NMNC4310 Metabolism
The nurse is counseling a client with type 1 diabetes about choosing food items that are low in carbohydrate (CHO) content. Which food selection made by the client indicates effective teaching? 1 Skim milk 2 Apple juice 3 Nonfat yogurt 4 Fresh orange juice
1 RATIONALE: Skim milk contains about 12 g of CHO per cup. There are about 30 g CHO in 1 cup of apple juice. There are about 16 g CHO in 1 cup of nonfat yogurt. There are about 25 g CHO in 1 cup of orange juice.
A client with type 1 diabetes is placed on an insulin pump. Which is the priority short-term goal when teaching this client to control the diabetes? 1 "The client will adhere to the medical regimen." 2 "The client will remain normoglycemic for 3 weeks." 3 "The client will demonstrate correct use of the insulin pump." 4 "The client will list three self-care activities that are necessary to control the diabetes."
3 RATIONALE: Demonstrating the correct use of the administration equipment is a short-term, client-oriented goal that is necessary for the client to control the diabetes and is measurable when the client performs a return demonstration for the nurse. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable, but it is a long-term goal. Although listing three self-care activities that are necessary to control the diabetes is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge.
A client diagnosed with type 1 diabetes states, "I hate shots. Why can't I take the insulin in tablet form?" Which is the nurse's best response? 1 "Your diabetic condition is too serious for oral insulin." 2 "Insulin is poorly absorbed orally, so it is not available in a tablet." 3 "Insulin by mouth causes a high incidence of allergic and adverse reactions." 4 "Once your diabetes is controlled, your primary health care provider might consider oral insulin."
2 RATIONALE: The chemical structure of insulin is altered by gastric secretions, rendering it ineffective. There is no such thing as oral insulin; this comment about the seriousness of the diabetic condition may increase anxiety. There are no data to support the statement regarding allergic or adverse reactions, and insulin is given parenterally, not orally. Insulin is not absorbed but is destroyed by gastric secretions; there is no insulin that is effective if taken by mouth.
Which finding would the nurse expect in the urinalysis report of a client with diabetes insipidus? 1 pH of urine: 9 2 Specific gravity of urine: 0.4 3 Red blood cells (RBCs) in urine: 6 hpf 4 White blood cells (WBCs) in urine: 8 hpf
2 RATIONALE: The normal specific gravity of urine lies between 1.003 and 1.030. The specific gravity of urine of clients with diabetes insipidus is low due to the impaired functioning of antidiuretic hormone. The pH of normal urine ranges from 6.5 to 7.0. A pH higher than 8 indicates a urinary tract infection (UTI). Normal urine contains between 0 and 4 hpf of RBCs. A count greater than 4 hpf indicates tuberculosis, cystitis, neoplasm, and glomerulonephritis. In a normal urine sample, WBCs lie in the range of 0 to 5 hpf. Any increase in the number of WBCs indicates a urinary tract inflammation.
The nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. Which statement by the nurse correctly identifies when insulin needs decrease? 1 "Insulin needs often decrease when puberty is reached." 2 "When there is an infection is present, the body requires less insulin." 3 "Emotional stress can cause insulin needs to decrease." 4 "Increased muscle activity such as exercise, cause insulin needs to decrease."
4 RATIONALE: Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulin like effect. With increased growth and associated dietary intake, the need for insulin increases during puberty. An infectious process may require increased insulin. Emotional stress increases the need for insulin.
A health care team is caring for a client with diabetes insipidus. Which task is most suitable to be delegated to a licensed practical nurse (LPN) to provide effective client care? Select all that apply. One, some, or all responses may be correct. 1 Emptying the urinary drainage bag 2 Monitoring urine output 3 Assisting the client with eating 4 Administration of intravenous fluids 5 Administering oral rehydration medication
2,5 RATIONALE: The LPN scope of practice includes monitoring urine output. Administration of any type of oral medication can also be performed by the LPN. Activities related to a client's hygiene, such as emptying the drainage, are usually performed by unlicensed assistive personnel (UAP). Feeding the client is usually performed by a UAP. Administration of intravenous fluids is the responsibility of the registered nurse.
A client with a new diagnosis of type 1 diabetes is told that lifelong insulin will be needed. The client becomes agitated and says, "I am scared of shots. If that is my only option, I'll just have to go into a coma and die!" How will the nurse respond? 1 "Injections are not the only option available for insulin." 2 "It won't be so bad; you will get used to it if you will only try." 3 "This is one of those times when you need to act like an adult." 4 "Clients have the right to refuse treatment, but I need you to sign this form that removes us from liability for your decision."
1 RATIONALE: An insulin nasal spray was approved by the Food and Drug Administration (FDA) in 2014 and is available for clients who do not want insulin injections. The nurse should use therapeutic communication in interacting with clients. Intimidating the client by suggesting that actions are childlike and suggesting that the client's concerns are not significant are not therapeutic responses. The nurse's primary concern should be for the client's well-being, not protection from liability.
A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1 "I will take the medication with food." 2 "I must swallow my medication whole and not crush or chew it." 3 "I will notify my doctor if I develop muscular or abdominal discomfort." 4 "I will stop taking metformin for 24 hours before and after having a test involving dye."
4 RATIONALE: Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.
A client is newly diagnosed with diabetes. The nurse would instruct the client to monitor for which indication of hypoglycemia? 1 Kussmaul respirations 2 Bradycardia 3 Confusion 4 Anorexia
3 RATIONALE: The most common symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Kussmaul respirations are associated with hyperglycemia or ketoacidosis. Tachycardia, not bradycardia, is associated with hypoglycemia. Anorexia is associated with hyperglycemia.
A client experiences ineffective control of type 1 diabetes. The client's study results indicate that a sudden decrease in blood glucose level is followed by rebound hyperglycemia. When this event occurs, which action would the nurse take? 1 Give the client 8 oz (240 mL) of orange juice. 2 Seek a prescription to increase the insulin dose at bedtime. 3 Encourage the client to eat smaller, more frequent meals. 4 Collaborate with the primary healthcare provider to alter the insulin prescription.
4 RATIONALE: The client is experiencing the Somogyi effect. It is a paradoxical situation in which sudden decreases in blood glucose are followed by rebound hyperglycemia. The body responds to the hypoglycemia by secreting glucagon, epinephrine, growth hormone, and cortisol to counteract the low blood sugar; this results in an excessive increase in the blood glucose level. It most often occurs in response to hypoglycemia when asleep. The primary health care provider may choose to decrease the insulin dose and then reassess the client. Giving the client 8 oz (240 mL) of orange juice will further increase the serum glucose level and is contraindicated. Increasing the insulin dose at bedtime will further worsen the problem. Encouraging the client to eat smaller, more frequent meals will not address the hypoglycemia and rebound hyperglycemia that occurs when sleeping. However, a bedtime snack may help minimize this event.
