Test 5 Questions

A patient with insulin dependent diabetes (IDDM) is admitted to the hospital following a three-day history of productive cough, fever and chills. A diagnosis of pneumonia is made. Vital signs on admission are temperature of 103.2, pulse 112, respirations are 32 and deep and rapid. The nurse's first action should be to: A. Administer oxygen at 2 L/min via nasal cannula B. Obtain a blood sample for glucose and acetone C. Administer 5U of regular insulin D. Give orange juice with sugar packets added

A. "Administer oxygen at 2 L/miin via nasal cannula

Which statement by the patient with type 2 diabetes is accurate? A. "I will limit my alcohol intake to 1 drink each day." B. "I am not allowed to eat any sweets because of my diabetes." C. "I cannot exercise because I take a blood glucose-lowering medication." D. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

A. "I will limit my alcohol intake to 1 drink each day."

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? A. A1C 9% B. BP 126/80 mm Hg C. FBG 130 mg/dl (7.2 mmol/L) D. LDL cholesterol 100 mg/dL (2.6 mmol/l)

A. A1C 9%

A 63 year-old patient is newly diagnosed with type 2 diabetes. In formulating an education plan that encourages the patient to become an active participant in the management of his diabetes, the nurse should first A. Assess the patient's understanding of what it means to have diabetes B. Assume the responsibility for all the patient's care to reduce his stress level C. Ask the patient's family to participate in the diabetes education program with him D. Set goals for the patient

A. Assess the patient's understanding of what it means to have diabetes You must first assess to find out what the patient already knows and what information needs to be re-taught

A father calls the pediatrician's office concerned about his 5-year-old type 1 diabetic child who has been ill. He reports that upon checking the child's urine, it was positive for ketones. What is the nurse's best response to this father? A. "Come to the office immediately." B. "Encourage the child to drink calorie-free liquids." C. "Hold the next dose of insulin." D. "Administer an extra dose of insulin now."

B. "Encourage the child to drink calorie-free liquids."

A nurse is providing teaching for a client who has type 2 diabetes mellitus and it starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication? A. "I'll take this medication after I eat." B. "I'll take this medicine 30 minutes before I eat." C. "I'll take this medicine just before I go to bed." D. "I'll take this medication at least 1 hour before I eat."

B. "I'll take this medication 30 minutes before I eat." - Reaglinide causes a rapid, short-lived release of insulin. The client should take this medication within 30 minutes before each meal so that insulin is available when food is digested

A client with type 1 diabetes mellitus who takes NPH daily in the morning calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? A. "I should not exercise since I am taking insulin." B. "The best time for me to exercise is after breakfast." C. "The best time for me to exercise is mid- to late afternoon." D. "NPH is a basal insulin, so I should exercise in the evening."

B. "The best time for me to exercise is after breakfast."

An adolescent with Type 1 diabetes is learning about a diabetic diet. He asks the nurse if he will ever be able to go out to eat with his friends again. What is the most appropriate answer for the nurse to give? A. "You can go out with them, but you should take your own snack with you." B. "Yes. You will learn what foods are allowed so you can eat with your friends." C. "When you get food out in a restaurant, be sure to order diet soft drinks." D. "Eating out will not be possible on a diabetic diet. Why don't you plan to invite your friends to your house?"

B. "Yes. You will learn what foods are allowed so you can eat with your friends."

A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? A. Check blood glucose immediately after breakfast B. Administer insulin when breakfast arrives C. Hold breakfast for 1 hour after insulin administration D. Clarify the prescription because insulin should not be administered at this time.

B. Administer insulin when breakfast arrives

A nurse is reviewing laboratory reports of a client who has HHS. Which of the following findings should the nurse report? A. Blood pH of 7.2 B. Blood osmolarity 350 mOsm/L C. Blood potassium 3.8 mg/dL D. Blood creatinine 0.8 mg/dL

B. Blood osmolarity 350 mOsm/L

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis. In the acute phase, the nurse plans for which priority intervention? A. Correct the acidosis B. Administer 5% dextrose intravenously C. Apply a monitor for an electrocardiogram D. Administer short-duration insulin intravenously

4. Administer short-duration insulin intravenously

A client with a diagnosis of diabetic ketoacidosis is being treated in the emergency department. Which of the findings supports this diagnosis? Select all that apply A. Increase in pH B. Comatose state C. Deep, rapid breathing D. Decreased urine output E. Elevated blood glucose level

B. Comatose state C. Deep, rapid breathing E. Elevated blood glucose level

A nurse is providing discharge teaching to a client who had diabetic ketoacidosis. Which of the following information should the nurse include about preventing DKA? Select all that apply A. Drink 2 L of fluids a day B. Monitor blood glucose every 4 hours when ill C. Administer insulin as prescribed when ill D. Notify the provider when blood glucose is 200 mg/dL E. Report ketones in the urine after 24 hours of illness

A. Drink 2 L of fluid a day B. Monitor blood glucose every 4 hours when ill C. Administer insulin as prescribed when ill E. Report ketones in the urine after 24 hours of illness

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify A. ECG changes and arrhythmias related to potassium B. Fluid overload resulting from aggressive fluid replacement C. The presence of hypovolemic shock related to osmotic diuresis D. Cardiovascular collapse resulting from the effects of excess glucose on cardiac muscle

A. ECG changes and arrhythmias related to potassium

A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? Select all that apply A. Eat at regular intervals B. Decrease intake of saturated fats C. Increase daily fiber intake D. Limit saturated fat intake to 15% of daily caloric intake E. Include omega-3 fatty acids in the diet

A. Eat at regular intervals B. Decrease intake of saturated fats C. Increase daily fiber intake E. Include omega-3 fatty acids in the diet

A nurse is reviewing the health history of a client who has diabetes mellitus type 2. Which of the following are risk factors for hyperglycemic hyperosmolar state (HHS)? Select all that apply A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Take a calcium channel blocker D. Age 77 years E. Daily insulin injections

A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Take a calcium channel blocker D. Age 77 years

Glyburide is prescribed for a patient when her type 2 diabetes has not been controlled with diet and exercise. When teaching the patient about glyburide, the nurse explains that A. Glyburide is thought to stimulate insulin production and release by the pancreas B. Glyburide is a substitute for insulin and acts by directly stimulating glucose uptake into the cell C. Glyburide, like all oral anti-diabetes agents, does not cause the hypoglycemic reactions that may occur with insulin use D. Glyburide and other sulfonylureas lower blood sugar by decreasing the rate of hepatic glucose production, preventing gluvoneogenesis

A. Glyburide is thought to stimulate insulin production and release by the pancreas

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? Select all that apply. A. Insulin administration B. Elimination of sugar from the diet C. Need to reduce physical activity D. Use of a portable blood glucose monitor E. Hypoglycemia prevention, symptoms, and treatment

A. Insulin administration D. Use of a portable blood glucose monitoring E. Hypoglycemia prevention, symptoms, and treatment

To reduce the risks of complications in type 2 diabetics, the nurse knows that in addition to medication to control the blood glucose the patient should be taking (select all that apply) A. Lipid lowering medication B. Insulin C. 81 mg ASA D. ACE inhibitior E. Tricyclic antidepressant F. Weight loss medication

A. Lipid lowering medication C. 81 mg ASA D. ACE inhibitor

A client is diagnosed as having insulin-dependent diabetes mellitus (IDDM). She received regular insulin at 7:40 am. When is she most likely to develop a hypoglycemic reaction? A. Mid-morning B. Mid-afternoon C. Early afternoon D. During the night

A. Mid-morning

A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dl. The nurse knows that this result indicates A. Normal finding B. Diabetes mellitus C. Impaired fasting glucose D. Impaired oral glucose tolerance

A. Normal finding A fasting plasma glucose tolerance of 126 mg/dl or greater is an indicator for diabetes

The client has been diagnosed to have type 2 diabetes mellitus. Which of the following signs and symptoms characterize the disease? Select all that apply. A. Occurs after 30 years of age B. Obesity C. Requires lifetime insulin injection D. Can be controlled by diet, exercise, and drug therapy E. Prone to diabetic ketoacidosis F. Experience weight loss G. May require exogenous insulin during times of stress, surgery, and/or pregnancy

A. Occurs after 30 years of age B. Obesity D. Can be controlled by diet, exercise, and drug therapy G. May require exogenous insulin during times of stress, surgery, and/or pregnancy C, E, F describe type 1

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? A. Polyuria B. Diaphoresis C. Pedal edema D. Decreased respiratory rate

A. Polyuria

A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following findings should the nurse instruct the client to report as an adverse effect of metformin? A. Somnolence B. Constipation C. Fluid retention D. Weight gain

A. Somnolence - Can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle gain. It is rare but very serious adverse effect caused by metformin and should be reported to the provider.

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestation would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply A. Tremors B. Anorexia C. Irritability D. Nervousness E. Hot, dry skin F. Muscle cramps

A. Tremors C. Irritability D. Nervousness

Which are appropriate therapies for patients with diabetes? Select all that apply A. Use of statins to reduce CVD risk B. Use of diuretics to treat nephropathy C. Use of ACE inhibitors to treat nephropathy D. Use of serotonin agonists to decrease appetite E. Use of laser photocoagulation to treat retinopathy

A. Use of stains to reduce CVD risk C. Use of ACE inhibitors to treat nephropathy E. Use of laser photocoagulation to treat retinopathy

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client reports a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? A. "I need to stop my insulin." B. "I need to increase my fluid intake." C. "I need to monitor my blood glucose every 3 to 4 hours." D. "I need to call my primary health care provider because of these symptoms."

A."I need to stop my insulin."

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety? A. Administer a sedative B. Convey empathy, trust, and respect toward the client C. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear D. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening

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

Polydipsia and polyuria related to diabetes are primarily due to A. The release of ketones from cells during fat metabolism B. Fluid shifts resulting from the osmotic effect of hyperglycemia C. Damage to the kidneys from exposure to high levels of glucose D. Changes in RBCs resulting from attachment of excess glucose to hemoglobin

B. Fluid shifts resulting from the osmotic effect of hyperglycemia

A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? Select all that apply A. Weight gain B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis

B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis

A patient with a 20-year history of type 2 diabetes has symmetrical peripheral polyneuropathy of his feet and legs with almost total loss of sensitivity to touch and temperature. He also has peripheral vascular disease evidenced by decreased peripheral pulses and dependent rubor (redness). To prevent injury and infection to the feet and legs, the nurse teaches the patient that A. He should soak his feet in warm water everyday B. He should no go barefoot and should always wear shoes with soles C. He should use a heating pad to warm his feet when they feel cool to touch D. The use of commercial keratolytic agents to remove corns and calluses is preferred to cutting off corns and calluses

B. He should not go barefoot and should always wear shoes with soles

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? A. Lack of knowledge B. Inadequate fluid volume C. Compromised family coping D. Inadequate consumption of nutrients

B. Inadequate fluid volume

When intensive insulin therapy is used for control of diabetes, the nurse recognizes that the type of insulin preferred for meal coverage is A. NPH insulin B. Lispro insulin C. Lantus D. Afrezza

B. Lispro insulin

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply A. Polyuria B. Shakiness C. Palpitations D. Blurred vision E. Lightheadedness F. Fruity breath odor

B. Shakiness C. Palpitations E. Lightheadedness

A patient with newly diagnosed type 2 diabetes asks the nurse what "type 2" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type one diabetes primarily in that with type 2 diabetes.... A. The patient is totally dependent on an outside source of insulin B. There is decreased insulin secretion and/or resistance to insulin that is produced C. There are islet cell antibodies and insulin autoantibodies that destroy beta cells in the pancreas D. It is preceded by a viral infection at a young age

B. There is decreased insulin secretion and/or resistance to insulin that is produced A, C, D all describe type 1

The client with diabetes mellitus type 1 is found unresponsive in the clinical setting. Which nursing action is a priority? A. Call the physician stat B. Treat the client for hypoglycemia C. Assess the client's vital signs D. Call a code

B. Treat the client for hypoglycemia

A thirty-five year old male has been an insulin-dependent diabetic for twenty years and now is unable to maintain an erection. Which of the following would you most likely suspect? A. Atherosclerosis B. Diabetic nephropathy C. Autonomic neuropathy D. Somatic neuropathy

C. Autonomic neuropathy

A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose 278 mg/d. Which of the following actions should the nurse take? A. Draw up the regular insulin and then the glargine insulin in the same syringe B. Draw up the glargine insulin then the regular insulin in the same syringe C. Draw up and administer regular insulin and glargine insulin in separate syringes D. Administer the regular insulin, wait 1 hour, and then administer the glargine insulin

C. Draw up and administer regular insulin and glargine insulin the separate syringes

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis. The initial blood glucose level is 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL. The nurse would next prepare to administer which medication? A. An ampule of 50% dextrose B. NPH insulin subcutaneously C. IV fluids containing dextrose D. Phenytoin for the prevention of seizures

C. IV fluids containing dextrose

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemia syndrome is made. The nurse would immediately prepare to initiate which anticipated primary health care provider's prescription? A. Endotracheal intubation B. 100 units of NPH insulin C. Intravenous infusion of normal saline D. Intravenous infusion of sodium bicarbonate

C. Intravenous infusion of normal saline

A diagnosis of hyperglycemia hyperosmolar nonketotic coma is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse anticipates that initial treatment of the patient will include A. Long-acting IV insulin B. Oxygen via nasal cannula C. Normal saline IV fluid bolus D. 5% dextrose IV

C. Normal saline IV fluid bolus

A nurse is caring for a client who has a blood glucose of 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. Recheck blood glucose in 15 minutes B. Provide a carbohydrate and protein food C. Provide 15 g of simple carbohydrates D. Report findings to the provider

C. Provide 15 g of simple carbohydrates

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of A. Polyuria B. Severe dehydration C. Rapid, deep respirations D. Decreased serum potassium

C. Rapid, deep respirations

A nurse is reviewing the medical record for a client who is to begin therapy for DKA. Which of the following prescriptions should the nurse expect? A. Administer an IV infusion of regular insulin at 0.3 units/kg/hr B. Administer a slow IV infusion of 3% sodium chloride C. Rapidly administer an IV infusion of 0.9% sodium chloride D. Add glucose to the IV infusion when blood glucose is 350 mg/dL

C. Rapidly administer an IV infusion of 0.9% sodium chloride

A nurse is teaching clients about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the client to expect a peak effect 1 to 5 hours after administration? A. Insulin glargine B. NPH insulin C. Regular insulin D. Insulin lispro

C. Regular insulin. - Regular insulin has a peak effect around 1 to 5 hours after administration

The nurse is teaching a client to self-administer insulin. The instructions should include teaching the client to A. Inject the needle at a 90-degree angle into the muscle B. Vigorously massage the area after injecting the insulin C. Rotate injection sites D. Keep the open bottle of insulin in the refrigerator

C. Rotate injection sites

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 70 mg/dL, temperature of 101, pulse of 82 beats per minute, respirations of 20 breaths per minute, and blood pressure of 118/68 mmHg. Which finding would be the priority concern to the nurse? A. Pulse B. Respiration C. Temperature D. Blood pressure

C. Temperature

What is the best way to assess patient understanding of a recent teaching? A. The patient says "yes" when the nurse asks if they understand B. The patient gives the nurse a thumbs up C. The patient can teach-back the content just taught through verbal or physical demonstration D. The patient states "I'll ask my daughter if I have any questions, but I'm pretty sure I understand."

C. The patient can teach-back the content just taught through verbal or physical examination Teach-back is the best way to find out if a patient understands the education provided

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? A. "I will stop taking my insulin if I'm too sick to eat." B. "I will decrease my insulin dose during times of illness." C. "I will adjust my insulin dose according to the level of glucose in my urine." D. "I will notify my primary health provider if my blood glucose level is higher than 250 mg/dL

D. "I will notify my primary health care provider if my blood glucose level is higher than 250 mg/dL

A nurse is providing teaching to a client who has a prescription for pramlintide for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? Select all that apply A. "Take oral medications 30 minutes before injection." B. "Use upper arms as preferred injection sites." C. "Mix pramlintide with breakfast dose of insulin." D. "Inject pramlintide just before a meal." E. "Discard open vials after 28 days."

D. "Inject pramlintide just before a meal." - Can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injection this mediation E. "Discard open vials after 28 days." - Unused medication in the open pramlintide vial should be discarded after 28 days.

What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability? A. Call the provider B. Give insulin as ordered C. Assess for other neurologic symptoms D. Check the patient's blood glucose levels

D. Check the patient's blood glucose level

The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient? A. Store both insulins in the refrigerator B. Shake the insulins for 1 full minute before use C. Administer the injection at a 30-degree angle D. Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe

D. Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe A. Would be stored at room temperature B. You would roll the vial not shake C. You would inject at a 90-degree angle

The nurse teaches a patient with type 1 diabetes about the Somogyi effect and dawn phenomenon, emphasizing that A. The Somogyi effect occurs early at night and the dawn phenomenon occurs on arising B. The Somogyi effect is characterized by hyperglycemia and the dawn phenomenon by hypoglycemia C. The Somogyi effect occurs when the patient is asleep, and the dawn phenomenon occurs after the patient awakens D. In the Somogyi effect, hyperglycemia results from too much insulin, and the dawn phenomenon results from too little insulin

D. In the Somogyi effect hyperglycemia results from too much insulin, and the dawn phenomenon results from too little insulin - There is not enough insulin circulating in dawn phenomenon A. Somogyi and Dawn phenomenon both occur during rising B. Both result from hyperglycemia C. Both occur will asleep

A nurse is caring for a client who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plant to monitor? A. WBC B. Amylase C. Platelet count D. Liver function tests

D. Liver function tests - Acarbose can cause liver toxicity when taken long-term. Ensure the client's liver function is monitored while taking this medication

A 20-year-old college student who has Type 1 diabetes normally walks each evening as part of her exercise regimen. She now plans to enroll in a swimming class to meet her physical education requirements. The nurse teaches the patient that adjustments to her treatment plan should include A. Delaying the meal eaten before swimming class until after the session is over. B. Adding 10 units of regular insulin to her usual morning dose on the days she plans to swim. C. Timing her morning insulin injection so that the peak action will occur during her swimming class D. Monitoring her glucose levels before, during, and after swimming to determine the need for alterations in food or insulin

D. Monitoring her glucose level before, during, and after swimming to determine the need for alterations in food or insulin

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? A. The patient must receive insulin therapy to prevent ketoacidosis B. The patient has islet cell antibodies that have destroyed the pancreases ability to make insulin C. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections D. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome

D. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome

A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? Select all that apply A. Remove calluses using over-the-counter remedies B. Apply lotion between the toes C. Test water temperature with the fingers before bathing D. Trim toenails straight across E. Wear closed-toe shoes

D. Trim toenails straight across E. Wear closed-toe shoes