Diabetes- (in class) NCLEX
The nurse is teaching the client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? A. "I should begin exercising for at least an hour a day." B. "I should monitor my diet." C. "If I lose weight, I may not need to use the insulin anymore." D. "Weight loss can be a sign of diabetic ketoacidosis."
A. "I should begin exercising for at least an hour a day." For long-term maintenance of major weight loss, large amounts of exercise (7 hr/wk) or moderate or vigorous aerobic physical activity may be helpful, but the client must start slowly.
The client has just been diagnosed with diabetes. Which factor is most important for the nurse to assess before providing instruction about the disease and its management? A. Current lifestyle B. Educational and literacy level C. Sexual orientation D. Current energy level
B. Educational and literacy level A large amount of information must be synthesized; typically written instructions are given. This is essential information.
Which explanation best assists the client in differentiating type 1 diabetes from type 2 diabetes? A. Most clients with type 1 diabetes are born with it. B. People with type 1 diabetes are often obese. C. Those with type 2 diabetes make insulin, but in inadequate amounts. D. People with type 2 diabetes do not develop typical diabetic complications.
C. Those with type 2 diabetes make insulin, but in inadequate amounts.
The nurse is providing discharge teaching to the client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching? A. "I can break in my shoes by wearing them all day." B. "I need to monitor my feet daily for blisters or skin breaks." C. "I should never go barefoot." D. "I should quit smoking."
A. "I can break in my shoes by wearing them all day." Shoes should be properly fitted and worn for a few hours a day to break them in, with frequent inspection for irritation or blistering.
Which is the best referral that the nurse can suggest to a client newly diagnosed with diabetes? A. American Diabetes Association B. Centers for Disease Control and Prevention C. Health care provider office D. Pharmaceutical representative
A. American Diabetes Association The American Diabetes Association can provide national and regional support and resources to clients with diabetes and their families.
A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." These are the client's vital signs: T 98.4° F (36.9º C), P 112, R 38, BP 91/54, and O2 saturation 99% on room air. Which action should the nurse take first? A. Check the blood glucose. B. Administer oxygen. C. Offer reassurance. D. Attach a cardiac monitor.
A. Check the blood glucose. The client's clinical presentation is consistent with diabetic ketoacidosis (kushmill breathing), and the nurse should initially check the client's glucose level.
The nurse caring for four diabetic clients has the following activities to perform. Which of these is appropriate to delegate to the nursing assistant? A. Perform hourly bedside blood glucose checks for a client with hyperglycemia. B. Verify the infusion rate on a continuous infusion insulin pump. C. Monitor a client with blood glucose of 68 mg/dL for tremors and irritability. D. Check on a client who is reporting palpitations and anxiety.
A. Perform hourly bedside blood glucose checks for a client with hyperglycemia. Performing bedside glucose monitoring is an activity that may be delegated because it does not require extensive clinical judgment to perform; the nurse follows up with the results.
You have just received change-of-shift report on the endocrine unit. Which client should you see first? A. The type 1 diabetic client whose insulin pump is beeping "occlusion" B. The newly diagnosed type 1 diabetic client who is reporting thirst C. The type 2 diabetic client with a blood glucose of 150 mg/dL D. The type 2 diabetic client with a blood pressure of 150/90
A. The type 1 diabetic client whose insulin pump is beeping "occlusion" Because glucose levels will increase quickly in clients who use continuous insulin pumps, the nurse should assess this client and the insulin pump first to avoid DKA.
The nurse is teaching the client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective? A. "I should go barefoot in my house so that my feet are exposed to air." B. "I must inspect my shoes for foreign objects before putting them on." C. "I will soak my feet in warm water to soften calluses before trying to remove them." D. "I must wear canvas shoes as much as possible to decrease pressure on my feet."
B. "I must inspect my shoes for foreign objects before putting them on." o avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on.
The nurse is teaching the client about the manifestations and emergency treatment of hypoglycemia. In assessing the client's knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates correct understanding of hypoglycemia management? A. "I should drink a glass of water." B. "I should eat three graham crackers." C. "I should give myself 1 mg of glucagon." D. "I should sit down and rest."
B. "I should eat three graham crackers."
The nurse is providing discharge teaching to the client with newly diagnosed diabetes. Which statement by the client indicates correct understanding about the need to wear a medical alert bracelet? A. "If I become hyperglycemic, it is a medical emergency." B. "If I become hypoglycemic, I could become unconscious." C. "Medical personnel may need confirmation of my insurance." D. "I may need to be admitted to the hospital suddenly."
B. "If I become hypoglycemic, I could become unconscious." Hypoglycemia is the most common cause of medical emergency. A medical alert bracelet is helpful if the client becomes hypoglycemic and is unable to provide self-care.
The client with type 1 diabetes mellitus received regular insulin at 7 AM. The client should be monitored for hypoglycemia at which time? A. 7:30 AM B. 11 AM C. 2 PM D. 7:30 PM
B. 11 AM Onset of regular insulin in ½ to 1 hour; peak is 2 to 4 hours. Therefore 11 AM is the anticipated onset time for regular insulin received at 7 AM.
The client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family? A. Causes and treatment of hyperglycemia B. Causes and treatment of hypoglycemia C. Dietary control D. Insulin administration
B. Causes and treatment of hypoglycemia The causes and treatment of hypoglycemia must be understood by the client and family to manage the client's diabetes effectively.
You have just taken change-of-shift report on a group of clients on the medical unit. Which client should you assess first? A. The client taking repaglinide (Prandin) who has nausea and back pain B. The client taking glyburide (Diabeta) who is dizzy and sweaty C. The client taking metformin (Glucophage) who has abdominal cramps D. The client taking pioglitazone (Actos) who has bilateral ankle swelling
B. The client taking glyburide (Diabeta) who is dizzy and sweaty This client has symptoms consistent with hypoglycemia and should be assessed first because he displays the most serious adverse effect of antidiabetic medications.
The client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response? A. "It is overwhelming, isn't it?" B. "Let's see how much you can learn today, so you are less nervous." C. "Let's tackle it piece by piece. What is most scary to you?" D. "Other people do it just fine."
C. "Let's tackle it piece by piece. What is most scary to you?" This approach will allow the client to have a sense of mastery with acceptance.
The diabetic client has a hemoglobin (Hb)A1c level of 9.4. What does the nurse say to the client regarding this finding? A. "Keep up the good work." B. "This is not good at all." C. "What are you doing differently?" D. "You need more insulin."
C. "What are you doing differently?" Assessing the client's regimen or changes he may have made is the basis for formulating interventions to gain control of blood glucose.
The client with type 2 diabetes has been admitted for surgery, and the physician has placed her on insulin. The client wants to know why she should have to take this. What is your best response? A. "Your diabetes is worse, so you will need to take insulin." B. "You can't take your metformin while in the hospital." C. "Your body is under more stress, so you will need to have insulin to support your medication." D. "You will have to take insulin from now on because the surgery will affect your diabetes."
C. "Your body is under more stress, so you will need to have insulin to support your medication." Because of the stress of surgery and NPO status, short-term insulin therapy may be needed perioperatively for the client who uses oral agents.
Which of these clients with diabetes should the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit? A. A 58-year-old with sensory neuropathy who needs teaching about foot care B. A 68-year-old with diabetic ketoacidosis who has an IV running at 250 mL/hr C. A 70-year-old who needs blood glucose monitoring and insulin before each meal D. A 76-year-old who was admitted with fatigue and shortness of breath
C. A 70-year-old who needs blood glucose monitoring and insulin before each meal A nurse from the labor/delivery unit would be familiar with blood glucose monitoring and insulin administration because clients with type 1 and gestational diabetes are frequently cared for in the labor/delivery unit.
The intensive care client with ketoacidosis (DKA) is receiving insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make? A. Urine output B. 12-lead electrocardiogram (ECG) C. Potassium level D. Rate of IV fluids
C. Potassium level With insulin therapy, serum potassium levels fall rapidly as potassium shifts into the cells. Detecting and treating the underlying cause is essential.
When preparing a mixed insulin injection, which action does the nurse perform first? A. Draws up the longer-acting insulin B. Draws up the short-acting insulin C. Puts air in the longer-acting insulin vial D. Puts air in the shorter-acting insulin vial
C. Puts air in the longer-acting insulin vial Putting air in the longer-acting insulin vial is the first step in preparing a mixed insulin injection.
In reviewing the physician admission requests for the client admitted with hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis? A. 20 mEq KCl for each liter of IV fluid B. IV regular insulin at 2 units/hr C. IV normal saline at 100 mL/hr D. 1 ampule NaHCO3 IV now
D. 1 ampule NaHCO3 IV now NaHCO3 is given for the acid-base imbalance of diabetic ketoacidosis, not the hyperglycemic-hyperosmolar state, which presents with hyperglycemia and absence of ketosis/acidosis.
A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (HbA1c) is 8.2%. Which action will the nurse plan to take next? A. Instruct the client to continue with the current diet and Glucophage use. B. Discuss the need to check blood glucose several times every day. C. Talk about the possibility of adding rapid-acting insulin to the regimen. D. Ask the client about current dietary intake and medication use.
D. Ask the client about current dietary intake and medication use. The nurse's first action should be to assess whether the client is adherent to the currently prescribed diet and medications.
Which of these nursing actions can the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes? A. Assist the client's spouse in choosing appropriate dietary items. B. Evaluate the client's use of a home blood glucose monitor. C. Inspect the extremities for evidence of poor circulation. D. Assist the client with washing his feet and applying moisturizing lotion.
D. Assist the client with washing his feet and applying moisturizing lotion. Assisting with personal hygiene is included in the role of home health aides.
Which complication of diabetes should the nurse report to the provider? The nurse receives report on a 52-year-old client with type 2 diabetes. CHART EXHIBIT: Assessment Prescriptions Lungs clear Right great toe mottled and cold to touch Diagnostics Glucose 179 Hemoglobin A1C 6.9 Prescriptions insulin 8 units if blood glucose 250 to 275 Regular insulin 10 units if glucose 275 to 300 Client states wears eyeglasses to read. A. Poor glucose control B. Visual changes C. Respiratory distress D. Peripheral tissue perfusion
D. Peripheral tissue perfusion A cold, mottled toe may indicate arterial occlusion secondary to arterial occlusive disease or embolization; this must be reported to avoid potential gangrene and amputation.
The client recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the client the proper use of the machine? A. Day of discharge B. On admission C. When the client states readiness D. While performing the test in the hospital
D. While performing the test in the hospital Teaching the client about the operation of the machine while performing the test in the hospital is the best way for the client to learn. The teaching can be reinforced before discharge.
