Diabetes #7
Four hours after surgery, the blood glucose level of a client who has type 1 diabetes is elevated. What intervention should the nurse implement? 1 Administer an oral hypoglycemic 2 Institute urine glucose monitoring 3 Give supplemental doses of regular insulin 4 Decrease the rate of the intravenous infusion
Correct 3 The blood glucose level needs to be reduced; regular insulin begins to act in 30 to 60 minutes. The client has type 1, not type 2, diabetes, and an oral hypoglycemic will not be effective. Blood glucose levels are far more accurate than urine glucose levels. The rate may be increased because polyuria often accompanies hyperglycemia.
At 4:30 pm, a client who is receiving NPH insulin every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's most accurate interpretation of what the client is likely experiencing? 1 Polydipsia 2 Ketoacidosis 3 Glycogenesis 4 Hypoglycemia
Correct 4 The time of the client's response corresponds to the expected peak action (4 to 12 hours after administration) of the intermediate-acting insulin that was administered in the morning; this can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness. Osmotic diuresis causes thirst; this is related to hyperglycemia, not to hypoglycemia. Warm, dry, flushed skin and lethargy are associated with ketoacidosis. Glycogenesis, the formation of glycogen in the liver, is unrelated to nervousness and cool, moist skin.
A nurse is planning an evening snack for a child receiving NPH insulin. What is the reason for this nursing action? 1 It encourages the child to stay on the diet. 2 Energy is needed for immediate utilization. 3 Extra calories will help the child gain weight. 4 Nourishment helps counteract late insulin activity.
Correct 4 A bedtime snack is needed for the evening. NPH insulin is intermediate-acting insulin, which peaks 4 to 12 hours later and lasts for 18 to 24 hours. Protein and carbohydrate ingestion before sleep prevents hypoglycemia during the night when the NPH is still active. The snack is important for diet-insulin balance during the night, not encouragement. There are no data to indicate that extra calories are needed; a bedtime snack is routinely provided to help cover intermediate-acting insulin during sleep. The snack must contain mainly protein-rich foods, not simple carbohydrates, to help cover the intermediate-acting insulin during sleep.
A nurse explains to a client with diabetes that self-monitoring of blood glucose is preferred to urine glucose testing. Why is blood glucose monitoring preferred? 1 Blood glucose monitoring is more accurate. 2 Blood glucose monitoring is easier to perform. 3 Blood glucose monitoring is done by the client. 4 Blood glucose monitoring is not influenced by drugs.
Correct 1 Blood glucose testing is a more direct and accurate measure; urine testing provides an indirect measure that can be influenced by kidney function and the amount of time the urine is retained in the bladder. Whereas blood and urine testing is relatively simple, testing the blood involves additional knowledge. Both procedures can be done by the client. Whether or not it is influenced by drugs is not a factor. Although some urine tests are influenced by drugs, there are methods to test urine to bypass this effect.
An 8-year-old child is being given insulin glargine before breakfast. What is the most appropriate information for the nurse to give the parents concerning a bedtime snack? 1 Offer a snack to prevent hypoglycemia during the night. 2 Give the child a snack if signs of hyperglycemia are present. 3 Avoid a snack because the child is being treated with long-acting insulin. 4 Keep a snack at the bedside in case the child gets hungry during the night.
Correct 1 Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the child should eat the snack before going to bed.
A newborn weighing 9 lb 14 oz (4479 g) is delivered by cesarean due to cephalopelvic disproportion. The Apgar scores are 7 at 1 minute and 9 at 5 minutes. Which nursing action should be taken after the initial physical assessment? 1 Administer oxygen by hood 2 Determine the blood glucose level 3 Pass a gavage tube for a formula feeding 4 Transfer the newborn to the neonatal intensive care unit
Correct 2 The simple measure of determining the infant's blood glucose level will reveal hypoglycemia in this large-for-gestational-age infant. There are no data that indicate a need for oxygen. Formula will not be given at this time, and there are no data that indicate a need for gavage feeding. The situation does not indicate the need for transfer of the newborn to the neonatal intensive care unit. The Apgar scores demonstrate that this infant is adapting to extrauterine life.
An infant of a diabetic mother is admitted to the neonatal intensive care unit. What is the priority nursing intervention for this infant? 1 Clamping the cord a second time 2 Obtaining heel blood to test the glucose level 3 Starting an intravenous (IV) infusion of glucose in water 4 Instilling an ophthalmic antibiotic to prevent an eye infection
Correct 2 Hypoglycemia may be present because of the sudden withdrawal of maternal glucose and increased fetal insulin production, which continues after birth. The umbilical vein may be needed to start an IV; it should not be damaged. An IV infusion of glucose should not be started until the blood glucose level has been determined. Instilling an antibiotic into the eyes can be delayed until the blood glucose level has been determined.
A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? 1 Stimulates the pancreas to produce insulin 2 Accelerates the liver's release of stored glycogen 3 Increases glucose transport across the cell membrane 4 Lowers blood glucose in the absence of pancreatic function
Correct 1 Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.
The clinical findings of a client with diabetes mellitus show decreased glucose tolerance. Which complication is anticipated in the client? 1 Cystitis 2 Thin and dry skin 3 Decreased bone density 4 Frequent yeast infections
Correct 4 Decreased glucose tolerance may cause frequent yeast infections, but it is not associated with the risk of cystitis, thin and dry skin, and decreased bone density. The risk of cystitis, thin and dry skin, and decreased bone density are due to decreased ovarian production of estrogen.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra tablet should be taken before exercise. What is the best response by the nurse? 1 "You will need to decrease your exercise." 2 "An extra tablet will help your body use glucose correctly." 3 "When taking medicine, your diet will not be affected by exercise." 4 "No, but you should observe for signs of hypoglycemia while exercising."
Correct 4 Exercise improves glucose metabolism; with exercise there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy.
A nurse is monitoring a client's laboratory results for a fasting plasma glucose level. Within which range of a fasting plasma glucose level does the nurse conclude that a client is considered to be diabetic? 1 40 to 60 mg/dL (2.2 to 3.3 mmol/L) 2 80 to 99 mg/dL (4.5 to 5.5 mmol/L) 3 100 to 125 mg/dL (5.6 to 6.9 mmol/L) 4 126 to 140 mg/dL (7.0 to 7.8 mmol/L)
Correct 4 Results in the range 126 to 140 mg/dL (7.0 to 7.8 mmol/L) indicate diabetes. Results in the range 40 to 60 mg/dL (2.2 to 3.3 mmol/L) indicate hypoglycemia. Results in the range 80 to 99 mg/dL (4.5 to 5.5 mmol/L) are considered expected (normal). Results in the range 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicate prediabetes according to the American Diabetes Association. (Results in the range of 6.1 to 6.9 mmol/L indicate prediabetes according to the Canadian Diabetes Association Guidelines.)
A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? 1 Ketoacidosis 2 Somogyi phenomenon 3 Hypoglycemic reaction 4 Hyperosmolar nonketotic coma
Correct 1 Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat, causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.
A nurse is teaching a 15-year-old adolescent with newly diagnosed type 1 diabetes about self-care. What is the primary long-term goal this nurse and client should agree on? 1 Maintaining normoglycemia 2 Complying with the diabetic diet 3 Adhering to an exercise program 4 Developing a nonstressful lifestyle
Correct 1 Maintaining normoglycemia is a realistic goal because it decreases the risk of complications such as neuropathy, retinopathy, and atherosclerosis. A regimen of insulin, exercise, and diet will help the adolescent achieve this goal. Compliance with a diabetic diet is an objective because it will help the adolescent achieve the long-term goal; diet alone is insufficient to achieve normoglycemia. Adherence to an exercise program is an objective because it will help the adolescent achieve the long-term goal; exercise alone is insufficient to achieve normoglycemia. Development of a nonstressful lifestyle is a worthwhile goal, but it is not realistic.
The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms? 1 Nervous and weak 2 Thirsty with a headache 3 Flushed and short of breath 4 Nausea and abdominal cramps
Correct 1 Nervousness and weakness are the most commonly reported symptoms of hypoglycemia and are related to increased sympathetic nervous system activity. Feeling flushed and short of breath are adaptations of hyperglycemia. Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of hyperglycemia.
The nurse is teaching a client newly diagnosed with diabetes about the importance of glucose monitoring. Which blood glucose levels should the nurse identify as hypoglycemia? 1 68 mg/dL (3.8 mmol/L) 2 78 mg/dL (4.3 mmol/L) 3 88 mg/dL (4.9 mmol/L) 4 98 mg/dL (5.4 mmol/L)
Correct 1 Normal blood glucose level for an adult is 72-108 mg/dL (4-6 mmol/L). Clients who have blood glucose levels below 72 mg/dL (4 mmol/L) may experience hypoglycemia; 78 mg/dL (4.3 mmol/L), 88 mg/dL (4.9 mmol/L), and 98 mg/dL (5.4 mmol/L) are normal blood glucose levels.
Which formula is most preferable for a child who has lactose intolerance? 1 Soy-based formula 2 Whey hydrolysate formula 3 Cow's milk-based formula 4 Amino acid-based formula
Correct 1 Soy-based formula is a commercially available formula that has a high amount of protein but does not contain lactose. Amino acid-based formula is preferable for a child who has food allergies. However, it is not the most preferable formula for the child with lactose intolerance. Whey hydrolysate formula and cow's milk-based formula contain high amounts of lactose.
A 10-year-old girl with diabetes joins the school's soccer team. Her mother is unsure whether to tell the coach of her child's condition. The mother asks the school nurse for guidance. On what information should the nurse base the response? 1 Children with diabetes who participate in active sports can have episodes of hypoglycemia. 2 Children may have to leave athletic teams if school authorities learn that they have diabetes. 3 The school nurse will treat the child if clinical findings of hypoglycemia are recognized early. 4 The coach might violate confidentiality by discussing the child's condition with other faculty members.
Correct 1 The people associated with the school who are interacting with the child should be told about the child's condition. Knowledgeable people can be alert for early signs of hypoglycemia and have snacks available for the child to help prevent a hypoglycemic episode. Forcing the child to leave the team is a form of discrimination; children with diabetes are allowed to engage in activities as long as their diabetes remains under control. The adult who is with the child when the signs of hypoglycemia first appear should be prepared to treat the child; this person may or may not be the nurse. Information about the child's health status is on a "need to know" basis; professionals are expected to honor confidentiality.
A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? Select all that apply. 1 Polyuria 2 Polydipsia 3 Paralytic ileus 4 Respiratory rate of 24 breaths/min 5 Serum glucose of 105 mg/dL (5.8 mmol/L)
Correct 1, 2, 4 Glucose that is being filtered in the kidney acts as an osmotic diuretic; glycosuria promotes polyuria. Polydipsia (excessive thirst) and fluid intake are the responses to excess fluid loss related to osmotic diuresis. With hyperglycemia, there may be hyperventilation in an attempt to blow off carbon dioxide if ketones are produced; 24 breaths/min is characteristic of hyperventilation. Paralytic ileus is not associated with hyperglycemia. Serum glucose of 105 mg/dL (5.8 mmol/L), by most standards, is within the expected range of 60 to 110 mg/dL (3.3 to 6.1 mmol/L).
A nurse working in the diabetes clinic is evaluating a client's success with managing the medical regimen. What is the best indication that a client with type 1 diabetes is successfully managing the disease? 1 Reduction in excess body weight 2 Stabilization of the serum glucose 3 Demonstrated knowledge of the disease 4 Adherence to the prescription for insulin
Correct 2 A combination of diet, exercise, and medication is necessary to control the disease; the interaction of these therapies is reflected by the serum glucose level. Weight loss may occur with inadequate insulin. Acquisition of knowledge does not guarantee its application. Insulin alone is not enough to control the disease.
During a teaching session about insulin injections, a client asks the nurse, "Why can't I take the insulin in pills instead of taking shots?" What is the nurse's best response? 1 "Insulin cannot be manufactured in pill form." 2 "Insulin is destroyed by gastric juices, rendering it ineffective." 3 "Your health care provider decides the route of administration." 4 "Your health care provider will prescribe pills when you are ready."
Correct 2 Insulin in tablet form is inactivated by gastric juices; insulin given by injection avoids exposure to digestive enzymes. Insulin is not given orally at this time because it is inactivated by digestive enzymes. The response "Your health care provider will prescribe pills when you are ready" is incorrect information and provides false reassurance; the client currently is insulin dependent. The response "Your health care provider decides the route of administration" does not answer the client's question; insulin is administered intravenously or subcutaneously, and the route depends on the client's needs.
An unconscious 16-year-old adolescent with type 1 diabetes is brought to the emergency department. The blood glucose level is 742 mg/dL (41.2 mmol/L). What finding does the nurse expect during the initial assessment? 1 Pyrexia 2 Hyperpnea 3 Bradycardia 4 Hypertension
Correct 2 Rapid breathing is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a characteristic compensatory mechanism for correcting metabolic acidosis. An increase in temperature will occur if an infection is present; it is not a response to hyperglycemia. Tachycardia, not bradycardia, results from the hypovolemia of dehydration. Hypotension, not hypertension, may result from the decreased vascular volume associated with hyperglycemia.
A client with type 1 diabetes mellitus has a finger stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime. A prescription for sliding-scale regular insulin exists. What should the nurse do? 1 Call the health care provider. 2 Encourage the intake of fluids. 3 Administer the insulin as prescribed. 4 Give the client a half cup of orange juice.
Correct 3 A value of 258 mg/dL (14.3 mmol/L) is above the expected range of 70 to 100 mg/dL (3.6 to 5.6 mmol/L); the nurse should administer the regular insulin as prescribed. Calling the health care provider is unnecessary; a prescription for insulin exists and should be implemented. Encouraging the intake of fluids is insufficient to lower a glucose level this high. Giving the client a half cup of orange juice is contraindicated because it will increase the glucose level further; orange juice, a complex carbohydrate, and a protein should be given if the glucose level is too low.
An insulin pump is instituted for a client with type 1 diabetes. The nurse plans discharge instructions. Which short-term goal is the priority for this client? 1 "Adhere to the medical regimen." 2 "Remain normoglycemic for 3 weeks." 3 "Demonstrate correct use of the insulin pump." 4 "List three self-care activities that help control the diabetes."
Correct 3 Demonstrating correct use of the insulin pump is the short-term, client-oriented goal necessary for the client to manage the pump and avoid hypo- and hyperglycemia; this outcome can be measured by observing a return demonstration by the client. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable but requires the client to manage the insulin pump. Although listing three self-care activities that help control the diabetes is a measurable short-term goal, it is not the priority when the client must master use of the insulin pump.
A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action? 1 Have the client assessed for an enlarged prostate. 2 Obtain a urine specimen from the client to test for ketonuria. 3 Perform a finger stick to test the client's blood glucose level. 4 Assess the client's lower extremities for the presence of pitting edema.
Correct 3 The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention, but of hyperglycemia.
A nurse is reviewing the laboratory report of a 13-year-old adolescent with type 1 diabetes. What test is considered the most accurate in the evaluation of the effectiveness of diet and insulin therapy over time? 1 Blood pH 2 Serum protein level 3 Serum glucose level 4 Glycosylated hemoglobin
Correct 3 The glycosylated hemoglobin (GHb) test provides an accurate long-term index of the child's average blood glucose level for the 10- to 12-day period before the test; the more glucose the red blood cells were exposed to, the greater the GHb percentage. A high blood pH may indicate developing ketoacidosis, but it reflects short-term variations. Serum protein readings do not reflect the effectiveness of glucose management. Serum glucose readings reflect short-term (hours) variations.
At 7:00 AM a nurse learns that an adolescent with diabetes had a 6:30 AM fasting blood glucose level of 180 mg/dL (10.0 mmol/L). What is the priority nursing action at this time? 1 Encouraging the adolescent to start exercising 2 Asking the adolescent to obtain an immediate glucometer reading 3 Informing the adolescent that a complex carbohydrate such as cheese should be eaten 4 Telling the adolescent that the prescribed dose of rapid-acting insulin should be administered
Correct 4 A blood glucose level of 180 mg/dL (10.0 mmol/L) is above the average range, and the prescribed rapid-acting insulin is needed. Although exercise does decrease insulin requirements and does lower the blood glucose level, the immediate action of insulin is needed. Asking the adolescent to obtain an immediate glucometer reading is an action that will not correct the problem; the blood glucose level is already known. Food intake at this time will increase the level of blood glucose.
A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective? 1 "I should massage my feet and legs with oil or lotion." 2 "I should apply heat intermittently to my feet and legs." 3 "I should eat foods high in protein and carbohydrate kilocalories." 4 "I should control my blood glucose with diet, exercise, and medication."
Correct 4 Controlling the diabetes decreases the risk of infection; this is the best prevention. Oil or lotion that is not completely absorbed may provide a warm, moist environment for bacterial growth. Coexisting neuropathy may result in injury from heat application. Protein, carbohydrates, and fats must be in an appropriate balance; high carbohydrate intake can provide too many calories.
