Week 7 Post-Lecture Quiz
The clinical findings of a client with diabetes mellitus show decreased glucose tolerance. Which complication is anticipated in the client? A. Frequent yeast infections B. Thin and dry skin C. Cystitis D. Decreased bone density.
A. Frequent yeast infections Decreased glucose tolerance may cause frequent yeast infections, but it is not associated with the risk of cystitis, thin and dry skin, and decreased bone density. The risk of cystitis, thin and dry skin, and decreased bone density are due to decreased ovarian production of estrogen.
A client with type 1 diabetes mellitus has a finger stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime. A prescription for sliding-scale regular insulin exists. What should the nurse do? A. Administer the insulin as prescribed. B. Call the health care provider. C. Give the client a half cup of orange juice. D. Encourage the intake of fluids.
A. Administer the insulin as prescribed. A value of 258 mg/dL (14.3 mmol/L) is above the expected range of 70 to 100 mg/dL (3.6 to 5.6 mmol/L); the nurse should administer the regular insulin as prescribed. Calling the health care provider is unnecessary; a prescription for insulin exists and should be implemented. Encouraging the intake of fluids is insufficient to lower a glucose level this high. Giving the client a half cup of orange juice is contraindicated because it will increase the glucose level further; orange juice, a complex carbohydrate, and a protein should be given if the glucose level is too low.
The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions? Select all that apply. A. Dry between the toes after bathing B. Use a heating pad when the feet feel cold. C. Soak the feet in warm water daily. D. Remove corns as soon as they appear. E. Wear shoes when out of bed.
A. Dry between the toes after bathing E. Wear shoes when out of bed. Wearing shoes protects the feet from trauma they should fit well and should be worn over clean socks. Drying between the toes after bathing prevents maceration and skin breakdown, thus maintaining skin integrity. Soaking the feet is contraindicated because it can cause macerations and skin breakdown, which allow a portal of entry for pathogenic organisms. Clients should not self-treat corns, calluses, warts, or ingrown toenails because of the potential for trauma and skin breakdown; these conditions should be treated by a podiatrist. Use of a heating pad, hot water bottle, or hot water is contraindicated because of the potential for burns; diabetic neuropathy, if present, does not allow the client to accurately evaluate the extremes of temperature.
The health care provider prescribes one tube of glucose gel for the client with type 1 diabetes. The nurse recognizes that this is for treatment of which diabetes complication? A. Diabetic acidosis B. Insulin-induced hypoglycemia C. Hyperinsulin secretion D. Idiosyncratic reactions to insulin
B. Insulin-induced hypoglycemia Glucose gel delivers a measured amount of simple sugars to provide glucose to the blood for rapid action. Acidosis occurs when there is an increased serum glucose level; therefore glucose gel is not indicated. Diabetes mellitus involves a decreased insulin production. Glucose gel is not indicated in idiosyncratic reactions to insulin.
The nurse is caring for a client with diabetes mellitus who is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. What does the nurse recognize as the only type of insulin that is compatible with intravenous solutions? A. Insulin lispro B. Regular insulin C. NPH insulin D. Insulin glargine
B. Regular insulin Regular insulin acts rapidly, is approved for IV administration, and is compatible with intravenous solutions. Insulin lispro is not compatible with intravenous solutions; it is a rapid-acting insulin. Insulin glargine is not compatible with intravenous solutions; it is a long-acting insulin. NPH insulin is not compatible with intravenous solutions; it is an intermediate-acting insulin.
A client has been placing used insulin needles in a container sealed with heavy-duty tape. The client asks where the container can be disposed of. How should the nurse respond? A. Mail it to the Environmental Protection Agency (EPA). B. Take it to the local hazardous waste collection site. C. Place it in the regular household trash. D. Take it to the local health department for disposal.
B. Take it to the local hazardous waste collection site. Each state (province) has its own waste management guidelines for proper disposal of sharps containers, as well as hazardous waste collection sites. Clients cannot place needles in the regular household trash because sharps are considered medical waste. The local health department does not collect sharps containers. Sharps containers are not mailed directly to the EPA.
A nurse realizes that a client has been administered a double dose of insulin by mistake and informs the primary healthcare provider. Which element of the decision-making reflects in the nurse's action? A. Responsibility B. Authority C. Accountability D. Autonomy
C. Accountability Accountability means being answerable for one's actions. The nurse's action of admitting the mistake and seeking instructions to correct it indicates accountability. Authority is the legitimate power to give instructions and make final decisions in a situation. Autonomy is freedom of choice and responsibility for the choices. Responsibility indicates the duties and activities that an individual is employed to perform.
A client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis. Which component is increased in the blood and a direct cause of acidosis? A. Glutamic acid B. Lactic acid C. Ketones D. Glucose
C. Ketones The ketones produced excessively in diabetes are a by-product of the breakdown of body fats and proteins for energy; this occurs when insulin is not secreted or is unable to be used to transport glucose across the cell membrane into the cells. The major ketone, acetoacetic acid, is an alpha-ketoacid that lowers the blood pH, resulting in acidosis. Glucose does not change the pH. Lactic acid is produced as a result of muscle contraction; it is not unique to diabetes. Glutamic acid is a product of protein metabolism.
A client with diabetes mellitus complains of difficulty seeing. What would the nurse suspect as the causative factor? A. Lack of glucose in the retina B. Destructive effect of ketones on retinal metabolism C. Inadequate glucose supply to rods and cones D. The growth of new retina blood vessels or "neovascularization"
D. The growth of new retina blood vessels or "neovascularization" Proliferative diabetic retinopathy is the growth of new retinal blood vessels, also known as "neovascularization." When retinal blood flow is poor and hypoxia develops, retinal cells secrete growth factors that stimulate the formation of new blood vessels in the eye. These new vessels are thin, fragile, and bleed easily, leading to eye hemorrhage and vision loss. Hemorrhages in the eyes precipitate retinal detachment, resulting in blindness. There is an increase in serum glucose in clients with diabetes mellitus; thickening of the capillary basement membranes can occur, even if the glucose level is maintained within normal limits. Ketones do not affect retinal metabolism; retinopathy is a result of vascular changes, retinal detachment, and hemorrhage within the eye.
A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? A. Increases glucose transport across the cell membrane B. Stimulates the pancreas to produce insulin C. Lowers blood glucose in the absence of pancreatic function D. Accelerates the liver's release of stored glycogen
B. Stimulates the pancreas to produce insulin Glyburide an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.
