Chapter 46- Diabetes

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: 160 mg/dL 120 mg/dL 180 mg/dL 140 mg/dL

180 mg/dL

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

7:45 AM

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. Administer isotonic fluid at a high volume. Administer potassium replacements. Monitor serum electrolytes and blood glucose levels.

Administer glucose.

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

Beta cells

Which of the following is an age-related change that may affect diabetes? Select all that apply. Decreased renal function Taste changes Increased bowel motility Increased proprioception Decreased vision

Decreased renal function Taste changes Decreased vision

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

Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes

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

Fruity breath

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? Hyponatremia Polyphagia Ketonuria Hypoglycemia

Hypoglycemia

A group of students are reviewing the various types of drugs that are used to treat diabetes mellitus. The students demonstrate understanding of the material when they identify which of the following as an example of an alpha-glucosidase inhibitor? Glyburide Rosiglitazone Metformin Miglitol

Miglitol

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

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: provide time for privacy. provide support for the spouse or significant other. suggest referral to a sex counselor or other appropriate professional. encourage the client to ask questions about personal sexuality.

Suggest referral to a sex counselor or other appropriate professional.

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.

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.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? Carbohydrate intake Protein metabolism Blood glucose level Weight loss

Weight loss

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 1 diabetes. is pregnant and has type 2 diabetes. has type 2 diabetes.

has type 2 diabetes.

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

It carries glucose into body cells.

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 have lost 10 pounds without even trying." "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."

"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."

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? "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." "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 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 are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood."

"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? "Ketones can damage your kidneys and eyes." "Ketones will tell us if your body is using other tissues for energy." "Ketones help the physician determine how serious your diabetes is." "The spleen releases ketones when your body can't use glucose."

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

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

"Test your blood glucose every 4 hours."

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? "You should take your insulin after you eat breakfast and dinner." "Your insulin will last 8 hours, and you will need to take it three times a day." "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." "Your insulin will begin to act in 15 minutes."

"You should take your insulin after you eat breakfast and dinner."

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 increase your food intake." "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 exercise or reduce your food intake."

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 NPH insulin in dextrose 5% in water 100 units of regular insulin in dextrose 5% in water

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: 15 g of carbohydrates. 20 g of carbohydrates. 25 g of carbohydrates. 10 g of carbohydrates.

15 g of carbohydrates.

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

3 months

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? Begin fluid replacements. Give prescribed antiemetics. Administer prescribed dose of insulin. Administer bicarbonate to correct acidosis.

Begin fluid replacements.

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? Polyphagia Ketonuria Hyponatremia Hypoglycemia

Hypoglycemia

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: Defensive coping. Impaired adjustment. Deficient knowledge (treatment regimen). Health-seeking behaviors (diabetes control).

Deficient knowledge (treatment regimen).

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

Glargine (Lantus)

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

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

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? Decreased appetite Cheyne-Stokes respirations Diaphoresis Increased urine output

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

It enhances the transport of glucose across the cell membrane.

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

A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene? Give the client 4 oz of milk and a graham cracker with peanut butter. Obtain a repeat fingerstick glucose level. Notify the physician. Obtain a serum glucose level.

Obtain a repeat fingerstick glucose level.

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? Provides best information on the body's ability to maintain normal blood functioning Is less costly than performing daily blood sugar test Best indicator for the nutritional state of the client Reflects the amount of glucose stored in hemoglobin over past several months.

Reflects the amount of glucose stored in hemoglobin over past several months.

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 Serum glycosylated hemoglobin (Hb A1c) Urine ketones Fasting blood glucose test

Serum glycosylated hemoglobin (Hb A1c)

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. Type 1 diabetes always develops before the age of 20. New cases of diabetes will be split roughly evenly between type 1 and type 2. New cases of diabetes are highly uncommon in older adults.

Serum osmolarity

Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? Thiazolidinediones Biguanides Sulfonylureas Alpha-glucosidase inhibitors

Sulfonylureas

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

Urinary tract infections

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 is experiencing effects of the aging process. Client has not consumed sufficient calories. 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 been exercising more than usual.

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? Systemic inflammatory response syndrome Diabetic ketoacidosis Hyperglycemic hyperosmolar syndrome Multiple-organ dysfunction syndrome

Hyperglycemic hyperosmolar syndrome