Med_Surg_Chapter_51

Med-Surg Chapter 51: Assessment and Management of Patients With Diabetes Question A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, “You look anorexic.” Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? • "Your body is using protein and fat for energy instead of glucose." Question A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? • Increased hunger Question A 1200-calorie diet and exercise are prescribed for a client with newly diagnosed type 2 diabetes. The nurse is teaching the client about meal planning using exchange lists. The teaching is determined to be effective based on which statement by the client? • "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda." Question A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it? • "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." Question A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The father reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? • Begin fluid replacements. Question A client has been diagnosed with prediabetes and discusses treatment strategies with the nurse. What can be the consequences of untreated prediabetes? • All options are correct. Question A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: • polyphagia. Question A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client’s symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? • Assess the client's breath odor Question A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first? • Infuse 0.9% normal saline solution 1 L/hr for 2 hours. Question A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? • Blood glucose level 1,100 mg/dl Question A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? • 7:45 AM Question A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? • Crying whenever diabetes is mentioned Question A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? • ketoacidosis Question A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? • Serum osmolarity Question A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? • Metformin Question A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? • 1/2 cup fruit juice or regular soft drink Question A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? • Serum glucose level of 52 mg/dl Question A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client? • Low blood glucose concentration Question A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: • Deficient knowledge (treatment regimen). Question A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: • "It tells us about your sugar control for the last 3 months." Question A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? • Underlying problem of insulin resistance Question A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? • Sweating, tremors, and tachycardia Question A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? • Rapid, thready pulse Question A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? • Coma, anxiety, confusion, headache, and cool, moist skin Question A client has been diagnosed with prediabetes and discusses treatment strategies with the nurse. What can be the consequences of untreated prediabetes? • All options are correct. Question A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? • "I skip lunch when I don't feel hungry." Question A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? • "Ketones will tell us if your body is using other tissues for energy." Question A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? • They increase the need for insulin. Question A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: • 8:30 AM. Question A nurse educator has been invited to a local senior center to discuss health-maintaining strategies for older adults. During a session on nutrition, the nurse discusses diabetes mellitus, its symptoms, and consequences. In the United States, diabetes mellitus is the leading cause of death. • seventh Question A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? • Control blood glucose levels. Question A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? • Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Question A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: • suggest referral to a sex counselor or other appropriate professional. Question A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: • 15 to 20 g of a fast-acting carbohydrate such as orange juice. Question A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? • Albumin Question A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? • Dietitian Question A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? • The short-acting insulin is withdrawn before the intermediate-acting insulin. Question A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of “sick days.” The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse’s best response? • "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Question A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? • Presence of autoantibodies against islet cells Question A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? • Reviewing the patient’s diet history to identify eating habits and lifestyle and cultural eating patterns Question A patient who is diagnosed with type 1 diabetes would be expected to: • Need exogenous insulin. Question A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? • "Your child will need less blood work as his glucose levels stabilize." Question After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? • “I might need insulin later on but probably not as much or as often.” Question An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? • Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Question During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: • at least three times per week. Question During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? • Glycosylated hemoglobin level Question Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? • Serum glycosylated hemoglobin (Hb A1c) Question Lispro (Humalog) is an example of which type of insulin? • Rapid-acting Question NPH is an example of which type of insulin? • Intermediate-acting Question The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? • Increases ability for glucose to get into the cell and lowers blood sugar Question The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? • Sensory neuropathy Question The greatest percentage of people have which type of diabetes? • Type 2 Question The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? • 10 to 15 minutes Question The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? • It carries glucose into body cells. Question The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? • Reflects the amount of glucose stored in hemoglobin over past several months. Question The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? • NPH Question The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? • Insulin production insufficient Question The nurse is teaching an older client how to self-administer insulin. Which of the following would be most helpful to the client who is having difficulty drawing up the correct dosage of insulin in the syringe? • Syringe magnifier Question The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: The pancreatic hormone glucagon will stimulate the liver to release stored gluco Question When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? • Accuracy of the dosage Question When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: • "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." Question When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? • Hypoglycemia Question Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? • Using sterile technique during the dressing change Question Which would be included in the teaching plan for a client diagnosed with diabetes mellitus? • An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. Question Which type of insulin acts most quickly? • Lispro Question Which statement is correct regarding glargine insulin? • It cannot be mixed with any other type of insulin. Question Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? • Fruity breath Question Which age-related change may affect diabetes and its management? • Decreased renal function Question Which statement is true regarding gestational diabetes? • A glucose challenge test should be performed between 24 and 28 weeks. Question Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? • The client has eaten and has not taken or received insulin. Question Which of the following medications is considered a glitazone? • Actos Question Which instruction about insulin administration should a nurse give to a client? • "Always follow the same order when drawing the different insulins into the syringe." Question Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? • Do not mix with other insulins. Question Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? • Presence of islet cell antibodies Question The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? • It carries glucose into body cells. Question Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? • The client has eaten and has not taken or received insulin. Question Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? • High sugar pulls fluid into the bloodstream, which results in more urine production. Question Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? • "Test your blood glucose every 4 hours." Question Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. • Elevated blood urea nitrogen (BUN) and creatinine • Rapid onset • More common in type 1 diabetes Question Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? • Presence of islet cell antibodies