M. Surgical (Sounder) Diabetes

The nurse is monitoring the results of periodic serum laboratory studies drawn on a client with diabetic ketoacidosis (DKA) receiving an insulin infusion. The nurse determines that which value needs to be reported? 1.Potassium 3.1 mEq/L 2.Calcium 9.2 mg/dL 3.Sodium 137 mEq/L 4.Serum osmolality 288 mOsm/kg H2O

1.Potassium 3.1 mEq/L

A client is brought to the emergency department with suspected diabetic ketoacidosis (DKA). Which finding should the nurse note as being consistent with this diagnosis? 1.High serum glucose level and an increase in pH 2.Decreased urine output and Kussmaul's respirations 3.Low serum potassium and high serum bicarbonate level 4.High serum glucose level and low serum bicarbonate level

4.High serum glucose level and low serum bicarbonate level

A client with type 2 diabetes mellitus has a blood glucose of more than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the primary health care provider's documentation and would expect to note which diagnosis? 1.Hypoglycemia 2.Pheochromocytoma 3.Diabetic ketoacidosis (DKA) 4.Hyperglycemic hyperosmolar state (HHS)

4.Hyperglycemic hyperosmolar state (HHS)

A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the nurse that after giving the injection, the insulin seems to leak through the skin. The nurse can appropriately determine the problem by asking the client which? 1."Are you rotating the injection site?" 2."Are you aspirating before you inject the insulin?" 3."Are you using a 1-inch needle to give the injection?" 4."Are you placing an air bubble in the syringe before injection?"

1."Are you rotating the injection site?"

The nurse is assisting in preparing a care plan for a client with diabetes mellitus who has hyperglycemia. The nurse should focus on which potential problem for this client? 1.Dehydration 2.Lack of knowledge about nutrition 3.Inability of family to cope with the client's diagnosis 4.The need for knowledge about the causes of hyperglycemia

1.Dehydration

The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement made by the client indicates the need for further teaching? 1."I'll eat a balanced meal plan." 2."I need to drink diet soft drinks." 3."I need to buy special dietetic foods." 4."I will snack on fruit instead of cake."

3."I need to buy special dietetic foods."

The nurse in an outpatient diabetes clinic is assisting in caring for a client on insulin pump therapy. Which statement by the client indicates a need for further teaching regarding insulin pump therapy? 1."I'll need to check my blood sugars before meals in case I need a premeal insulin bolus." 2."If my blood sugars are elevated, I can bolus myself with additional insulin as prescribed." 3."Now that I have this pump, I don't have to worry about insulin reactions or ketoacidosis occurring again." 4."I still need to follow an appropriate diet and exercise plan even though I don't have to inject myself daily anymore."

3."Now that I have this pump, I don't have to worry about insulin reactions or ketoacidosis occurring again.

The nurse has reinforced instructions about measuring blood glucose levels to a client newly diagnosed with diabetes mellitus. The nurse determines that the client understands the procedure when making which most accurate statement? 1."I should check my blood glucose level once a day." 2."I should check my blood glucose level 2 hours after each meal." 3."I should check my blood glucose level before eating a big meal." 4."I should check my blood glucose level before eating each meal regardless of how much I eat."

4."I should check my blood glucose level before eating each meal regardless of how much I eat."

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise? 1."I should not exercise after lunch." 2."I should not exercise after breakfast." 3."I should not exercise in the late evening." 4."I should not exercise in the late afternoon."

4."I should not exercise in the late afternoon."

The nurse is caring for a child with a diagnosis of diabetes insipidus. The nurse anticipates that the primary health care provider will prescribe which medications? 1.Methimazole 2.Furosemide 3.Propylthiouracil 4.Desmopressin acetate

4.Desmopressin acetate

The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information should the nurse obtain from the client during data collection? 1.Plan for injection rotation 2.Consistency of aspiration 3.Preparation of the injection site 4.Angle at which the medication is administered

1.Plan for injection rotation

The nurse has collected data on a client with diabetes mellitus. Findings include a fasting blood glucose of 130 mg/dL, temperature 101° F, pulse of 88 beats per minute, respirations of 22 breaths per minute, and a blood pressure of 118/78 mm Hg. Which finding would be of concern to the nurse? 1.Temperature 2.Blood glucose 3.Blood pressure 4.Pulse and respirations

1.Temperature

Which client complaint should alert the nurse to a possible hypoglycemic reaction? 1.Tremors and double vision 2.Anorexia and blurred vision 3.Hot, dry skin and weakness 4.Muscle cramps and elevated temperature

1.Tremors and double vision

The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The client's skin is warm and flushed, and the pulse and respiratory rate are elevated from the client's baseline. Which action should the nurse implement? 1.Give the client a glass of orange juice. 2.Check the client's capillary blood glucose. 3.Prepare for the administration of an insulin drip. 4.Prepare for the administration of a bolus dose of 50% dextrose. Terms

2.Check the client's capillary blood glucose.

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which signs/symptoms are indicative of this disorder? 1.Blurred vision and hot, dry skin 2.Excessive thirst and urine output 3.Diarrhea and decreased urine output 4.Weight gain and increased urine specific gravity

2.Excessive thirst and urine output

A client recently diagnosed with diabetes mellitus requiring insulin tells the clinic nurse that he is traveling by air throughout the next week. The client asks the nurse for any suggestions about managing the disorder while traveling. Which action should the nurse tell the client to do? 1.Check the blood glucose every 2 hours during the flight. 2.Obtain referrals to primary health care providers in the destination cities. 3.Keep snacks in carry-on luggage to prevent hypoglycemia during the flight. 4.Pad the insulin and syringes against breakage and place in a suitcase to be stowed.

3.Keep snacks in carry-on luggage to prevent hypoglycemia during the flight.

The nurse is reinforcing instructions to a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) regarding measures to prevent a recurrence. Which instruction is important for the nurse to emphasize? 1.Eat six small meals daily. 2.Test the urine ketone level. 3.Monitor blood glucose level frequently. 4.Receive appropriate follow-up health care.

3.Monitorblood glucose level frequently

The nurse is caring for a client with type 1 diabetes mellitus who is hyperglycemic. Which problem should the nurse consider first when planning care for this client? 1.Insomnia 2.Lack of appetite 3.Signs of dehydration 4.The need for knowledge about the diagnosis

3.Signs of dehydration

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse who is assisting with care for the client obtains which item in preparation for the treatment of this syndrome 1.NPH insulin 2.A nasal cannula 3.IV infusion of sodium bicarbonate

4.Intravenous (IV) infusion of normal saline

A client newly diagnosed with diabetes mellitus is having difficulty learning the technique of blood glucose measurement. The nurse should teach the client to do which action to perform the procedure properly? 1.Wash the hands first using cold water. 2.Puncture the center of the finger pad. 3.Puncture the finger as deeply as possible. 4.Let the arm hang dependently and milk the digit.

4.Let the arm hang dependently and milk the digit.

A client newly diagnosed with diabetes mellitus takes NPH insulin every day at 7:00 am. The nurse has taught the client how to recognize the signs of hypoglycemia. The nurse determines that the client understands the information presented if the client watches for which signs and symptoms in the late afternoon? 1.Nausea and vomiting, and abdominal pain 2.Hunger; shakiness; and cool, clammy skin 3.Drowsiness; red, dry skin; and fruity breath odor 4.Increased urination; thirst; and rapid, deep breathing

Hunger; shakiness; and cool, clammy skin

The nurse is assigned to care for a client at home who has a diagnosis of type 1 diabetes mellitus. When the nurse arrives to care for the client, the client tells the nurse that she has been vomiting and has diarrhea. Which additional statement by the client indicates a need for further teaching? 1."I need to stop my insulin." 2."I need to increase my fluid intake." 3."I need to call my primary health care provider." 4."I need to monitor my blood glucose every 4 to 6 hours.

1."I need to stop my insulin."

The nurse has reinforced home care measures to a client diagnosed with diabetes mellitus regarding exercise and insulin administration. Which statement by the client indicates a need for further teaching? 1."I should perform my exercise at peak insulin time." 2."I should always carry a quick-acting carbohydrate when I exercise." 3."I should always wear a Medic-Alert bracelet, especially when I exercise." 4."I should avoid exercising at times when a hypoglycemic reaction is likely to occur."

1."I should perform my exercise at peak insulin time."

A client with diabetes mellitus decides to exercise an extra 30 minutes. The client is now experiencing hypoglycemia. Hypoglycemia is supported by which noted data? Select all that apply. 1.Hunger 2.Shakiness 3.Cool, clammy skin 4.Fruity breath odor 5.Rapid, deep breathing

1.Hunger 2.Shakiness 3.Cool, clammy skin

The nurse is reinforcing instructions to a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse should teach the client that which result is a sign of hypoglycemia? 1.Less than 50 mg/dL 2.Less than 90 mg/dL 3.Less than 100 mg/dL 4.Less than 120 mg/dL

1.Less than 50 mg/dL

A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client states to the nurse, "I will call the doctor next time I can't eat for more than a day or so." The nurse plans care understanding that which statement accurately reflects this client's level of knowledge? 1.The client needs immediate education before discharge. 2.The client requires follow-up teaching regarding the administration of insulin. 3.The client's statement is accurate, but knowledge should be evaluated further. 4.The client's statement is inaccurate, and the client should be scheduled for outpatient diabetic counseling.

1.The client needs immediate education before discharge.

A client with diabetes mellitus is scheduled to have a fasting blood glucose level determined in the morning. The nurse tells the client not to eat or drink after midnight. When the client asks for further information, the nurse clarifies by stating that which should be acceptable to take before the test? 1.Water 2.Tea without any sugar 3.Coffee without any milk 4.Clear liquids such as apple juice

1.Water

The nurse has provided diabetic teaching with the family of a client newly diagnosed with diabetes. The nurse determines that the family understands the reason for having glucagon on hand for emergency home use if the family indicates that the purpose of the medication is to treat which condition? 1.Diabetic ketoacidosis 2.Hypoglycemia from insulin overdose 3.Hyperglycemia from insufficient insulin 4.Hyperglycemia occurring on "sick days"

2.Hypoglycemia from insulin overdose

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific signs of this complication should be included on the list? 1.Shakiness 2.Increased thirst 3.Profuse sweating 4.Decreased urine output

2.Increased thirst

The nurse is caring for a client newly diagnosed with diabetes mellitus. The client asks the nurse whether eating at a restaurant will affect the diabetic control and whether this is allowed. Which nursing response is appropriate? 1."You really should not eat in restaurants." 2."If you plan to eat in a restaurant, you need to avoid carbohydrates." 3."You should order a half-portion meal and have fresh fruit for dessert." 4."You should increase your daily dose of insulin by half on the day you plan to eat out."

3."You should order a half-portion meal and have fresh fruit for dessert."

The nurse is collecting data from a client with type 2 diabetes mellitus. Which statement by the client indicates an understanding of the medication regimen? 1."By taking these medications, I am able to eat more." 2."When I become ill, I need to increase the number of pills I take." 3."I should take my metformin only if my blood glucose is elevated." 4."The medication that I am taking helps release the insulin I already make."

4."The medication that I am taking helps release the insulin I already make."

A hospitalized client is newly diagnosed with diabetes mellitus. The client must take both NPH and regular insulin for glucose control. The nurse develops a teaching plan to help the client meet which outcome as a first step in managing the disease? 1.Avoid all strenuous exercise. 2.Maintain health at an optimum level. 3.Lose 40 pounds to achieve ideal body weight. 4.Adjust insulin according to capillary blood glucose levels.

4.Adjust insulin according to capillary blood glucose levels.

A client with type 1 diabetes mellitus takes NPH insulin every morning and checks the blood glucose level four times per day. The client tells the nurse that yesterday the late afternoon blood glucose was 60 mg/dL and that she "felt funny." Which statement by the client indicates an understanding of this occurrence? 1."I forgot to take my usual mid-afternoon snack yesterday." 2."I took less insulin this morning so I won't feel funny today." 3."My blood glucose levels are running low because I'm tired." 4."I don't know why I have to check my blood glucose four times a day. That seems too much."

1."I forgot to take my usual mid-afternoon snack yesterday."

A comatose client with an admitting diagnosis of diabetic ketoacidosis (DKA) has a blood glucose value of 368 mg/dL, arterial pH of 7.2, arterial bicarbonate of 14 mEq/L, and is positive for serum ketones. The diagnosis is supported by which noted data? Select all that apply. 1.Shakiness 2.Hypertension 3.Fruity breath odor 4.Rapid, deep breathing 5.Dry mucous membranes

3.Fruity breath odor 4.Rapid, deep breathing 5.Dry mucous membranes

The nurse is assigned to assist in caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). Which is the priority nursing action for this client who is in the acute phase? 1.Correct the acidosis. 2.Administer IV 5% dextrose. 3.Administer intravenous (IV) regular insulin. 4.Apply an electrocardiogram (ECG) monitor.

3.Administer intravenous (IV) regular insulin.

The nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care? 1.Soak the feet in hot water. 2.Avoid using soap to wash the feet. 3.Apply a moisturizing lotion to dry feet, but not between the toes. 4.Always have a podiatrist cut your toenails; never cut them yourself.

3.Apply a moisturizing lotion to dry feet, but not between the toes.

The wife of a client with diabetes mellitus who takes insulin calls the nurse in a primary health care provider's office about her husband. She states that her husband is sleepy and that his skin is warm and flushed. She adds that his breathing is faster than normal and his pulse rate seems fast. Which action should the nurse tell the wife to do first? 1.Call an ambulance. 2.Take his temperature. 3.Check his blood glucose level. 4.Drive him to the primary health care provider's office.

3.Check his blood glucose level.

The nurse is assisting in preparing a plan of care for the client with diabetes mellitus and plans to reinforce the client's understanding regarding the signs/symptoms of hypoglycemia. Which signs/symptoms should the nurse review? 1.Slow pulse; lethargy; and warm, dry skin 2.Elevated pulse; lethargy; and warm, dry skin 3.Elevated pulse; shakiness; and cool, clammy skin 4.Slow pulse, confusion, and increased urine output

3.Elevated pulse; shakiness; and cool, clammy skin

A client with diabetes mellitus visits the health care clinic. The client previously had been well controlled with glyburide, but recently the fasting blood glucose has been running 180 to 200 mg/dL. Which medication, if added to the client's regimen, may be contributing to the hyperglycemia? 1.Atenolol 2.Allopurinol 3.Prednisone 4.Phenelzine

3.Prednisone

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is reinforcing instructions to the client regarding the program. Which instruction should the nurse include? 1.Try to exercise before mealtime. 2.Administer insulin after exercising. 3.Take a blood glucose test before exercising. 4.Exercise should be performed during peak times of insulin.

3.Take a blood glucose test before exercising.

Glucagon hydrochloride injection would most likely be prescribed for which disorder? 1.Thyroid crisis 2.Hypoadrenalism 3.Type 1 diabetes mellitus 4.Excess growth hormone secretion

3.Type 1 diabetes mellitus

When the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective? 1."I will stop taking my insulin if I'm too sick to eat." 2."I will decrease my insulin dose during times of illness." 3."I will adjust my insulin dose according to the level of glucose in my urine." 4."I will notify my primary health care provider if my blood glucose level is consistently greater than 250."

4."I will notify my primary health care provider if my blood glucose level is consistently greater than 250."

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which finding should the nurse expect to note as confirming this diagnosis? 1.Coma 2.Decreased urine output 3.Increased respirations and an increase in pH 4.Elevated blood glucose and low plasma bicarbonate

4.Elevated blood glucose and low plasma bicarbonate

A client who is managing diabetes mellitus with insulin injections asks the nurse for information about any necessary changes in her diet to avoid hyperinsulinism. Which diet would be appropriate for the client? 1.Low-fiber, high-fat diet 2.Limit carbohydrate intake to three meals per day 3.Large amounts of carbohydrates between low-protein meals 4.Small frequent meals with protein, fat, and carbohydrates at each meal

4.Small frequent meals with protein, fat, and carbohydrates at each meal

The nurse is reinforcing dietary instructions to a client newly diagnosed with diabetes mellitus. The nurse accurately instructs the client with which statement? 1.It is best to eat meals at approximately the same time each day. 2.It is best to adjust mealtimes depending on blood glucose levels. 3.It is best to vary mealtimes if insulin is not administered at the same time every day. 4.It is best to avoid being concerned about the time of meals as long as snacks are taken on time.

1.It is best to eat meals at approximately the same time each day.

The nurse is reinforcing instructions to a client newly diagnosed with diabetes mellitus regarding insulin administration. The primary health care provider has prescribed a mixture of NPH and regular insulin. The nurse should stress that which is the first step? 1.Draw up the correct dosage of NPH insulin into the syringe. 2.Draw up the correct dosage of regular insulin into the syringe. 3.Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. 4.Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin.

3.Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin.

The nurse is caring for a client newly diagnosed with type 1 diabetes mellitus. In reviewing the medical record the nurse should note which signs and symptoms? Select all that apply. 1.Oliguria 2.Polyphagia 3.Poor healing 4.Blurred vision 5.Extreme thirst 6.Rapid weight loss

2.Polyphagia 5.Extreme thirst 6.Rapid weight loss

The nurse is collecting data on a client with hyperparathyroidism. Which question would elicit accurate information about this condition from the client? 1."Do you have tremors in your hands?" 2."Are you experiencing pain in your joints?" 3."Have you had problems with diarrhea lately?" 4."Do you notice swelling in your legs at night?"

2.Regular insulin

The nurse reinforces teaching to a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops? 1.Polyuria 2.Shakiness 3.Blurred vision 4.Fruity breath odor

2.Shakiness

The nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. Which statement made by the client would indicate hyperglycemia and thus warrant primary health care provider (PHCP) notification? 1."I am urinating a lot." 2."My pulse is really slow." 3."I am sweating for no reason." 4."My blood pressure is really high."

1."I am urinating a lot."

The nurse is collecting data from a client newly diagnosed with diabetes mellitus regarding the client's learning readiness. Which client behavior indicates to the nurse that the client is not ready to learn? 1.The client asks if the spouse can attend the classes also. 2.The client asks appropriate questions about what will be taught. 3.The client asks for written materials about diabetes before class. 4.The client complains of fatigue whenever the nurse plans a teaching session.

4.The client complains of fatigue whenever the nurse plans a teaching session.

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. Which intervention would be appropriate to decrease the client's anxiety? 1.Administer a sedative. 2.Convey empathy, trust, and respect toward the client. 3.Ignore the signs and symptoms of anxiety so that they will soon disappear. 4.Make sure the client knows all the correct medical terms so that he or she can understand what is happening.

2.Convey empathy, trust, and respect toward the client.

A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge? 1.Keep insulin vials refrigerated at all times. 2.Rotate the insulin injection sites systematically. 3.Increase the amount of insulin before unusual exercise. 4.Monitor the urine acetone level to determine the insulin dosage.

2.Rotate the insulin injection sites systematically.

The primary health care provider (PHCP) prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which is the most appropriate intervention? 1.The medication is administered within 60 minutes before the morning and evening meal. 2.The medication is withheld and the PHCP is called to question the prescription for the client. 3.The client is monitored for gastrointestinal (GI) side effects after administration of the medication. 4.The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.

2.The medication is withheld and the PHCP is called to question the prescription for the client.

The nurse is planning to instruct a client with diabetes mellitus who has hypertension about "sick day management." Which beverage does the nurse avoid putting on a list of easily consumed carbohydrate-containing beverages for use when the client cannot tolerate food orally? 1.Cola 2.Ginger ale 3Apple juice 4.Mineral water

4.Mineral water

The nurse reviews the nursing care plan of an older client with diabetic neuropathy of the lower extremities as a result of type 2 diabetes mellitus. The nurse plans care knowing that which problem has the highest priority for this client? 1.Pain as a result of intermittent claudication 2.Lack of self-esteem as a result of perceived loss of abilities 3.Lack of self-confidence as a result of impaired ability to walk 4.The possibility of injury as a result of decreased sensation in the legs and feet

4.The possibility of injury as a result of decreased sensation in the legs and feet

The nurse is reviewing the prescriptions of a client diagnosed with diabetes mellitus who was admitted because of an infected foot ulcer. Which primary health care provider's prescription supports the treatment of this condition? 1.A decreased-calorie diet 2.An increased-calorie diet 3.A decreased amount of NPH daily insulin 4.An increased amount of NPH daily insulin

4.An increased amount of NPH daily insulin

The nurse participating in a free health screening at the local mall obtains a random blood glucose level of 200 mg/dL on an otherwise healthy client. The nurse tells the client to do which as a next step? 1.Seek treatment for diabetes mellitus. 2.Ask the pharmacist about starting insulin therapy. 3.Begin blood glucose monitoring three times a day. 4.Call the primary health care provider to have the value rechecked as soon as possible.

4.Call the primary health care provider to have the value rechecked as soon as possible.