Diabetes

Question 1

A nurse is teaching a client with diabetes mellitus who asks, Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL? How should the nurse respond?

Answer 1

Your brain needs a constant supply of glucose because it cannot store it.

Question 2

A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the clients polyuria?

Answer 2

Serum osmolarity: 375 mOsm/kg

Question 3

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?

Answer 3

Diabetes can cause blindness, so I should see the ophthalmologist yearly.

Question 4

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first?

Answer 4

Examine the clients feet for signs of injury.

Question 5

A nurse cares for a client who has a family history of diabetes mellitus. The client states, My father has type 1 diabetes mellitus. Will I develop this disease as well? How should the nurse respond?

Answer 5

Your risk of diabetes is higher than the general population, but it may not occur.

Question 6

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this clients plan of care to delay the onset of microvascular and macrovascular complications?

Answer 6

Maintain tight glycemic control and prevent hyperglycemia.

Question 7

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?

Answer 7

A 48-year-old American Indian

Question 8

A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this clients teaching to prevent bloodborne infections?

Answer 8

Do not share your monitoring equipment.

Question 9

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this clients teaching?

Answer 9

Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs).

Question 10

After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy?

Answer 10

I will take this medicine immediately before I eat.

Question 11

A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take?

Answer 11

Review the clients liver function study results.

Question 12

A nurse cares for a client with diabetes mellitus who asks, Why do I need to administer more than one injection of insulin each day? How should the nurse respond?

Answer 12

A single dose of insulin each day would not match your blood insulin levels and your food intake patterns.

Question 13

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?

Answer 13

The lower abdomen is the best location because it is closest to the pancreas.

Question 14

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first?

Answer 14

Administer 1 mg of intramuscular glucagon.

Question 15

A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, Can I ask my niece to prefill my syringes and then store them for later use when I need them? How should the nurse respond?

Answer 15

Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up.

Question 16

A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this clients discharge education?

Answer 16

Change the needle every 3 days.

Question 17

After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching?

Answer 17

I should look into swimming or water aerobics to get my exercise.

Question 18

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition?

Answer 18

Increased rate and depth of respiration

Question 19

A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client?

Answer 19

pH 7.28, HCO3 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg

Question 20

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take?

Answer 20

Administration of intravenous insulin

Question 21

A nurse cares for a client who has type 1 diabetes mellitus. The client asks, Is it okay for me to have an occasional glass of wine? How should the nurse respond?

Answer 21

One glass of wine is okay with a meal and is counted as two fat exchanges.

Question 22

A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this clients teaching to decrease the clients insulin needs?

Answer 22

Walk at a moderate pace for 1 mile daily.

Question 23

A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing. How should the nurse respond?

Answer 23

One acute rejection episode does not mean that you will lose the new organs.

Question 24

After teaching a client who is recovering from pancreas transplantation, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional education?

Answer 24

If I develop an infection, I should stop taking my corticosteroid.

Question 25

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the clients breath has a fruity odor. Which action should the nurse take?

Answer 25

Consult the provider to test for ketoacidosis.

Question 26

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The clients blood glucose level is 160 mg/dL. Which action should the nurse take?

Answer 26

Document the finding in the clients chart.

Question 27

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this clients teaching to prevent injury?

Answer 27

Use a bath thermometer to test the water temperature.

Question 28

A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, My cousin has depression and is taking this drug. Do you think Im depressed? How should the nurse respond?

Answer 28

Its for peripheral neuropathy. Do you have burning pain in your feet or hands?

Question 29

A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client?

Answer 29

Presence of protein in the urine

Question 30

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the clients diet should the nurse decrease?

Answer 30

Proteins

Question 31

A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the clients clinical manifestations have not changed. Which action should the nurse take next?

Answer 31

Administer another half-cup of orange juice.

Question 32

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately?

Answer 32

Serum potassium level of 2.5 mmol/L

Question 33

A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this clients teaching?

Answer 33

Monitor your blood glucose levels at least every 4 hours while sick.

Question 34

A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted?

Answer 34

Glasgow Coma Scale score is unchanged.

Question 35

A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin?

Answer 35

1600

Question 36

After teaching a client with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?

Answer 36

Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick.

Question 37

When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, I will never be able to stick myself with a needle. How should the nurse respond?

Answer 37

Tell me what it is about the injections that are concerning you.

Question 38

A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take?

Answer 38

Instruct the client to rotate sites for insulin injection.

Question 39

A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose?

Answer 39

Metformin (Glucophage)

Question 40

After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?

Answer 40

I should decrease my intake of protein and eliminate carbohydrates from my diet.

Question 41

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen:

Fasting blood glucose: 75 mg/dL
Postprandial blood glucose: 200 mg/dL

Hemoglobin A1c level: 5.5%

Answer 41

Good control of blood glucose

Question 42

A nurse prepares to administer insulin to a client at 1800. The clients medication administration record contains the following information:

Insulin glargine: 12 units daily at 1800

Regular insulin: 6 units QID at 0600, 1200, 1800, 2400

Based on the clients medication administration record, which action should the nurse take?

Answer 42

Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.

Question 43

A nurse prepares to administer prescribed regular and NPH insulin. Place the nurses actions in the correct order to administer these medications.

1. Inspect bottles for expiration dates.
2. Gently roll the bottle of NPH between the hands.
3. Wash your hands.
4. Inject air into the regular insulin.
5. Withdraw the NPH insulin.
6. Withdraw the regular insulin.
7. Inject air into the NPH bottle.
8. Clean rubber stoppers with an alcohol swab.

Answer 43

3, 1, 2, 8, 7, 4, 6, 5

Question 44

A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.)

a. 56-year-old African-American male
b. Female with a 30-pound weight gain during pregnancy
c. Male with a history of pancreatic trauma
d. 48-year-old woman with a sedentary lifestyle
e. Male with a body mass index greater than 25 kg/m2
f. 28-year-old female who gave birth to a baby weighing 9.2 pounds

Answer 44

A, D, E, F

Question 45

A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.)

a. Deep and fast respirations
b. Decreased urine output
c. Tachycardia
d. Dependent pulmonary crackles
e. Orthostatic hypotension

Answer 45

A, C, E

Question 46

A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this clients teaching? (Select all that apply.)

a. Do not walk around barefoot.
b. Soak your feet in a tub each evening.
c. Trim toenails straight across with a nail clipper.
d. Treat any blisters or sores with Epsom salts.
e. Wash your feet every other day.

Answer 46

A,C

Question 47

A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.)

a. Stroke
b. Kidney failure
c. Blindness
d. Respiratory failure
e. Cirrhosis

Answer 47

A, B, C

Question 48

A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.)

a. Registered dietitian
b. Clinical pharmacist
c. Occupational therapist
d. Health care provider
e. Speech-language pathologist

Answer 48

A, B, D