Theory 1 Module 9 Diabetes Ultimate set
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). Which information will the nurse plan to teach the patient? a. Self-monitoring of glucose b. Using small doses of regular insulin c. Lifestyle changes to lower the glucose d. Effects of oral hypoglycemic medications
C The patient's impaired fasting glucose indicates prediabetes, and the patient would be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not need to self-monitor glucose.
A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200mg/dL. Which of the following information should the nurse include?
Expect the NPH insulin level to peak in 6 to 14 hr.
A nurse is assessing a client who is receiving liothyronine for treatment of hypothyroidism. The nurse should recognize which of the following finding is a therapeutic response to the medication?
Increase in energy. Depression, lethargy, and fatigue are manifestations of HYPOthyroidism and effective treatment will improve these manifestations.
Deep, rapid breathing.
Kussmaul respirations
HHS treatment
NS and insulin; potassium as needed
Hypoglycemia S/S
-shakiness -confusion -diaphoresis -palpitations -headache -lack of coordination -blurred vision -seizures -coma
A nurse observes mild hand tremors in a client who has diabetes mellitus. Which of the following actions should the nurse take after obtaining a glucose meter reading of 60 mg/dL?
Administer 15 g of carbohydrates
A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication?
Alcohol
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? a. Fasting blood glucose b. Glycosylated hemoglobin c. Oral glucose tolerance test d. Urine dipstick for glucose and ketones
B
After change-of-shift report, which patient would the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12% b. A 23-yr-old patient with type 1 diabetes who has a glucose of 40 mg/dL c. A 50-yr-old patient who uses exenatide and is reporting acute abdominal pain d. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202 mg/dL
B
Which action would the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness? a. Assess the patient for symptoms of hyperglycemia. b. Give the patient a snack of peanut butter and crackers. c. Have the patient drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours
B
Which laboratory value reported by the assistive personnel (AP) indicates an urgent need for the nurse to assess the patient? a. Bedtime glucose of 140 mg/dL b. Noon glucose of 52 mg/dL c. Fasting glucose of 130 mg/dL d. 2-hr postprandial glucose of 220 mg/dL
B
Which statement by the person who has newly diagnosed type 1 diabetes indicates a need for additional instruction from the nurse? a. ―I will need a bedtime snack because I take an evening dose of NPH insulin.‖ b. ―I can choose any foods, as long as I use enough insulin to cover the calories.‖ c. ―I can have an occasional beverage with alcohol if I include it in my meal plan.‖ d. ―I will eat something at meal times to prevent hypoglycemia, even if I am not hungry.‖
B
The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6 AM glucose is 230 mg/dL. Which action would the nurse teach the patient to take? a. Check the glucose during the night. b. Avoid snacking right before bedtime. c. Increase the rapid-acting insulin dose. d. Administer a larger dose of long-acting insulin
A
Which patient with type 1 diabetes has the highest risk for developing hypoglycemic unawareness? A. A 58-yr-old patient with diabetic retinopathy B. A 73-yr-old patient who takes propranolol (Inderal) C. A 19-yr-old patient who is on the college track team D. A 24-yr-old patient with a hemoglobin A1C of 8.9%
B-Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful? a. The patient administers the glargine 30 minutes before each meal. b. The patient's family prefills the syringes with the mix of insulins weekly. c. The patient discards the open vials of glargine and regular insulin after 4 weeks. d. The patient draws up the regular insulin and then the glargine in the same syringe.
C
Which information provided by a nurse to a patient newly diagnosed with type 2 diabetes is accurate? a. Insulin is not used to control glucose in patients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Changes in diet and exercise may control glucose levels with type 2 diabetes. d. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic coma.
C
A 30-yr-old patient has a new diagnosis of type 2 diabetes. When would the nurse recommend the patient schedule a dilated eye examination? a. Every 2 years b. Every 6 months c. As soon as available d. At the age of 39 years
C
A nurse is assessing a client who has diabetes mellitus and reports foot pain. The nurse should evaluate the client for which of the following alterations as indications that the client has an infection?
an increase in neutrophils, localized edema
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM
C. 10:30 PM to 1:30 AM Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10-30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.
A person with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a glucose level of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate?
Cardiac monitoring to detect potassium changes Rationale: This person has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.
The nurse has been teaching a patient who has type 2 diabetes about managing glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? a. ―If I overeat at a meal, I will still take the usual dose of medication.‖ b. ―Other medications besides the Glucotrol may affect my blood sugar.‖ c. ―When I am ill, I may have to take insulin to control my blood sugar.‖ d. ―My diabetes won't cause complications because I don't need insulin.‖
D
The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication? a. The patient's blood pressure is 154/92. b. The patient has a history of emphysema. c. The patient reports chest pressure when walking. d. The patient's morning glucose level is 96 mg/dL
D
Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? a. The patient's glucose level is 174 mg/dL. b. The patient is scheduled for a chest x-ray in an hour. c. The patient has gained 2 lb (0.9 kg) in the past 24 hours. d. The patient's estimated glomerular filtration rate is 42 mL/mi
D
A nurse is preparing to administer lisper insulin to a client who has type I diabetes mellitus. Which of the following actions should the nurse take? a. Assess for hypoglycemia 4 hours after the insulin injection. b. Inject the insulin 15 minutes before a meal. c. Monitor for polyuria. d. Administer with short-acting insulin.
b. Inject the insulin 15 minutes before a meal.
A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?
Decrease in the level of thyroid stimulating hormone (TSH). In HYPOthyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH and endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid glans. Administration of exogenous thyroid hormones turns off this feedback loop, which results in a decreased level of TSH.
A nurse is teaching a client who has DM and receives 25 units of NPH insulin every morning if her blood glucose is above 200 mg/dL. Which of the following information should the nurse include?
Expect the NPH insulin to peak in 6-14 hours. It is an intermediate acting insulin with an onset of 1-2 hors, peaking at 6-14 hours, and duration of 16-24 hours. The client is at risk for HYPOglycemia during the peak time.
A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus?
Fasting blood glucose 155mg/dL
Protein is converted to glucose by the liver.
Glucogenesis
A nurse is caring for a term macrocosmic newborn whose mother has poorly controlled type 2 diabetes. The newborn has respiratory distress syndrome. The nurse should be aware that the most likely cause of the respiratory distress is which of the following?
Hyperinsulinemia
A nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. Which of the following instructions should the nurse include in the teaching?
Keep the open vial of insulin at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy.
Intermediate insulin that peaks in 4 to 14 hours.
Novolin N
A nurse is providing teaching to an adolescent who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching?
Obtain an influenza vaccine annually.
A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this child?
Regular insulin
A nurse is caring for an adolescent client who has a long history of DM and is long admitted to the ED confused, flushed, and with an acetone odor on the breath . DKA is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?
Regular insulin is classified as a short-acting insulin. It can be given IV with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe HYPERglycemia and DKA.
Rebound hyperglycemia.
Somogyi effect
A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include? a. Discard the NPH solution if it appears cloudy. b. Shake the insulin vigorously before loading the syringe. c. Expect the NPH insulin to peak in 6 to 14 hours. d. Freeze unopened insulin vials.
c. Expect the NPH insulin to peak in 6 to 14 hours.
Elevated blood glucose.
hyperglycemia
A nurse is teaching a client who has a new prescription for NPH insulin. Which of the following instructions should the nurse include?
"Eat a snack 8 hours after taking this medication." NPH insulin peaks in 6-14 hours after dosing. The client is at risk for HYPOglycemia and might require a snack at this time. Clients should check blood glucose 8-10 hours after administration of NPH insulin. If HYPOglycemic, consume a small snack of 15 grams of carbs and recheck blood glucose again in 15 min.
A client who has type 2 diabetes mellitus asks the nurse, "Why did I develop diabetes?" Which of the following responses should the nurse make?
"Your body has insulin resistance and decreased insulin secretion."
What causes HHS?
Type 2 Diabetes Hyperosmolarity and hyperglycemia dominate. Persistent hyperglycemia causes osmotic diuresis resulting in loss of fluids and electrolytes. Water shifts from intracellular to extracellular space.
A nurse is developing a teaching plan for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following actions should the nurse plan to take first? - Establish short-term, realistic goals for the client. - Give the client access to a video about diabetes. - Determine what the client knows about managing diabetes. - Evaluate the effectiveness of the client's admission teaching plan.
- Determine what the client knows about managing diabetes. The first action the nurse should take using process is to assess or collect data from the client. The nurse should find out what the client knows before proceeding with the plan.
A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client's morning blood glucose as 210 mg/dL instead of 120 mg/dL and administered the insulin does appropriate for a reading over 200 mg/dL before the client's breakfast. Which of the following actions is the nurse's priority? - Give the client 15 to 20 g of carbohydrate. - Monitor the client for hypoglycemia. - Complete an incident report. - Notify the nurse manager.
- Monitor the client for hypoglycemia. The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should immediately check the client's blood glucose level, expecting it to be low because of the excessive dose of insulin. If it is within the expected reference range, the nurse should continue to monitor the client for signs of hypoglycemia.
A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? - Ranitidine - Guaifenesin - Prednisone - Atorvastatin
- Prednisone Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication.
A nurse is assessing a client who has hypothyroidism. The nurse should expect which of the following findings? - Exophthalmos - Palpitations - Weight gain - Diaphoreses
- The nurse should expect to find weight gain in clients who have hypothyroidism, even with no change in dietary intake.
A nurse in a clinic is reviewing the lab values of a client who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following lab values? - Thyroid stimulation hormone (TSH) - Free T4 - Serum T4 - Serum T3
- Thyroid stimulation hormone (TSH) The nurse should anticipate that TSH will be elevated.
A nurse is assisting a client who has hypothyroidism with meal planning. Which of the following foods should the nurse recommend that the client add to her diet? - Ripe bananas - Poached eggs - Whole grains - Baked chicken
- Whole grains Constipation is a classic manifestation of hypothyroidism; therefore, this client should increase her fluid and fiber intake. Whole grains provide ample amounts of fiber.
A person is admitted with diabetes, malnutrition, cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? (Select all that apply.) The level is consistent with renal insufficiency from renal nephropathy. The level may be high because of dehydration that accompanies hyperglycemia. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. The patient may be excreting sodium and retaining potassium from malnutrition. This level shows adequate treatment of the cellulitis and acceptable glucose control.
The level is consistent with renal insufficiency from renal nephropathy. The level may be high because of dehydration that accompanies hyperglycemia. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia.
A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider?
0.9% sodium chloride IV bolus
A nurse is providing teaching to a client who has a new diagnosis of type II diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? Select all that apply. a. Polyuria b. Blurred vision c. Polydipsia d. Tachycardia e. Moist, clammy skin
b. Blurred vision d. Tachycardia e. Moist, clammy skin
A nurse is providing teaching to a client who has a diabetes mellitus about carbohydrate intake needs when exercising. Which of the following foods should the nurse include as containing a 15g serving of carbohydrates? a. 2 slices of bread b. 1 cup sugar-free yogurt c. 1 cup milk d. 1 cup regular ice cream
c. 1 cup milk
A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels?
6.3%
A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding interpreting the result of this test? a. The patient uses oral contraceptives. b. The patient runs several days a week. c. The patient has been pregnant three times. d. The patient has a family history of diabetes
A
A patient who has diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse explain for mealtime coverage? a. Lispro (Humalog) b. Glargine (Lantus) c. Detemir (Levemir) d. NPH (Humulin N)
A
A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action would the nurse implement first? a. Infuse 1 L of normal saline rapidly. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/hr.
A
The nurse has administered 4 oz of orange juice to an alert patient whose glucose was 62 mg/dL. Fifteen minutes later, the glucose is 67 mg/dL. Which action would the nurse take next? a. Give the patient 4 to 6 oz more orange juice. b. Administer the PRN glucagon (Glucagon) 1 mg IM. c. Have the patient eat some peanut butter with crackers. d. Notify the health care provider about the hypoglycemia.
A
Which information would the nurse include in teaching a patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? a. Choose flat-soled leather shoes. b. Set heating pads on a low temperature. c. Use a callus remover for corns or calluses. d. Soak feet in warm water for an hour each day.
A
Which nursing action can the nurse delegate to experienced assistive personnel (AP) who are working in the diabetic clinic? a. Measure the ankle-brachial index. b. Check for changes in skin pigmentation. c. Assess for unilateral or bilateral foot drop. d. Ask the patient about symptoms of depression
A
Which patient action indicates accurate understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? a. The patient cleans the skin with soap and water before the injection. b. The patient avoids injecting the insulin into the upper abdominal area. c. The patient stores the insulin in the freezer between prescribed doses. d. The patient pushes the plunger down while removing the syringe from the injection site
A
Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy? a. ―Do you feel bloated after eating?‖ b. ―Have you seen any skin changes?‖ c. ―Do you need to increase your insulin dosage when you are stressed?‖ d. ―Have you noticed any painful new ulcerations or sores on your feet?‖
A
The nurse is assessing a patient newly diagnosed with type 2 diabetes. Which symptom reported by the patient correlates with the diagnosis? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision
A The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes but are not classic manifestations.
Sulfonylureas and meglitinides
increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrate in the intestine
Glucagon-like peptide receptor agonists
increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.
Metformin
is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity.
Microvascular complications of diabetes mellitus.
nephropathy, neuropathy, retinopathy
Arises because of insulin resistance.
type 2 diabetes
Hyperglycemia S/S
frequent urination, deep rapid labored respirations, thirst, hunger, dry mucous membranes, weakness, malaise, rapid, weak pulse, hypotension, soft eyeballs
The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision
A. Excessive thirst The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.
The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. Which finding would the nurse anticipate? a. Anorexia b. Weight loss c. Dark colored urine d. Craving sugary drinks
B
A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?
Insomnia. Levothyroxine overdose will result in HYPERthyroidism = insomnia, tachycardia, and hyperthermia.
A nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching?
"Check your urine for ketones when blood glucose levels are greater than 240 mg/dL."
A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include?
"Maintain stable blood glucose levels."
A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parents indicates an understanding of the teaching?
"My son might complain of feeling shaky when he has a low blood glucose level."
A nurse is teaching about levothyroxine with a client who has primary HYPOthyroidism. Which of the following statements should the nurse use when teaching the client?
"Tremors, nervousness, and insomnia may indicate your dose is too high. This may indicate an overdose of the medication and they will need to notify the provider.
inhaled insulin
(afrezza) -onset: 12-15 min -peak: 60 min -duration: 2.5-3 hr
A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia?
Cool, clammy skin
A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates a need for the nurse to implement additional teaching? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.
D When the patient is ketotic, exercise increase the glucose level; persons with type 1 diabetes should be taught to avoid exercise when ketosis is present. Other recommendations include (1) before exercise, if glucose 100 mg/dL, eat a 15-g carbohydrate snack. After 15 to 30 min, recheck glucose levels. (2) Delay exercise if <100 mg/dL. Patients using drugs that place them at risk for hypoglycemia should always carry a fast-acting source of carbohydrate, such as glucose tablets or hard candies, when exercising. (3) Before exercise, if glucose 250 mg/dL in a person with type 1 DM and ketones are present, delay vigorous activity until ketones are gone. Drink fluids
DKA s/s
D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis, Acetone breath, Anorexia d/t nausea
Regular insulin (Humulin R, Novolin R)
Short-acting insulin ☐ Administer 30 to 60 min before meals to control postprandial hyperglycemia.
To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually? (Select all that apply.) a. Chest x-ray b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria e. Complete blood count (CBC) f. Monofilament testing of the foot
b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria f. Monofilament testing of the foot
HHS s/s
• elevated BG levels up to 600 • extreme dehydration • fever above 101 • altered level of consciousness
A nurse is providing teaching to a school-age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the child indicates an understanding of the teaching?
"I should eat a snack half an hour before playing soccer."
A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide?
"Glipizide stimulates your pancreas to release insulin."
A nurse is providing teaching for a client who is newly diagnosed type 2 DM and has a prescription for glipizide. Which of the following statements made by the nurse best describes glipizide?
"Glipizide stimulates your pancreas to release insulin." It is an oral antidiabetic medication that is classified as a sulfonylurea agent. These medications help to lower blood glucose levels in clients who have type 2 DM using several methods including reducing glucose output by the liver, increasing sensitivity to insulin, and stimulating the release of insulin form the functioning beta cell in the pancreas.
The nurse is teaching a patient with type 2 diabetes how to prevent diabetic nephropathy. Which patient statement indicates that teaching has been successful?
"I can help control my blood pressure by avoiding foods high in salt." Rationale: The ADA recommends persons with type 2 diabetes should consume less than 2,300 mg of salt daily. People with type 2 diabetes need to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment. Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia.
A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching?
"I give the insulin injections in my abdominal area."
The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement?
"I should look at the condition of my feet every day." Rationale: People with diabetes need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Routine care includes regular bathing.
A nurse is providing teaching about self-administration of insulin to the parent of a school-aged child who has a new onset of DM. Which of the following statement by the parent indicates a need for further teaching?
"I will be sure my child aspirates before injecting the insulin." This step is not necessary anymore.
A nurse is teaching about self-monitoring to a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?
"I will check my blood glucose every 4 hours when I am sick."
The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which patient statement requires an intervention by the nurse? "I will discard any insulin bottle that is cloudy in appearance." "The best injection site for insulin administration is in my abdomen." "I can wash the site with soap and water before insulin administration." "I may keep my insulin at room temperature (75°F) for up to 1 month."
"I will discard any insulin bottle that is cloudy in appearance." Rationale: Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance.
A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching?
"I will feel shaky."
The nurse is teaching a patient with type 2 diabetes about exercise to help control glucose. The nurse determines the patient understands the teaching when the patient states:
"I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week." Rationale: The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days/wk and resistance training 3 times a week.
A nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. which of the following statements by the client indicates a need for further teaching?
"I will use insulin glargine in my insulin pump." The client should use a short-acting insulin in the pump. The pump is designed to administer rapid-acting or short acting insulin 24 hours a da. Glargine is classified as a long-acting insulin and is administered at the same time each day to maintain stable blood glucose concentration for a 24 hours period.
A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching?
"I'll check my feet every day for sores and bruises."
A nurse is teaching a client who is taking metformin XR for type II diabetes mellitus. Which of the following instructions should the nurse include in the teaching?
"Take the medication with a meal."
A nurse is a client who is taking metformin XR for type 2 DM. Which of the following instructions should the nurse include in the teaching?
"Take the medication with a meal." This will help the client avoid HYPOglycemia and GI upset and to provide the most absorption of the medication.
A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client who has diabetes mellitus. When mixing the two types of insulin, which of the following actions should the nurse take first?
Inject 20 units of air into the NPH insulin vial.
A nurse is caring for a 9-year-old boy who has a new diagnosis of diabetes mellitus and is eager to return to school and participate in social events. The mother tells the nurse she is afraid to let him take part in physical activities at school. Which of the following responses should the nurse make?
"Tell me more about how you are feeling about your son's activities."
A nurse is teaching a school-age child who has type 1 diabetes mellitus and his parents about illness management. Which of the following instructions should the nurse include?
"Test the urine for ketones."
A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? - "I am to take my blood sugar reading after meals." - "Insulin allows me to eat ice cream at bedtime." - "A weight reduction program will make me hypoglycemic." - "I give the insulin injection in my abdominal area."
- "I give the insulin injection in my abdominal area." The client should give insulin injections in one anatomic area for a consistent day-to-day absorption. The abdomen is the area for fastest absorption.
A nurse is providing teaching about foot care for a client who has type 2 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? - "I should soak my feet before trimming my nails." - "I should buy new shoes late in the day." - "I should wear a clean pair of nylon socks every day." - "I should use a heating pad at night when my feet feel cold."
- "I should buy new shoes late in the day." The client's feet are larger later in the day. Therefore, this is the best time to buy new shoes.
A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? - "I'll wear sandals in warm weather." - "I'll put lotion between my toes after drying my feet." - "I'll check my feet every day for sores and bruises." - "I'll soak my feet in cold water every night before I go to bed."
- "I'll check my feet every day for sores and bruises." The client should check his feet daily to monitor for any problems and observe any other changes before they become serious. He can use a hand mirror to examine areas that are difficult for him to see.
A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? - "Have an eye examination once per year." - "Examine your feet carefully every day." - "Wear compression stockings daily." - "Maintain stable blood glucose levels."
- "Maintain stable blood glucose levels." Keeping blood glucose under control is the client's best protection against long-term complications of diabetes, since increased blood sugar contributes to neuropathic disease, and microvascular complications such as retinopathy and nephropathy, as well as to macrovascular complications.
A nurse s caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times? - 0720 - 0730 - 0745 - 0815
- 0745 Regular insulin should be given 20 to 30 minutes before eating because the onset of action is 30 minutes. There are circumstances when this lag time guide can be adjusted.
A nurse is providing teaching to a client who has diabetes mellitus about carbohydrate intake needs when exercising. Which of the following foods should the nurse include as containing a 15 g serving of carbohydrates? - 2 slices bread - 1 cup sugar-free yogurt - 1 cup milk - 1 cup regular ice cream
- 1 cup milk The nurse should instruct the client that 1 cup of milk contains 15 g of carbohydrates. 1 slice of bread, 1/3 cup of sugar-free yogurt, and 1/2 cup of regular ice cream contain 15 g carbohydrates each.
A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe? - 14 units - 28 units - 32 units - 42 units
- 42 units Each order for units of insulin is combined in the same syringe. The nurse should withdraw the regular insulin into the syringe first.
A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels? - 6.3% - 7.8% - 8.5% - 10%
- 6.3% The client who has diabetes mellitus needs to manage activity and diet while monitoring blood glucose levels. High levels of blood glucose cause damage to kidney function. The goal for a client who has diabetes mellitus is to keep the HbA1c values at 6.5% or less.
A nurse is providing dietary teaching to a client who has nephropathy secondary to diabetes mellitus and plans to make dietary adjustments. Which of the following instructions should the nurse include? - Consume less than 45% of total calories from carbohydrates per day. - Eat no more than 300 mg of cholesterol per day. - Consume less that 0.8 g/kg of body weight of protein per day. - Eat at least 45 g of fiber per day.
- Consume less that 0.8 g/kg of body weight of protein per day. Clients who have diabetes should adjust protein intake to less than 08 g/kg of body weight per day to delay renal injury.
A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following instructions should the nurse include? - Perform vigorous exercise when blood glucose is less than 100 mg/dL - Do not exercise if ketones are present in your urine. - Avoid eating for 2 hr before exercise. - Examine your feet weekly.
- Do not exercise if ketones are present in your urine. The nurse should instruct the client not exercise if ketones are present in her urine because this is an indication of inadequate insulin and increases the risk for hyperglycemia.
A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include? - Discard the NPH solution if it appears cloudy. - Shake the insulin vigorously before loading the syringe. - Expect the NPH insulin to peak in 6 to 14 hr. - Freeze unopened insulin vials.
- Expect the NPH insulin to peak in 6 to 14 hr. NPH insulin is an intermediate-acting insulin. Its onset of action is 1 to 2 hr, peaking at 6 to 14 hrs. Its duration of action is 16 to 24 hr. The client is at risk for hypoglycemia during the peak time.
A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. To focus on affective learning with this client, which of the following interventions should the nurse use? - Ask the client to perform a return demonstration of insulin injection. - Review the action of insulin therapy. - Explore the client's feelings about dietary modifications. - Have the client practice blood-glucose monitoring using a glucometer.
- Explore the client's feelings about dietary modifications. This teaching intervention allows the client to express his acceptance of this change and focuses on affective learning
A nurse is reviewing the lab results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus? - HbA1c 5.5% - 2 hr blood glucose 170 mg/dL - Fasting blood glucose 155 mg/dL - Casual blood glucose 180 mg/dL
- Fasting blood glucose 155 mg/dL A fasting blood glucose above 126 mg/dL meets the criteria for a diagnosis of diabetes mellitus. An HbA1c level above 6.5%, 2 hr blood glucose of greater than 200 mg/dL, and casual blood glucose greater than 200 mg/dL are criteria for diagnosing diabetes mellitus.
A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations? - Sensitivity - Constipation - Frequent mood changes - Weight gain of 4.5 kg (10 lb) in 3 weeks
- Frequent mood changes Hyperthyroidism develops when the thyroid gland produces an excess of the thyroid hormones that regulate the metabolic rate. Clients experience emotional lability that fluctuates between emotional hyperexcitability and irritability. They often cannot sit quietly.
A nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine. Which of the following instructions should the nurse provide regarding this type of insulin? - Insulin glargine has a duration of 3 to 6 hr. - Insulin glargine has a duration of 6 to 10 hr. - Insulin glargine has a duration of 16 to 24 hr. - Insulin glargine has a duration of 18 to 24 hr.
- Insulin glargine has a duration of 18 to 24 hr. Insulin glargine is a long duration insulin that has a duration of 18 to 24 hr. It is only dosed once a day.
A nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. On which of the following medications should the nurse prepare to instruct the client? - Radioactive iodine - Levothyroxine - Sumatriptan - Levofloxacin
- Levothyroxine Levothyroxine is a synthetic thyroid hormone that is chemically identical to thyroxine (T4). It is used in the treatment of hypothyroidism. The nurse should prepare to instruct the client on this medication.
A nurse is caring for a client who has type 1 diabetes mellitus. Which of the following recommendations should the nurse make to the client for a sweetener? - Corn syrup - Natural honey - Nonnutritive sugar substitute - Guava nectar
- Nonnutritive sugar substitute Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Nonnutritive sugar substitutes allow the client to sweeten the taste of foods without increasing carbohydrate intake.
A nurse is assessing a client who is admitted with hyperthyroidism. The client reports a weight loss of 5.4 kg (12 lb) in the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following actions should the nurse take to prevent a thyroid crisis? - Provide a quiet, low-stimulus environment. - Administer aspirin as prescribed for any sign of hyperthermia. - Keep the client NPO. - Observe the client carefully for signs of hypocalcemia.
- Provide a quiet, low-stimulus environment. Thyroid crisis can occur in response to a stressor, so the nurse should minimize stressful stimuli in the client's environment.
A nurse is providing teaching to a client who has a new prescription for levothyroxine for hypothyroidism. The nurse should instruct the client to avoid which of the following herbal supplements? - Saw palmetto - Cranberry - Soy - Garlic
- Soy The nurse should instruct the client to avoid soy because soy can reduce the effectiveness of the levothyroxine.
What is hyperosmolar hyperglycemic state?
-acute problem of patients with Type 2 DM -serious life threatening emergency -mortality is high -blood glucose > 600 - plasma osmolality >340 -lethargic -decreasing LOC -seizures -extreme thirst (no ketones)
A nurse is preparing to administer lsspro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take?
Inject the insulin 15 minutes before a meal
how to draw up NPH and Regular insulin
1. Gently rotate cloudy insulin 2. Inject air into cloudy insulin (longer acting) 3. Inject air into clear insulin (rapid or short acting) 4. Draw up clear insulin (rapid or short acting) 5. Draw up cloudy insulin (long acting)
What is the correct order when mixing regular insulin and NPH insulin?
1. Inspect for contaminants. 2. Toll NPH (cloudy) between palm of hands. 3. Inject air into NPH insulin vial. 4. Inject air into regular insulin (clear) vial. 5. Withdraw short-acting insulin (clear) into syringe. 6. Add intermediate acting insulin (cloudy) to syringe. The mixture is stable for 28 days.
A nurse is preparing to administer lispro insulin to a client who has type 2 DM Which of the following actions should the nurse take?
Inject the insulin 15 minutes before a meal because it is a rapid-acting insulin that has an onset within 15-30 min. The client may develop HYPOglycemia quickly if they do not eat.
Regular insulin onset
30-60 min
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes? A 21-yr-old with a hemoglobin A1C of 8.4% A 35-yr-old with a fasting glucose of 111 mg/dL A 68-yr-old with a random glucose of 190 mg/dL A 78-yr-old with a 2-hour glucose tolerance glucose of 184 mg/dL
A 21-yr-old with a hemoglobin A1C of 8.4% Rationale: Criteria for a diagnosis of diabetes include a hemoglobin A1C of 6.5% or greater, fasting glucose level of 126 mg/dL or greater, 2-hour glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random glucose of 200 mg/dL or greater.
A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe?
42 units
A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider would the nurse implement first? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Ask the patient about home insulin doses. d. Start an insulin infusion at 0.1 units/kg/hr.
A
A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia? a. 10:00 AM b. 12:00 AM c. 2:00 PM d. 4:00 PM
A
The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 32 kg/m2 .Which goal in the plan of care is most important for this patient? a. The patient will reach a glycosylated hemoglobin level of less than 7%. b. The patient will follow a diet and exercise plan that results in weight loss. c. The patient will choose a diet that distributes calories throughout the day. d. The patient will state the reasons for eliminating simple sugars in the diet
A
The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action would the nurse take first? a. Assess the patient's perception of what it means to have diabetes. b. Ask the patient's family to participate in the diabetes education program. c. Demonstrate how to check glucose using the patient's blood glucose monitor. d. Discuss the need for the patient to actively participate in diabetes management.
A
The nurse is taking a health history from a 29-yr-old patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take? a. Schedule the patient for a fasting glucose level. b. Teach the patient about administering regular insulin. c. Teach about an increased risk for fetal problems with gestational diabetes. d. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.
A
Which nursing action is most important in assisting an older patient who has diabetes to engage in moderate daily exercise? a. Determine what types of activities the patient enjoys. b. Remind the patient that exercise improves self-esteem. c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity.
A
Which patient action indicates an accurate understanding of the nurse's teaching about the use of an insulin pump? a. The patient programs the pump for an insulin bolus after eating. b. The patient changes the location of the insertion site every week. c. The patient takes the pump off at bedtime and restarts it each morning. d. The patient plans a diet with more calories than usual when using the pump.
A
Which patient statement to the nurse indicates a need for additional instruction in administering insulin? a. ―I should inject the insulin into a muscle that I plan to exercise vigorously.‖ b. ―I can buy the 0.5-mL syringes because the line markings are easier to see.‖ c. ―I do not need to aspirate the plunger to check for blood before injecting insulin.‖ d. ―I should draw up the regular insulin first, after injecting air into the NPH bottle.‖
A
A nurse is caring for a 4-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following play activities should the nurse recognize is therapeutic in helping the child deal with the injection?
A needless syringe and a doll
A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply)? A. The level may be increased as a result of dehydration that accompanies hyperglycemia. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The level is consistent with renal insufficiency that can develop with renal nephropathy. D. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. E. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.
A, C, D. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.
Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)
A. Increased triglyceride levels Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.
A nurse is performing a monofilament sensory assessment of a client who has diabetes mellitus. When performing this assessment, for which of the following complications is the nurse monitoring?
Neuropathy
A nurse is teaching a client who has DM and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication?
Alcohol to prevent disulfiram reaction such as nausea, headache, and HYPOglycemia
The nurse is assigned to care for a person newly diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the person to actively participate in managing diabetes, what would be the nurse's initial intervention?
Assess the person's perception of what it means to have diabetes. Rationale: For teaching to be effective, the first step is to do an assessment. Teaching can be individualized after the nurse is aware of what a diagnosis of diabetes means to the person. After the initial assessment, current knowledge can be assessed, and goals should be mutually set.
A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy, the home health nurse makes a visit. Which finding would the nurse promptly discuss with the health care provider? a. Hemoglobin A1C level is 7.9%. b. Glomerular filtration rate is decreased. c. Last eye examination was 18 months ago. d. Patient has questions about the prescribed diet.
B
A patient who has diabetes and reports burning foot pain at night receives a new prescription. Which information would the nurse teach the patient about the purpose of amitriptyline? a. Amitriptyline decreases the depression caused by your foot pain. b. Amitriptyline helps prevent transmission of pain impulses to the brain. c. Amitriptyline corrects some of the blood vessel changes that cause pain. d. Amitriptyline improves sleep and makes you less aware of nighttime pain.
B
A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. Which advice would the clinic nurse plan to give the patient? a. Increase the morning dose of NPH insulin (Novolin N). b. Check glucose level before, during, and after swimming. c. Time the morning insulin injection to peak while swimming. d. Delay eating the noon meal until after finishing the swimming.
B
An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome (HHS). Which action would the nurse anticipate taking? a. Giving 50% dextrose b. Inserting an IV catheter c. Initiating O2 by nasal cannula d. Administering glargine (Lantus) insulin
B
The nurse teaches a person with diabetes about a healthy eating plan. Which statement made by the person indicates that teaching was successful? A. "I plan to lose 25 pounds this year by following a high-protein diet." B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." C. "I should include more fiber in my diet than a person who does not have diabetes." D. "If I use an insulin pump, I will not need to limit foods with saturated fat in my diet."
B
Which action by the patient who is self-monitoring blood glucose indicates a need for additional teaching? a. Washes the puncture site using warm water and soap. b. Chooses a puncture site in the center of the finger pad. c. Hangs the arm down for a minute before puncturing the site. d. Says the result of 120 mg indicates ―good blood sugar‖ control.
B
Which information about glyburide would the nurse include when teaching a patient who has type 2 diabetes? a. Glyburide decreases glucagon secretion from the pancreas. b. Glyburide stimulates insulin production and release from the pancreas. c. Glyburide should be taken even if the morning glucose level is low. d. Glyburide should not be used for 48 hours after receiving IV contrast media
B
A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." C. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
B. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.
A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia?
Blurred vision, tachycardia, moist, clammy skin
A 26-yr-old female who has type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and reports a glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. Which action would the nurse advise the patient to take? a. Use only the lispro insulin until the symptoms are resolved. b. Limit intake of calories until the glucose is less than 120 mg/dL. c. Monitor blood glucose every 4 hours and contact the clinic if it rises. d. Decrease carbohydrates until glycosylated hemoglobin is less than 7%
C
A hospitalized patient who has diabetes received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. Which nursing action would be the best way to prevent the patient from experiencing hypoglycemia? a. Plan to decrease the evening dose of insulin. b. Save the lunch tray for the patient's later return. c. Request that if testing is further delayed, the patient must eat lunch first.
C
A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test? a. The patient's glucose is 128 mg/dL. b. The patient's most recent A1C was 7.5%. c. The patient took the prescribed metformin today. d. The patient took the prescribed enalapril 4 hours ago.
C
A patient who takes metformin (Glucophage) to manage type 2 diabetes developed an allergic rash from an unknown cause and the health care provider prescribed prednisone. Which change in the plan of care at would the nurse anticipate? a. The patient may need a diet higher in calories while receiving prednisone. b. The patient may develop acute hypoglycemia while taking the prednisone. c. The patient may require administration of insulin while taking prednisone. d. The patient may have rashes caused by metformin-prednisone interactions.
C
A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action would the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice.
C
A patient with diabetes rides a bicycle to and from work every day. Which site would the nurse teach the patient to use to administer the morning insulin? a. Thigh b. Buttock c. Abdomen d. Upper arm
C
A person with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, the person is totally dependent on an outside source of insulin." C. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
C
An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider? a. Hemoglobin A1C level of 6.2% b. Heart rate at rest of 58 beats/min c. Blood pressure of 140/88 mmHg d. High-density lipoprotein (HDL) level of 65 mg/dL
C
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM
C
When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? a. Communicate the glucose level and insulin dose to the circulating nurse in surgery. b. Discuss the reason for insulin therapy during the immediate postoperative period. c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period
C
Which patient statement indicates that the nurse's teaching about exenatide (Byetta) has been effective? a. ―I may feel hungrier than usual when I take this medicine.‖ b. ―I will not need to worry about hypoglycemia with the Byetta.‖ c. ―I should take my daily aspirin at least an hour before the Byetta.‖ d. ―I will take the pill at the same time I eat breakfast in the morning.‖
C
The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works? A. Increases insulin production from the pancreas. B. Slows the absorption of carbohydrate in the small intestine. C. Reduces glucose production by the liver and enhances insulin sensitivity. D. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.
C. Reduces glucose production by the liver and enhances insulin sensitivity. Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.
A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI. C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration.
C. Cardiac monitoring to detect potassium changes This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.
A patient, who is admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? A. Central apnea B. Hypoventilation C. Kussmaul respirations D. Cheyne-Stokes respirations
C. Kussmaul respirations In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.
The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet?
Cheese Rationale: Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.
The nurse has been teaching a person with diabetes how to perform blood glucose monitoring (BGM). During evaluation of the person's technique, the nurse identifies a need for additional teaching when the person does what?
Chooses a puncture site in the center of the finger pad. Rationale: The person should select a site on the sides of the fingertips, not on the center of the finger pad because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.
After change-of-shift report, which patient will the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who was admitted with dawn phenomenon b. A 60-yr-old patient with type 1 diabetes whose most recent glucose reading was 230 c. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and reports burning foot pain d. A 35-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
D
The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level
D. Glycosylated hemoglobin level A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.
DKA vs HHS
DKA = Hyperglycemia, ketosis, acidemia DKA: - glucose 250-500 - HCO3 < 18 - elevated anion gap - serum/urine ketones - serum osmolarity <320 HHS: opposite HHS = Hyperosmolarity, hyperglycemia, Altered Mental Status
A nurse is teaching a client how to draw up regular insulin and NPH insulin into the same syringe. Which of the following instructions should the nurse include?
Discard regular insulin if cloudy as it should be clear. NPH insulin is the one that has a cloudy appearance since it is a suspension that needs to be rolled between your hands to mix.
A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following instructions should the nurse include?
Do not exercise if ketones are present in your urine.
A person with type 1 diabetes reports a headache, changes in vision, and being anxious. A portable glucose monitor is not available. Which action would the nurse advise the patient to take?
Eat 15 g of simple carbohydrates. Rationale: When a patient with type 1 diabetes is unsure about the meaning of the symptoms they are experiencing, they should treat for hypoglycemia to prevent seizures and coma from occurring. Have the patient check the glucose as soon as possible. The fat in the pizza and the diet pop would not allow the glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the glucose level.
A nurse is caring for a client who is at 22 weeks gestation and has been unable to control her gestational diabetes mellitus with diet and exercise. The nurse should anticipate a prescription from the provider for which of the following medications for the client?
Glyburide
he nurse caring for a person hospitalized with diabetes would look for which laboratory test result to obtain information on their past glucose control? Prealbumin level Urine ketone level Fasting glucose level Glycosylated hemoglobin level
Glycosylated hemoglobin level Rationale: A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.
A nurse is assisting a client who has thyrotoxicosis after taking too high of a level of levothyroxine. Which of the following manifestations should the nurse expect?
Heat intolerance. A client with an acute overdose will exhibit heat intolerance, sweating, and hyperthermia. These manifestations are indication of excessive levels of thyroid hormones that could lead to death.
DKA treatment
High IV flow rate (150-200hr) with insulin R in prescribed mixture (Rehydrate and push K back into cell, Oxygenate)
A nurse is assessing a cline who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect?
Hypoglycemia
A nurse is caring for a newborn who has macrosomia and whose mother has diabetes mellitus. The nurse should recognize which of the following newborn complications as the priority focus of care?
Hypoglycemia
Hypoglycemia (cold and clamy) vs Hyperglycemia (hot and dry): symptoms
Hypoglycemia: sudden onset, bizarre behaviors, pale, clammy skin, seizures Hyperglycemia: Gradual onset, hot dry skin, tired, acetone on breath, Kussmauls breathing
The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes?
Increased triglyceride levels Rationale: Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.
A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client who has DM. When mixing the 2 types of insulin, which of the actions should the nurse take first?
Inject 20 units of air into the NPH insulin vial because his insulin is the intermediate-acting insulin which will be drawn up last in order to avoid contaminating the regular insulin with the NPH insulin.
A patient, admitted with diabetes, has a glucose level of 580 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find?
Kussmaul respirations Rationale: In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored.
Long-acting insulin that takes 6 to 14 hours to start working.
Lantus
A nurse is providing teaching to a client who has a new diagnosis of HYPOthyroidism. On which of the following medications should the nurse prepare to instruct the client?
Levothyroxine is a synthetic hormone that is chemically identical to thyroxine (T4)
The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include?
Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin.
A patient with diabetes is scheduled for a fasting glucose level at 8:00 AM. The nurse teaches the patient to only drink water after what time?
Midnight before the test Rationale: Typically, a patient is ordered to be NPO for 8 hours before a fasting glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.
A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a reading over 200 mg/dL before the client's breakfast. Which of the following actions is the nurse's priority?
Monitor the client for hypoglycemia
Short-acting insulin that reaches the blood within 30 minutes.
Novolin R
Rapid-acting insulin that reaches the blood within 5 minutes.
Novolog
A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively?
Obtain comprehensive dental care. Rationale: A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health.
Lispro onset, peak, duration
Onset - 5-15 min Peak - 1/2 - 1 hr Duration - 3-4 hrs
NPH onset, peak, duration
Onset: 2-4 hours Peak: 4-10 hours Duration: 10-16 hours
Glargine onset, peak, duration
Onset: 3-4 hours Peak: None Duration: 24 hours
A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance?
Prednisone
The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What would the nurse teach the patient about how this medication works?
Reduces glucose production by the liver and enhances insulin sensitivity. Rationale: Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity.
A nurse is providing teaching to a client who has a new prescription for levothyroxine for HYPOthyroidism. The nurse should instruct the client to avoid which of the following herbal supplements?
Soy because it can reduce the effectiveness of levothyroxine.
A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect?
Weight loss
A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels? a. 6.3% b. 7.8% c. 8.5% d. 10%
a. 6.3%
DKA
acetone and keytones increase! once treated expect postassium to drop! have K+ ready
A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? a. "Have an eye examination once per year." b. "Examine your feet carefully every day." c. "Wear compression stockings daily." d. "Maintain stable blood glucose levels."
b. "Examine your feet carefully every day."
A nurse is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times? a. 0720 b. 0730 c. 0745 d. 0815
c. 0745
A nurse is caring for a client who has a new diagnosis of type I diabetes mellitus. To focus on affective learning with this client, which of the following interventions should the nurse use? a. Ask the client to perform a return demonstration of insulin injection. b. Review the action of insulin therapy. c. Explore the client's feelings about dietary modifications. d. Have the client practice blood-glucose monitoring using a glucometer.
c. Explore the client's feelings about dietary modifications.
A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus? a. Hb A1C 5.5% b. 2 hour blood glucose 170 mg/dL c. Fasting blood glucose 155 mg/dL d. Casual blood glucose 180 mg/dL
c. Fasting blood glucose 155 mg/dL
A nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine. Which of the following instructions should the nurse provide regarding this type of insulin? a. Insulin glargine has a duration of 3 to 6 hours. b. Insulin glargine has a duration of 6 to 10 hours. c. Insulin glargine has a duration of 16 to 24 hours. d. Insulin glargine has a duration of 18 to 24 hours.
d. Insulin glargine has a duration of 18 to 24 hours.
A nurse is preparing a teaching session about reducing the risk of complications of diabetes mellitus. Which of the following information should the nurse plan to include in the teaching?
reduce cholesterol and saturated fat intake, increase physical activity and daily exercise, enroll in a smoking-cessation program, maintain optimal blood pressure to prevent kidney damage
