prepU diabetes & hypertension
Which instruction about insulin administration should a nurse give to a client?
"Always follow the same order when drawing the different insulins into the syringe."
A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include?
"Flex your calf muscles, avoid alcohol, and change positions slowly."
Which statement indicates that a client with diabetes mellitus understands proper foot care?
"I'll wear cotton socks with well-fitting shoes."
A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is:
"I'm going to give your son some insulin. Then I'll be happy to talk with you."
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 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."
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?
"Ketones will tell us if your body is using other tissues for energy."
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?
"Limiting my salt intake to 2 grams per day will improve my blood pressure."
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?
"Rotate injection sites within the same anatomic region, not among different regions."
A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize?
"Sit quietly for 5 minutes prior to taking blood pressure."
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."
A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective?
1/2 cup fruit juice or regular soft drink
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:
10 to 15 g of a simple carbohydrate.
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?
10-15 minutes
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:
138 mg/dL, 2 hours postprandial.
The nurse is monitoring a client with hypertension and chronic kidney disease. What is the target blood pressure for the client?
140/90 mm Hg
A female patient with diabetes who weighs 150 pounds has an ideal body weight of 118 pounds. She can lose 1 pound per week and drop her extra 32 pounds in approximately 8 months. To meet this goal, the nurse advises the patient to decrease her calories by:
3,500 per week
A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time?
7:45AM
Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension?
A client diagnosed with kidney disease
Which statement is true regarding gestational diabetes?
A glucose challenge test should be performed between 24 and 28 weeks.
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:
A1c
A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first?
Administer 50% glucose intravenously.
The nurse is administering metoprolol to a client. What type of medication should the nurse educate the client about?
Beta blocker
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
Blood glucose level 1,100 mg/dl
A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important?
Control BG levels
Which of the following is an age-related change that may affect diabetes? Select all that apply.
Decreased renal function Taste changes Decreased vision
A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority?
Deficient fluid volume related to osmotic diuresis
Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply.
Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentration.
A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The physician orders a chest x-ray, which reveals an enlarged heart. What diagnostic test does the nurse anticipate preparing the patient for to determine left ventricular enlargement?
Echocardiography
A client with hypertension has been able to maintain a blood pressure of 130/70 mm Hg for 1 year while reducing dietary sodium and taking hydrochlorothiazide (HCTZ) and atenolol. What treatment plan will the nurse educate the client about?
Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake
The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure?
Heart and blood vessels
Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply.
Heart failure Retinal damage Stroke
Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus?
High sugar pulls fluid into the bloodstream, which results in more urine production.
When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?
Hyperkalemia
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
A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites?
Insulin is absorbed more rapidly at abdominal injection sites than at other sites.
The nurse is caring for an older adult client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP?
Loss of arterial elasticity
A patient with a diagnosis of type 2 diabetes has been vigilant about glycemic control since being diagnosed and has committed to increasing her knowledge about the disease. To reduce her risk of developing diabetic nephropathy in the future, this patient should combine glycemic control with what other preventative measure?
Maintenance of healthy blood pressure and prompt treatment of hypertension
A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?
Metformin
The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching?
Positions the arm at waist level
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for?
Postural hypotension and resulting injury
Lispro (Humalog) is an example of which type of insulin?
Rapid-acting
A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure?
Reduce the blood pressure by 20% to 25% within the first hour of treatment.
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?
Regular
A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan?
Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns
A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?
Serum glucose level of 52 mg/dl
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety?
Sit on the edge of the chair and rise slowly
A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply.
Smoking Diabetes mellitus Physical inactivity
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.
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?
The client has eaten and has not taken or received insulin.
Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus?
The client has not eaten but continues to take insulin or oral antidiabetic medications.
A client is diagnosed with diabetes mellitus. The client reports visiting the gym regularly and is a vegetarian. Which of the following factors is important to consider when the nurse assesses the client?
The client's consumption of carbohydrates
Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension?
The incidence and prevalence of hypertension increase with age.
The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar:
The pancreatic hormone glucagon will stimulate the liver to release stored glucose.
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.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?
They increase the need for insulin.
Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?
Using sterile technique during the dressing change
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.
A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse would administer the insulin at which site as the preferred site?
abdomen
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?
accuracy of dosage
The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of what?
adrenal gland
A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client?
age
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)?
blood glucose can be controlled through diet and exercise
The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find?
blood pH of 6.9
The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should
check client's heart rate
The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents?
continuous IV infusion
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?
dietician
When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures
differ no more than 5 mm Hg between arms.
A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for?
dizziness
Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin?
do not mix with other insulins
Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred?
echocardiography
After teaching a group of students about diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome (HHNKS), the instructor determines that additional teaching is needed when the students identify which of the following as characteristic of HHNKS?
elevated serum potassium levels
A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have?
essential (primary)
During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure?
glycosylated hemoglobin level (A1c)
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:
has type 2 diabetes
A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect?
hyperkalemia
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse?
hypertension causes no symptoms
Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage?
hypertensive emergency
A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of:
hypoglycemia
Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?
hypokalemia & hypoglycemia
A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes?
increased thirst, hunger, urination
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?
increases ability for glucose to get into cell and lowers blood sugar
It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine
increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood
NPH is an example of which type of insulin?
intermediate-acting
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?
ketoacidosis
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:
ophthalmic examination
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:
polyphagia
A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together?
potassium level
A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified?
prehypertensive
A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes?
presence of autoantibodies against islet cells
A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?
rapid, thready pulse
Which finding indicates that hypertension is progressing to target organ damage?
retinal blood vessel damage
The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet?
sensory neuropathy
The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium?
spironolactone
The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client?
stroke
The nurse is seeing a client for the first time and has just checked the client's blood pressure. The nurse would consider the client prehypertensive if:
systolic BP is between 120 and 139 mm Hg
The nurse understands that client education related to antihypertensive medication should inform the client:
to avoid over-the-counter cold and sinus medications
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?
underlying problem of insulin resistance
A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching?
use all available injection sites in one area
Which factor is the focus of nutrition intervention for clients with type 2 diabetes?
weight loss
