Diabetes Mellitus

A nurse is preparing a teaching session about reducing the risk of complications of diabetes mellitus. Which of the following information should the nurse plan to include in the teaching? (Select all that apply.) A. Reduce cholesterol and saturated fat intake. B. Increase physical activity and daily exercise. C. Enroll in a smoking-cessation program. D. Sustain hyperglycemia to reduce deterioration of nerve cells. E. Maintain optimal blood pressure to prevent kidney damage.

A. Reduce cholesterol and saturated fat intake. B. Increase physical activity and daily exercise. C. Enroll in a smoking-cessation program. E. Maintain optimal blood pressure to prevent kidney damage. Hyperglycemia leads to neuropathy through blood vessels changes that cause nerve hypoxia.

A nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching? A. "Test your blood glucose levels every 8 hours." B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." C. "Withhold your usual daily dose of insulin." D. "Drink 240 to 360 milliliters of calorie-free liquids every 8 hours."

B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." This indicates DKA, pt should contact provider if he has moderate/large amounts of ketones in his urine. Pt should check BG level at least every 4-6 hr when he is also experiencing anorexia, nausea, and vomiting. During illness pt is at risk for hyperglycemia, so pt should take usual dose of insulin to keep BG levels w/in expected reference range. To prevent dehydration pt should drink 240-360 mL (8-12 oz) of calorie-free liquids every hour, if BG level is low he should drink fluids containing sugar.

A nurse is teaching a client who has diabetes mellitus and a new prescription for prednisone for a rash. Which of the following statements by the client indicates the need for further teaching? A. "I might need to decrease my regular insulin during this time." B. "I will gradually stop the prednisone when my rash goes away." C. "I might feel a little emotional when I am on this medicine." D. "I might have a hard time falling asleep while taking prednisone."

B. "I will gradually stop the prednisone when my rash goes away." The pt should discontinue glucocorticoids gradually to reduce risk for adrenal insufficiency. Manifestations of adrenal insufficiency include nausea, vomiting, confusion, & hypotension. Glucocorticoids can cause hyperglycemia, pts might req. reduced calories and increased hypoglycemic meds, mood changes, irritability, and insomnia are adverse rxns, pt should report severe psychological disturbances, like hallucinations or depression.

A client who has type 2 diabetes mellitus asks the nurse, "Why did I develop diabetes?" Which of the following responses should the nurse make? A. "Your body is destroying the cells that secrete insulin." B. "Your body has insulin resistance and decreased insulin secretion." C. "An infection in your pancreas destroyed the cells that make insulin." D. "Your kidneys are not able to reabsorb water which leads to type 2 diabetes mellitus."

B. "Your body has insulin resistance and decreased insulin secretion."

A nurse is caring for a client who has type I diabetes mellitus and is not following the guidelines for therapy. Which of the following should the nurse consider as contributing factors to the client's nonadherence? (Select all that apply.) A. Gender B. Culture C. Literacy D. Dexterity E. Motivation

B. Culture C. Literacy D. Dexterity E. Motivation Gender does not contribute to nonadherence. Culture (sociocultural background, beliefs, practices, values, and traditions). Literacy (ability to read and correctly administer med) and dexterity (physical ability to use equipment needed) affect adherence. Motivation to follow Tx plan and pt perception of seriousness of illness affect adherence.

A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication? A. Grapefruit juice B. Milk C. Alcohol D. Coffee

C. Alcohol The nurse should teach the pt to avoid alcohol while taking this med to prevent disulfiram reaction, such as nausea, headache, and hypoglycemia. Grapefruit juice can cause atorvastatin toxicity if used while taking atorvastatin. Milk, coffee, and caffeine do not interact with chlorpropamide.

A nurse is developing a teaching a plan for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Establish short-term, realistic goals for the client. B. Give the client access to a video about diabetes. C. Determine what the client who knows about managing diabetes. D. Evaluate the effectiveness of the client's admission teaching plan.

C. Determine what the client knows about managing diabetes. The first action a nurse should take using the nursing process is to assess/collect data from pt. Nurse should find out what the pt knows before proceeding w/ the plan. All the other choices are correct, but not the first action that needs to be taken.

A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus? A. HbA1c 5.5% B. 2 hr blood glucose 170 mg/dL C. Fasting blood glucose 155 mg/dL D. Casual blood glucose 180 mg/dL

C. Fasting blood glucose 155 mg/dL DM diagnosis: fasting BG above 126 mg/dL, HbA1c > 6.5%, 2 hr BG (oral glucose tolerance test) > 200 mg/dL, casual BG > 200 mg/dL

A nurse is caring for a client who has type 1 diabetes mellitus. Which of the following recommendations should the nurse make to the client for a sweetener? A. Corn syrup B. Natural honey C. Nonnutritive sugar substitute D. Guava nectar

C. Nonnutritive sugar substitute Pts with DM 1 need to limit carbohydrate intake. Nonnutritive sugar substitutes allow pt to sweeten taste of foods w/out increasing carb intakes.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? A. Ranitidine B. Guafenesin C. Prednisone D. Atorvastatin

C. Prednisone Prednisone- glucose intolerance and hyperglycemia, pt might require increased dosage of hypoglycemic med. Ranitidine- serum creatinine levels Guafenesin- drowsiness and dizziness Atorvastatin- thyroid fxn tests

A nurse is caring for a 7-year-old child who has an upper respiratory infection and type 1 diabetes mellitus. Which of the following statements by the mother indicates a need for further instruction? A. "I will encourage her to drink half a cup of water or sugar-free fluids every 30 minutes." B. "I will report a change in her breathing or any signs of confusion." C. "I will notify the doctor if her temperature is not controlled with acetaminophen." D. "I will continue to check his blood sugar two times every day."

D. "I will continue to check his blood sugar two times every day." Pt with type 1 DM and is ill is at risk of DKA (breakdown of body fat for energy and ketones in blood and urine). Acute illness increase glucose levels, so glucose levels and urine ketones should be checked every 3 hr. BID is not enough.

A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? A. Assess for hypoglycemia 4 hr after the insulin injection. B. Inject the insulin 15 min before a meal. C. Monitor for polyuria. D. Administer with short-acting insulin.

B. Inject the insulin 15 min before a meal. The nurse should administer lispro insulin 15 min before a meal, bc lispro insulin is rapid-acting insulin that has an onset w/in 15-30 min. Pt may develop hypoglycemia quickly if they don't eat. Nurse should assess for hypoglycemia for 1-3 hr (when lispro peaks). Polyuria = hyperglycemia. The nurse may administer by mixing lispro insulin (longer-acting) in the same syringe.

A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect? A. Hypertension B. Hematuria C. Weight loss D. Bradycardia

C. Weight loss Hypotension, weight loss, and tachycardia are expected findings. Hematuria is not.

A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe? A. 14 units B. 28 units C. 32 units D. 42 units

D. 42 units Each order for units of insulin is combined in the same syringe. The nurse should withdraw the regular insulin into the syringe first.

A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia? A. Bradycardia B. Cool, clammy skin C. Vomiting D. Fruity odor on the client's breath

B. Cool, clammy skin Cool, clammy skin and tachycardia are manifestations of hypoglycemia. Nausea and vomiting and fruity odor on pt's breath = hyperglycemia.

A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? A. "I am to take my blood sugar reading after meals." B. "Insulin allows me to eat ice cream at bedtime." C. "A weight reduction program will make me hypoglycemic." D. "I give the insulin injections in my abdominal area."

D. "I give the insulin injections in my abdominal area." Pt should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching? A. " I will feel shaky." B. "I will be more thirsty than usual." C. "My skin will be warm and moist." D. "My appetite will be decreased."

A. "I will feel shaky." Hypoglycemia: shaky, nervous, cool, clammy skin. Hyperglycemia: increased thirst, dehydration, warm, moist skin, hunger, weakness.

A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. To focus on effective learning with this client, which of the following interventions should the nurse use? A. Ask the client to perform a return demonstration of insulin injection. B. Review the action of insulin therapy. C. Explore the client's feelings about dietary modifications. D. Have the client practice blood-glucose monitoring using a glucometer.

C. Explore the client's feelings about dietary modifications. The teaching intervention allows pt to express his acceptance of this change and focuses on affective learning.

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? A. "Have an eye examination once per year." B. "Examine your feet carefully every day." C. "Wear compression stockings daily." D. "Maintain stable blood glucose levels."

D. "Maintain stable blood glucose levels." Keeping blood glucose under control is pt's best protection against long-term complications of DM, increased BG contributes to neuropathic disease, & microvascular complications (like retinopathy & neuropathy), as well as to macrovascular complications. Annual eye exams & daily feet exams are important, but not preventative. Constant use of compression stockings can impair circulation and increase risk of complications. Pts with DM should NOT wear them routinely.