritizes which assessment question? 1. "Have you taken your medication as directed?" 2. "Did you eat or drink anything new this week?" 3. "Have you increased the amount of fiber in your diet?" 4. "Did you drink any alcoholic beverages this week?"

Correct Answer: 4 Rationale 1: Assessing medication regimen compliance is important but is not the priority. Rationale 2: Assessing dietary changes is important but is not the priority. Rationale 3: Assessing dietary changes is important but is not the priority. Rationale 4: When alcohol is taken with sulfonylureas, some patients experience a disulfiram-like reaction that includes flushing, palpitations, and nausea.

The client has type 2 diabetes mellitus. The nurse has taught the client about the illness and evaluates that learning has occurred when the client makes which statement? 1. "My beta cells just cannot produce enough insulin for my cells." 2. "My peripheral cells have increased sensitivity to insulin." 3. "My cells have increased their receptors, but there is not enough insulin." 4. "My cells cannot use the insulin my pancreas makes."

Correct Answer: 4 Rationale 1: The beta cells continue to produce insulin with type 2 diabetes. Rationale 2: Peripheral cells have a decreased, not an increased, sensitivity to insulin. Rationale 3: There is a decrease, not an increase, in receptor sites with type 2 diabetes. Rationale 4: With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it.

A patient with type 1 diabetes mellitus is maintained on insulin. The patient has decided to participate in a sports tournament at work. Which information would the nurse provide regarding diet and insulin? 1. "Do not take your insulin the morning of a game." 2. "Plan on eating a big meal after your game." 3. "Take an oral hypoglycemic agent on game days rather than insulin." 4. "Eat something before the game and drink a sports drink during the game."

Correct Answer: 4 Rationale 1: The patient should not skip insulin. Rationale 2: Glucose demands will be during the game. Rationale 3: Oral hypoglycemics are not used to treat patients with type 1 diabetes mellitus. Rationale 4: The best plan is for the patient to eat something just before exercise and then to consume a sports drink during the game.

A patient who takes insulin states, "My blood glucose has been low the last few mornings." Which statement would the nurse evaluate as a possible cause of this change? 1. "I have been taking a garlic supplement to prevent colds." 2. "I have been taking St. John's wort to help with my memory." 3. "I have been taking extra vitamin C since so many people have influenza." 4. "I have been taking vitamin D to help build up my bones."

Correct Answer: 1 Rationale 1: Garlic may potentiate the hypoglycemic effect of insulin. Rationale 2: St. John's wort is not implicated in this change. Rationale 3: Vitamin C is not implicated in this change. Rationale 4: Vitamin D is not implicated in this change.

The client has type 1 diabetes mellitus and receives insulin. Which laboratory test will the nurse assess? 1. Potassium 2. Serum amylase 3. AST (aspartate aminotransferase) 4. Sodium

Correct Answer: 1 Rationale 1: Insulin causes potassium to move into the cell and may cause hypokalemia. Rationale 2: There is no need to monitor the serum amylase level. Rationale 3: There is no need to monitor the AST (aspartate aminotransferase) level. Rationale 4: There is no need to monitor the sodium level.