Chapter 46: Assessment and Management of Patients with Diabetes PrepU

Which instruction about insulin administration should a nurse give to a client? "Discard the intermediate-acting insulin if it appears cloudy." "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."

"Always follow the same order when drawing the different insulins into the syringe."

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 amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." "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." "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."

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. "I sleep at least 8 hours each night." "I have to void nearly every hour." "I cannot seem to quench my thirst." "At times my vision is blurry." "I have lost 10 pounds without even trying."

"I have to void nearly every hour." "I cannot seem to quench my thirst." "At times my vision is blurry." "I have lost 10 pounds without even trying."

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." "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 will receive a whole organ with extra cells to produce insulin."

"I might need insulin later on but probably not as much or as often."

Which statement best indicates that a client understands how to administer his own insulin injections? "I need to wash my hands before I give myself my injection." "I wrote down the steps in case I forget what to do." "If I'm not feeling well, I can get a friend or neighbor to help me." "I need to be sure no air bubbles remain."

"I wrote down the steps in case I forget what to do."

A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? "I have a cough and cold that just won't go away." "I notice pain when I urinate." "I'm thirsty all the time. I just can't get enough to drink." "It seems like I have no appetite. I have to make myself eat.

"I'm thirsty all the time. I just can't get enough to drink."

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? "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." "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." "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."

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 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."

"Ketones will tell us if your body is using other tissues for energy."

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? "Administer insulin into areas of scar tissue or hypertrophy whenever possible." "Inject insulin into healthy tissue with large blood vessels and nerves." "Administer insulin into sites above muscles that you plan to exercise heavily later that day." "Rotate injection sites within the same anatomic region, not among different regions."

"Rotate injection sites within the same anatomic region, not among different regions."

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline? "You'll need less insulin when you exercise or reduce your food intake." "You'll need more insulin when you exercise or increase your food intake." "You'll need more insulin when you exercise or decrease your food intake." "You'll need less insulin when you increase your food intake."

"You'll need less insulin when you exercise or reduce your food intake."

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."

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 is young and will soon forget this experience." "Your child will need less blood work as his glucose levels stabilize." "Our laboratory technicians use tiny needles and they're really good with children." "I'll see if the physician can reduce the number of blood draws."

"Your child will need less blood work as his glucose levels stabilize."

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? 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

1/2 cup fruit juice or regular soft drink

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: 10 to 15 g of a simple carbohydrate. 2 to 5 g of a simple carbohydrate. 25 to 30 g of a simple carbohydrate. 18 to 20 g of a simple carbohydrate.

10 to 15 g of a simple carbohydrate.

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 dextrose 5% in water 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution 100 units of NPH insulin in dextrose 5% in water 100 units of regular insulin in normal saline solution

100 units of regular insulin in normal saline solution

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. 25 g of carbohydrates. 20 g of carbohydrates.

15 g of carbohydrates.

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.V. bolus of dextrose 50%. 10 units of fast-acting insulin. 15 to 20 g of a fast-acting carbohydrate such as orange juice. I.M. or subcutaneous glucagon.

15 to 20 g of a fast-acting carbohydrate such as orange juice.

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

4 to 6 hours

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? 8.5% 8.0% 6.5% 7.5 %

6.5%

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

7:45 AM

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.

Which would be included in the teaching plan for a client diagnosed with diabetes mellitus? Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued. Sugar is found only in dessert foods. The only diet change needed in the treatment of diabetes is to stop eating sugar. An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.

An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.

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

Blood glucose level 1,100 mg/dl

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

Client has not consumed sufficient calories. Client has not consumed food and continues to take insulin or oral antidiabetic medications. Client has been exercising more than usual.

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? Increase frequency of glucose self-monitoring. Take half the usual dose of insulin until symptoms resolve. Decrease food intake until nausea passes. Do not take insulin if not eating.

Increase frequency of glucose self-monitoring.

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).

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? Dietitian Social worker Home health nurse Psychiatrist

Dietitian

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? Do not mix with other insulins. Draw up the drug first, then add regular insulin. It is rapidly absorbed and has a fast onset of action. Administer the total daily dosage in two doses.

Do not mix with other insulins.

The nurse is caring for a client receiving insulin isophane suspension (NPH) at breakfast. What is an important dietary consideration for the nurse to keep in mind? Delay dinner meal. Make sure breakfast is not delayed. Provide fewest amount of carbohydrates at lunch meal. Encourage midday snack.

Encourage midday snack.

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

Fruity breath

Which of the following insulins are used for basal dosage? NPH (Humulin N) Glargine (Lantus) Aspart (Novolog) Lispro (Humalog)

Glargine (Lantus)

An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? Hyperglycemic hyperosmolar syndrome Systemic inflammatory response syndrome Diabetic ketoacidosis Multiple-organ dysfunction syndrome

Hyperglycemic hyperosmolar syndrome

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

Hypoglycemia

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

Hypokalemia and hypoglycemia

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? Fatigue Increased hunger Dizziness Numbness

Increased hunger

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

Increased urine osmolarity

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 Decreased appetite Increased urine output Diaphoresis

Increased urine output

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 stimulates the pancreatic beta cells. It aids in the process of gluconeogenesis. It enhances the transport of glucose across the cell membrane. It decreases the intestinal absorption of glucose.

It enhances the transport of glucose across the cell membrane.

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? Onset most common during adolescence Insulin production insufficient Less common than type 1 diabetes Little to no relation to pre-diabetes

Insulin production insufficient

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

Intermediate-acting

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 stimulates the pancreatic beta cells. It decreases the intestinal absorption of glucose. It aids in the process of gluconeogenesis. It carries glucose into body cells.

It carries glucose into body cells.

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 Older than 65 years of age Younger than 30 years of age Obesity at diagnoses

Ketosis-prone Little or no endogenous insulin Younger than 30 years of age

Which type of insulin acts most quickly? Glargine Regular NPH Lispro

Lispro

A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client? Hypertonicity Polyuria Low blood glucose concentration Allergic reactions

Low blood glucose concentration

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? Metformin Repaglinide Glyburide Glipizide

Metformin

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

NPH

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? Altered glucose metabolism Obesity Rare ketosis Presence of autoantibodies against islet cells

Presence of autoantibodies against islet cells

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 10.2 mg/dl Serum calcium level of 8.9 mg/dl

Serum glucose level of 52 mg/dl

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

Presence of islet cell antibodies

A client newly diagnosed with type 1 diabetes asks the nurse why injection site rotation is important. What is the nurse's best response? Promote absorption. Minimize discomfort. Prevent muscle destruction. Avoid infection.

Promote absorption.

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? Rapid, thready pulse Arm and leg trembling Slow, shallow respirations Cool, moist skin

Rapid, thready pulse

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

Rapid-acting

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? Regular Lente NPH Glargine

Regular

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 Lantus Regular Lispro

Regular

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? 6-hour glucose tolerance test Fasting blood glucose test Urine ketones Serum glycosylated hemoglobin (Hb A1c)

Serum glycosylated hemoglobin (Hb A1c)

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? 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. The client has not been exercising.

The client has not eaten but continues to take insulin or oral antidiabetic medications.

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 exercise routine The client's consumption of carbohydrates The client's mental and emotional status History of radiographic contrast studies that used iodine

The client's consumption of carbohydrates

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: Insulin will be released to facilitate the transport of sugar. The process of gluconeogenesis will be inhibited. Glycogenesis will be decreased by the liver. The pancreatic hormone glucagon will stimulate the liver to release stored glucose.

The pancreatic hormone glucagon will stimulate the liver to release stored glucose.

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? 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. The participants are unlikely to develop a new onset of type 1 diabetes. Type 1 diabetes always develops before the age of 20.

The participants are unlikely to develop a new onset of type 1 diabetes.

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.

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 decrease the need for insulin. They increase the need for insulin. They cause wide fluctuations in the need for insulin. They have no effect.

They increase the need for insulin.

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.

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 lifelong immunosuppressive therapy Underlying problem of insulin resistance Need for exocrine enzymatic drainage

Underlying problem of insulin resistance

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

Urinary tract infections

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? Debriding the wound three times per day Using sterile technique during the dressing change Cleaning the wound with a povidone-iodine solution Applying a heating pad

Using sterile technique during the dressing change

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. 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. 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.

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 three times per week. at least five times per week. every day. at least once per week.

at least three times per week.

A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the: beta cells of the pancreas. alpha cells of the pancreas. parafollicular cells of the thyroid. adenohypophysis.

beta cells of the pancreas.

Which of the following medications is considered a glitazone? metformin with glyburide metformin pioglitazone dapagliflozin

pioglitazone

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. suggest referral to a sex counselor or other appropriate professional. provide support for the spouse or significant other.

suggest referral to a sex counselor or other appropriate professional.

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.