Chapter 59 Diabetes

16. The nurse is planning teaching for a client who is starting acarbose for diabetes mellitus type 2. Which statement will the nurse include in the teaching? A. "Be sure to take the drug with each meal." B. "Take the drug every evening before bedtime." C. "Take the drug on an empty stomach in the morning." D. "Decide on the best day of the week to take the drug."

ANS: A Acarbose is an alpha-glucosidase inhibitor that works in the intestinal tract to prevent enzymes from breaking down starches into glucose. However, it must be taken with food at each meal, usually 3 times a day, to allow the drug to work as intended.

6. A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? A. "Maintain tight glycemic control and prevent hyperglycemia." B. "Restrict your fluid intake to no more than 2 L a day." C. "Prevent hypoglycemia by eating a bedtime snack." D. "Limit your intake of protein to prevent ketoacidosis."

ANS: A Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for patients with diabetes. Preventing hypoglycemia and ketosis, although important, is not as important as maintaining daily glycemic control.

22. After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? A. "If I develop an infection, I should stop taking my corticosteroid." B. "If I have pain over the transplant site, I will call the surgeon immediately." C. "I should avoid people who are ill or who have an infection." D. "I should take my cyclosporine exactly the way I was taught."

ANS: A Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Antirejection drugs cause immunosuppression, and the patient should avoid crowds and people who are ill. Changing the routine of antirejection medications may cause them to not work optimally.

18. The nurse assesses a client with diabetic ketoacidosis. Which assessment finding would the nurse correlate with this condition? A. Increased rate and depth of respiration B. Extremity tremors followed by seizure activity C. Oral temperature of 102° F (38.9° C) D. Severe orthostatic hypotension

ANS: A Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis.

5. A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How would the nurse respond? A. "Your risk of diabetes is higher than the general population, but it may not occur." B. "No genetic risk is associated with the development of type 1 diabetes mellitus." C. "The risk for becoming a diabetic is 50% because of how it is inherited." D. "Female children do not inherit diabetes mellitus, but male children will."

ANS: A Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.

13. After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? A. "The lower abdomen is the best location because it is closest to the pancreas." B. "I can reach my thigh the best, so I will use the different areas of my thighs." C. "By rotating the sites in one area, my chance of having a reaction is decreased." D. "Changing injection sites from the thigh to the arm will change absorption rates."

ANS: A The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration.

11. A nurse cares for a patient who is prescribed pioglitazone. After 6 months of therapy, the client reports that he has a new onset of ankle edema. What assessment question would the nurse take? A. "Have you gained unexpected weight this week?" B. "Has your urinary output declined recently?" C. "Have you had fever and achiness this week?" D. "Have you had abdominal pain recently?"

ANS: A Thiazolidinediones (including pioglitazone) can cause cardiovascular adverse effects including health failure which is manifested by peripheral edema and unintentional weight gain. The client should have been taught to weigh every week and report sudden increases in weight.

26. A nurse assesses a client who has diabetes mellitus and notes that the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup (120 mL) of orange juice, the client's signs and symptoms have not changed. What action would the nurse take next? A. Administer another half-cup (120 mL) of orange juice. B. Administer a half-ampule of dextrose 50% intravenously. C. Administer 10 units of regular insulin subcutaneously. D. Administer 1 mg of glucagon intramuscularly.

ANS: A This patient is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse would administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment would be repeated. The patient does not need intravenous dextrose, insulin, or glucagon.

4. A nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes mellitus? (Select all that apply.) A. Stroke B. Kidney failure C. Blindness D. Respiratory failure E. Cirrhosis

ANS: A, B, C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.

6. The nurse is caring for a client who has severe hypoglycemia and is experiencing a seizure. What actions will the nurse take at this time? (Select all that apply.) A. Administer glucagon 1 mg subcutaneously. B. Be sure the bed side rails are in the up position. C. Notify the primary health care provider immediately. D. Monitor the client's blood glucose level. E. Increase the intravenous infusion rate immediately.

ANS: A, B, C, D The client who has severe hypoglycemia often has a blood sugar of less than 20 mg/dL (1.0 mmol/L) and may be unconscious or seizing. Therefore, the client cannot swallow and needs glucagon. To keep the client safe during the seizure, the nurse ensures that the side rails are up to prevent the client from falling out of bed. The nurse would also monitor the client's blood sugar to evaluate the effectiveness of the interventions.

5. A nurse collaborates with the interprofessional team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members would the nurse include in this interprofessional team meeting? (Select all that apply.) A. Registered dietitian nutritionist B. Clinical pharmacist C. Occupational therapist D. Primary health care provider E. Speech-language pathologist

ANS: A, B, D When planning care for a client newly diagnosed with diabetes mellitus, the nurse would collaborate with a registered dietitian nutritionist, clinical pharmacist, and primary health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.

3. A nurse teaches a client with diabetes mellitus about foot care. Which statements would the nurse include in this client's teaching? (Select all that apply.) A. "Do not walk around barefoot." B. "Soak your feet in a tub each evening." C. "Trim toenails straight across with a nail clipper." D. "Treat any blisters or sores with Epsom salts." E. "Wash your feet every other day."

ANS: A, C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client would be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client would be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the primary health care provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.

2. A nurse assesses a patient who is experiencing diabetic ketoacidosis (DKA). For which assessment findings would the nurse monitor the client? (Select all that apply.) A. Deep and fast respirations B. Decreased urine output C. Tachycardia D. Dependent pulmonary crackles E. Orthostatic hypotension

ANS: A, C, E DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually, patients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur.

1. A nurse assesses adults at a health fair. Which adults would the nurse counsel to be tested for diabetes? (Select all that apply.) A. A 56-year-old African-American male B. A 22-year-old female with a 30-lb (13.6 kg) weight gain during pregnancy C. A 60-year-old male with a history of liver trauma D. A 48-year-old female with a sedentary lifestyle E. A 50-year-old male with a body mass index greater than 25 kg/m2 F. A 28-year-old female who gave birth to a baby weighing 9.2 lb (4.2 kg)

ANS: A, D, E, F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, and Hispanics), obesity and physical inactivity, and giving birth to large babies. Liver trauma and a 30-lb (13.6 kg) gestational weight gain are not risk factors.

33. A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: • Fasting blood glucose: 75 mg/dL (4.2 mmol/L) • Postprandial blood glucose: 200 mg/dL (11.1 mmol/L) • Hemoglobin A1C level: 5.5% How would the nurse interpret these laboratory findings? A. Increased risk for developing ketoacidosis B. Good control of blood glucose C. Increased risk for developing hyperglycemia D. Signs of insulin resistance

ANS: B

A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL (3.3 mmol/L)?" How would the nurse respond? A. "Glucose is the only fuel used by the body to produce the energy that it needs." B. "Your brain needs a constant supply of glucose because it cannot store it." C. "Without a minimum level of glucose, your body does not make red blood cells." D. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."

ANS: B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the patient to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.

7. The nurse is caring for a client who has diabetes mellitus type 1 and is experiencing hypoglycemia. Which assessment findings will the nurse expect? (Select all that apply.) A. Warm, dry skin B. Nervousness C. Rapid deep respirations D. Dehydration E. Ketoacidosis F. Blurred vision

ANS: B, F The client who has hypoglycemia is often anxious, nervous, and possibly confused. Due to lack of glucose, vision may be blurred or the client may report diplopia (double vision). Clients who have hyperglycemia from diabetes mellitus type 1 have warm skin, Kussmaul respirations that are rapid and deep, dehydration due to elevated blood glucose, and ketoacidosis.

12. A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How would the nurse respond? A. "You need to start with multiple injections until you become more proficient at self-injection." B. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." C. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." D. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock."

ANS: B Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the patient decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the client's risk of insulin shock.

9. A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement would the nurse include in this client's teaching? A. "Change positions slowly when you get out of bed." B. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." C. "If you miss a dose of this drug, you can double the next dose." D. "Discontinue the medication if you develop a urinary infection."

ANS: B NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.

29. The nurse is caring for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 7:00 a.m. (0700). At which time would the nurse assess the client for potential hypoglycemia related to the NPH insulin? A. 8:00 a.m. (0800) B. 4:00 p.m. (1600) C. 8:00 p.m. (2000) D. 11:00 p.m. (2300)

ANS: B Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the patient at 2000 and 2300 would be too late. The nurse would check the patient at 1600 (4:00 p.m.).

24. A nurse assesses a client with diabetes mellitus. Which assessment finding would alert the nurse to decreased kidney function in this client? A. Urine specific gravity of 1.033 B. Presence of protein in the urine C. Elevated capillary blood glucose level D. Presence of ketone bodies in the urine

ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.

25. A nurse develops a dietary plan for a client with diabetes mellitus and new-onset micro-albuminuria. Which component of the client's diet would the nurse decrease? A. Carbohydrates B. Proteins C. Fats D. Total calories

ANS: B Restriction of dietary protein is recommended for clients with microalbuminuria to delay progression to renal failure. The client's diet does not need to be decreased in carbohydrates, fats, or total calories.

8. A nurse teaches a patient about self-monitoring of blood glucose levels. Which statement would the nurse include in this client's teaching to prevent blood-borne infections? A. "Wash your hands after completing each test." B. "Do not share your monitoring equipment." C. "Blot excess blood from the strip with a cotton ball." D. "Use gloves when monitoring your blood glucose."

ANS: B Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client would be taught to avoid sharing any equipment, including the lancet holder. The client would also be taught to wash his or her hands before testing. He or she would not need to blot excess blood away from the strip or wear gloves.

34. The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the client's glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance. What action would the nurse take? A. Administer the potassium and then consult with the primary health care provider about the fluid prescription. B. Increase the intravenous rate and then consult with the primary health care provider about the potassium prescription. C. Administer the potassium first before increasing the infusion flow rate for the client. D. Increase the intravenous flow rate before administering the potassium to the client.

ANS: B The client is acutely ill and is severely dehydrated and hypokalemic, requiring more IV fluids and potassium. However, potassium would not be infused unless the urine output is at least 30 mL/hr. The nurse would first increase the IV rate and then consult with the primary health care provider about the potassium.

28. A nurse teaches a client with diabetes mellitus about sick-day management. Which statement would the nurse include in this client's teaching? A. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." B. "Monitor your blood glucose levels at least every 4 hours while sick." C. "If vomiting, do not use insulin or take your oral antidiabetic agent." D. "Try to continue your prescribed exercise regimen even if you are sick."

ANS: B When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick.

19. A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values would the nurse identify as potential ketoacidosis in this client? A. pH 7.38, HCO3 22 mEq/L (22 mmol/L), PCO2 38 mm Hg, PO2 98 mm Hg B. pH 7.28, HCO3 18 mEq/L (18 mmol/L), PCO2 28 mm Hg, PO2 98 mm Hg C. pH 7.48, HCO3 28 mEq/L (28 mmol/L), PCO2 38 mm Hg, PO2 98 mm Hg D. pH 7.32, HCO3 22 mEq/L (22 mmol/L), PCO2 58 mm Hg, PO2 88 mm Hg

ANS: B When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels.

4. A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What action would the nurse take first? A. Document the finding in the client's chart. B. Assess tactile sensation in the client's hands. C. Examine the client's feet for signs of injury. D. Notify the primary health care provider.

ANS: C Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse would inspect them for any signs of injury. After assessment, the nurse would document findings in the client's chart. Testing sensory perception in the hands may or may not be needed. The primary health care provider can be notified after assessment and documentation have been completed.

15. The nurse is planning teaching for a client who is starting exenatide extended release (ER) for diabetes mellitus type 2. Which statement will the nurse include in the teaching? A. "Be sure to take the drug once a day before breakfast." B. "Take the drug every evening before bedtime." C. "Give your drug injection the same day every week." D. "Take the drug with dinner at the same time each day."

ANS: C Exenatide ER is an incretin mimetic (GLP-1 agonist) that works with insulin to lower blood glucose levels by reducing pancreatic glucagon secretion, reducing liver glucose production, and delaying gastric emptying. As an extended-release drug, it is given only once a week by injection.

2. The nurse is assessing a client for risk of developing metabolic syndrome. Which risk factor is associated with this health condition? A. Hypotension B. Hyperthyroidism C. Abdominal obesity D. Hypoglycemia

ANS: C The client at risk for metabolic syndrome typically has hypertension, abdominal obesity, hyperlipidemia, and hyperglycemia.

32. After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? A. "I should increase my intake of vegetables with higher amounts of dietary fiber." B. "My intake of saturated fats should be no more than 10% of my total calorie intake." C. "I should decrease my intake of protein and eliminate carbohydrates from my diet." D. "My intake of water is not restricted by my treatment plan or medication regimen."

ANS: C The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.

36. The nurse is caring for a newly admitted client who is diagnosed with hyperglycemic-hyperosmolar state (HHS). What is the nurse's priority action at this time? A. Assess the client's blood glucose level. B. Monitor the client's urinary output every hour. C. Establish intravenous access to provide fluids. D. Give regular insulin per agency policy.

ANS: C The first priority in caring for a client with HHS is to increase blood volume to prevent shock or severe hypotension from dehydration. The nurse would monitor vital signs, urinary output, and blood glucose to determine if interventions were effective. Regular insulin is also indicated but not as the first priority action.

23. A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement would the nurse include in this client's teaching to prevent injury? A. "Examine your feet using a mirror every day." B. "Rotate your insulin injection sites every week." C. "Check your blood glucose level before each meal." D. "Use a bath thermometer to test the water temperature."

ANS: D Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.

30. When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How would the nurse respond? A. "I can give your injections to you while you are here in the hospital." B. "Everyone gets used to giving themselves injections. It really does not hurt." C. "Your disease will not be managed properly if you refuse to administer the shots." D. "Tell me what it is about the injections that are concerning you."

ANS: D Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed. Giving the injections for the client does not promote self-care ability. Telling the client that others give themselves injections may cause the client to feel bad. Stating that you don't know another way to manage the disease is dismissive of the client's concerns.

7. A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? A. A 19-year-old Caucasian B. A 22-year-old African American C. A 44-year-old Asian American D. A 58-year-old American Indian

ANS: D Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle age places this patient at highest risk.

17. After teaching a client who has diabetes mellitus with retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? A. "I have so many complications; exercising is not recommended." B. "I will exercise more frequently because I have so many complications." C. "I used to run for exercise; I will start training for a marathon." D. "I should look into swimming or water aerobics to get my exercise."

ANS: D Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.

27. A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which would alert the nurse to intervene immediately? A. Serum chloride level of 98 mEq/L (98 mmol/L) B. Serum calcium level of 8.8 mg/dL (2.2 mmol/L) C. Serum sodium level of 132 mEq (132 mmol/L) D. Serum potassium level of 2.5 mEq/L (2.5 mmol/L)

ANS: D Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration.

21. A nurse teaches a client with type 1 diabetes mellitus. Which statement would the nurse include in this client's teaching to decrease the client's insulin needs? A. "Limit your fluid intake to 2 L a day." B. "Animal organ meat is high in insulin." C. "Limit your carbohydrate intake to 80 g a day." D. "Walk at a moderate pace for 1 mile daily."

ANS: D Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for patients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 g of carbohydrates each day.

10. After teaching a patient with type 2 diabetes mellitus who is prescribed nateglinide, the nurse assesses the client's understanding. Which statement made by the patient indicates a correct understanding of the prescribed therapy? A. "I'll take this medicine during each of my meals." B. "I must take this medicine in the morning when I wake." C. "I will take this medicine before I go to bed." D. "I will take this medicine immediately before I eat."

ANS: D Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the client's blood glucose levels causing hypoglycemia. The medication should be taken before meals instead of during meals.

35. The nurse is caring for a newly admitted older adult who has a blood glucose of 300 mg/dL (16.7 mmol/L), a urine output of 185 mL in the past 8 hours, and a blood urea nitrogen (BUN) of 44 mg/dL (15.7 mmol/L). What diabetic complication does the nurse suspect? A. Diabetic ketoacidosis (DKA) B. Severe hypoglycemia C. Chronic kidney disease (CKD) D. Hyperglycemic-hyperosmolar state (HHS)

ANS: D The client most likely has diabetes mellitus type 2 and has a high blood glucose causing increased blood osmolarity and dehydration, as evidenced by an insufficient urinary output and increased BUN. Older adults are at the greatest risk for dehydration due to age-related physiologic changes.

31. A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. What action would the nurse take? A. Apply ice to the site to reduce inflammation. B. Consult the provider for a new administration route. C. Assess the client for other signs of cellulitis. D. Instruct the client to rotate sites for insulin injection.

ANS: D The client's tissue has been damaged from continuous use of the same site. The client would be educated to rotate sites. The damaged tissue is not caused by cellulitis or any type of infection, and applying ice may cause more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be appropriate or practical to change the administration route.

20. A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. What action would the nurse take? A. Administration of oxygen via facemask B. Intravenous administration of 10% glucose C. . Implementation of seizure precautions D. Administration of intravenous insulin

ANS: D The rapid, deep respiratory efforts of Kussmaul respirations are the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The patient who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the patient glucose would be contraindicated. The patient does not require seizure precautions.

14. A nurse reviews the laboratory test values for a client with a new diagnosis of diabetes mellitus type 2. Which A1C value would the nurse expect? A. 5.0% B. 5.7% C. 6.2% D. 7.4%

ANS: D A client is diagnosed with diabetes if the client's A1C is 6.5% or greater. All listed values are below that level except for 7.4%.

3. After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? A. "At my age, I should continue seeing the ophthalmologist as I usually do." B. "I will see the eye doctor when I have a vision problem and yearly after age 40." C. "My vision will change quickly. I should see the ophthalmologist twice a year." D. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

ANS: D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.