EAQ + HESI- Diabetes Flashcards
Which is the etiological factor of nephrogenic diabetes insipidus (DI)?
Meningitis
Lithium therapy
Graves disease
Sulfonamide therapy
Lithium therapy
Lithium therapy is the etiological factor of nephrogenic DI. Central nervous system infections such as meningitis are etiological factors of central DI. Goiter, an enlarged thyroid gland, is commonly seen in clients with Graves disease. Sulfonamide is a goitrogen that can cause goiter.
Which is a secondary cause of adrenal insufficiency?
Hemorrhage
Tuberculosis
Pituitary tumors
Metastatic cancer
Pituitary tumors
Adrenal insufficiency is also called Addison disease. Secondary causes of adrenal insufficiency include pituitary tumors. Primary causes, which are responsible for adrenal insufficiency, include hemorrhage, tuberculosis, and metastatic cancer.
Which gland secretes melatonin?
Pineal gland
Thyroid gland
Adrenal gland
Parathyroid gland
Pineal gland
The pineal gland secretes the hormone melatonin, which regulates the circadian rhythm and reproductive system at the onset of puberty. The thyroid gland secretes thyroid hormones. The adrenal gland secretes androgens, corticosteroids, and catecholamines. The parathyroid gland secretes the hormone calcitonin.
Which blood glucose levels would the nurse identify as hypoglycemia?
68 mg/dL (3.8 mmol/L)
78 mg/dL (4.3 mmol/L)
88 mg/dL (4.9 mmol/L)
98 mg/dL (5.4 mmol/L)
68 mg/dL (3.8 mmol/L)
Normal blood glucose level for an adult is 72 to 108 mg/dL (4-6 mmol/L). Clients who have blood glucose levels less than 72 mg/dL (4 mmol/L) may experience hypoglycemia; 78 mg/dL (4.3 mmol/L), 88 mg/dL (4.9 mmol/L), and 98 mg/dL (5.4 mmol/L) are normal blood glucose levels.
Normal blood glucose level for an adult is ___________ mg/dL
72 to 108
hypoglycemia symptoms occur when blood glucose levels fall below ___ mg/dL.
70
Which disorder is caused by the deficiency of antidiuretic hormone?
Acromegaly
Diabetes insipidus
Cushing syndrome
Syndrome of inappropriate antidiuretic hormone
Diabetes insipidus
Which term would the nurse use in a report to describe the absence of menstrual periods in a 35-year-old nonpregnant client?
Rhinorrhea
Menopause
Amenorrhea
Dyspareunia
Amenorrhea
The absence of menstrual periods in a nonpregnant client younger than 55 years old is called ______________ .
amenorrhea
Rhinorrhea is an ________ state that is manifested by a runny nose
allergic
Dyspareunia is ______ during sexual intercourse
pain
Which surgery will a client undergo if the pituitary gland must be removed?
Mastectomy
Prostatectomy
Thyroidectomy
Hypophysectomy
Hypophysectomy
A hypophysectomy is the surgical removal of the pituitary gland (hypophysis) or its tumor. A mastectomy is the surgical removal of breast tissue. A prostatectomy is the surgical removal of the prostate gland. A thyroidectomy is the surgical removal of the thyroid gland.
Which hormone is released from the posterior pituitary gland?
Oxytocin
Prolactin
Growth hormone
Luteinizing hormone
Oxytocin
Prolactin, growth hormone, and luteinizing hormone are produced by the __________ pituitary gland.
anterior
Which hormone has both inhibiting and releasing action?
Prolactin
Somatostatin
Somatotropin
Gonadotropin
Prolactin
Which hormone is formed from cholesterol?
Insulin
Cortisol
Prolactin
Growth hormone
Cortisol
All lipid-soluble hormones are synthesized from cholesterol. Cortisol, a lipid-soluble hormone, is secreted by the adrenal cortex. All water-soluble hormones are formed from amino acids. Insulin, prolactin, and growth hormone are water-soluble hormones. Insulin is secreted by the pancreas. Prolactin and growth hormone are secreted by the pituitary gland.
Which action would be appropriate to implement when collecting a 24-hour urine test?
Start the time of the test after discarding the first voiding.
Discard the last voiding in the 24-hour period for the test.
Insert a urinary retention catheter to promote the collection of urine.
Strain the urine after each voiding before adding the urine to the container.
Start the time of the test after discarding the first voiding.
Which organ has only beta-1 receptors?
Liver
Heart
Bladder
Pancreas
The heart has only beta-1 receptors, which increase heart rate and contractility.
The liver has only alpha receptors.
The bladder and pancreas have both alpha and beta receptors.
Which catecholamine receptor is responsible for increased heart rate?
Beta-1 receptor
Beta-2 receptor
Alpha-1 receptor
Alpha-2 receptor
Beta-1 receptors are responsible for increased heart rate.
Beta-2 receptors, alpha-1 receptors, and alpha-2 receptors are not present in the heart; therefore, they are not responsible for increasing the heart rate.
Beta receptors are present in such organs as blood vessels, kidneys, bronchioles, and bladder. Alpha receptors are present in such organs as eyes, skin, and liver.
Which hormone regulates blood levels of calcium?
Parathyroid hormone (PTH)
Luteinizing hormone (LH)
Thyroid-stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Parathyroid hormone (PTH)
Which hormone is released from the pancreas?
Oxytocin
Prolactin
Calcitonin
Somatostatin
Somatostatin
Somatostatin is a hormone produced by the pancreas that inhibits the release of insulin and glucagon.
Oxytocin is a hormone produced by the posterior pituitary gland that acts on the uterus and mammary glands. Prolactin is a hormone produced by the anterior pituitary gland that targets the ovaries and mammary glands in women and testes in men. Calcitonin is a hormone produced by the thyroid gland that interacts with bone tissue.
Which gland is an exocrine gland?
Thyroid gland
Salivary gland
Pituitary gland
Parathyroid gland
Salivary gland
Exocrine glands are glands with ducts that produce enzymes but not hormones. These glands secrete enzymes into ducts. The salivary gland secreting saliva is an example of an exocrine gland. Endocrine glands are ductless glands that produce hormones that are secreted into the blood. Thyroid, pituitary, and parathyroid glands are examples of endocrine glands.
The nurse cares for a client with an abnormal cortisol level. The nurse recalls which information about cortisol?
Cortisol metabolizes free fatty acids.
Cortisol stimulates gluconeogenesis.
Cortisol stimulates protein synthesis.
Cortisol levels decline in stressful conditions.
Cortisol stimulates gluconeogenesis.
Cortisol maintains the blood glucose concentration by stimulating the liver for gluconeogenesis. Gluconeogenesis involves formation of glucose from amino acids and fatty acids. Cortisol mobilizes free fatty acids and inhibits protein synthesis. The blood levels of cortisol increase in stressful conditions.
Which hormone would the nurse identify as inhibiting insulin and glucagon secretion?
Amylin
Somatostatin
Triiodothyronine (T 3)
Pancreatic polypeptide
Somatostatin
Which adverse effect can be seen in a female client with gonadotropin deficiency and who is undergoing hormone replacement therapy?
Thrombosis
Hypotension
Dehydration
Increased thirst
Thrombosis
To ensure a quality specimen and an accurate test result, which instruction would the nurse give a client who is scheduled to undergo urine endocrine testing?
“Start the urine collection when the bladder is full.”
“Store the urine specimen in a cooler with ice.”
“Store the urine specimen in a home refrigerator.”
“Save the urine specimen that begins the collection.”
“Store the urine specimen in a cooler with ice.”
The urine specimen that is collected for endocrine testing should be stored in a cooler with ice to prevent bacterial growth in the specimen. The nurse should instruct the client to start the urine collection after emptying the bladder. The client should be instructed not to store the urine specimen in a home refrigerator with other food and drinks because it could lead to cross-contamination. The client should be instructed to refrain from saving the urine specimen that begins the collection because the timing for urine collection starts from after the initial voiding specimen.
Which procedure is preferred to find out the composition of a thyroid nodule and ascertain the need for further surgical intervention?
Mass spectrometry
Computed tomography scans
Glycosylated hemoglobin test
Needle biopsy
Needle biopsy
A nurse educator instructs a new nurse during orientation about the physiological processes of the endocrine system. Which statement made by the new nurse indicates effective learning?
“The endocrine system comprises glands with narrow ducts.”
“The endocrine system comprises salivary and lacrimal glands.”
“The hormones of the endocrine system exert their action by ‘lock and key’ mechanism.”
“The hormones secreted by endocrine system exert their action on all tissues they contact.”
“The hormones of the endocrine system exert their action by ‘lock and key’ mechanism.”
Which gland is affected in aldosteronoma?
Kidney cortex
Thyroid gland
Pituitary gland
Adrenal cortex
Adrenal cortex
The nurse is teaching a client newly diagnosed with type 1 diabetes about self-care. Which is the primary long-term goal?
Maintaining normoglycemia
Complying with the diabetic diet
Adhering to an exercise program
Developing a nonstressful lifestyle
Maintaining normoglycemia
Which complication is the nurse’s main priority during the early postoperative period after a subtotal thyroidectomy?
Hemorrhage
Thyrotoxic crisis
Airway obstruction
Hypocalcemic tetany
Airway obstruction
Maintaining airway patency is always the priority to permit gas exchange necessary to maintain life. Although important, hemorrhage, thyrotoxic crisis, and hypocalcemic tetany do not exceed patency of the airway in priority.
Why is 15 g of a simple sugar administered when a client with diabetes experiences hypoglycemia?
Inhibits glycogenesis
Stimulates release of insulin
Increases blood glucose levels
Provides more storage of glucose
Increases blood glucose levels
Which hormones are secreted by the posterior pituitary gland? Select all that apply. One, some, or all responses may be correct.
Oxytocin
Prolactin
Corticotropin
Antidiuretic hormone
Melanocyte-stimulating hormone
Oxytocin
Antidiuretic hormone
Which instruction would the nurse provide to a 6’ 0”, 160-pound client newly diagnosed with type 1 diabetes who wants to self-administer injections with an insulin pen? Select all that apply. One, some, or all responses may be correct.
Prime the needle with two units.
Use a 29-gauge insulin needle.
Give the injection at 45-degree angle.
Refrain from recapping the needle.
Dial the pen to deliver the unit dose.
All of the above
Which sign or symptom would the nurse expect to find on assessment of a client with a blood glucose level of 55 mg/dL?
Increased thirst
Abdominal pain
Frequent urination
Cold, clammy skin
Cold, clammy skin
A client with a blood glucose level of 55 mg/dL indicates hypoglycemia. Clinical manifestations would include cold, clammy skin; tachycardia; nervousness; and slurred speech.
A client with hyperglycemia would present with increased thirst (polydipsia), abdominal pain, increased urination (polyuria), and polyphagia.
A client with ______________ would present with increased thirst (polydipsia), abdominal pain, increased urination (polyuria), and polyphagia.
hyperglycemia
Which action would the nurse include in the plan of care for a client undergoing a transsphenoidal hypophysectomy? Select all that apply. One, some, or all responses may be correct.
Assessing for clear nasal drainage
Maintaining strict intake and output
Increasing daily dietary fiber intake
Elevating the head of the bed 30 degrees
Instructing on the use of an incentive spirometer
All of the above
A deficiency in which hormone causes breast atrophy in female clients?
Growth hormone
Luteinizing hormone
Thyroid-stimulating hormone
Adrenocorticotropic hormone
Luteinizing hormone
Which medication can cause diabetes insipidus?
Cabergoline
Metyrapone
Demeclocycline
Aminoglutethimide
Demeclocycline
A deficiency in which hormone reduces the growth of axillae and pubic hair in female clients?
Growth hormone
Antidiuretic hormone
Thyroid-stimulating hormone
Adrenocorticotropic hormone
Adrenocorticotropic hormone
The nurse administers vasopressin to a client and recalls that the medication is which type of hormone?
Growth hormone
Luteinizing hormone
Antidiuretic hormone
Thyroid-stimulating hormone
Antidiuretic hormone
The nurse would observe a client for which side effect when administering androgen therapy?
Baldness
Headaches
Gastric irritation
Orthostatic hypotension
Baldness
The nurse is reviewing the medical records of several clients. Which client has a condition that is an autoimmune disorder?
Addison disease
Cushing syndrome
Hashimoto disease
Sheehan syndrome
Hashimoto disease
Which cells produce the thyrocalcitonin hormone?
Islet cells
Adrenal cells
Pituitary cells
Parafollicular cells
Parafollicular cells
The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms?
Nervous and weak
Thirsty with a headache
Flushed and short of breath
Nausea and abdominal cramps
Nervous and weak
Nervousness and weakness are the most commonly reported symptoms of hypoglycemia and are related to increased sympathetic nervous system activity. Feeling flushed and short of breath are adaptations of hyperglycemia. Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of hyperglycemia.
Nervousness and weakness are the most commonly reported symptoms of ____________ and are related to increased sympathetic nervous system activity.
hypoglycemia
Feeling flushed and short of breath, Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of _____________ .
hyperglycemia
Which information would the nurse provide a client with diabetes mellitus (DM) regarding alcohol consumption?
Before meals
One drink per week
Complete abstinence
With or shortly after meals
With or shortly after meals
Which infection control measures would the nurse provide a client regarding blood glucose monitoring? Select all that apply. One, some, or all responses may be correct.
Wear gloves.
Reuse lancets.
Perform hand washing.
Clean site before fingerstick.
Share blood glucose monitor.
Perform hand washing.
Clean site before fingerstick.
The nurse is educating a client about managing hypoglycemia unawareness. Which information would the nurse provide?
Refrain from alternative testing sites.
Use any available meter to monitor levels.
Initiate continuous blood glucose monitoring.
Calibrate the meter before managing hypoglycemia.
Refrain from alternative testing sites.
When the client is managing hypoglycemia, the same site should be used to obtain blood glucose levels. This provides consistent readings because blood glucose levels are changing rapidly. The client should use his or her meter to monitor blood glucose levels for consistency. Continuous blood glucose monitoring should be implemented when the client is stable, not during hypoglycemic episodes. The client should calibrate the meter once a day, but not when hypoglycemic. The client needs a meter that can provide instant results without waiting for tests to be performed on the meter itself.
The nurse educator is providing information about different insulin types. Which type of insulin can be safely mixed with regular human insulin in the same syringe?
Insulin glargine
Insulin detemir
Insulin lispro mix 75/25
Isophane insulin neutral protamine hagedorn (NPH)
Isophane insulin neutral protamine hagedorn (NPH)
Which information would the nurse provide to a client taking dulaglutide?
Give with insulin.
Administer medication orally.
Works without exercise.
Perform self-injection weekly.
Perform self-injection weekly.
A client newly diagnosed with type 1 diabetes asks why it is necessary to exercise on a regular basis. Which response is accurate?
“Exercise decreases insulin sensitivity.”
“It stimulates glucagon production.”
“Exercise improves the cellular uptake of glucose.”
“It reduces metabolic requirements for glucose.”
“Exercise improves the cellular uptake of glucose.”
Why is blood glucose self-monitoring preferred over urine glucose testing?
Blood glucose monitoring is more accurate.
Blood glucose monitoring is easier to perform.
Blood glucose monitoring is done by the client.
Blood glucose monitoring is not influenced by medications.
Blood glucose monitoring is more accurate.
The nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. Which interventions would the nurse include to decrease the risk of complications? Select all that apply. One, some, or all responses may be correct.
Examine the feet daily.
Wear well-fitting shoes.
Perform regular exercise.
Powder the feet after showering.
Visit the primary health care provider weekly.
Test bathwater with the toes before bathing.
Examine the feet daily.
Wear well-fitting shoes.
Perform regular exercise.
Which client response is most important for the nurse in the postanesthesia care unit to monitor when caring for a client who had a thyroidectomy?
Urinary retention
Signs of restlessness
Decreased blood pressure
Signs of respiratory obstruction
Signs of respiratory obstruction
Which intervention would the nurse implement for a client who has type 1 diabetes and has an elevated blood glucose?
Administer an oral hypoglycemic.
Institute urine glucose monitoring.
Give supplemental doses of regular insulin.
Decrease the rate of the intravenous infusion.
Give supplemental doses of regular insulin.
Which gland secretes gonadotropin-releasing hormone to help control the events of puberty?
Hypothalamus
Thyroid
Anterior pituitary
Posterior pituitary
Hypothalamus
In which order do the events of antidiuretic hormone (ADH) secretion stimulated by plasma osmolarity occur?
Osmoreceptors are activated.
Extracellular fluid is decreased.
Plasma osmolarity is increased.
Antidiuretic hormone (ADH) is released.
Water is reabsorbed from renal tubules.
1.Extracellular fluid is decreased.
2.Plasma osmolarity is increased.
3.Osmoreceptors are activated.
4.Antidiuretic hormone (ADH) is released.
5.Water is reabsorbed from renal tubules.
Glucose transportation into the cells through cell membranes takes place in which order?
Attachment of insulin to cell receptors
Secretion of proinsulin by beta cells
Storage of proinsulin in the pancreas
Transformation of proinsulin into active insulin
Secretion of proinsulin by beta cells
Storage of proinsulin in the pancreas
Transformation of proinsulin into active insulin
Attachment of insulin to cell receptors
Which is the target tissue for the parathyroid hormone?
Intestines
All body cells
Mammary glands
Sympathetic effectors
Intestines
The target tissue of the parathyroid hormone is the intestines. Growth hormone acts on all body cells. The mammary gland is the target tissue of oxytocin. Epinephrine and norepinephrine act on the sympathetic effectors.
The ___________ gland is the target tissue of oxytocin
mammary
Which exogenous conditions are responsible for increased cortisol secretion? Select all that apply. One, some, or all responses may be correct.
Asthma
Adrenal adenomas
Cancer chemotherapy
Organ transplantation
Carcinomas of the lung
Asthma
Cancer chemotherapy
Organ transplantation
Which molecule excessively accumulates in the blood to precipitate the signs and symptoms associated with a diabetic coma?
Sodium bicarbonate, causing alkalosis
Ketones as a result of rapid fat breakdown, causing acidosis
Nitrogen from protein catabolism, causing ammonia intoxication
Glucose from rapid carbohydrate metabolism, causing drowsiness
Ketones as a result of rapid fat breakdown, causing acidosis
Identify the primary causes of adrenal insufficiency. Select all that apply. One, some, or all responses may be correct.
Hemorrhage
Tuberculosis
Pituitary tumors
Postpartum pituitary necrosis
Acquired immunodeficiency syndrome (AIDS)
The primary causes of adrenal insufficiency are hemorrhage, tuberculosis, and AIDS.
Pituitary tumors and postpartum pituitary necrosis are the secondary cases of adrenal insufficiency.
Which nursing intervention is appropriate during the first 24 hours after a thyroidectomy when the nurse is concerned about thyroid storm?
Perform range-of-motion exercises.
Humidify the room air continuously.
Assess for hoarseness every 2 hours.
Check vital signs every 2 hours after they stabilize.
Check vital signs every 2 hours after they stabilize.
Before having surgery, a client with type 1 diabetes insulin requirements are elevated but well controlled. Which insulin requirements would the nurse anticipate for this client postoperatively?
Decrease
Fluctuate
Increase sharply
Remain elevated
Remain elevated
When teaching a client with type 2 diabetes, which statement by the nurse reflects accurate information about preparing for a serum glucose test?
“Eat your usual breakfast.”
“Have clear liquids for breakfast.”
“Take your medication before the test.”
“Do not ingest anything before the test.”
“Do not ingest anything before the test.”
Which information would the nurse include in a teaching plan about what causes diabetic acidosis?
A breakdown of fat stores for energy
Ingestion of too many highly acidic foods
Excessive secretion of endogenous insulin
Increased amounts of cholesterol in the extracellular compartment
A breakdown of fat stores for energy
When teaching the client about when to call the primary health care provider if they are showing signs of hypothyroidism after a thyroidectomy, which statement made by the client shows that teaching was effective?
“I will call if I get dry hair and can’t tolerate the cold.”
“I would call if I have muscle cramps and feel sluggish.”
“I will call if I am feeling fatigued and my pulse rate goes up.”
“I should call if my heart is beating really fast and I gain a lot of weight.”
“I will call if I get dry hair and can’t tolerate the cold.”
Dry, sparse hair and cold intolerance are characteristic responses to low serum thyroxine. Muscle cramping is associated with hypocalcemia. Low thyroxine levels reduce the metabolic rate, resulting in fatigue, but do not increase the pulse rate. Low thyroxine levels reduce the metabolic rate, resulting in weight gain and bradycardia, not tachycardia.
A client with diabetes mellitus who shows decreased glucose tolerance is at risk for which complication?
Cystitis
Thin and dry skin
Decreased bone density
Frequent yeast infections
Frequent yeast infections
What is the etiology of Kussmaul respirations?
To compensate for metabolic acidosis, respirations are deep and rapid.
To overcome respiratory acidosis, the respirations are fast and shallow.
Injury to the brain’s respiratory center results in periods of apnea.
Hypoxemia causes labored, gasping, and irregular respirations.
To compensate for metabolic acidosis, respirations are deep and rapid.
To compensate for ketoacidosis (metabolic acidosis), the lungs attempt to remove CO2 through a pattern of deep, rapid respirations referred to as Kussmaul respirations.
To achieve the goal of restoring the client’s fluid volume, the nurse would expect to implement which intervention?
Insert a saline lock for PRN diuretic administration.
Administer an albumin/furosemide continuous infusion.
Maintain an infusion of normal saline solution.
Obtain a type and crossmatch for 2 units of packed RBCs.
Maintain an infusion of normal saline solution.
The treatment of hyperglycemia includes fluid replacement to correct dehydration caused by the increased concentration of glucose in the blood. Isotonic fluids, such as normal saline, are initially used to treat the dehydration.
To restore the client’s [high] blood glucose to a normal level, what should the nurse prepare to administer?
An IV infusion containing regular insulin.
Humulin-N insulin subcutaneously (SQ) before meals.
50% dextrose IV push.
Glucagon SQ PRN per sliding scale.
An IV infusion containing regular insulin.
Continuous IV infusions containing regular insulin are used to reduce the client’s blood glucose level. The client’s IV solution will be changed to one that contains glucose when the blood glucose level reaches 250 mg/dL.
The client tells the nurse that they know that diabetes (type 1) is a chronic condition and realizes they probably have had it for a while. The client wonders why they haven’t experienced any symptoms before now.
How should the nurse respond?
“The symptoms were so minor that you just didn’t notice them until you got the flu.”
“The type of diabetes you have is the acute form of diabetes, rather than the chronic form.”
“The onset of symptoms is so gradual that your body adjusts to the changes.”
“The symptoms have an abrupt onset that is often brought on by a viral illness like the flu.”
“The symptoms have an abrupt onset that is often brought on by a viral illness like the flu.”
Since type 1 diabetes seems to involve an interaction of genetic predisposition with an environmental trigger, the onset of symptoms is often abrupt and follows an illness like the flu.
The client states that they wish they hadn’t gotten the flu so that the diabetes wouldn’t have been discovered and they could keep having a normal life.
What is the best initial response by the nurse?
“What do you mean when you say a normal life?”
“It’s better to find out now before complications develop.”
“Perhaps you would like to speak to someone who has diabetes.”
“It must be quite a shock to learn that you have diabetes.”
“It must be quite a shock to learn that you have diabetes.”
This statement acknowledges the client’s feelings and is open-ended to allow the client to continue to verbalize their feelings if they wish.
The goal of treatment with hypoglycemic agents is maintenance of stable blood glucose levels to prevent acute complications of hypoglycemia and hyperglycemia and long-term complications associated with hyperglycemia. The client will initially administer 70% NPH/30% regular insulin subcutaneously (SQ) every morning, a sliding scale dose of regular insulin SQ before lunch and dinner, and NPH (N) insulin at bedtime. Which statement made by the client indicates a correct understanding of insulin self-administration?
“My daily dose of 70% NPH/30% regular insulin is based on how much I ate the day before.”
“The amount of short-acting insulin I take every day is based on my blood sugar readings.”
“I should store my insulin in the refrigerator and remove it 30 minutes before I need it.”
“I will alternate my injection sites from leg to abdomen each day to avoid overuse.”
“The amount of short-acting insulin I take every day is based on my blood sugar readings.”
The nurse observes the client administer the morning dose of insulin. The client pinches the skin on the front of the thigh and inserts the needle at a 90-degree angle.
Which action should the nurse implement?
Advise the client to remove the needle and reinsert it at a 45-degree angle.
Instruct the client to pull the plunger back slightly before injecting the insulin.
Tell the client to remove the needle and draw up a new dose of insulin.
Encourage the client to inject the insulin with the needle in place as inserted.
Encourage the client to inject the insulin with the needle in place as inserted.
The client has performed the steps for subcutaneous injection correctly. Since aspiration is not necessary, the client is ready to inject the insulin.
An hour before the next dose of sliding scale insulin is scheduled, the client tells the nurse that they are really nervous about self-administering the insulin and shows the nurse their shaky and sweaty hands.
What is the priority nursing action?
Obtain the client’s vital signs.
Check the client’s blood glucose.
Assure the client that they will be able to give themself the injections.
Offer to bring the client an orange so they can practice giving injections.
Check the client’s blood glucose.
Being shaky and sweaty are symptoms of hypoglycemia. Therefore, it is most important to check the client’s blood glucose. If low, the nurse should provide a snack of milk and graham crackers.
Once the client is feeling better, the client practices injection skills and later states that they feel more comfortable about self-administration. The next morning, the client is preparing to administer the insulin with the nurse’s supervision. However, the nurse is called back to the desk by the unit clerk and learns that several clients are having problems that require immediate attention.
Which action should the nurse take first?
Return to the client’s room to supervise the scheduled insulin injection.
Administer a dose of IV antibiotics to a diabetic with an infected foot ulcer.
Administer IV dextrose to a diabetic client with a blood glucose level of 25 mg/dL (1.39 mmol/L).
Hang a new bag of sodium chloride for a diabetic with a blood glucose level of 275 mg/dL (14.26 mmol/L).
Administer IV dextrose to a diabetic client with a blood glucose level of 25 mg/dL (1.39 mmol/L).
This is the most critical client care situation. The client’s blood glucose is dangerously low and lack of action by the nurse could endanger the client’s life. The charge nurse uses a form of triage based on the client with the most critical need.
The client attends a series of classes on diabetes management. The client learns that goals of diet therapy for type 1 diabetes are to consume all essential nutrients, achieve and maintain ideal body weight, and maintain blood glucose levels as near normal as possible. The client tells the nurse that they understand the importance of a well-balanced diet, but they are in college and will want to go out for a beer every now and again. The client indicates that a can of beer has a lot of calories and they will watch what they eat if they plan to have a drink. What is the best response by the nurse?
“Drinking alcohol is prohibited on a diabetic diet because you can’t predict how your blood glucose will react.”
“Alcohol does contain a lot of empty calories, but it’s also likely to cause your blood glucose to decrease.”
“Plan to take extra insulin when you drink beer because drinking will increase your blood glucose.”
“A can of beer equals one carbohydrate exchange. Adjust your calories and food intake accordingly.”
“Alcohol does contain a lot of empty calories, but it’s also likely to cause your blood glucose to decrease.”
Twelve ounces of beer is the equivalent of two fat exchanges, which may elevate triglyceride levels, as well as adding empty calories. It is important that the diabetic understand that alcohol may induce hypoglycemia. Therefore, the client should drink alcohol only in moderation and with or shortly after meals.
The client tells the nurse that they will make sure to drink plenty of water and will take a little extra regular insulin before beginning strenuous exercise.
What is the best response by the nurse?
Remind the client to carry with them a simple carbohydrate snack.
Acknowledge the client’s understanding of correct pre-exercise measures.
Advise the client that extra insulin should not generally be taken before exercise.
Teach the client that extra insulin will provide more energy.
Advise the client that extra insulin should not generally be taken before exercise.
Exercise may cause hypoglycemia during or after the activity. Therefore, additional carbohydrates may be needed before, during, or after exercise. Clients should perform self-monitoring of blood glucose levels to determine the effects of exercise those levels. In addition, it is important to remember that exercise in a client with uncontrolled diabetes results in hyperglycemia and may lead to ketosis. Diabetics with ketonuria and a blood glucose of 250 mg/dL (11.10 mmol/L) or higher should avoid exercise.
The Somogyi effect is the term for _____________________________ after nighttime hypoglycemia. It is often caused by too much insulin or lack of an adequate bedtime snack.
rebound morning hyperglycemia
After discharge, the client is scheduled for a follow-up evaluation at the outpatient clinic. A glycosylated hemoglobin (Hgb) level is drawn and the result is 11%.
Which statement by the client reflects an understanding of glycosylated Hgb?
“The results of the test are probably high because I was not fasting before my blood was drawn this morning.”
“The results of my test are probably high because I went to a party last night and did not follow my diet.”
“I know that I need to check my glycosolated Hgb before each meal and at bedtime, but I don’t always have time.”
“At least I won’t have this done again for 3 months. I will work really hard at following my diet between now and then.”
“At least I won’t have this done again for 3 months. I will work really hard at following my diet between now and then.”
This test reflects average blood glucose levels over a period of approximately 120 days, the life of the average red blood cell (RBC). Glucose molecules attach to hemoglobin in RBCs. The longer the glucose in the blood is above normal, the higher the percentage of glycosylated hemoglobin. Normal levels range from 4% to 6% (0.04 to 0.06%), with levels over 8% (0.08%) indicating poor glycemic control. Note: Normal values may differ, depending on the lab.
The client’s 15-year-old sister had a fasting blood glucose test last week. The client’s sister felt that she had some of the same symptoms that the client had before being diagnosed with diabetes. The client tells the nurse that the sister’s results were 135 mg/dL (7.49 mmol/L).
How should the nurse respond?
“She needs a second test performed before a diagnosis is made.”
“Since her value is high, it sounds like both of you have diabetes.”
“Her value is low and indicates that she does not have diabetes.”
“She is too young to develop type 1 diabetes. She may have type 2.”
“She needs a second test performed before a diagnosis is made.”
The diagnosis of diabetes is based on two fasting blood glucose levels greater than 126 mg/dL (6.99 mmol/L).
The diagnosis of diabetes is based on two fasting blood glucose levels greater than ____ mg/dL (6.99 mmol/L).
126
Illness increases the risk for dehydration and _______glycemia
hyper
The highest risk for the onset of type 1 diabetes is linked to the presence of certain _________
antigens
Women with gestational diabetes have a high risk for developing diabetes after __________, but not all will get the disease.
pregnancy
The client asks the nurse to describe the differences between HHS and DKA.
How should the nurse respond?
HHS is the result of excess insulin, rather than hyperglycemia and ketosis.
HHS is primarily caused by excess ketone bodies, although hyperglycemia occurs.
HHS is caused by persistent hyperglycemia, but ketosis does not occur.
HHS is the result of fluid and electrolyte imbalance, not blood glucose.
HHS is caused by persistent hyperglycemia, but ketosis does not occur.
HHS is caused by persistent hyperglycemia resulting in osmotic diuresis, which results in fluid and electrolyte losses. There is enough insulin present to prevent breakdown of fats that leads to ketosis. Therefore, ketones are not found in the urine.
HHS primarily affects type ___ diabetics who are significantly dehydrated.
2
Which finding indicates that the client is experiencing a complication of diabetes? (Select all that apply.)
Select all that apply
Burning sensation in the toes.
Visual acuity of 20/60.
Protein in the urine.
Blood pressure of 110/60.
A sore on the foot that is not healing.
-Burning sensation in her toes
-Protein in her urine
-A sore on her foot that is having trouble healing.
