Chapter 46: Assessment and Management of Patients with Diabetes

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? -"I always carry hard candy to eat in case my blood sugar level drops." -"I avoid exposure to the sun as much as possible." -"I always wear my medical identification bracelet." -"I skip lunch when I don't feel hungry."

"I skip lunch when I don't feel hungry." Explanation: The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1493. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1493

Which statement indicates that a client with diabetes mellitus understands proper foot care? -"I'll schedule an appointment with my physician if my feet start to ache." -"I'll rotate insulin injection sites from my left foot to my right foot." -"I'll go barefoot around the house to avoid pressure areas on my feet." -"I'll wear cotton socks with well-fitting shoes."

"I'll wear cotton socks with well-fitting shoes." Explanation: The client demonstrates understanding of proper foot care if he states that he'll wear cotton socks with well-fitting shoes because cotton socks wick moisture away from the skin, helping to prevent fungal infections, and well-fitting shoes help avoid pressure areas. Aching isn't a common sign of foot problems; however, a tingling sensation in the feet indicates neurovascular changes. Injecting insulin into the foot may lead to infection. The client shouldn't go barefoot. Doing so can cause injury. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, SPECIAL ISSUES IN DIABETES CARE, p. 1527. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1527

Once digested, what percentage of carbohydrates is converted to glucose? -70 -80 -90 -100

100 Explanation: Once digested, 100% of carbohydrates are converted to glucose. However, approximately 50% of protein foods are also converted to glucose, but this has minimal effect on blood glucose concentration. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1494. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1494

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: -10 g of carbohydrates. -15 g of carbohydrates. -20 g of carbohydrates. -25 g of carbohydrates.

15 g of carbohydrates. Explanation: The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1495. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1495

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: -8:30 AM. -10:30 AM. -12:30 PM. -2:30 PM.

8:30 AM. Explanation: Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1500. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1500

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? -Inserting a feeding tube and providing tube feedings -Administering a 500-ml bolus of normal saline solution -Administering 1 ampule of 50% dextrose solution, per physician's order -Observing the client for 1 hour, then rechecking the fingerstick glucose level

Administering 1 ampule of 50% dextrose solution, per physician's order Explanation: The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1513. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1513

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? -Coma, anxiety, confusion, headache, and cool, moist skin -Kussmaul respirations, dry skin, hypotension, and bradycardia -Polyuria, polydipsia, hypotension, and hypernatremia -Polyuria, polydipsia, polyphagia, and weight loss

Coma, anxiety, confusion, headache, and cool, moist skin Explanation: Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mg/dl) include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1512. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1512

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? -Respirations of 12 breaths/minute -Cloudy urine -Blood sugar 170 mg/dL -Fruity breath

Fruity breath Explanation: The rising ketones and acetone in the blood can lead to acidosis and be detected as a fruity odor on the breath. Ketoacidosis needs to be treated to prevent further complications such as Kussmaul respirations (fast, labored breathing) and renal shutdown. A blood sugar of 170 mg/dL is not ideal but will not result in glycosuria and/or trigger the classic symptoms of diabetes mellitus. Cloudy urine may indicate a UTI. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? -With diabetes, drinking more results in more urine production. -Increased ketones in the urine promote the manufacturing of more urine. -High sugar pulls fluid into the bloodstream, which results in more urine production. -The body's requirement for fuel drives the production of urine.

High sugar pulls fluid into the bloodstream, which results in more urine production. Explanation: The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, p. 1514. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1514

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? -Numbness -Increased hunger -Fatigue -Dizziness

Increased hunger Explanation: The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1512. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1512 Add a Note

NPH is an example of which type of insulin? -Rapid-acting -Short-acting -Intermediate-acting -Long-acting

Intermediate-acting Explanation: NPH is an intermediate-acting insulin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1500. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1500

Which statement is correct regarding glargine insulin? -Its peak action occurs in 2 to 3 hours. -It cannot be mixed with any other type of insulin. -It is absorbed rapidly. -It is given twice daily.

It cannot be mixed with any other type of insulin. Explanation: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1500. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1500

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? -NPH -Iletin II -Lispro (Humalog) -Glargine (Lantus)

NPH Explanation: Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1500. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1500

A patient who is diagnosed with type 1 diabetes would be expected to: -Be restricted to an American Diabetic Association diet. -Have no damage to the islet cells of the pancreas. -Need exogenous insulin. -Receive daily doses of a hypoglycemic agent.

Need exogenous insulin. Explanation: Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1499. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1499

The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet? -Autonomic neuropathy -Retinopathy -Sensory neuropathy -Nephropathy

Sensory neuropathy Explanation: Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The client's feet are inspected on each visit to ensure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Foot and Leg Problems, p. 1425. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1425

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? -Serum glucose level of 450 mg/dl -Serum glucose level of 52 mg/dl -Serum calcium level of 8.9 mg/dl -Serum calcium level of 10.2 mg/dl

Serum glucose level of 52 mg/dl Explanation: Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1511. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1511

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? -The client has not eaten but continues to take insulin or oral antidiabetic medications. -The client has not been exercising. -The client has not complied with the prescribed treatment regimen. -The client has eaten but has not taken or received insulin.

The client has not eaten but continues to take insulin or oral antidiabetic medications. Explanation: Hypoglycemia occurs when a client with diabetes is not eating and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the client has not been compliant with the prescribed treatment regimen. If the client has eaten and has not taken or received insulin, diabetic ketoacidosis is more likely to develop. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, p. 1514. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1514

A client is diagnosed with diabetes mellitus. The client reports visiting the gym regularly and is a vegetarian. Which of the following factors is important to consider when the nurse assesses the client? -The client's consumption of carbohydrates -History of radiographic contrast studies that used iodine -The client's mental and emotional status -The client's exercise routine

The client's consumption of carbohydrates Explanation: While assessing a client, it is important to ask about consumption of carbohydrates due to the client's high blood sugar. Although other factors such as the client's mental and emotional status, history of tests involving iodine, and exercise routine can be part of data collection, they are not the priority when assessing a client with high blood sugar. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, pp. 1493-1495. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1493-1495

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? -If two different types of insulin are ordered, they need to be given in separate injections. -When mixing insulin, the NPH insulin is drawn up into the syringe first. -When mixing insulin, the regular insulin is drawn up into the syringe first. -There is no need to inject air into the bottle of insulin before withdrawing the insulin.

When mixing insulin, the regular insulin is drawn up into the syringe first. Explanation: When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1509. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1509

A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance? -glycosylated hemoglobin -hematocrit B1C -postprandial glucose -CAT scan

glycosylated hemoglobin Explanation: Once a client with diabetes receives a treatment regimen to follow, the physician can assess the effectiveness of treatment and the client's compliance by obtaining a hemoglobin A1c test. The results of this test reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. Normally, the level of glycosylated hemoglobin is less than 7%. Amounts of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1499. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1499

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: -urine glucose level. -fasting blood glucose level. -serum fructosamine level. -glycosylated hemoglobin level.

glycosylated hemoglobin level. Explanation: Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1499. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1499

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? -ketoacidosis -hyperosmolar hyperglycemic nonketotic syndrome -hepatic disorder -All options are correct.

ketoacidosis Explanation: Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490

Which instruction about insulin administration should a nurse give to a client? -"Always follow the same order when drawing the different insulins into the syringe." -"Shake the vials before withdrawing the insulin." -"Store unopened vials of insulin in the freezer at temperatures well below freezing." -"Discard the intermediate-acting insulin if it appears cloudy."

"Always follow the same order when drawing the different insulins into the syringe." Explanation: The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1509. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1509

During a routine medical evaluation, a client is found to have a random blood glucose level of 210 mg/dL. Which client statement(s) made by the client are concerning to the nurse? Select all that apply. -"At times my vision is blurry." -"I have to void nearly every hour." -"I cannot seem to quench my thirst." -"I sleep at least 8 hours each night." -"I have lost 10 pounds without even trying."

"At times my vision is blurry." "I have to void nearly every hour." "I cannot seem to quench my thirst." "I have lost 10 pounds without even trying." Explanation: Criteria for the diagnosis of diabetes include symptoms of diabetes plus a random or casual plasma glucose concentration equal to or greater than 200 mg/dL. Symptoms of diabetes include vision changes, polyuria (or the increased need to urinate), polydipsia (or increased thirst), and sudden weight loss. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, pp. 1491-1492. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1491-1492

A newly admitted client with a diagnosis of type 1 diabetes asks the nurse what caused their diabetes. When the nurse is explaining to the client the etiology of type 1 diabetes, what process should the nurse describe? -"The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." -"Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it." -"The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." -"Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."

"Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down." Explanation: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not "make" glucose. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Type 1 Diabetes, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490 Add a Note

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it? -"I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." -"If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." -"I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." -"If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates."

"I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." Explanation: The client stating that he'll remain hydrated and pay attention to his eating, drinking, and voiding needs indicates understanding of HHNS. Inadequate fluid intake during hyperglycemic episodes commonly leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of non-diet soda would be appropriate for hypoglycemia. A client whose diabetes is controlled with oral antidiabetic agents usually doesn't need to monitor blood glucose levels. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1518.

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? -"This transplant will provide me with a cure for my diabetes." -"I will receive a whole organ with extra cells to produce insulin." -"They'll need to create a connection from the pancreas to allow enzymes to drain." -"I might need insulin later on but probably not as much or as often."

"I might need insulin later on but probably not as much or as often." Explanation: Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of insulin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1504. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1504 Add a Note

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? "The spleen releases ketones when your body can't use glucose." -"Ketones will tell us if your body is using other tissues for energy." -"Ketones can damage your kidneys and eyes." -"Ketones help the physician determine how serious your diabetes is."

"Ketones will tell us if your body is using other tissues for energy." Explanation: The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? -"Don't take your insulin or oral antidiabetic agent if you don't eat." -"It's okay for your blood glucose to go above 300 mg/dl while you're sick." -"Test your blood glucose every 4 hours." -"Follow your regular meal plan, even if you're nauseous."

"Test your blood glucose every 4 hours." Explanation: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, p. 1514. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1514

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? -"Your child will need less blood work as his glucose levels stabilize." -"Your child is young and will soon forget this experience." -"I'll see if the physician can reduce the number of blood draws." -"Our laboratory technicians use tiny needles and they're really good with children."

"Your child will need less blood work as his glucose levels stabilize." Explanation: Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician if he can reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: -2 to 5 g of a simple carbohydrate. -10 to 15 g of a simple carbohydrate. -18 to 20 g of a simple carbohydrate. -25 to 30 g of a simple carbohydrate.

10 to 15 g of a simple carbohydrate. Explanation: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? -100 units of regular insulin in normal saline solution -100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution -100 units of regular insulin in dextrose 5% in water -100 units of NPH insulin in dextrose 5% in water

100 units of regular insulin in normal saline solution Explanation: Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, p. 1516. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1516

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: -I.M. or subcutaneous glucagon. -I.V. bolus of dextrose 50%. -15 to 20 g of a fast-acting carbohydrate such as orange juice. -10 units of fast-acting insulin.

15 to 20 g of a fast-acting carbohydrate such as orange juice. Explanation: This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1513. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1513

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds: -120 mg/dL -140 mg/dL -160 mg/dL -180 mg/dL

180 mg/dL Explanation: Glycosuria occurs when the renal threshold for sugar exceeds 180 mg/dL. Glycosuria leads to an excessive loss of water and electrolytes (osmotic diuresis). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490

What is the duration of regular insulin? -4 to 6 hours -3 to 5 hours -12 to 16 hours -24 hours

4 to 6 hours Explanation: The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1500. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1500

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? -6.5% -7.5% -8.0% -8.5%

6.5% Explanation: Normally, the level of glycosylated hemoglobin is less than 7%. Thus, a level of 6.5% would indicate that the client's blood glucose level is well controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dl. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1492. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1492

A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client: -9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). -21 units regular insulin and 9 units NPH. -10 units regular insulin and 20 units NPH. -20 units regular insulin and 10 units NPH.

9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). Explanation: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 units of NPH and 9 units of regular insulin. The other choices are incorrect dosages for the ordered insulin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1509. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1509

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: -Impaired adjustment. -Defensive coping. -Deficient knowledge (treatment regimen). -Health-seeking behaviors (diabetes control).

Deficient knowledge (treatment regimen). Explanation: The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? -Polyuria -Hypoglycemia -Blurred vision -Polydipsia

Hypoglycemia Explanation: The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1512. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1512

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? -Hypokalemia and hypoglycemia -Hypocalcemia and hyperkalemia -Hyperkalemia and hyperglycemia -Hypernatremia and hypercalcemia

Hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1517. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1517

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? -Cool, clammy skin -Jugular vein distention -Increased urine osmolarity -Decreased serum sodium level

Increased urine osmolarity Explanation: In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1519. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1519

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? -Cheyne-Stokes respirations -Increased urine output -Decreased appetite -Diaphoresis

Increased urine output Explanation: Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? -Increases ability for glucose to get into the cell and lowers blood sugar -Creates an overall feeling of well-being and lowers risk of depression -Decreases need for pancreas to produce more cells -Decreases risk of developing insulin resistance and hyperglycemia

Increases ability for glucose to get into the cell and lowers blood sugar Explanation: Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1496. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1496

A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to: -Stimulate the beta cells of the pancreas to secrete insulin. -Decrease the body's sensitivity to insulin. -Inhibit the production of glucose by the liver. -Increase the absorption of carbohydrates in the intestines.

Inhibit the production of glucose by the liver. Explanation: The action of the biguanides can be found in Table 30-6 in the text. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1505. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1505

A diabetic client using insulin reports weight gain. Which response from the nurse explains the most likely cause of the weight increase? -Insulin is an anabolic hormone. -Insulin provides more efficient use of glucose. -Faulty fat metabolism is shut off. -Weight gain is attributed to fluid retention.

Insulin is an anabolic hormone. Explanation: Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1489. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1489

A young adult client with type 1 diabetes does not want to have to self-administer insulin injections several times a day. Which medication approach would the nurse recommend that best controls the condition and meets the client's needs? -Insulin pump -1 injection per day -2 injections premixed -Injection before each meal

Insulin pump Explanation: The insulin pump most closely mimics regular pancreas function and increases meal and exercise flexibility. The use of the pump would meet the client's needs of not wanting to self-administer several injections of insulin every day. With one injection per day, there is difficulty controlling fasting blood glucose if the type of insulin does not last. The client could also develop afternoon hypoglycemia if the single dose is increased in order to control the morning fasting glucose level. Two injections per day might meet the client's needs of minimal self-injections; however, for this regimen, there needs to be a fixed schedule of meals and exercise and it is difficult to adjust the dose if premixed insulin is used. Self-administering insulin before each meal will not meet the client's needs since this requires more injections than any other regimen. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1503. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1503 Add a Note

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? -It carries glucose into body cells. -It aids in the process of gluconeogenesis. -It stimulates the pancreatic beta cells. -It decreases the intestinal absorption of glucose.

It carries glucose into body cells. Explanation: Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Insulin does not have an effect on the intestinal absorption of glucose. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1489. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1489

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? -It enhances the transport of glucose across the cell membrane. -It aids in the process of gluconeogenesis. -It stimulates the pancreatic beta cells. -It decreases the intestinal absorption of glucose.

It enhances the transport of glucose across the cell membrane. Explanation: Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1439. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1439

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? -Cool, moist skin -Rapid, thready pulse -Arm and leg trembling -Slow, shallow respirations

Rapid, thready pulse Explanation: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1515. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1515

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? -Fasting blood glucose test -6-hour glucose tolerance test -Serum glycosylated hemoglobin (Hb A1c) -Urine ketones

Serum glycosylated hemoglobin (Hb A1c) Explanation: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1499. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1499

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? -Serum potassium level -Serum sodium level -Arterial blood gas (ABG) values -Serum osmolarity

Serum osmolarity Explanation: Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Hyperglycemic Hyperosmolar Syndrome, pp. 1516-1517. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1516-1517

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? -Serum potassium level -Serum calcium level -Serum sodium level -Serum chloride level

Serum potassium level Explanation: The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Hyperglycemic Hyperosmolar Syndrome, p. 1517. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1517

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: -Transport of potassium. -Release of glucose. -Synthesis of glucose from noncarbohydrate sources. -Storage of glucose as glycogen in the liver.

Synthesis of glucose from noncarbohydrate sources. Explanation: Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490

A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? -The participants are unlikely to develop a new onset of type 1 diabetes. -New cases of diabetes are highly uncommon in older adults. -New cases of diabetes will be split roughly evenly between type 1 and type 2. -Type 1 diabetes always develops before the age of 20.

The participants are unlikely to develop a new onset of type 1 diabetes. Explanation: Type 1 diabetes usually (but not always) develops in people younger than 20. In older adults, an onset of type 2 is far more common. A significant number of older adults develops type 2 diabetes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1489. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1489

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client: -prefers to take insulin orally. -has type 2 diabetes. -has type 1 diabetes. -is pregnant and has type 2 diabetes.

has type 2 diabetes. Explanation: Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't ordered oral antidiabetic agents because the effect on the fetus or breast-fed infant is uncertain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1504. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1504

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: -use commercial preparations to remove corns. -cut the toenails by rounding edges. -wash and inspect the feet daily. -walk barefoot at least once each day.

wash and inspect the feet daily. Explanation: A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed straight across. Clients with diabetes mellitus should never walk barefoot. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Foot and Leg Problems, p. 1527. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1527

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply. -Increases lean muscle mass -Increases resting metabolic rate as muscle size increases -Decreases the levels of high-density lipoproteins -Decreases total cholesterol -Increases glucose uptake by body muscles

-Increases lean muscle mass -Increases resting metabolic rate as muscle size increases -Decreases total cholesterol -Increases glucose uptake by body muscles Explanation: All of the options are benefits of exercise except the effect of decreasing the levels of HDL. Exercise increases the levels of HDL. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1496. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1496

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? -7:45 AM -8:00 AM -8:15 AM -8:30 AM

7:45 AM Explanation: Insulin lispro has an onset of 5 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:45 AM at the latest. Otherwise, the client may experience hypoglycemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1500. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1500

Which statement is true regarding gestational diabetes? -It occurs in most pregnancies. -Onset usually occurs in the first trimester. -A glucose challenge test should be performed between 24 and 28 weeks. -There is a low risk for perinatal complications.

A glucose challenge test should be performed between 24 and 28 weeks. Explanation: A glucose challenge test should be performed between 24 and 28 weeks in women at average risk. It occurs in less than 10% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1491.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? -Duration of the insulin -Accuracy of the dosage -Area for insulin injection -Technique for injecting

Accuracy of the dosage Explanation: The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1514. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1514

A client with diabetic ketoacidosis has been brought into the ED. Which intervention is not a goal in the initial medical treatment of diabetic ketoacidosis? -Administer glucose. -Monitor serum electrolytes and blood glucose levels. -Administer isotonic fluid at a high volume. -Administer potassium replacements.

Administer glucose. Explanation: Insulin is given intravenously. Insulin reduces the production of ketones by making glucose available for oxidation by the tissues and by restoring the liver's supply of glycogen. As insulin begins to lower the blood glucose level, the IV solution is changed to include one with glucose. Periodic monitoring of serum electrolytes and blood glucose levels is necessary. Isotonic fluid is instilled at a high volume, for example, 250 to 500 mL/hour for several hours. The rate is adjusted once the client becomes rehydrated and diuresis is less acute. Potassium replacements are given despite elevated serum levels to raise intracellular stores. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, p. 1515. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1515

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? -Give prescribed antiemetics. -Begin fluid replacements. -Administer prescribed dose of insulin. -Administer bicarbonate to correct acidosis.

Begin fluid replacements. Explanation: Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, p. 1515. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1515

Insulin is secreted by which of the following types of cells? -Beta cells -Melanocytes -Neural cells -Basal cells

Beta cells Explanation: Insulin is secreted by the beta cells, in the islets of Langerhans of the pancreas. In diabetes, cells may stop responding to insulin, or the pancreas may decrease insulin secretion or stop insulin production completely. Melanocytes are what give the skin its pigment. Neural cells transmit impulses in the brain and spinal cord. Basal cells are a type of skin cell. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1489. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1489

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? -Arterial pH 7.25 -Plasma bicarbonate 12 mEq/L -Blood glucose level 1,100 mg/dl -Blood urea nitrogen (BUN) 15 mg/dl

Blood glucose level 1,100 mg/dl Explanation: HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Hyperglycemic Hyperosmolar Syndrome, p. 1516. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1516

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? -Recent weight gain of 20 lb (9.1 kg) -Failure to monitor blood glucose levels -Skipping insulin doses during illness -Crying whenever diabetes is mentioned

Crying whenever diabetes is mentioned Explanation: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1508. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1508

Lispro (Humalog) is an example of which type of insulin? -Rapid-acting -Intermediate-acting -Short-acting -Long-acting

Rapid-acting Explanation: Humalog is a rapid-acting insulin. NPH is an intermediate-acting insulin. A short-acting insulin is Humulin-R. An example of a long-acting insulin is Glargine (Lantus). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, diabetes, p. 1498. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1498

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? -"Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." -"When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." -"Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." -"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Explanation: Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1499. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1499

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? -"I will refer you to a dietician who can help you with your weight." -"You may be having undiagnosed infections, causing you to lose extra weight." -"Your body is using protein and fat for energy instead of glucose." -"Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."

"Your body is using protein and fat for energy instead of glucose." Explanation: Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, p. 1515. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1515

Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. -Client has not consumed food and continues to take insulin or oral antidiabetic medications. -Client has not consumed sufficient calories. -Client has been exercising more than usual. -Client has been sleeping excessively. -Client is experiencing effects of the aging process.

-Client has not consumed food and continues to take insulin or oral antidiabetic medications. -Client has not consumed sufficient calories. -Client has been exercising more than usual. Explanation: Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1512. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1512

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. -Ketosis-prone -Little or no endogenous insulin -Obesity at diagnoses -Younger than 30 years of age -Older than 65 years of age

-Ketosis-prone -Little or no endogenous insulin -Younger than 30 years of age Explanation: Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1489. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1489

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? -10 to 15 minutes -30 to 40 minutes -1 to 2 hours -3 hours

10 to 15 minutes Explanation: The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1500. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1500

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? -1/2 cup fruit juice or regular soft drink -4 oz of skim milk -1/2 tbsp honey or syrup -three to five LifeSavers candies

1/2 cup fruit juice or regular soft drink Explanation: In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1513. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1513

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? -1 month -3 months -6 months -9 months

3 months Explanation: Glycosylated hemoglobin is a blood test that reflects average blood glucose concentrations over a period of 3 months. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1499. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1499

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. -Elevated blood urea nitrogen (BUN) and creatinine -Rapid onset -More common in type 1 diabetes -Absent ketones -Normal arterial pH level

Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes Explanation: DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, pp. 1514-1515. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1514-1515

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? -Epinephrine -Glucagon -50% dextrose -Hydrocortisone

Glucagon Explanation: During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1513. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1513

A client with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom? -Weight gain -Muscle wasting and tissue loss -Dehydration -Altered mental state

Muscle wasting and tissue loss Explanation: Polyphagia results from the catabolic state induced by insulin deficiency and the breakdown of proteins and fats. Although clients with type 1 diabetes may experience polyphagia (increased hunger), they may also exhibit muscle wasting, subcutaneous tissue loss, and weight loss due to impaired glucose and protein metabolism and impaired fatty acid storage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1491. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1491

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? -Polyuria, headache, and fatigue -Polyphagia and flushed, dry skin -Polydipsia, pallor, and irritability -Nervousness, diaphoresis, and confusion

Nervousness, diaphoresis, and confusion Explanation: Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1512. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1512

An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? -A faulty heater -Autonomic neuropathy -Peripheral neuropathy -Sudomotor neuropathy

Peripheral neuropathy Explanation: As the neuropathy progresses, the feet become numb. In addition, a decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) and a decreased sensation of light touch may lead to an unsteady gait. Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Neuropathies, p. 1523. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1523

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? -Presence of autoantibodies against islet cells -Obesity -Rare ketosis -Altered glucose metabolism

Presence of autoantibodies against islet cells Explanation: There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? -Presence of islet cell antibodies -Obesity -Rare ketosis -Requirement for oral hypoglycemic agents

Presence of islet cell antibodies Explanation: Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1489. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1489

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? -NPH -Regular -Lispro -Lantus

Regular Explanation: Short-acting insulins are called regular insulin (marked R on the bottle). Regular insulin is a clear solution and is usually administered 20 to 30 minutes before a meal, either alone or in combination with a longer-acting insulin. Regular insulin is the only insulin approved for IV use. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1500. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1500

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? -Making sure that the patient is aware that quantity of foods will be limited -Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found -Determining whether the patient is on insulin or taking oral antidiabetic medication -Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns Explanation: The first step in preparing a meal plan is a thorough review of the patient's diet history to identify eating habits and lifestyle and cultural eating patterns. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1493. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1493

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? -Sweating, tremors, and tachycardia -Dry skin, bradycardia, and somnolence -Bradycardia, thirst, and anxiety -Polyuria, polydipsia, and polyphagia

Sweating, tremors, and tachycardia Explanation: Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1512. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1512

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? -The client continues medication therapy despite adequate food intake. -The client has not consumed sufficient calories. -The client has been exercising more than usual. -The client has eaten and has not taken or received insulin.

The client has eaten and has not taken or received insulin. Explanation: If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Ketoacidosis, p. 1514. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1514

The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: -The pancreatic hormone glucagon will stimulate the liver to release stored glucose. -Insulin will be released to facilitate the transport of sugar. -Glycogenesis will be decreased by the liver. -The process of gluconeogenesis will be inhibited.

The pancreatic hormone glucagon will stimulate the liver to release stored glucose. Explanation: When sugar levels are low, glucagon promotes hyperglycemia by stimulating the release of stored glucose. Glycogenolysis and gluconeogenesis will both be increased. Insulin secretion would promote hypoglycemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? -The short-acting insulin is withdrawn before the intermediate-acting insulin. -The intermediate-acting insulin is withdrawn before the short-acting insulin. -Different types of insulin are not to be mixed in the same syringe. -If administered immediately, there is no requirement for withdrawing one type of insulin before another.

The short-acting insulin is withdrawn before the intermediate-acting insulin. Explanation: When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy." Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1509. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1509

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? -They have no effect. -They decrease the need for insulin. -They increase the need for insulin. -They cause wide fluctuations in the need for insulin.

They increase the need for insulin. Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, ACUTE COMPLICATIONS OF DIABETES, p. 1514. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1514

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? -Between 8:00 and 10:00 a.m. -Between 4:00 and 6:00 p.m. -Between 7:00 and 9:00 p.m. -This insulin has no peak action and does not cause a hypoglycemic reaction.

This insulin has no peak action and does not cause a hypoglycemic reaction. Explanation: "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1498. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1498

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? -Increased risk for urologic complications -Need for exocrine enzymatic drainage -Underlying problem of insulin resistance -Need for lifelong immunosuppressive therapy

Underlying problem of insulin resistance Explanation: Clients with type 2 diabetes are not offered the option of a pancreas transplant because their problem is insulin resistance, which does not improve with a transplant. Urologic complications or the need for exocrine enzymatic drainage are not reasons for not offering pancreas transplant to clients with type 2 diabetes. Any transplant requires lifelong immunosuppressive drug therapy and is not the factor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1490. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1490

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? -Low blood pressure -Urinary tract infections -Lifelong obesity -Elevated triglycerides

Urinary tract infections Explanation: Elevated levels of blood glucose and glycosuria supports bacterial growth and places the diabetic at greater risk for urinary tract, skin, and vaginal infections. Obesity, elevated triglycerides, and high blood pressure are considered symptoms of metabolic syndrome, which can result in type 2 diabetes mellitus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Neuropathies, p. 1524. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1524

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: -at least once per week. -at least three times per week. -at least five times per week. -every day.

at least three times per week. Explanation: Clients with diabetes must exercise at least three times per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once per week wouldn't achieve these goals. Exercising more than three times per week, although beneficial, would exceed the minimum requirement. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1497. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1497

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: -polyphagia. -polydipsia. -polyuria. -anorexia.

polyphagia. Explanation: While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, DIABETES, p. 1491. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1491

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: -encourage the client to ask questions about personal sexuality. -provide time for privacy. -provide support for the spouse or significant other. -suggest referral to a sex counselor or other appropriate professional.

suggest referral to a sex counselor or other appropriate professional. Explanation: The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 46: Assessment and Management of Patients with Diabetes, Diabetic Neuropathies, pp. 1524-1525. Chapter 46: Assessment and Management of Patients with Diabetes - Page 1524-1525