Ch. 56 Diabetes Mellitus Flashcards
Which client assessment finding indicates to the nurse the possible presence of diabetic autonomic neuropathy?
A. Hyperglycemia
B. Increased thirst
C. Intermittent constipation
D. Loss of sensation in both feet
C. Intermittent constipation
The nurse is caring for a client newly diagnosed with diabetes who asks, “Why am I always so thirsty?” Which nursing response is most appropriate.
A. “The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst.”
B. “Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugary drinks.”
C. “The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level.”
D. “Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost.”
C. “The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level.”
Which assessment finding in a client with diabetes mellitus indicates to the nurse that the disease is damaging the kidneys?
A. Ketone bodies in the urine during acidosis
B. Glucose in the urine during hyperglycemia
C. Protein in the urine during a random urinalysis
D. White blood cells (WBCs) in the urine during a random urinalysis
C. Protein in the urine during a random urinalysis
The nurse is caring for a client newly diagnosed with T1DM who asks, “why can’t insulin be taken by mouth?” What nursing response is appropriate?
A. “Injected insulin works faster than oral drugs to lower blood glucose levels.”
B. “Oral insulin is so weak that it would require very high dosages to be effective.”
C. “Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes”
D. “Insulin is a “high alert drug” and could more easily be abused if it were available as an oral agent.”
C. “Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes”
At what time will the nurse plan to monitor for hypoglycemia in a client with type 1 diabetes who received regular insulin at 7:00 a.m.?
A. 7:30 a.m.
B. 11:00 a.m.
C. 2:00 p.m.
D. 7:30 p.m.
B. 11:00 a.m.
A client expressed fear and anxiety over the life changes associated with diabetes, stating, “I am scared that I can’t do it all and will get so sick that I will be a burden on my family.” What is the nurse’s best response?
A. “It is overwhelming, isn’t it?”
B. “Many people live with diabetes and do it just fine.”
c. “Let’s tackle it piece by piece. What is most scary to you?”
D. “Let’s see how much you can learn today, so you are less nervous.”
C. “Let’s tackle it piece by piece. What is most scary to you?”
The nurse has just received report on a group of clients. What client is the nurse’s first priority?
A. A 40 year old taking glyburide who is dizzy and sweaty
B. A 45 year old taking metformin who has abdominal cramps
C. A 50 year old taking repaglinide who has nausea and back pain
D. A 55 year old taking pioglitazone who has bilateral ankle swelling
A. A 40 year old taking glyburide who is dizzy and sweaty
Which action has the highest priority for the nurse to take when a client with type 1 diabetes arrives in the emergency department breathing deeply and stating, “I can’t catch my breath.” Vital signs are: T 98.4F, P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air.
A. Administer oxygen
B. Assessing blood glucose level
C. Connecting a cardiac monitor
D. Assessing arterial blood gas (ABG) values
B. Assessing blood glucose level
Which factor is most important for the nurse to assess before providing instruction to a client newly diagnosed with diabetes about the disease and its management?
A. Sexual orientation
B. Education and literacy levels
C. Current lifestyle for diet and exercise
D. Current energy level and rest patterns
B. Education and literacy levels
Which client statement who is learning about self-injection of insulin indicates to the nurse that additional teaching is needed?
A. “The abdominal site is best because it is closest to the pancreas.”
B. “ I can reach my thigh best, so I will use different areas of the same thigh.”
C. “By rotating sites without one area, my chance of having skin changes is less.”
D. “If I change my injection site from the thigh to an arm, the insulin absorption may be different.”
A. “The abdominal site is best because it is closest to the pancreas.”
Which nursing action is appropriate when assessing that a client who has had diabetes for 15 years has decreased sensory perception in both feet?
A. Documenting the finding as the only action
B. Examining both feet for indications of injury
C. Testing the sensory perception of the client’s hands
D. Explaining to the client that peripheral neuropathy is now present
B. Examining booth feet for indications of injury
What action will the nurse advise for a client with diabetes who has a 3cm callus on the ball of the right foot?
A. “Make an appointment with your podiatrist as soon as possible.”
B. “Make an appointment with a pedicurist and have them cut or file off the callus.”
C. “Soak your feet nightly in warm water and peel off a little of the callus every day.”
D. “Apply an over-the-counter callus-dissolving pad and follow the package directions.”
A. “Make an appointment with your podiatrist as soon as possible.”
How will the nurse reply when a client with type 2 diabetes tells the nurse that he would like to have a 12-ounce glass of beer with supper but believes that is now impossible?
A. “If you give up dessert, you can still have one beer.”
B. “There are nonalcoholic beers available that you can substitute for a regular beer.”
C. “You can have a beer with a meal if you test yourself for hypoglycemia an hour later.”
D. “You can have a beer with a meal if you test yourself for hyperglycemia an hour later.”
C. “You can have a beer with a meal if you test yourself for hypoglycemia an hour later.”
Which client statement indicates understanding to the nurse of what to do when the sensations of hunger and shakiness occur?
A. “I will drink a glass of water.”
B. “I will eat three graham crackers.”
C. “I will give myself a dose of glucagon.”
D. “I will sit down and rest.”
B. “I will eat three graham crackers.”
The nurse is caring for a client with type 2 diabetes who is recovering from surgery. The client asks, why am I getting insulin, I usually take metformin. What is the best nursing response?
A. “You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two.”
B. “You must take insulin from now on because the surgery has aggravated the intensity of your diabetes.”
C. “Your pre surgical testing indicates that you now have type 1 diabetes and require daily insulin.”
D. “Your insurance doesn’t permit metformin to be used during hospitalization.”
A. “You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two.”
