site.iugaza.edu.pssite.iugaza.edu.ps/naselnoor/files/2012/02/The-Client... · Web viewWhen a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a

The Client with Diabetes Mellitus19. The nurse is teaching a diabetic client usingan empowerment approach. The nurse should initiateteaching by asking which of the following?■ 1. “How much does your family need to beinvolved in learning about your condition?”■ 2. “What is required for your family to manageyour symptoms?”■ 3. “What activities are most important for you tobe able to maintain control of your diabetes?”■ 4. “What do you know about your medicationsand condition?”20. A nurse is participating in a diabetes screeningprogram. Who of the following is (are) at risk fordeveloping type 2 diabetes? Select all that apply.■ 1. A 32-year-old female who delivered a 9½-lbinfant.■ 2. A 44-year-old Native American Indian whohas a body mass index (BMI) of 32.■ 3. An 18-year-old Hispanic who jogs four timesa week.■ 4. A 55-year-old Asian American who has hypertensionand two siblings with type 2 diabetes.■ 5. A 12-year-old who is overweight.21. A 57-year-old with diabetes insipidus is hospitalizedfor care. Which fi nding should the nursereport to the physician?■ 1. Urine output of 350 mL in 8 hours.■ 2. Urine specifi c gravity of 1.001.■ 3. Potassium of 4.0 mEq.■ 4. Weight gain.22. The nurse is checking the laboratory resultson a 52-year-old client with type 1 diabetes (seechart). What laboratory result indicates a problemthat should be managed?■ 1. Blood glucose.■ 2. Total cholesterol.■ 3. Hemoglobin.■ 4. Low-density lipoprotein (LDL) cholesterol.Laboratory ResultsTest ResultBlood glucose 192 mg/dLTotal cholesterol 250 mg/dLHemoglobin 12.3 mg/dLLow-density lipoprotein cholesterol 125 mg/dL23. A client with type 1 diabetes mellitus hasdiabetic ketoacidosis. Which of the following fi ndingshas the greatest effect on fl uid loss?■ 1. Hypotension.■ 2. Decreased serum potassium level.■ 3. Rapid, deep respirations.■ 4. Warm, dry skin.24. A client is to receive glargine (Lantus) insulin

in addition to a dose of aspart (NovoLog). When thenurse checks the blood glucose level at the bedside,it is greater than 200 mg/dL. How should the nurseadminister the insulins?■ 1. Put air into the glargine insulin vial, and thenair into the aspart insulin vial, and draw upthe correct dose of aspart insulin fi rst.■ 2. Roll the glargine insulin vial, then roll theaspart insulin vial. Draw up the longer-actingglargine insulin fi rst.■ 3. Shake both vials of insulin before drawing upeach dose in separate insulin syringes.■ 4. Put air into the glargine insulin vial, anddraw up the correct dose in an insulinsyringe; then, with a different insulin syringe,put air into the aspart vial and draw up thecorrect dose.25. An adult client with type 2 diabetes is takingmetformin (Glucophage) 1,000 mg two times everyday. After the nurse provides instructions regardingthe interaction of alcohol and metformin, the nurseevaluates that the client understands the instructionswhen the client says:■ 1. “If I know I’ll be having alcohol, I mustnot take metformin; I could develop lacticacidosis.”■ 2. “If my physician approves, I may drink alcoholwith my metformin.”■ 3. “Adverse effects I should watch for are feelingexcessively energetic, unusual muscle stiffness,low back pain, and a rapid heartbeat.”■ 4. “If I feel bloated, I should call my physician.”26. A client has recently been diagnosed withtype 2 diabetes mellitus and is to take tolbutamide(Orinase). When teaching the client about the drug,the nurse explains that tolbutamide is believed tolower the blood glucose level by which of the followingactions?■ 1. Potentiating the action of insulin.■ 2. Lowering the renal threshold of glucose.■ 3. Stimulating insulin release from functioningbeta cells in the pancreas.■ 4. Combining with glucose to render it inert.27. Which information should the nurse includewhen developing a teaching plan for a client newlydiagnosed with type 2 diabetes mellitus. Select allthat apply.■ 1. A major risk factor for complications is obesityand central abdominal obesity.■ 2. Supplemental insulin is mandatory for controllingthe disease.■ 3. Exercise increases insulin resistance.■ 4. The primary nutritional source requiringmonitoring in the diet is carbohydrates.

■ 5. Annual eye and foot examinations are recommendedby the American Diabetes Association(ADA).

28. When teaching the diabetic client aboutfoot care, the nurse should instruct the client to dowhich of the following?■ 1. Avoid going barefoot.■ 2. Buy shoes a half size larger.■ 3. Cut toenails at angles.■ 4. Use heating pads for sore feet.29. A client with diabetes mellitus asks the nurseto recommend something to remove corns from histoes. The nurse should advise the client to:■ 1. Apply a high-quality corn plaster to the area.■ 2. Consult a physician or podiatrist aboutremoving the corns.■ 3. Apply iodine to the corns before peeling themoff.■ 4. Soak the feet in borax solution to peel off thecorns.30. A client with diabetes mellitus comes to theclinic for a regular 3-month follow-up appointment.The nurse notes several small bandages coveringcuts on the client’s hands. The client says, “I’m soclumsy. I’m always cutting my fi nger cooking orburning myself on the iron.” Which of the followingresponses by the nurse would be most appropriate?■ 1. “Wash all wounds in isopropyl alcohol.”■ 2. “Keep all cuts clean and covered.”■ 3. “Why don’t you have your children do thecooking and ironing?”■ 4. “You really should be fi ne as long as you takeyour daily medication.”31. The client with diabetes mellitus says, “If Icould just avoid what you call carbohydrates in mydiet, I guess I would be okay.” The nurse shouldbase the response to this comment on the knowledgethat diabetes affects metabolism of which ofthe following?■ 1. Carbohydrates only.■ 2. Fats and carbohydrates only.■ 3. Protein and carbohydrates only.■ 4. Proteins, fats, and carbohydrates.32. A client with type 1 diabetes mellitus isadmitted to the emergency department. Which ofthe following respiratory patterns requires immediateaction?■ 1. Deep, rapid respirations with longexpirations.■ 2. Shallow respirations alternating with longexpirations.■ 3. Regular depth of respirations with frequent

pauses.■ 4. Short expirations and inspirations.

33. Which of the following fi ndings should thenurse report to the client’s physcian for a client withunstable type 1 diabetes mellitus? Select all thatapply.■ 1. Systolic blood pressure, 145 mm Hg.■ 2. Diastolic blood pressure, 87 mm Hg.■ 3. High-density lipoprotein (HDL), 30 mg/dL.■ 4. Glycosylated hemoglobin (HbA1c), 10.2%.■ 5. Triglycerides, 425 mg/dL.■ 6. Urine ketones, negative.34. The nurse should caution the client withdiabetes mellitus who is taking a sulfonylurea thatalcoholic beverages should be avoided while takingthese drugs because they can cause which of thefollowing?■ 1. Hypokalemia.■ 2. Hyperkalemia.■ 3. Hypocalcemia.■ 4. Disulfi ram (Antabuse)–like symptoms.35. Which of the following conditions is themost signifi cant risk factor for the development oftype 2 diabetes mellitus?■ 1. Cigarette smoking.■ 2. High-cholesterol diet.■ 3. Obesity.■ 4. Hypertension.36. Which of the following indicates a potentialcomplication of diabetes mellitus?■ 1. Infl amed, painful joints.■ 2. Blood pressure of 160/100 mm Hg.■ 3. Stooped appearance.■ 4. Hemoglobin of 9 g/dL.37. The nurse is teaching the client about homeblood glucose monitoring. Which of the followingblood glucose measurements indicates hypoglycemia?■ 1. 59 mg/dL.■ 2. 75 mg/dL.■ 3. 108 mg/dL.■ 4. 119 mg/dL.38. Assessment of the diabetic client for commoncomplications should include examination of the:■ 1. Abdomen.■ 2. Lymph glands.■ 3. Pharynx.■ 4. Eyes.39. The client with type 1 diabetes mellitus istaught to take isophane insulin suspension NPH(Humulin N) at 5 p.m. each day. The client shouldbe instructed that the greatest risk of hypoglycemia

will occur at about what time?■ 1. 11 a.m., shortly before lunch.■ 2. 1 p.m., shortly after lunch.■ 3. 6 p.m., shortly after dinner.■ 4. 1 a.m., while sleeping.

40. A nurse is teaching a client with type 1diabetes mellitus who jogs daily about the preferredsites for insulin absorption. What is the most appropriatesite for a client who jogs?■ 1. Arms.■ 2. Legs.■ 3. Abdomen.■ 4. Iliac crest.41. A client with diabetes is taking insulin lispro(Humalog) injections. The nurse should advise theclient to eat:■ 1. Within 10 to 15 minutes after the injection.■ 2. 1 hour after the injection.■ 3. At any time, because timing of meals withlispro injections is unnecessary.■ 4. 2 hours before the injection.42. The best indicator that the client has learnedhow to give an insulin self-injection correctly iswhen the client can:■ 1. Perform the procedure safely and correctly.■ 2. Critique the nurse’s performance of thep rocedure.■ 3. Explain all steps of the procedure correctly.■ 4. Correctly answer a posttest about the procedure.43. The nurse is instructing the client on insulinadministration. The client is performing a returndemonstration for preparing the insulin. The client’smorning dose of insulin is 10 units of regular and22 units of NPH. The nurse checks the dose accuracywith the client. The nurse determines thatthe client has prepared the correct dose when thesyringe reads how many units?________________________ units.44. Angiotensin-converting enzyme (ACE) inhibitorsmay be prescribed for the client with diabetesmellitus to reduce vascular changes and possiblyprevent or delay development of:■ 1. Chronic obstructive pulmonary disease.■ 2. Pancreatic cancer.■ 3. Renal failure.■ 4. Cerebrovascular accident.45. The nurse should teach the diabetic clientthat which of the following is the most commonsymptom of hypoglycemia?■ 1. Nervousness.■ 2. Anorexia.

■ 3. Kussmaul’s respirations.■ 4. Bradycardia.46. The nurse is assessing the client’s use ofmedications. Which of the following medicationsmay cause a complication with the treatment plan ofa client with diabetes?■ 1. Aspirin.■ 2. Steroids.■ 3. Sulfonylureas.■ 4. Angiotensin-converting enzyme (ACE) inhibitors.

47. A client with type 1 diabetes mellitus hasinfl uenza. The nurse should instruct the client to:■ 1. Increase the frequency of self-monitoring(blood glucose testing).■ 2. Reduce food intake to diminish nausea.■ 3. Discontinue that dose of insulin if unableto eat.■ 4. Take half of the normal dose of insulin.48. Which of the following is a priority nursingdiagnosis for the diabetic client who is taking insulinand has nausea and vomiting from a viral illnessor infl uenza?■ 1. Imbalanced nutrition: Less than body requirements.■ 2. Ineffective health maintenance related toineffective coping skills.■ 3. Acute pain.■ 4. Activity intolerance.49. During a home visit, a diabetic client beginsto cry and says, “I just cannot stand the thought ofhaving to give myself a shot every day.” Which ofthe following would be the best response by thenurse?■ 1. “If you do not give yourself your insulinshots, you will die.”■ 2. “We can teach your daughter to give the shotsso you will not have to do it.”■ 3. “I can arrange to have a home care nurse giveyou the shots every day.”■ 4. “What is it about giving yourself the insulinshots that bothers you?”

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Choose the single best answer for each question.Questions 1 and 2 refer to the following case study.A 54-year-old man who is new to the area presentsfor a routine medical evaluation. He reports a history ofhypertension for which he takes long-acting diltiazem.He also reports mild fatigue and notes that he has experiencednocturnal voiding approximately twice perweek for the past 18 months. He denies drinking alcoholbut has a 30 pack-year history of smoking. He has a48-year-old brother with type 2 diabetes, and his father

died of a myocardial infarction at age 53 years. On physicalexamination, the patient is obese and his bloodpressure is 140/90 mm Hg and pulse is 60 bpm. Otherresults of physical examination are normal. A fastingplasma glucose level is 138 mg/dL.1. What is the most appropriate management of thepatient’s glucose level?A) Repeat the fasting blood glucose measurementon another dayB) Order a glycosylated hemoglobin levelC) Perform an oral glucose tolerance testD) Follow up with a fasting blood glucose measurementin 1 year2. A second fasting glucose measurement for this patientis 157 mg/dL. All of the following studieswould be helpful at this time EXCEPT:A) ElectrocardiographyB) Fasting lipid panelC) 24-Hour urine cortisol levelD) Glycosylated hemoglobin levelQuestions 3 and 4 refer to the following laboratorystudies.The patient’s total cholesterol level is 290 mg/dL,and his low-density lipoprotein and triglyceride levelsare increased. His high-density lipoprotein level is31 mg/dL. Based on his laboratory results, the patientis diagnosed with type 2 diabetes. He receives diabetes education and dietary counseling. At this time, his ophthalmoscopicexamination and urinalysis are normal,and no microalbuminuria is present. Results from anexercise stress test are normal.The patient returns for follow-up testing 4 monthslater. He continues to smoke but claims he has beencompliant with his diet; however, his weight is unchanged.His glycosylated hemoglobin level has increasedfrom 7.2 mg/dL at baseline to 7.5 mg/dL.He returns again for follow-up 7 months later. Hisblood pressure is now 150/80 mmHg. Repeated laboratorytesting reveals a fasting blood glucose level of210 mg/dL. His glycosylated hemoglobin level hasincreased to 8.2 mg/dL.3. Which therapeutic measure would be most appropriateat this time?A) Begin therapy with insulinB) Begin therapy with metforminC) Begin therapy with acarboseD) Try 6 more months of behavior modification4. Which of the following statements is TRUE?A) A standardized diet is essential for all patientswith diabetesB) Poorly controlled diabetic patients should beencouraged to exercise vigorously to improveglucose controlC) Meticulous glucose control with multiple insulininjections per day based on the DiabetesControl and Complications Trial results should

be universally prescribedD) None of the above

MULTIPLE CHOICE

1. The nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce enough insulin so my blood glucose is elevated because of:

1. prolonged elevation of stress hormone levels (cortisol, epinephrine, glucagon, growth hormone).

2. malfunction of the glycogen-storing capabilities of the liver.

3. destruction of the beta cells in the pancreas.

4. insulin resistance of the receptor cells of the muscle tissue.

ANS: 3

Type 1 diabetes mellitus is a disease in which the pancreas does not produce adequate insulin because of the destruction of beta cells.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1002

OBJ: 6 TOP: Type 1 Diabetes

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

2. When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a pill instead of insulin, you reply that in type 2 diabetes, the body makes insulin but:

1. overweight and underactive people simply cannot use the insulin produced.

2. metabolism is slowed in some people so they have to take a pill to speed up their metabolism.

3. sometimes the autoimmune system works against the action of the insulin.

4. the cells become resistant to the action of insulin. Pills are given to increase the sensitivity.

ANS: 4

Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of insulin and the blood glucose level rises. Oral hyperglycemic agents make the cells more sensitive.

PTS: 1 DIF: Cognitive Level: Application REF: 1002

OBJ: 6 TOP: Type 2 Diabetes


MSC: NCLEX: Health Promotion and Maintenance

3. A patient tells the nurse that she eats “huge” amounts of food but stays hungry most of the time. The nurse explains that hunger experienced by persons with type 1 diabetes is caused by the:

1. excess amount of glucose

2. need for additional calories to correct the increased metabolism.

3. fact that the cells cannot use the blood glucose.

4. need for exercise to stimulate insulin secretion.

ANS: 3

The cells cannot use the glucose without insulin, so the diabetic client still feels hungry although there is abundant glucose circulating in the blood.


OBJ: 1 TOP: Hunger in the Diabetic



4. The nurse stresses that the type 1 diabetic is at risk for cardiovascular disorders because lack of insulin causes:

1. high glucose levels that irritate and shrink the vessels.

2. inadequate metabolism of proteins, which causes ketosis.

3. increased fatty acid levels.

4. increased metabolism of ketones, which causes hypertension.

ANS: 3

The increase in fatty acid levels causes an increase in triglyceride and an attendant rise in low-density lipoprotein (LDL) levels.


OBJ: 10 TOP: Diabetes—Complications

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. The goal of diabetic self-care is to keep the patient’s blood sugar level normal. Hyperglycemia occurs when:

1. blood glucose levels rise, stimulating production of insulin.

2. insulin conversion of glycogen to glucose is inhibited.

3. the body responds to glucose-starved tissues by changing stored glycogen into glucose.

4. glycogen is unable to be stored in the liver and muscles.

ANS: 3

The hypothalamus is receiving a message that the cells need glucose, so it responds by adding more glucose to the already overburdened blood.


OBJ: 1 TOP: Hyperglycemia


6. The young patient complains that diabetes is causing her to “have no life at all . . . . It’s too hard.” The most helpful response is:

1. “Yes, you must make some sacrifices.”

2. “It’s hard, but with significant alterations in your lifestyle, you can live a long life.”

3. “What’s hard about exercise, diet, and medicine?”

4. “Let’s talk about what makes it so hard.”

ANS: 4

Involving the patient in decisions about how she will cope with diabetes will make the goal more realistic and personal, which will give it a greater chance of success.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1028

OBJ: 10 TOP: Diabetes Lifestyle

KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

7. When the type 2 diabetic patient says, “Why in the world are they looking at my hemoglobin? I thought my problem was with my blood sugar.” The nurse responds that the level of hemoglobin A1c:

1. shows how a high glucose level can cause a significant drop in the hemoglobin level.

2. shows what the glucose level has done for the last 3 months.

3. indicates a true picture of the patient’s nutritional state.

4. reflects the effect of high glucose levels on the ability to produce red blood cells.

ANS: 2

By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose can be evaluated for the last 3 months, because the glucose stays bound to the hemoglobin for the life of the red blood cell (RBC).


OBJ: 9 TOP: Hemoglobin A1c-Glycosylated Hemoglobin Level



8. The patient with type 2 diabetes shows a blood sugar reading of 72 at 6 AM. Based on the reading of 72, the nurse should:

1. notify the charge nurse of the reading.

2. give regular insulin per sliding scale.

3. give him cup of milk.

4. administer the oral hyperglycemic tablet.

ANS: 3

The patient is hypoglycemic and needs an immediate source of glucose, such as milk or orange juice. The oral hyperglycemic agent will not work quickly enough. Notifying the charge nurse can be done later. Giving insulin per sliding scale would lower the blood sugar level.


OBJ: 5 TOP: Hypoglycemic Reaction



9. The nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a life-threatening condition that results in:

1. the inability of carbohydrates, fats, and proteins to be metabolized.

2. the storage of glycogen, so that there is a severe shortage of glucose in the

bloodstream.

3. dangerously elevated pH and bicarbonate levels in the blood.

4. severe hypoglycemia, which can result in coma and convulsions.

ANS: 1

DKE is mainly related to the use of fat as an energy source because of the inability to use glucose. The metabolism of fat produces ketones.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 1007

OBJ: 7 TOP: Diabetic Ketoacidosis


10. The patient has been admitted to the hospital with the diagnosis of diabetic ketoacidosis. The nurse anticipates that the patient will exhibit vital signs of:

1. T, 99; P, 62; R, 16 and shallow.

2. T, 98.6; P, 76; R, 16 and deep.

3. T, 98; P, 84; R, 18 and shallow.

4. T, 97.4; P, 100; R, 20 and deep.

ANS: 4

DKA is caused by the attempt of the body to metabolize fat for energy, which results in an acidotic state. The classic signs of DKA are hypothermia, tachycardia, and Kussmaul’s respirations (rapid and deep) to blow off the acid ions via respirations. The respirations will have a fruity odor.


OBJ: 8 TOP: Diabetic Ketoacidosis


11. The home health nurse is assessing a type 1 diabetic patient who has been controlled for 6 months. The nurse is surprised and concerned about a blood glucose reading of 52. This episode of hypoglycemia is probably caused by the patient’s having:

1. taken a new form of birth control pill this morning.

2. used large amounts of sugar substitute in her tea this morning.

3. had a 2-hour long exercise class at the spa this morning.

4. underdosed herself with insulin this morning.

ANS: 3

Excessive exercise used up the glucose that was made available by the insulin taken by the patient. The patient now has too much insulin for the available glucose and has become hypoglycemic.


OBJ: 5 TOP: Diabetes—Treatment



12. As part of the teaching plan in preparation for discharge, the patient with type 1 diabetes needs guidelines for exercise. Be sure to include which of the following?

1. Plan your exercise so that it coincides with the peak action of insulin.

2. Insulin should be injected into the lower extremity before exercise because that site provides the greatest absorption.

3. Exercise should be done daily at the same time of day and at the same intensity.

4. Keep exercise at a minimum to conserve your energy.

ANS: 3

If the body is using more glucose than available, the body will draw on fatty acids, which will give off ketones.


OBJ: 5 TOP: Exercise KEY: Nursing Process Step: Implementation


13. The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor has ordered two types of insulin, 10 U of regular insulin and 35 U of NPH insulin. The proper procedure is to:

1. draw up the insulins in two separate syringes so that there can be no confusion.

2. draw up the regular insulin before drawing up the NPH insulin.

3. inject air into the NPH insulin, draw it up to 35 U, then inject air into the clear regular insulin and withdraw to 45 U.

4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.

ANS: 4

When drawing up two insulins, the vials are injected with air and the regular insulin is drawn first. This slow and time-consuming activity has been greatly reduced with the advent of premixed insulins.


OBJ: 5 TOP: Insulin Administration



14. A patient has come into the emergency room with her friend. Her friend states that she had been acting very strangely and confused. The friend states that the patient has diabetes and takes insulin. The nurse knows that signs and symptoms of hypoglycemia include:

1. slow pulse rate and low blood pressure.

2. irritability, anxiety, confusion, and dizziness.

3. flushing, anger, and forgetfulness.

4. sleepiness, edema, and sluggishness.

ANS: 2

When blood sugar levels fall, hormones are activated to increase serum glucose. One of the hormones is epinephrine, which causes these symptoms.


OBJ: 2 TOP: Hypoglycemia


15. A patient has come to the doctor’s office after finding out that her blood glucose level was 135 mg/dL. She states that she had not eaten before the test and was told to come and see her doctor. She asks you if she has diabetes. The nurse responds:

1. “Having a fasting serum glucose that high certainly indicates diabetes.”

2. “That test indicates that we need to do more tests that are specific for diabetes.”

3. “How do you feel? Do you have any other signs of diabetes?”

4. “Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a diagnosis.”

ANS: 2

The nurse needs to answer the patient’s question in a way that gives information and is not misleading. Although 135 is high, there may be a nonpathologic explanation. More tests should be done to evaluate the patient.


OBJ: 4 TOP: Laboratory Tests for Diabetes



16. The teaching plan for a 22-year-old woman on Avandia (rosiglitazone) would include a caution relative to:

1. decreased effectiveness of her birth control pills.

2. excessive exposure to the sun.

3. sudden drop in blood pressure with dizziness.

4. possible severe diarrhea.

ANS: 1

Avandia causes some birth control pills to be less effective.

PTS: 1 DIF: Cognitive Level: Analysis

REF: 1016, Drug Therapy table OBJ: 4

TOP: Side Effects of Avandia KEY: Nursing Process Step: Implementation


17. The type 1 diabetic patient has an insulin order for NPH insulin, 35 U, to be given at 7 AM. The patient is also NPO for laboratory work that will not be drawn until 10 AM. The nurse should:

1. give the insulin as ordered.

2. give the insulin with a small snack.

3. inform the charge nurse.

4. hold the insulin until after the blood draw.

ANS: 4

Holding the insulin for the NPO order is appropriate. The patient will not be getting food until after the blood draw, so will not need the insulin until then. Giving the insulin as ordered will create a possibility of hypoglycemia before the blood is drawn. Giving a snack to a patient who is NPO is inappropriate.


OBJ: 10 TOP: Insulin with NPO Order



18. The patient comes to the diabetes clinic and confides to the nurse that she does not follow the diet exchange program that she was given. You respond:

1. “The exchange program is a carefully developed and very important program that allows you to take control of your disease.”

2. “A lot of people have trouble with that program. You aren’t the first one to go off your diet.”

3. “We had better go ahead and check your blood work to see what you’ve done to yourself.”

4. “Okay. Let’s talk about what you do eat and drink and how you manage your diabetes.”

ANS: 4

In order to evaluate effectiveness of treatment, you must find out how the patient perceives the importance of diet, drugs, and exercise.


OBJ: 10 TOP: Nutrition KEY: Nursing Process Step: Evaluation


19. When the Type 1 diabetic patient asks why his 7 AM insulin has been changed from NPH insulin to 70/30 premixed insulin, the nurse explains that 70/30 insulin:

1. is absorbed more rapidly into the bloodstream.

2. has no peak action time and lasts all day.

3. makes insulin administration easier and safer.

4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.

ANS: 4

70/30 insulin is 30% rapid-acting and 70% intermediate-acting insulin. The rapid action of the 7 AM premixed insulin prevents hyperglycemia after the morning meal.


OBJ: 10 TOP: Use of 70/30 Insulin


MSC: NCLEX: Safe, Physiological Integrity

20. In drawing up a patient diabetes teaching plan, the nurse needs to include the following:

1. Develop an exercise plan, because regular exercise helps control your blood glucose level.

2. Monitor your blood sugar only if you are not feeling well so that you don’t prick your fingertips too much.

3. If you are experiencing nervousness, palpitations, or hunger, take a small dose (1 to 2 U) of regular insulin and call the doctor.

4. Use over-the-counter measures for any foot blisters, calluses, or wounds before you seek medical help.

ANS: 1

Exercise is an integral part of the patient taking charge of his or her diabetes and needs to be included in the teaching plan.

PTS: 1 DIF: Cognitive Level: Application

REF: 1023, Diagnostic Tests and Procedures table OBJ: 8

TOP: Diabetes Teaching Plan KEY: Nursing Process Step: Implementation


21. A patient who has been diagnosed with endogenous hypoglycemia most likely has:

1. taken an overdose of hypoglycemic drugs.

2. been following a very restricted fasting diet or is malnourished.

3. excessive secretion of insulin or an increase in glucose metabolism.

4. exercised unwittingly without replenishing needed fluid and nutrients.

ANS: 3

Endogenous refers to within; in this case, it refers to internal factors, such as an increase of insulin or of glucose metabolism. Both these conditions would lead to hypoglycemia.

PTS: 1 DIF: Cognitive Level: Application REF: 1027, Table 46-1

OBJ: 2 TOP: Hypoglycemia

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

22. The nurse giving Humulin R 20 U at 7 AM is aware that this drug will peak in:

1. 15 minutes.

2. 30 minutes.

3. 1 hour.

4. 2 hours.

ANS: 1

Humulin R has its onset in about 15 minutes, but its peak is in 2 hours.

PTS: 1 DIF: Cognitive Level: Knowledge

REF: 1013, Drug Therapy table OBJ: 10

TOP: Humulin R Insulin Peak KEY: Nursing Process Step: Evaluation


23. It is recognized that people with diabetes are at greater risk for complications than nondiabetic patients because of:

1. high blood pressure, which can lead to a stroke.

2. genetic susceptibility, which leads to a generalized weakening of the immune system.

3. thickening of the basement membrane of the capillaries.

4. chronic pain, which leads to activity intolerance.

ANS: 3

Thickening of the basement membrane of the capillaries is responsible for damage to the eyes, kidneys, and nerve fibers, as well as the peripheral circulation.


OBJ: 9 TOP: Complications of Diabetes

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

24. The nurse suspects that the patient with type 1 diabetes may be experiencing the Somogyi phenomenon when the patient exhibits:

1. headache on awakening and enuresis.

2. 6 AM blood sugar of 58 and nausea.

3. abdominal pain and blood pressure elevation.

4. drowsiness and disorientation after eating.

ANS: 1

The Somogyi phenomenon occurs because of a rebound hyperglycemia after a period of hypoglycemia during the early morning. The patient wakes with a headache, enuresis, nausea and vomiting, nightmares, and a high blood sugar level.


OBJ: 10 TOP: Somogyi Phenomenon


25. The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNKS). Her blood glucose level is very high (880 mg/dL on admission). The physician believes that her condition is to the result of large amounts of glucose solutions administered intravenously during kidney dialysis. The nurse would anticipate that the patient would exhibit:

1. a fruity breath and high level of ketones in her urine.

2. severe dehydration and hypernatremia caused by the hyperglycemia.

3. exactly the same symptoms and signs as diabetic ketoacidosis.

4. Kussmaul’s respirations, nausea, and vomiting.

ANS: 2

IV solutions containing glucose will bypass the digestive system, so there is no trigger for the pancreas to release insulin, but there is just enough insulin to prevent the breakdown of fatty acids and the formation of ketones.


OBJ: 9 TOP: Hyperglycemic Hyperosmolar Nonketotic Syndrome


MULTIPLE RESPONSE

1. The nurse tells a patient that the functional causes of hypoglycemia include (select all that apply):

1. dumping syndrome.

2. overdose of insulin.

3. Addison’s disease.

4. spontaneous hypoglycemia.

5. chronic alcoholism.

ANS: 1, 3, 4

Dumping syndrome, Addison’s disease and spontaneous hypoglycemia are functional causes of hypoglycemia; overdose of insulin and chronic alcoholism are exogenous causes.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1027, Table 46-1

OBJ: 2 TOP: Functional Causes of Hypoglycemia



2. The teaching plan for a diabetic patient for foot care would include that the patient should (select all that apply):

1. wash and carefully dry the feet every day.

2. apply lotion between the toes.

3. protect the feet from extreme temperatures.

4. walk barefoot only indoors.

5. buy shoes that are comfortable and supportive.

ANS: 1, 3, 5

Washing, inspecting, and drying the feet, especially between the toes, is essential. Protecting the feet from heat and cold and wearing supportive shoes is important to good foot health. Lotion can be applied to the soles and tops of the feet, but not between the toes. Walking barefoot is contraindicated for a diabetic.

PTS: 1 DIF: Cognitive Level: Application

REF: 1006, Patient Teaching Plan OBJ: 9 TOP: Foot Care

KEY: Nursing Process Step: Planning


3. The teaching plan for a diabetic is focused on smoking cessation and control of hypertension for the avoidance of microvascular complications, such as (select all that apply):

1. macular degeneration.

2. end-stage renal disease (ESRD).

3. coronary artery disease (CAD).

4. peripheral vascular disease (PVD).

5. cerebrovascular accident (CVA).

ANS: 1, 2

Macular degeneration and ESRD are both microvascular complications. CAD, PVD, and CVA are all macrovascular complications.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1004-1005

OBJ: 9 TOP: Microvascular Complications

KEY: Nursing Process Step: Planning


OTHER

1. The nurse instructs a patient about how insulin affects blood glucose. Arrange the events in sequence.

1. Beta cells are stimulated to release insulin.

2. Glucose enters the bloodstream.

3. Glycogen is converted to glucose by alpha cells (glycogenesis).

4. Glycogen is stored in the liver.

5. Insulin transports glucose to muscle cells.

ANS:

2, 1, 5, 4, 3

Insulin transports the glucose to muscle cells or converts it to glycogen, which is stored in the liver to be accessed when hypoglycemia occurs.


OBJ: 1 TOP: Insulin's Effect on Glucose



Documents

site.iugaza.edu.pssite.iugaza.edu.ps/naselnoor/files/2012/02/The-Client... · Web viewWhen a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a