A nurse provides instructions to a client with type 1 diabetes mellitus about home care
measures to treat hypoglycemia. The nurse determines that the client understands the
instructions if which statement is made?
A. I will self administer insulin
B. I will notify my health care provider if I become hypoglycemic
C. I will eat six saltine crackers - Answers C. I will eat six saltine crackers
Rationale: Hypoglycemia is the term used to describe a blood glucose level below 70mg/dL. The
client must consume a substance that contains 10 to 15 g of carbohydrates.
A client newly diagnosed with type 1 diabetes mellitus exercises daily. When teaching this client
about medication therapy, the nurse tells the client to inject the daily dose of insulin in which
location?
A. In a site that will be exercised
B. In a site that will not be exercised
C. In a site that is intermittently exercised - Answers B. In a site that will not be exercised
Rationale: Exercise of a body part increases the rate of absorption of insulin from that site. For
this reason, the client should inject insulin into an area that will not be exercised. This will help
the client to avoid hypoglycemia from rapid insulin absorption.
The nurse is developing a care plan for an older client diagnosed with diabetic neuropathy of the
lower extremities due to poor glucose regulation. The nurse understands that which problem is
the priority of this client?
A. Decreased sensation in legs and feet
B. A minor headache
C. Nausea after taking medication - Answers A. Decreased sensation in legs and feet
,Rationale: The client with diabetic neuropathy of the lower extremities has diminished ability to
feel sensations in the leg and feet. This client is at risk for tissue injury and for falls as a result
of this nervous system impairment
A client diagnosed with insulin-dependent diabetes mellitus tells the nurse, "I am having a
hypoglycemic reaction." What should the nurse select to treat this problem?
A. 4 oz of orange juice
B. half a cup of sugar free soda
C. 25 jelly beans
D. 1 teaspoon of honey - Answers A. 4 oz of orange juice
Rationale: A 10-15g simple carbohydrate load is generally needed to increase the blood glucose
level quickly and adequately
A nurse is providing information to a client who has just learned that he has type 1 diabetes
mellitus. The nurse tells the client that the blood level of HbA1c will need to be checked
periodically. How does the nurse explain the purpose of the test to the client?
A. It is used to measure your blood glucose after you have just eaten a meal
B. It is used to measure the degree of glucose control in the preceding 3 months
C. It is used to measure you blood glucose levels right before you go to bed every night -
Answers B. It is used to measure the degree of the glucose control in the preceding 3 months
A nurse is assessing an older adult client who is receiving IV therapy. The nurse should
recognize that which of the following findings indicates fluid volume excess? (Select all that
apply).
A. bounding pulse
B. pitting edema
C. swelling at IV site
, D. urine specific gravity greater than 1.030
E. crackles upon auscultation - Answers A. bounding pulse
B. pitting edema
E. crackles upon auscultation
Rationale:
Swelling at IV site indicates fluid accumulation due to infiltration not due to fluid volume excess.
Urine specific gravity measures concentration of all chemical particles in urine. A urine specific
gravity greater than 1.030 indicates dehydration while a gravity less than 1.010 indicates fluid
volume excess
A nurse is assessing a client who has a sodium level of 116mEq/L. Which of the following
findings should the nurse expect?
A. nausea and vomiting
B. Extreme thirst
C. Flushed skin - Answers A. nausea and vomiting
Rationale: A sodium value of 116mEq/L indicates hyponatremia. Nausea and vomiting are
expected findings for a client with this sodium level.
A nurse is assessing a client who has hypokalemia as a result of nausea, vomiting, and diarrhea.
Which of the following findings should the nurse expect?
A. hyperactive reflexes
B. extreme thirst
C. weak, irregular pulse - Answers C. weak, irregular pulse
Rationale: Common manifestations of potassium depletion include a weak and irregular pulse,
muscle weakness, fatigue, and ventricular dysrhythmias