Diabetes application Q's
Mnemonic for hypoglycemia = TIRED
TIRED • Tachycardia • Irritability • Restlessness • Excessive Hunger • Diaphoresis Rhyme Cold and clammy, need some candy
A nurse is discussing insulin needs with an adolescent with recently diagnosed type 1 diabetes. What information is important for the nurse to include concerning insulin administration? a. Insulin will be required throughout life. b. Insulin may be taken orally until adulthood. c. Insulin needs increase with strenuous exercise. d. Insulin needs decrease in the presence of an infection.
a. Insulin will be required throughout life. All those involved must understand that the child does not have an endogenous source of insulin and will require insulin administration throughout life. At this time there is no oral insulin with which to treat type 1 diabetes. Insulin needs decrease, not increase, during exercise. Insulin needs increase, not decrease, in the presence of an infection.
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? a. Administer oxygen by hood b. Determine the blood glucose level c. Pass a gavage tube for a formula feeding d. Transfer the newborn to the neonatal intensive care unit
b. Determine the blood glucose level 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.
A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition? a. Sodium bicarbonate, causing alkalosis b. Ketones as a result of rapid fat breakdown, causing acidosis c. Nitrogen from protein catabolism, causing ammonia intoxication d. Glucose from rapid carbohydrate metabolism, causing drowsiness
b. Ketones as a result of rapid fat breakdown, causing acidosis. Ketones are produced when fat is broken down for energy. Although rarely used, sodium bicarbonate may be administered to correct the acid-base imbalance resulting from ketoacidosis; acidosis is caused by excess acid, not excess base bicarbonate. Diabetes does not interfere with removal of nitrogenous wastes. Carbohydrate metabolism is impaired in the client with diabetes.STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.
A 9-year-old child with type 1 diabetes is hospitalized for insulin dosage regulation. A nurse observes the child sneaking food and trying to talk family members into bringing candy. What action should the nurse take when the child complains of feeling hypoglycemic? a. Test the urine for ketones. b. Obtain a blood glucose level. c. Offer orange juice with sugar. d. Determine when the child ate la
b. Obtain a blood glucose level. A check of the blood glucose level will confirm whether the child is hypoglycemic. Ketones are not in the urine during a hypoglycemic episode. Although offering orange juice with sugar might be appropriate to counter hypoglycemia, it does not reveal whether the child is hypoglycemic or is being manipulative. Although the nurse may eventually ask when the child ate last, this is not the priority.
A nurse is reviewing how a hyperglycemic client's blood glucose can be lowered. The nurse recalls that the chemical that buffers the client's excessive acetoacetic acid is what? a. Potassium b. Sodium bicarbonate c. Carbon dioxide d. Sodium chloride
b. Sodium bicarbonate Sodium bicarbonate is a base and one of the major buffers in the body. Potassium, a cation, is not a buffer; only a base can buffer an acid. Carbon dioxide is carried in aqueous solution as carbonic acid (H 2CO 3); an acid does not buffer another acid. Sodium chloride is not a buffer; it is a salt.
The health care provider prescribes an oral hypoglycemic for the patient with type 2 diabetes. What will the nurse need to consider when developing the teaching plan? a. Oral hypoglycemics work by decreasing absorption of carbohydrates. b. Oral hypoglycemics work by stimulating the pancreas to produce insulin. c. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. d. Clients with type 2 diabetes do not need to be concerned about serious adverse effects from oral hypoglycemics.
c. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the drug prescribed. Oral hypoglycemic drugs can have serious adverse effects.
A nurse observes that a client's urine has a sweet fruity odor. Which information is most important to evaluate when performing a further client assessment? a. Vital signs b. Fluid balance c. Serum glucose level d. Dietary calorie count
c. Serum glucose level Sweet fruity-smelling urine is an indicator of ketoacidosis, which can result from uncontrolled diabetes. Hyperglycemia and hypoglycemia are assessed by serum glucose monitoring. Vital signs, fluid imbalance, and dietary counts have no relation to sweet fruity-smelling urine.
A client newly diagnosed with type 1 diabetes is taught to exercise on a regular basis. What is the primary reason for instruction on exercise? a. To decrease insulin sensitivity b. To stimulate glucagon production c. To improve the cellular uptake of glucose d. To reduce metabolic requirements for glucose
c. To improve the cellular uptake of glucose Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise. Regular vigorous exercise increases cell sensitivity to insulin. Glucagon action raises blood glucose but does not affect cell uptake or use of glucose. Cellular requirements for glucose increase with exercise.
The nurse is teaching a client about the prescribed diet after a Whipple procedure for cancer of the pancreas. Which statement should the nurse include in the dietary teaching? a. "There are no dietary restrictions because the tumor has been removed." b. "Your diet should be low in calories to prevent taxing your diseased pancreas." c. "Meals should be restricted in protein because of your compromised liver function." d. "Low-fat meals should be eaten to prevent interference with your fat digestion mechanism."
d. "Low-fat meals should be eaten to prevent interference with your fat digestion mechanism." Whipple procedure leads to malabsorption because of impaired delivery of bile to the intestine and interruption of glucose metabolism; interference with fat digestion occurs. Clients require small, frequent low-fat, high-protein, moderate-carbohydrate meals and supplemental feedings. The response "There are no dietary restrictions because the tumor has been removed" is false reassurance. High-calorie meals are needed to provide energy and to promote the use of protein for tissue repair. High protein is required for tissue building; there is no problem with the liver in clients with cancer of the pancreas unless metastasis occurs by direct extension.
A nurse is caring for a school-aged child with type 1 diabetes. There have been problems maintaining euglycemia. What laboratory test does the nurse expect to be prescribed that will reveal the effectiveness of the diabetic regimen over time? a. Serum glucose b. Glucose tolerance c. Fasting blood sugar d. Glycosylated hemoglobin
d. Glycosylated hemoglobin The glycosylated hemoglobin test provides an accurate long-term index of the average blood glucose level for the 100 to 120 days before the test; the test is not affected by short-term variations. A result of less than 8% for this child indicates that the diabetic regimen is effective. Serum glucose reflects short-term (hours) variations in blood glucose. Glucose tolerance reveals carbohydrate metabolism in response to a glucose load. Fasting blood sugar is a screening test to rule out diabetes mellitus.
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? a. Polydipsia b. Ketoacidosis c. Glycogenesis d. Hypoglycemia
d. Hypoglycemia 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.
The nurse cares for a client with diabetes mellitus. Bedside glucose monitoring shows the client's blood sugar is 48 mg/dL. The client is alert. Which treatment option is the best choice for this client? a. one cup vanilla ice cream b. peanut butter sandwich c. chocolate candy bar d. one cup of orange juice
d. one cup of orange juice. A blood sugar reading of 48 mg/dL is hypoglycemia and requires treatment with a fast-acting carbohydrate source. Providing 20-30 g of carbohydrate is appropriate when blood sugar levels are 50 mg/dL or lower. All of these options will raise the client's blood glucose level; however, the client's glucose is low enough to cause symptoms if not treated quickly. The nurse can follow up the juice administration with a source like peanut butter or milk to help stabilize the glucose level. If the client is not alert, 1/2 an amp of dextrose 50% IV, or a subcutaneous or sublingual glucose source is used. A blood glucose level below 70 mg/dL is considered hypoglycemia. Hypoglycemia can be triggered by several factors, including too much diabetes medication, too little food intake, altered gastric emptying, alcohol ingestion, exercise, and decreased kidney clearance. Clients usually experience symptoms such as diaphoresis, anxiousness, shaking, weakness, intense hunger, and blurred vision. Treatment of hypoglycemia is carbohydrate replacement by eating or drinking, or medication if unable to swallow.
