Diabetes

A client with type 2 diabetes has been receiving insulin in the hospital while being treated for sepsis. The client's infection is resolving and the primary health care provider writes a prescription to discontinue the 7:00 AM dose of insulin and to administer glyburide 5 mg twice daily. After administering the glyburide at 8:30 AM, the nurse sees that the insulin had already been administered at 7:00 AM. Which initial action would the nurse take?

Measure the vital signs. 2 Notify the primary health care provider. 3 Administer 15 G of fast acting carbohydrates 4 Check blood glucose for hypoglycemia.

On the first postoperative day after a total hip replacement a client asks for assistance onto the bedpan. Which instruct would the nurse give to the client?

"Use your elbows and hands to lift your pelvis off the bed." 2 "Extend both legs and pull on the trapeze to lift your pelvis." 3 "Turn gently toward the operative side while lifting your pelvis off the bed." 4 "Flex the knee on the unoperated leg and pull on the trapeze to lift your pelvis."

A client with type 2 diabetes is admitted to the ambulatory surgery unit for elective cataract surgery. Before surgery the client asks the nurse, "How will my diabetes be managed while I am here?" Which is the best response by the nurse?

1 "What did your surgeon tell you?" 2 "Has the anesthesiologist talked to you yet?" 3 "Your surgeon will write your postoperative prescriptions." 4 "I'm not quite certain I understand what you are asking."

A client with type 2 diabetes travels frequently and asks how to plan meals during trips. Which is the best response by the nurse?

1 "You can order diabetic foods on most airlines and in restaurants." 2 "Plan your food ahead and carry it with you from home" 3 "Monitor your blood glucose level frequently and eat accordingly." 4 "Choose the foods you normally do and follow your food plan wherever you are."

A client with recently diagnosed diabetes states, "I feel bad. My spouse and I do not get along. It seems as though my spouse doesn't care about my diabetes." Which response by the nurse is appropriate?

1 "You don't get along with your spouse." 2 "I'm sorry. What can I do to make you feel better?" 3 "It may be temporary because your spouse also needs time to adjust." Correct4 "You sound unhappy. Have you tried to talk to your spouse?"

Which initial nursing action would the nurse perform for a postoperative 2-month-old infant returning to the pediatric unit with an intravenous infusion running and a nasogastric tube in place?

1 Assessing the infant's status 2 Giving the infant a mild sedative 3 Connecting the nasogastric tube to wall suction 4 Placing the intravenous tubing through an infusion pump

Which eye problem is the leading cause of blindness in clients with diabetes?

1 Cataracts 2 Glaucoma 3 Retinopathy 4 Astigmatism

A client with diabetes mellitus who shows decreased glucose tolerance is at risk for which complication?

1 Cystitis 2 Thin and dry skin 3 Decreased bone density 4 Frequent yeast infections

When teaching a client with type 2 diabetes, which statement by the nurse reflects accurate information about preparing for a serum glucose test?

1 Eat your usual breakfast." 2 "Have clear liquids for breakfast." 3 "Take your medication before the test." 4 "Do not ingest anything before the test."

When obtaining the history of a client recently diagnosed with type 1 diabetes, which symptom would the nurse expect to see?

1 Edema 2 Anorexia 3 Weight loss 4 Hypoglycemic episodes

Which common cause of diabetic ketoacidosis would the nurse consider when caring for a postoperative client with diabetes?

1 Emotional stress 2 Presence of infection 3 Increased insulin dose Incorrect4 Inadequate food intake

The nurse is planning to teach an adolescent about diabetes and self-administration of insulin. Which would the nurse complete first?

1 Establish realistic goals. 2 Assess the adolescent's intellectual ability. 3 Determine what the adolescent knows about diabetes. 4 Gather the equipment that will be needed for the demonstration.

Which clinical findings would cause the nurse to suspect that an adolescent child with type 1 diabetes is hypoglycemic?

1 Increased thirst, sleepiness, and nausea 2 Confusion, dry mouth, and diminished reflexes 3 Difficulty concentrating, hunger, and diaphoresis 4 Flushed face, deep breathing, and abdominal pain

Which is the primary fluid shift that occurs with diabetes mellitus?

1 Intravascular to interstitial because of glycosuria 2 Interstitial to extracellular because of hypoproteinemia 3 Intracellular to intravascular because of hyperosmolarity 4 Intercellular to intravascular because of increased hydrostatic pressure

An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus?

1 Ketones 2 Glucose 3 Lactic acid 4 Glutamic acid

A client who is 60 pounds (27.2 kg) more than the ideal body weight is admitted to the hospital with a diagnosis of type 1 diabetes. Which concept would the nurse include in teaching about diabetes when discussing strategies to lose weight?

1 Obesity leads to insulin resistance. 2 Surplus fat causes excretion of insulin. 3 Fat cells absorb insulin and prevent its circulation to other cells. 4 Lipids accumulate in the pancreas and interfere with insulin production.

The nurse is caring for a client who is 1 day postoperative for a left hip fracture repair. Which clinical finding would the nurse assess further?

1 Pain at the surgical site 2 Small amount of serosanguinous drainage 3 Decreased range of motion to the left extremity 4 Sudden shortness of breath

A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." Which information would the nurse include in response to this client's statement?

1 Regulated food intake is basic to control. 2 Salt and sugar restriction is the main concern. 3 Small, frequent meals are better for glucose regulation. 4 Large meals can contribute to a weight problem.

When teaching a client with diabetes about monitoring for episodes of hypoglycemia, which symptom would the nurse include in the teaching plan?

1 Thirst 2 Nausea 3 Anorexia 4 Sweating

The nurse is caring for a postoperative client who has a nasogastric tube attached to low continuous suction. Which assessment finding indicates that the client may be experiencing hypokalemia?

1 Tingling of the fingertips and toes 2 Dry and sticky mucous membranes 3 Abdominal cramping and irritability 4 Muscle weakness and cardiac dysrhythmias

A client with type 1 diabetes receives Humulin R insulin in the morning. Shortly before lunch the nurse identifies that the client is diaphoretic and trembling. Which intervention is appropriate?

Administer insulin to the client. 2 Give the client lunch immediately. 3 Encourage the client to drink fluids. 4 Assess the client's blood glucose level.

The nurse is assisting in sports physicals of junior high students. Which finding would prompt the nurse to ask whether a student has a history of diabetes?

Clustered vesicles on the lower lip 2 Silver plaques on extensor surfaces 3 Cystic acne of the face and upper back 4 A velvety darkening of the skin around the neck

A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. Two days after surgery, which intervention is appropriate when preparing the client to eat dinner?

Checking the client's serum glucose level 2 Assisting the client out of bed into a chair 3 Placing the client in the high-Fowler position 4 Ensuring the client's residual limb is elevated

Before having surgery, a client with type 1 diabetes insulin requirements are elevated but well controlled. Which insulin requirements would the nurse anticipate for this client postoperatively?

Decrease 2 Fluctuate 3 Increase sharply 4 Remain elevate

Which factor may have precipitated ketoacidosis in a client with type 1 diabetes who has been adhering to a prescribed insulin regimen?

Increased exercise 2 Decreased food intake 3 Working the night shift 4 Upper respiratory infection

Which statement is accurate when teaching the client with diabetes about foot care?

1 "Remove any corns on your feet." 2 "Wear shoes that are a size larger than your feet." 3 "Examine your feet weekly for potential sores." 4 "Wear synthetic fiber socks when exercising."

A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a finger stick. Which is an appropriate response to this question?

1 "There is no difference between readings." Incorrect2 "These types of monitors are meant for children." 3 "Readings are on a different scale for each monitor." 4 "Faster readings can be obtained from a finger stick."

An adolescent who has just been found to have type 1 diabetes asks the nurse about exercise. Which is the best response by the nurse?

1 "Exercise should be restricted." 2 "Exercise will increase blood glucose." 3 "Extra snacks are needed before exercise." 4 "Extra insulin is required during exercise."

A client with diabetes is given instructions about foot care. Which statement made by the client shows effective learning?

1 "I will trim my toenails before bathing." 2 "I will soak my feet daily for 1 hour." Incorrect3 "I will examine my feet using a mirror at least once a week." Correct4 "I will break in my new shoes

A 15-year-old adolescent with type 1 diabetes arrives at the diabetic outpatient clinic with a parent. The adolescent sits back in the chair with arms folded, frowns, and displays a withdrawn attitude. The adolescent and parent argue in front of the nurse. Which is the best approach for the nurse to use?

1 Encouraging the adolescent to take more interest in and responsibility for treatment 2 Speaking separately with each of them, encouraging them to recognize and vent their anger 3 Trying to persuade the two of them to work out their differences together before returning to the clinic 4 Asking the parent to stay in the waiting room while the adolescent meets with the clinic's staff members

Which increased physiological response would the nurse include when explaining the need for weight loss to a client who is diagnosed with diabetes?

1 Fatty acid storage 2 Glucose oxidation 3 Insulin requirements 4 Cellular entry of glucose

The nurse teaches a client with type 1 diabetes how to best treat hypoglycemia. If the teaching is effective, which foods would the client identify to manage hypoglycemia?

1 Hard candy and fruit juice 2 Cheese sandwich and sugar 3 Chocolate candy and an orange Incorrect4 Peanut butter crackers and a glass of milk

An older adult with a history of diabetes reports giddiness, excessive thirst, and nausea. During an assessment, the nurse notices the client's body temperature as 105°F (40.6°C), orally. Which condition would the nurse suspect in the client?

1 Heat stroke 2 Heat exhaustion 3 Accidental hypothermia 4 Malignant hyperthermia

Which results would be expected when assessing the laboratory values of a client with type 2 diabetes?

1 Ketones in the blood but not in the urine 2 Glucose in the urine but not in the blood Incorrect3 Urine and blood positive for glucose and ketones 4 Urine negative for ketones and positive glucose in the blood

A client with type 1 diabetes for 25 years states, "I have been really bad for the past 15 years. I have not paid attention to my diet and have done little to control my diabetes." Which common complications of diabetes might the nurse expect to identify when assessing this client? Select all that apply. One, some, or all responses may be correct.

1 Leg ulcers 2 Loss of visual acuity 3 Thick, yellow toenails 4 Increased growth of body hair 5 Decreased sensation in the feet

A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." Which information would the nurse include in response to this client's statement?

1 Regulated food intake is basic to control. 2 Salt and sugar restriction is the main concern. Incorrect3 Small, frequent meals are better for glucose regulation. 4 Large meals can contribute to a weight problem.

The nurse determines that an adolescent with newly diagnosed type 1 diabetes has sufficient knowledge of the disorder. Which is the next appropriate action?

1 Setting goals with the client 2 Developing a rapport with the client 3 Teaching the client how to give insulin injections 4 Instructing the client how to monitor blood glucose

The nurse teaches a client with type 1 diabetes how to best treat hypoglycemia. If the teaching is effective, which foods would the client identify to manage hypoglycemia?

Hard candy and fruit juice 2 Cheese sandwich and sugar 3 Chocolate candy and an orange Incorrect4 Peanut butter crackers and a glass of milk

A client with diabetes mellitus complains of difficulty seeing. Which factor would the nurse suspect as being the cause?

Lack of glucose in the retina 2 The growth of new retina blood vessels or "neovascularization" 3 Inadequate glucose supply to rods and cones 4 Destructive effect of ketones on retinal metabolism

Which common complications of diabetes would the nurse assess for in a client with a long history of the disease? Select all that apply. One, some, or all responses may be correct.

Leg ulcers 2 Loss of visual acuity 3 Increased creatinine clearance Correct4 Prolonged capillary refill in the toes Correct5 Decreased sensation in the lower extremities

A client receives postoperative teaching and is instructed to avoid straining on defecation. Which food item chosen by the client indicates successful learning?

Ripe bananas Milk products Green vegetables Creamed potatoes

While obtaining the client's health history, which factor would the nurse identify that predisposes the client to type 2 diabetes?

1 Having diabetes insipidus 2 Eating low-cholesterol foods 3 Being 20 pounds (9 kg) overweight 4 Drinking a daily alcoholic beverage

The nurse is helping an adolescent with type 1 diabetes establish a consistent meal pattern. Which feedback indicates that further teaching is needed?

1 Weighs portion sizes for several months 2 Reads nutrition labels on prepared foods 3 Avoids complex carbohydrate substitutes 4 Limits sugar alternatives containing sorbitol

On the first postoperative day after a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports a sore throat when swallowing. Which intervention would the nurse take for this client?

Reorder the full-fluid diet. 2 Notify the primary health care provider. 3 Administer analgesics as prescribed before meals. Incorrect4 Provide saline gargles to moisten the mucous membranes.

Which symptoms would be seen in a client with type 1 diabetes who is experiencing hypoglycemia? Select all that apply. One, some, or all responses may be correct.

Vomiting 2 Headache 3 Tachycardia 4 Cool, clammy skin 5 Increased respirations

Which laboratory value supports the presence of diabetic ketoacidosis in a client with type 1 diabetes?

Decreased serum glucose levels 2 Decreased serum calcium levels 3 Increased blood urea nitrogen levels 4 Increased serum bicarbonate levels

A client with type 1 diabetes has dry, hot, flushed skin; a fruity odor to the breath; and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing?

Ketoacidosis 2 Somogyi phenomenon 3 Hypoglycemic reaction 4 Hyperosmolar nonketotic coma

Which action would the nurse take postoperatively to position a client who had an open reduction and insertion of a prosthesis for a fracture of the femoral neck?

Maintain the affected and unaffected leg in abduction. Keep both legs in functional body alignment Intermittently place the client in the prone position. Prevent adduction and external rotation of the affected extremity.

Which instruction would the nurse include in a teaching plan for a client who is taking an oral hypoglycemic daily for type 2 diabetes and is concerned about the need for special care at home if they develop the flu?

Skip the oral hypoglycemic pill, drink plenty of fluids, and stay in bed. 2 Avoid food, drink clear liquids, take a daily temperature, and stay in bed. 3 Eat as much as possible, increase fluid intake, and call the office again the next day. 4 Take the oral hypoglycemic pill, drink warm fluids, and check blood sugar before meals and at bedtime.

Which is an appropriate teaching goal for a client who is newly diagnosed as having type 2 diabetes?

To perform foot care weekly 2 To administer insulin as prescribed 3 To test urine for both sugar and acetone 4 To identify symptoms of hypoglycemia or hyperglycemia