Prep U - Chapter 51: Assessment and Management of Patients with Diabetes

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? Nephropathy Sensory neuropathy Autonomic neuropathy Retinopathy

Sensory neuropathy

Which instruction about insulin administration should a nurse give to a client? "Store unopened vials of insulin in the freezer at temperatures well below freezing." "Shake the vials before withdrawing the insulin." "Always follow the same order when drawing the different insulins into the syringe." "Discard the intermediate-acting insulin if it appears cloudy."

"Always follow the same order when drawing the different insulins into the syringe."

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: 25 g of carbohydrates. 15 g of carbohydrates. 10 g of carbohydrates. 20 g of carbohydrates.

15 g of carbohydrates.

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? a. "I might need insulin later on but probably not as much or as often." b. "This transplant will provide me with a cure for my diabetes." c. "I will receive a whole organ with extra cells to produce insulin." d. "They'll need to create a connection from the pancreas to allow enzymes to drain."

"I might need insulin later on but probably not as much or as often."

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? Urine ketones Fasting blood glucose test 6-hour glucose tolerance test Serum glycosylated hemoglobin (Hb A1c)

Serum glycosylated hemoglobin (Hb A1c)

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? Polyuria, polydipsia, and polyphagia Sweating, tremors, and tachycardia Bradycardia, thirst, and anxiety Dry skin, bradycardia, and somnolence

Sweating, tremors, and tachycardia

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? a. The client continues medication therapy despite adequate food intake. b. The client has been exercising more than usual. c. The client has not consumed sufficient calories. d. The client has eaten and has not taken or received insulin.

The client has eaten and has not taken or received insulin.

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? a. Psychiatrist b. Dietitian c. Home health nurse d. Social worker

dietitian

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client: a. prefers to take insulin orally. b. is pregnant and has type 2 diabetes. c. has type 1 diabetes. d. has type 2 diabetes.

has type 2 diabetes

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? a. Hypoglycemia b. Blurred vision c. Polydipsia d. Polyuria

hypoglycemia

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? Polyphagia Hyponatremia Hypoglycemia Ketonuria

hypoglycemia

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? Hypokalemia and hypoglycemia Hyperkalemia and hyperglycemia Hypocalcemia and hyperkalemia Hypernatremia and hypercalcemia

hypokalemia and hypoglycemia

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: anorexia. polyphagia. polyuria. polydipsia.

polyphagia

Lispro (Humalog) is an example of which type of insulin? Short-acting Rapid-acting Intermediate-acting Long-acting

rapid acting

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? Polyuria, polydipsia, and polyphagia Bradycardia, thirst, and anxiety Sweating, tremors, and tachycardia Dry skin, bradycardia, and somnolence

sweating, tremors, and tachycardia

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? "The spleen releases ketones when your body can't use glucose." "Ketones help the physician determine how serious your diabetes is." "Ketones can damage your kidneys and eyes." "Ketones will tell us if your body is using other tissues for energy."

"Ketones will tell us if your body is using other tissues for energy."

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Don't take your insulin or oral antidiabetic agent if you don't eat." "Test your blood glucose every 4 hours." "Follow your regular meal plan, even if you're nauseous."

"Test your blood glucose every 4 hours."

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? "You may be having undiagnosed infections, causing you to lose extra weight." "Your body is using protein and fat for energy instead of glucose." "I will refer you to a dietician who can help you with your weight." "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."

"Your body is using protein and fat for energy instead of glucose."

A nurse is educating a client about the benefits of fruit versus fruit juice in the diabetic diet. The client states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What are the best responses by the nurse? Select all that apply. - "Eating the fruit will lead to hyperglycemia and the fruit juice will not lead to hyperglycemia." - "Eating the fruit will give you more vitamins and minerals than the juice will." - "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." - "The fruit has less sugar than the juice." - "Eating the fruit is more satisfying than drinking the juice. You will get full faster."

- "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." - "The fruit has less sugar than the juice."

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. More common in type 1 diabetes Rapid onset Normal arterial pH level Absent ketones Elevated blood urea nitrogen (BUN) and creatinine

- Elevated blood urea nitrogen (BUN) and creatinine - Rapid onset - More common in type 1 diabetes

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? 10 to 15 minutes 30 to 40 minutes 1 to 2 hours 3 hours

10 to 15 minutes

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? a. 10 to 15 minutes b. 30 to 40 minutes c. 1 to 2 hours d. 3 hours

10 to 15 minutes

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 100 units of NPH insulin in dextrose 5% in water 100 units of regular insulin in normal saline solution 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution 100 units of regular insulin in dextrose 5% in water

100 units of regular insulin in normal saline solution

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: a. 80 mg/dL, 1 hour postprandial. b. 120 mg/dL, 1 hour postprandial. c. 138 mg/dL, 2 hours postprandial. d. 90 mg/dL before meals.

138 mg/dL, 2 hours postprandial.

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: 15 g of carbohydrates. 25 g of carbohydrates. 10 g of carbohydrates. 20 g of carbohydrates.

15 g of carbohydrates.

What is the duration of regular insulin? 4 to 6 hours 3 to 5 hours 24 hours 12 to 16 hours

4 to 6 hours

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? 8:00 AM 7:45 AM 8:30 AM 8:15 AM

7:45 AM

Which statement is true regarding gestational diabetes? a. It occurs in most pregnancies. b. Onset usually occurs in the first trimester. c. There is a low risk for perinatal complications. d. A glucose challenge test should be performed between 24 and 28 weeks.

A glucose challenge test should be performed between 24 and 28 weeks.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? Duration of the insulin Area for insulin injection Technique for injecting Accuracy of the dosage

Accuracy of the dosage

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: Health-seeking behaviors (diabetes control). Deficient knowledge (treatment regimen). Defensive coping. Impaired adjustment.

Deficient knowledge (treatment regimen).

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: Impaired adjustment. Health-seeking behaviors (diabetes control). Deficient knowledge (treatment regimen). Defensive coping.

Deficient knowledge (treatment regimen).

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? Nearly two-thirds of clients with diabetes mellitus are older than age 60. Approximately one-half of the clients diagnosed with type 2 diabetes are obese. Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus.

Diabetes mellitus is more common in Hispanics and Blacks than in Whites.

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. More common in type 1 diabetes Rapid onset Absent ketones Normal arterial pH level Elevated blood urea nitrogen (BUN) and creatinine

Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? a. Hydrocortisone b. Epinephrine c. Glucagon d. 50% dextrose

Glucagon

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? Respirations of 12 breaths/minute Cloudy urine Blood sugar 170 mg/dL Fruity breath

Hypokalemia and hypoglycemia

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? a. Hyperkalemia and hyperglycemia b. Hypernatremia and hypercalcemia c. Hypocalcemia and hyperkalemia d. Hypokalemia and hypoglycemia

Hypokalemia and hypoglycemia

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? Increase frequency of glucose self-monitoring. Decrease food intake until nausea passes. Take half the usual dose of insulin until symptoms resolve. Do not take insulin if not eating.

Increase frequency of glucose self-monitoring.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? Decreases need for pancreas to produce more cells Decreases risk of developing insulin resistance and hyperglycemia Creates an overall feeling of well-being and lowers risk of depression Increases ability for glucose to get into the cell and lowers blood sugar

Increases ability for glucose to get into the cell and lowers blood sugar

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? Glargine (Lantus) NPH Iletin II Lispro (Humalog)

NPH

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? Dry skin, bradycardia, and somnolence Polyuria, polydipsia, and polyphagia Sweating, tremors, and tachycardia Bradycardia, thirst, and anxiety

Sweating, tremors, and tachycardia

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? a. Dry skin, bradycardia, and somnolence b. Bradycardia, thirst, and anxiety c. Polyuria, polydipsia, and polyphagia d. Sweating, tremors, and tachycardia

Sweating, tremors, and tachycardia

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: Synthesis of glucose from noncarbohydrate sources. Release of glucose. Storage of glucose as glycogen in the liver. Transport of potassium.

Synthesis of glucose from noncarbohydrate sources.

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? a. The client has eaten but has not taken or received insulin. b. The client has not been exercising. c. The client has not eaten but continues to take insulin or oral antidiabetic medications. d. The client has not complied with the prescribed treatment regimen.

The client has not eaten but continues to take insulin or oral antidiabetic medications.

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? If administered immediately, there is no requirement for withdrawing one type of insulin before another. Different types of insulin are not to be mixed in the same syringe. The intermediate-acting insulin is withdrawn before the short-acting insulin. The short-acting insulin is withdrawn before the intermediate-acting insulin.

The short-acting insulin is withdrawn before the intermediate-acting insulin.

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know can be used intravenously? rapid acting short-acting long-acting intermediate-acting

short-acting

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? Need for exocrine enzymatic drainage Need for lifelong immunosuppressive therapy Increased risk for urologic complications Underlying problem of insulin resistance

Underlying problem of insulin resistance

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? When mixing insulin, the regular insulin is drawn up into the syringe first. There is no need to inject air into the bottle of insulin before withdrawing the insulin. If two different types of insulin are ordered, they need to be given in separate injections. When mixing insulin, the NPH insulin is drawn up into the syringe first.

When mixing insulin, the regular insulin is drawn up into the syringe first.

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? Red blood cells Albumin Bacteria White blood cells

albumin

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? White blood cells Red blood cells Bacteria Albumin

albumin

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? a. Red blood cells b. Albumin c. White blood cells d. Bacteria

albumin

A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site? Wear sterile gloves when inserting the needle. Change the needle every 3 days. Take the ordered antibiotics before initiating treatment. Use clean technique when changing the needle.

change the needle every 3 days

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? a. It is rapidly absorbed and has a fast onset of action. b. Administer the total daily dosage in two doses. c. Draw up the drug first, then add regular insulin. d. Do not mix with other insulins.

do not mix with other insulins

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? Hypernatremia and hypercalcemia Hypokalemia and hypoglycemia Hyperkalemia and hyperglycemia Hypocalcemia and hyperkalemia

fruity breath

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? a. Increase frequency of glucose self-monitoring. b. Take half the usual dose of insulin until symptoms resolve. c. Do not take insulin if not eating. d. Decrease food intake until nausea passes.

increase frequency of glucose self-monitoring

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? Fatigue Increased hunger Numbness Dizziness

increased hunger

Lispro (Humalog) is an example of which type of insulin? Intermediate-acting Rapid-acting Long-acting Short-acting

rapid-acting

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: provide time for privacy. encourage the client to ask questions about personal sexuality. provide support for the spouse or significant other. suggest referral to a sex counselor or other appropriate professional.

suggest referral to a sex counselor or other appropriate professional.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 18 to 20 g of a simple carbohydrate. 25 to 30 g of a simple carbohydrate. 10 to 15 g of a simple carbohydrate. 2 to 5 g of a simple carbohydrate.

10 to 15 g of a simple carbohydrate.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? Increased urine output Cheyne-Stokes respirations Diaphoresis Decreased appetite

increased urine output

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? a. hyperosmolar hyperglycemic nonketotic syndrome b. All options are correct. c. hepatic disorder d. ketoacidosis

ketoacidosis

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? a. Metformin b. Glyburide c. Glipizide d. Repaglinide

metformin

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? a. Retinopathy b. Sensory neuropathy c. Autonomic neuropathy d. Nephropathy

sensory neuropathy

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? "Your body is using protein and fat for energy instead of glucose." "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "I will refer you to a dietician who can help you with your weight." "You may be having undiagnosed infections, causing you to lose extra weight."

"Your body is using protein and fat for energy instead of glucose."

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? "Administer insulin into sites above muscles that you plan to exercise heavily later that day." "Rotate injection sites within the same anatomic region, not among different regions." "Inject insulin into healthy tissue with large blood vessels and nerves." "Administer insulin into areas of scar tissue or hypertrophy whenever possible."

"Rotate injection sites within the same anatomic region, not among different regions."

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? "I'll see if the physician can reduce the number of blood draws." "Our laboratory technicians use tiny needles and they're really good with children." "Your child will need less blood work as his glucose levels stabilize." "Your child is young and will soon forget this experience."

"Your child will need less blood work as his glucose levels stabilize."

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: at least five times per week. at least three times per week. at least once per week. every day.

at least three times per week.

A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first? Administer sodium bicarbonate 50 mEq IV push. Start an infusion of regular insulin at 50 U/hr. Infuse 0.9% normal saline solution 1 L/hr for 2 hours. Administer regular insulin 30 U IV push.

Infuse 0.9% normal saline solution 1 L/hr for 2 hours.

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? The short-acting insulin is withdrawn before the intermediate-acting insulin. If administered immediately, there is no requirement for withdrawing one type of insulin before another. Different types of insulin are not to be mixed in the same syringe. The intermediate-acting insulin is withdrawn before the short-acting insulin.

The short-acting insulin is withdrawn before the intermediate-acting insulin.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: a. glycosylated hemoglobin level. b. urine glucose level. c. fasting blood glucose level. d. serum fructosamine level.

glycosylated hemoglobin level