Diabetes Review
When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:
"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."
A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder?
"I'm thirsty all the time. I just can't get enough to drink."
A client with diabetes begins to cry and says, "I just cannot stand the thought of having to give myself a shot every day." What would be the best response by the nurse?
"What is it about giving yourself the insulin shots that bothers you?"
A nurse is caring for a client with diabetes mellitus. The client has a blood glucose level of 40 mg/dL. Which of the following rapidly absorbed carbohydrate would be most effective?
1/2 cup fruit juice or regular soft drink
The nurse is administering lispro (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast?
10 to 15 minutes
Once digested, what percentage of carbohydrates is converted to glucose?
100
A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer:
15 to 20 g of a fast-acting carbohydrate such as orange juice.
The nurse is instructing the client on insulin administration. The client is performing a return demonstration for preparing the insulin. The client's morning dose of insulin is 10 units of regular and 22 units of NPH. The nurse checks the dose accuracy with the client. The nurse determines that the client has prepared the correct dose when the syringe reads how many units? Record your answer using a whole number.
32
How long after administration of NPH insulin does it peak?
4-12 hours
What percent of calories of carbs does ADA recommend in a daily diet
50-60%
The nurse is teaching the client about home blood glucose monitoring. Which blood glucose measurement indicates hypoglycemia?
59 mg/dL (3.3 mmol/L)
A 14-year-old adolescent with type 1 diabetes checks his blood glucose level at 9:00 p.m. (2100) before going to bed. It has been 4 hours since his dinner and his regular insulin dose. His blood glucose level is 60 mg/dl (3.3 mmol/L), and he states that he feels a little shaky. What should the nurse suggest?
A bedtime snack of an 8-oz (240 mL) glass of milk and graham crackers with peanut butter
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl (2.2 mmol/L). His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?
Administering 1 ampule of 50% dextrose solution, per physician's order
Which of the following clinical manifestations of type 2 diabetes occurs if glucose levels are very high?
Blurred vision
Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])?
Can control blood glucose through diet and exercise
A patient with type 1 diabetes complains about waking up in the middle of the night nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood sugar readings have been 110 to 140 mg/dL; the patient admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse will plan to instruct the patient to do which of the following?
Check blood glucose at 3:00 in the morning.
Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin?
Do not mix with other insulins.
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.
Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes
If a patient with low blood sugar becomes unconscious what should be administered
IV 50% dextrose
A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. Which of the following symptoms would she include when reviewing classic symptoms associated with diabetes?
Increased thirst, increased hunger, and increased urination
A patient is admitted with diabetic ketoacidosis (DKA). The physician writes all of the following orders. Which order should the nurse implement first?
Infuse 0.9% normal saline solution 1 L/hr for 2 hours.
NPH is an example of which type of insulin?
Intermediate-acting
What important considerations would the nurse make when teaching and caring for a newly diagnosed client with diabetes mellitus?
Involving the client in the development of the teaching plan and encouraging questions and active participation
A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition?
Ketoacidosis
A nurse is teaching a patient recovering from diabetic ketoacidosis (DKA) about management of "sick days." The patient asks the nurse why it is important to monitor the urine for ketones. Which of the following statements is the nurse's best response?
Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy.
What is the only insulin that can be given intravenously?
Regular
Which of the following is included as a dietary guideline for a patient who has had bariatric surgery?
Restrict total meal size to less than 1 cup.
After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent arrhythmias?
Serum potassium level
Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus?
The patient has not consumed food and continues to take insulin or oral antidiabetic medications
Which of the following factors is the focus of nutrition intervention for clients with type 2 diabetes?
Weight loss
Which of the following factors is the focus of nutrition intervention for patients with type 2 diabetes?
Weight loss
When teaching the diabetic client about foot care, the nurse should instruct the client to:
avoid going barefoot.
A client with diabetes mellitus asks the nurse to recommend something to remove corns from his toes. The nurse should advise the client to:
consult a health care provider (HCP) about removing the corns
Assessment of the diabetic client for common complications should include examination of the:
eyes
What criteria may indicate a patient has diabetes based on lab work
fasting plasma glucose of 126 or higher on two separate occasions
In order to avoid complications of macro and micro pts should do what- control blood glucose
hyperglycemia
A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to:
increase the frequency of self-monitoring (blood glucose testing).
Inhibit production of glucose by the liber- biganide
metformin
Patient is shaking and weak with low sugar, give orange juice for hyperglycemia, half hour later symptoms have not subsided, what do you do
repeat the treatment
An adolescent with type 1 diabetes is monitoring her blood glucose level at home. Which action indicates that the client understands appropriate care management strategies for a blood glucose level of 250 mg/dL (13.9 mmol/L)? The client will:
take insulin
In order to decrease skin irritation when giving insulin what should they do?
warm it to room temperature
A nurse working in a community clinic is discussing lifestyle modifications with a client. The client has been advised to lose weight because of a BMI greater than 25. Which of the following statements by the nurse would be most therapeutic in helping the client?
"I can offer you some information outlining a variety of ways to lose weight."
Which statement indicates that a client with diabetes mellitus understands proper foot care?
"I'll wear cotton socks with well-fitting shoes."
The laboratory comes to draw an Hgb AIc. The client asks the nurse what this test represents. Which statement would be correct?
"This test reflects the average blood glucose over a period of approximately 2-3 months."
A client newly diagnosed with type 1 diabetes asks the nurse, "Why do I have to take two shots of insulin? One shot is not enough?" The nurse should tell the client:
"Two shots will give you better control and decrease complications."
During a follow-up visit 3 months following a new diagnosis of type 2 diabetes, a patient reports exercising and following a reduced-calorie diet. Assessment reveals that the patient has only lost 1 pound and did not bring the glucose-monitoring record. Which of the following tests will the nurse plan to obtain?
Glycosylated hemoglobin level
To confirm an acid-base imbalance, it is necessary to assess which findings from the results of a client's arterial blood gas (ABG) results? Select all that apply.
HCO3 PaCO2 pH
Which of the following is the most rapid acting insulin?
Humalog
A patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient?
Hypoglycemia
The nurse has been assigned to a client who has had diabetes for 10 years. The nurse gives the client's usual dose of regular insulin at 7 a.m. At 10:30 a.m., the client has light-headedness and sweating. The nurse should contact the physician, report the situation, background, and assessment, and recommend intervention for:
Hypoglycemia
Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine?
Ketones
When teaching newly diagnosed diabetic about survival skills what is the most important to teach
Signs and symptoms of hypoglycemia and hyperglycemia
A client with diabetes mellitus is receiving an oral antidiabetic agent. Which of the following aspects should the nurse observe when caring for this client?
Signs of hypoglycemia
One reason a patient who usually has well controlled blood sugar may experience hyperglycemia after surgery
Stress on the body can cause hyperglycemia
Which of the following categories of oral antidiabetic agents exert their primary action by directly stimulating the pancreas to secrete insulin?
Sulfonylureas
A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes?
To maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications"
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?
To restore liver glycogen and prevent secondary hypoglycemia
The nurse is teaching a patient about self-administration of insulin and mixing of regular and neutral protamine Hagedorn (NPH) insulin. Which of the following is important to include in the teaching plan?
When mixing insulin, the regular insulin is drawn up into the syringe first.
The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can:
perform the procedure safely and correctly.
An 8-year-old with diabetes is placed on an intermediate acting insulin and regular insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime. The snack will:
prevent late night hypoglycemia.