DM Ign ch67
Which finding in the client with diabetes indicates that exercise should be avoided at this time? a. Ketone bodies in the urine b. Blood sugar level of 155 mg/dL c. Pulse rate of 66 beats/min d. Weight 1 pound higher than the week before
The presence of ketone bodies in the urine is a contraindication to exercise because it indicates that the amount of insulin available is inadequate to promote intracellular glucose transport and uptake. Exercise would lead to further elevations in blood glucose levels.
In performing health screening in a local mall, the nurse determines that those with which risk factors are at risk for the development of type 2 diabetes? (Select all that apply.) a. Hypertension b. History of pancreatic trauma c. 30-pound weight gain during pregnancy d. Body mass index greater than 25 kg/m e. Triglyceride levels between 150 and 200 mg/dL f. Delivered baby weighing over 9 pounds
A, D, F Risk factors for type 2 diabetes include habitual inactivity, hypertension, delivery of a baby weighing over 9 pounds, history of vascular disease, body mass index greater than 25 kg/m, and triglyceride levels over 250 mg/dL.
The nurse assesses for which clinical manifestation in a client with uncontrolled diabetes mellitus and ketoacidosis?a. Increased rate and depth of respiration b. Extremity tremors followed by seizure activity c. Oral temperature of 102° F (38.9° C) d. Severe orthostatic hypotension
A. Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation.
A client with a 20-year history of diabetes mellitus and severe burning pain in the feet and hands as a result of peripheral neuropathy asks the nurse why an antidepressant has been prescribed. Which is the nurse's best response? a. "Many people experiencing chronic pain become depressed." b. "The antidepressants may counteract the chemicals causing your pain." c. "You are less likely to become addicted from using antidepressants than you are from using other types of pain killers." d. "The antidepressants also have strong anti-inflammatory properties and can reduce the pain you have from inflammation."
B Much of the pain and discomfort associated with peripheral neuropathy is caused by changes in neurotransmitter release at nerve synapses, especially serotonin. Small doses of antidepressants can inhibit serotonin uptake and provide some degree of analgesia.
The nurse administers 6 U of regular insulin and 10 U NPH insulin at 7 AM. At what time is the client most susceptible to hypoglycemia related to the NPH insulin? a. 8 AM b. 4 PM c. 8 PM d. 11 PM
B NPH is an intermediate acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours.
The nurse determines that which arterial blood gas values are consistent with ketoacidosis in the client with diabetes? a. pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg b. pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg c. pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg d. pH 7.28, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg
B. When the lungs can no longer offset the acidosis, the pH decreases below normal. The arterial blood gases show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels. pH PCO2 HCO3 Range: 7.35-7.45 35-45 mmHg 22-26 mEq/L
The nurse monitors for which clinical manifestations in the diabetic client admitted with DKA (diabetic ketoacidosis)? a. Shallow slow respirations and respiratory alkalosis b. Decreased urine output and hyperkalemia c. Tachycardia and orthostatic hypotension d. Peripheral edema and dependent pulmonary crackles
C DKA is the extreme consequence of severe insulin deficiency. Lack of insulin results in the release of free fatty acids, which leads to ketoacidosis. The lungs attempt to compensate for this acidosis by increasing the depth and rate of respirations. Increased urinary output (polyuria) is severe and may lead to tachycardia and orthostatic hypotension related to fluid volume deficit.
Three hours after surgery, the nurse notes that the breath of the client with type 1 diabetes has a "fruity" odor. Which is the nurse's best first action? a. Documenting the finding as the only action b. Increasing the IV fluid flow rate c. Testing the serum for ketone bodies d. Performing oral care
C. The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis.
The nurse teaches which intervention to prevent injury in the diabetic client who has numbness and reduced sensation secondary to severe peripheral neuropathy? a. "Examine your feet daily." b. "Rotate your insulin injection sites." c. "Wear white socks instead of colored socks." d. "Use a bath thermometer to test the water temperature."
D Clients with diminished sensory perception can easily experience a burn injury when bath water is too hot. Examining the feet daily does not prevent injury.
A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria? a. Serum sodium: 163 mEq/L b. Serum creatinine: 1.6 mg/dL c. Presence of urine ketone bodies d. Serum osmolarity: 375 mOsm/kg
D Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The client's serum osmolarity is high. The client's sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria Serum Osmolarity 275-295 mosm/kg
The nurse teaches the newly diagnosed client with type 1 diabetes that insulin needs can be decreased through which action? a. Reducing intake of water and other liquids to no more than 2 L/day b. Eating animal organ meats high in insulin c. Taking two 1-hour naps daily d. Walking 1 mile each day
D. Moderate exercise, such as walking, helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes.
Which priority intervention does the nurse take for the client having Kussmaul respirations as a result of diabetic ketoacidosis? a. Administration of oxygen by mask or nasal cannula b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin
D. The rapid, deep respiratory efforts of Kussmaul respiration is the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. The client who is in ketoacidosis and who does not also have a respiratory impairment does not need additional oxygen. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat.
