Diabetes Mellitus Questions and Answers

Diabetes Mellitus Questions and Answers

A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?

Prednisone (Deltasone)

Allopurinol (Zyloprim)

Atenolol (Tenormin)

Phenelzine (Nardil)

Rotating injection sites when administering insulin prevents which of the following complications?

Insulin resistance

Systemic allergic reactions

Insulin lipodystrophy

Insulin edema

Insulin forces which of the following electrolytes out of the plasma and into the cells?

Phosphorus

Potassium

Magnesium

Calcium

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.

Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.

Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.

A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:

Call the physician

Encourage the intake of fluids

Give the client ½ c. of orange juice

Administer the insulin as ordered

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide:

Fluid replacement

Oxygen

Carbohydrates

Dietary instruction

When a client is in diabetic ketoacidosis, the insulin that would be administered is:

Human regular insulin

Human NPH insulin

Insulin glargine injection

Insulin lispro injection

The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively:

25-40%

10-20%

50-60%

85-90%

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

Elevated blood glucose level and a low plasma bicarbonate

Comatose state

Decreased urine output

Increased respirations and an increase in pH

The lowest fasting plasma glucose level suggestive of a diagnosis of DM is:

90mg/dl

126mg/dl

115mg/dl

180mg/dl

A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse?

BP

Temperature

Respiration

Pulse

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: 1. High risk for d

Imbalanced nutrition: less than body requirements

Deficient knowledge: disease process and treatment

Disabled family coping: compromised

High risk for deficient fluid volume

Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:

Document weight changes because of fatty acid mobilization

Do all of the above

Protect the patient from sources of infection because of decreased cellular protein deposits

Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation

Which of the following chronic complications is associated with diabetes?

Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s

Retinopathy, neuropathy, and coronary artery disease

Leg ulcers, cerebral ischemic events, and pulmonary infarcts

Dizziness, dyspnea on exertion, and coronary artery disease

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:

Apply an electrocardiogram monitor

Correct the acidosis

Administer 5% dextrose intravenously

Administer regular insulin intravenously

Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection?

No changes

More insulin

Less insulin

Oral antidiabetic agents

Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:

Hypoglycemia

Hyponatremia

Ketonuria

Polyphagia

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?

IV bolus, followed by continuous infusion

Intramuscular

IV bolus only

Subcutaneous

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

Give subcutaneous insulin and monitor blood glucose

Monitor blood glucose, and assess for signs of hyperglycemia

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

Monitor blood glucose closely, and look for signs of hypoglycemia

Albert refuses his bedtime snack. This should alert the nurse to assess for:

Symptoms of hyperglycemia during the peak time of NPH insulin.

Signs of hypoglycemia earlier than expected.

Elevated serum bicarbonate and a decreased blood pH.

Sugar in the urine

 

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of:

16-20 hours

6-8 hours

24-28 hours

10-14 hours

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The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says:

“I need to rub my forearm vigorously until warm before testing at this site.”

“The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”

“I have to make sure that my current glucose monitor can be used at an alternate site.”

“Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.”

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to:

Make sure the client knows all the correct medical terms to understand what is happening

Administer a sedative

Convey empathy, trust, and respect toward the client

Ignore the signs and symptoms of anxiety so that they will soon disappear

A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?

Shallow respirations and severe abdominal pain

Cheyne-stokes respirations and foul-smelling urine

Decreased respirations and increased urine output

Kussmaul’s respirations and a fruity odor on the breath

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every:

Week

Third day

2-3 weeks

2-4 weeks

A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse’s primary responsibility to:

Assist the client out of bed to the chair

Check the client’s serum glucose level

Place the client in a high-fowlers position

Ensure that the client’s residual limb is elevated

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise?

“The best time for me to exercise is after breakfast.”

“The best time for me to exercise is every afternoon.”

“The best time for me to exercise is after my morning snack.”

“The best time for me to exercise is right after I eat.”

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

Observation for paleness of the lower extremities

Palpation for increased pulse volume in the arteries of the lower extremities

Integumentary inspection for the presence of brown spots on the lower extremities

Observation for blanching of the feet after the legs are elevated for 60 seconds

Glucose is an important molecule in a cell because this molecule is primarily used for:

Synthesis of protein

Extraction of energy

Building of genetic material

Formation of cell membranes

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

Weakness

Nausea

Diaphoresing

Blurred vision

The insulin that has the most rapid onset of action would be:

Lispro

Humulin N

Lente

Ultralente

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.

Palpitations

Thirst

Hyperventilation

Diaphoresis

Slurred speech

Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to exhibit? Select all that apply:

Low PCO2

Sweating

Acetone breath

Elevated serum bicarbonate

Retinopathy

A client with DM states, “I cannot eat big meals; I prefer to snack throughout the day.” The nurse should carefully explain that the:

Large meals can contribute to a weight problem

Small, frequent meals are better for digestion

Regulated food intake is basic to control

Salt and sugar restriction is the main concern

Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

1530 and 2130

1330 and 1930

1730 and 2330

1130 and 1330

A client’s blood gases reflect diabetic acidosis. The nurse should expect:

Decreased HCO3

Decreased PO2

Increased PCO2

Increased pH

The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order. 1. Inject air equal to NPH dose into NPH vial 2. Invert regular insulin bottle and withdraw regular insulin dose 3. Inject air equal to regular dose into regular dose 4. Invert NPH vial and withdraw NPH dose.

1, 4, 3, 2.

1, 2, 3, 4.

1, 4, 2, 3,

1, 3, 2, 4.

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:

Provides more storage of glucose

Increases blood glucose levels

Stimulates the release of insulin

Inhibits gluconeogenesis

Which of the following causes of HHNS is most common?

Undiagnosed, untreated diabetes mellitus

Removal of the adrenal gland

Undiagnosed, untreated hyperpituitarism

Insulin overdose

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:

6-14 hours after administration

2-4 hours after administration

18-24 hours after administration

16-18 hours after administration

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