Upgrade to remove ads
Only $35.99/year

H356 Exam 4 Diabetes & Kahoot

Terms in this set (61)

The nurse is caring for several clients diagnosed with diabetes mellitus. Which client would not require a​ sliding-scale insulin​ dose?
A client who missed a meal
A client who is under severe stress
A client who receives parenteral nutrition
A client who receives corticosteroids
A client who missed a meal

The client who missed a meal will not require a​ sliding-scale insulin dose. Administering insulin to this client could cause hypoglycemia. The other clients would need a​ sliding-scale insulin​ dose, as parenteral​ nutrition, stress, and corticosteroids are all risk factors for hyperglycemia.
The nurse is planning care for a client with diabetes mellitus and addressing the potential problem of risk of infection. Which intervention will best assist in addressing this​ risk?

Promoting smoking cessation.
Instructing the client to have an oral examination yearly.
Teaching the client to use lukewarm water and soap for foot and skin care.
Monitoring sensation in extremities daily.
Teaching the client to use lukewarm water and soap for foot and skin care.

Teaching the client good skin care by using lukewarm water and soap is an intervention that will address the potential problem of risk of infection. Instructing the client to have an oral examination​ yearly, promoting smoking​ cessation, and monitoring sensation in the extremities do not address the potential problem of risk of infection. The client should have an oral examination every 4 to 6 months.
A client with diabetes mellitus is being taught to monitor the blood glucose level. Which factor that affects accurate glucose monitoring should the nurse include in the​ instruction?
​(Select all that​ apply.)

Low hematocrit level
High hematocrit level
WBC​ (white blood​ cell) count
Overdose medications
Creatinine level
Low hematocrit level
High hematocrit level
Overdose medications

Factors that affect accurate glucose monitoring include medication​ overdoses, a low hematocrit​ level, and a high hematocrit level. The WBC count and creatinine levels do not affect accurate glucose monitoring.
The nurse is assisting a client with type 2 diabetes mellitus to plan to meet nutritional needs. Which general rules should the nurse include in the​ plan?
​(Select all that​ apply.)

Intake of​ 20% protein and​ 10% fat
Intake of​ 20% fat
Intake of​ 10% protein
15 grams of carbohydrate for every 1 unit of regular insulin
Intake of 45dash​65% of carbohydrates
Intake of​ 20% protein and​ 10% fat
15 grams of carbohydrate for every 1 unit of regular insulin
Intake of 45dash​65% of carbohydrates

The recommendations are 45dash​65% ​carbohydrates, 20%​ protein, 10%​ fat, and 15 grams of carbohydrate for every 1 unit of regular insulin.
The nurse is educating a client newly diagnosed with type 1 diabetes mellitus. Which information should the nurse include in client education about the regular monitoring of glucose​ levels?

​Self-monitoring of blood glucose should occur three or four times a day.
Urine testing is used only until glucose goals are achieved.
Urine testing will assist in measuring hypoglycemia.
​Self-monitoring of blood glucose is painless and noninvasive.
​Self-monitoring of blood glucose should occur three or four times a day.

​Self-monitoring of blood glucose should occur three or four times a day with type 1 diabetes mellitus. Urine testing will not detect or measure​ hypoglycemia, but it will show ketones if the client is severely hyperglycemic or during illness or​ pregnancy; it is not used only until glucose goals are achieved.​ Self-monitoring of blood glucose requires a client to prick the finger to obtain​ blood, so this test is not painless or noninvasive.
Which therapy is involved in the treatment of a client with​ diabetes?
​(Select all that​ apply.)

Daily weight checking
Nutrition
Medication
Fluid restriction
Exercise
Nutrition
Medication
Exercise

Clients with diabetes are treated with​ exercise, nutrition, and medication. Fluid restriction and daily weight checking are not part of the treatment plan for clients with diabetes.
Diabetes mellitus is the leading cause of which ​complication?

Encephalopathy
​End-stage renal disease
Heart failure
Coronary artery disease
End-stage renal disease

Diabetes mellitus damages the microvascular circulation and is the leading cause of​ end-stage renal disease. Although diabetes mellitus is associated with coronary artery disease and heart​ failure, it is not the leading cause of these conditions. Diabetes mellitus is not associated with encephalopathy.
Which is a pathophysiological feature of type 2 diabetes​ mellitus?
​(Select all that​ apply.)
Complete insulin deficiency
Inadequate insulin production
Insulin resistance
Ketone production
Complete destruction of beta cells
Inadequate insulin production
Insulin resistance

Type 2 diabetes mellitus is associated with a reduction in insulin production by pancreatic beta cells along with cellular resistance to insulin. Although the pancreas produces some​ insulin, enough to keep the body from breaking down fats into​ ketones, there is not enough to keep the​ client's blood glucose level within normal limits. Type 1 diabetes results from an autoimmune process that destroys all pancreatic beta​ cells, resulting in a complete insulin deficiency. Clients with type 1 diabetes mellitus will start to break down free fatty acids and produce ketones if they do not receive insulin injections.
A young client is admitted for lethargy and weight loss. Which clinical manifestation would the nurse suspect for a potential diagnosis of type 1 diabetes​ mellitus?
​(Select all that​ apply.)

Blurred vision
Weight gain
Fever
Polyuria
Glucosuria
Blurred vision
Polyuria
Glucosuria

Manifestations of type 1 diabetes mellitus are caused by the lack of insulin to transport glucose into the cells for energy. The resulting hyperglycemia leads to​ polyuria, glucosuria, and blurred vision. Polyuria occurs because water is drawn into the general​ circulation, increasing renal blood flow. Once the blood glucose exceeds the renal​ threshold, which is 180​ mg/dl, glucose will spill into the urine. Blurred vision is caused by swelling of the lenses of the eyes in response to increased fluid volume. Clients with type 1 diabetes mellitus usually lose weight as proteins and fats are metabolized for energy and water is lost in the urine. In​ addition, clients with type 1 diabetes are frequently unable to develop a fever when cellular fuel stores are depleted because of a lack of insulin.
Which risk factor is associated with type 2 diabetes​ mellitus?
​(Select all that​ apply.)

Physical inactivity
Weight loss
Blood pressure greater than or equals ​130/85 mmHg
HDL cholesterol greater than or equals 35​ mg/dl
Triglyceride level greater than or equals 250​ mg/dl
Physical inactivity
Blood pressure greater than or equals ​130/85 mmHg
Triglyceride level greater than or equals 250​ mg/dl

Metabolic syndrome is a constellation of risk factors that put the client at risk of type 2 diabetes mellitus and coronary artery disease. These risk factors include abdominal​ obesity, hypertension,​ triglyceridemia, low HDL​ cholesterol, and physical inactivity. Weight loss and normal HDL cholesterol levels do not put the client at risk of type 2 diabetes mellitus.
The nurse is taking a health history from a client who has diabetes mellitus. Which symptom reported by the client may indicate the development of​ complications?
​(Select all that​ apply.)

Frequent voiding of urine
Quick wound healing
Vision changes
Numbness in the feet
Dizziness
Frequent voiding of urine
Vision changes
Numbness in the feet
Dizziness

Vision​ changes, dizziness, numbness in the​ feet, and frequent voiding of urine may indicate that the client has developed complications of diabetes mellitus​ (DM). Clients with diabetes frequently experience prolonged wound​ healing; therefore, a report of quick wound healing would not indicate that the client has developed a complication of DM.
Which is a priority teaching point for the nurse to provide to a client with​ new-onset diabetes​ mellitus?
There may be vascular changes in the upper extremities.
Foot complications will arise when blood glucose levels are either too high or too low.
Sense of touch and perception of pain may be absent.
Complications may be caused by neuropathy.
Sense of touch and perception of pain may be absent.

The priority is for the client to be aware that their feet and legs may have an altered perception of touch and​ pain, which can lead to injuries to the feet that are not noticed. There may be vascular changes to the lower though not the upper​ extremities; and neuropathy is common in poorly regulated clients with diabetes.
Walter​ Wariner, an​ 82-year-old man, reports frequent bouts of nausea and indigestion. He tells the nurse that he has been experiencing numbness and tingling in his feet. Which is the best response by the​ nurse?
​"These may be symptoms of diabetes mellitus. You should have your blood sugar​ checked."
​"These are normal signs of aging. There is no need to​ worry."
​"These may be signs of renal failure. You should have your kidneys​ checked."
​"These may be signs of hypertension. You should have your blood pressure​ checked."
​"These may be symptoms of diabetes mellitus. You should have your blood sugar​ checked."

Frequent bouts of nausea and indigestion may be a symptom of gastroparesis. Numbness and tingling in the feet may indicate neuropathy. Both of these conditions are complications of diabetes mellitus.​ Therefore, Mr. Wariner should have his blood sugar checked to see whether it is elevated. Hypertension and renal failure typically do not result in the symptoms reported by Mr. Wariner. In​ addition, these symptoms are not a result of the normal aging​ process, so they should not be ignored.
Gladys Lewis is a​ 48-year-old woman with a history of hypertension who is admitted to the hospital with an​ infected, poorly healing wound on her right ankle. She reports that she has been experiencing​ fatigue, blurred​ vision, polyuria, and polydipsia for the past month. Ms. Lewis has a body mass index​ (BMI) of 32 and a blood glucose level of 225​ mg/dl, and her urine is negative for ketones. What does the nurse suspect may be happening to Ms.​ Lewis?
Client is having a hypoglycemic reaction
Client is experiencing diabetes insipidus
Client is experiencing hyperglycemia
Client has type 1 diabetes mellitus
Client is experiencing hyperglycemia

Ms.​ Lewis's risk factors of hypertension and​ obesity, as well as her symptoms of​ fatigue, blurred​ vision, polyuria, and​ polydipsia, are consistent with hyperglycemia and probably type 2 diabetes.​ New-onset type 1 diabetes is typically seen in young children and adolescents and associated with ketonemia. Ms.​ Lewis's blood glucose is​ elevated, so she is not hypoglycemic. Diabetes insipidus is a condition that occurs when there is an insufficient amount of antidiuretic hormone and is not associated with hyperglycemia.
Greer Bell is a​ 59-year-old man who was admitted to the hospital with reports of chest​ pain, dyspnea,​ polyuria, polydipsia, and polyphagia. His glycosylated hemoglobin ​(A1C​) is​ 9%. While the nurse is taking Mr.​ Bell's admission​ history, he mentions that his feet feel numb. Which would be the priority assessment for Mr.​ Bell?
Inspecting the eyes for cataracts
Assessing the feet for injury
Palpating the liver for enlargement
Assessing the location of both kidneys
Assessing the feet for injury

Mr. Bell has an elevated A1C and symptoms consistent with diabetes mellitus. In​ addition, he is reporting symptoms of peripheral neuropathy. These put him at risk of developing foot ulcers. Liver disease is not an expected complication of diabetes mellitus. Although nephropathy and such retinopathy as cataractsare complications of diabetes​ mellitus, the client is currently not reporting symptoms suggestive of these conditions.
The nurse is caring for a​ 70-year-old client admitted for possible type 2 diabetes mellitus. When obtaining the​ client's history, which conditions are potential indicators of diabetes mellitus in this older​ client?
​(Select all that​ apply.)
Periodontal disease
Hypertension
Glaucoma
Gastroparesis
Impotence
Periodontal disease
Glaucoma
Gastroparesis
Impotence

Periodontal​ disease, gastroparesis,​ impotence, and glaucoma are potential indicators of diabetes mellitus in older clients. Orthostatic​ hypotension, not​ hypertension, is a condition that is a potential indicator of diabetes mellitus in older clients.
A client with diabetes mellitus is admitted to the medical unit for chronic complications. The nurse ensures that the client​'s room is free of clutter and has a night​ light, and checks the water temperature before bathing the client. Which potential problem do these interventions address when caring for this​ client?

Risk of infection
Risk of injury
Acute pain
Ineffective coping
Risk of injury

These interventions address the potential problem of risk of injury. They do not address the potential problems of acute​ pain, ineffective​ coping, and risk of infection.
A nurse is doing discharge teaching with a client who has been newly diagnosed with diabetes mellitus type 2. Which statement from the client indicates the need for additional ​teaching?

I need to be alert for infections.
It is important to test my blood sugar at least four times a day.
As long as I​'m in my house I can walk barefoot.
I need to stay hydrated during the day.
As long as I​'m in my house I can walk barefoot

Clients with diabetes should always wear shoes in order to protect their feet from injury. The client should be alert for infection or​ injuries; stay well​ hydrated; and test the blood sugar four times a day.
A client is diagnosed with type 2 diabetes mellitus. Which information about type 2 diabetes mellitus should the nurse include when providing client​ education?

Metabolism of dietary carbohydrates is enhanced.
The onset of hyperglycemia is rapid.
The liver suppresses the release of glucose.
Insulin resistance occurs in peripheral tissues.
Insulin resistance occurs in peripheral tissues.

Type 2 diabetes mellitus occurs as a result of impaired insulin resistance in peripheral​ tissues, so this information needs to be included in client education. The liver does not suppress glucose release in type 2 diabetes​ mellitus; the liver produces more glucose than normal with type 2 diabetes mellitus. The onset of hyperglycemia is not rapid in type 2 diabetes​ mellitus; hyperglycemia increases gradually and usually exists long before the diagnosis of type 2 diabetes mellitus. The metabolism of dietary carbohydrates is not enhanced in type 2 diabetes​ mellitus; dietary carbohydrates are poorly metabolized in type 2 diabetes mellitus.
A client has questions about surgery to replace the need to take insulin several times a day. Which is a surgical intervention that can be considered for clients with diabetes​ mellitus?
​(Select all that​ apply.)
Islet cell transplantation
Removing the spleen
Replacing a part of the liver
Replacing pancreatic cells
Replacing the pancreas
Islet cell transplantation
Replacing pancreatic cells
Replacing the pancreas

Islet cell​ transplantation, replacing the​ pancreas, and replacing pancreatic cells are surgical interventions for clients with diabetes. Removing the spleen or transplanting the liver will not correct insulin production.
Which is a specific recommendation for exercise for a client with diabetes​ mellitus?
​(Select all that​ apply.)

Keep the exercise brief and moderate
Exercise no more than 60 minutes a week
Exercise at least 150 minutes per week
Stay hydrated during exercise
Keep sessions​ short, as prolonged sessions cause hypoglycemia
Keep the exercise brief and moderate
Exercise at least 150 minutes per week
Stay hydrated during exercise
Keep sessions​ short, as prolonged sessions cause hypoglycemia

The recommendation is to exercise at least 150 minutes per​ week; to keep the exercise brief and​ moderate; and to stay hydrated during exercise to prevent hypoglycemia or hyperglycemia. Prolonged exercise can cause hypoglycemia.
The nurse is caring for a pediatric client who is experiencing diabetic ketoacidosis​ (DKA). Which assessment finding indicates the need for the nurse to monitor this client for cardiac​ arrhythmias?

Decreased potassium level
Elevated blood glucose level
Decreased albumin level
Decreased urine output
Decreased potassium level

A decreased potassium level​ (hypokalemia) can cause cardiac arrhythmias. Elevated blood glucose​ level, decreased albumin​ level, and decreased urine output do not cause cardiac arrhythmias.
The nurse is caring for a child who is diagnosed with type 2 diabetes mellitus​ (DM). The parents want to know how this happened to their child. Which items in this​ child's history will the nurse share with the parents as risk factors for developing this type of​ DM?
​(Select all that​ apply.)
Active lifestyle
​High-fat diet
Race
Obesity
Family history of DM
High-fat diet
Race
Obesity
Family history of DM

Obesity, a​ high-fat diet, a family history of​ DM, and race are risk factors for developing type 2 DM. An active lifestyle is not a risk factor for developing type 2 DM.
The nurse is educating a group of children and their parents about risk factors for developing type 2 diabetes mellitus​ (DM). A parent asks the nurse to identify the most common age range for diagnosis. Which answer by the nurse is the most​ accurate?

10 to 19 years
16 to 18 years
Birth to 2 years
3 to 9 years
10 to 19 years

Children are at the greatest risk for diagnosis of type 2 diabetes mellitus between the ages of 10 to 19 years. The other age ranges are not the most accurate for the development of type 2 diabetes mellitus.
The nurse is caring for a child diagnosed with type 1 diabetes mellitus​ (DM). The nurse educates the child and parents that insulin dosing is based on which​ item?

Diet
Urine output
Weight
Age
Diet

Insulin dose is not based on​ weight, age, or urine output. Insulin dose is based on​ diet, specifically carbohydrate intake.
The nurse is reviewing fasting serum blood glucose levels on several children on a pediatric medicaldashsurgical unit. For which child does the nurse expect to provide information about treatment options for type 1 diabetes mellitus​ (DM)?
The child with a fasting blood glucose of 100​ mg/dL
The child with a fasting blood glucose of 120​ mg/dL
The child with a fasting blood glucose of 140​ mg/dL
The child with a fasting blood glucose of 80​ mg/dL
The child with a fasting blood glucose of 140​ mg/dL

Fasting blood glucose levels of 80​ mg/dL, 100​ mg/dL, and 120​ mg/dL are considered normal. A fasting blood glucose greater than or equal to 126​ mg/dL would contribute to a diagnosis of type 1 DM. A child with a fasting blood glucose of 140​ mg/dL meets this criterion.
The nurse is teaching a child with diabetes and her family about sick day guidelines. Which statement by the family indicates appropriate understanding of the material​ presented?

​"We will test for ketones when the blood glucose level is 200​ mg/dL."
​"We will test for ketones when the blood glucose level is 220​ mg/dL."
​"We will test for ketones when the blood glucose level is 160​ mg/dL."
​"We will test for ketones when the blood glucose level is 180​ mg/dL."
​"We will test for ketones when the blood glucose level is 220​ mg/dL."

Blood glucose levels of 160​ mg/dL, 180​ mg/dL, and 200​ mg/dL are​ elevated, but they would not require testing for ketones. Once the blood glucose level exceeds 200​ mg/dL, the child and family should test the urine for ketones.
Which are risk factors for the development of type 1 diabetes mellitus in​ children?
​(Select all that​ apply.)

Female gender
​High-fat diet
Overweight
Viral infection
Genetic predisposition
Viral infection
Genetic predisposition

The risk factors associated with the development of type 1 diabetes mellitus in children include a genetic predisposition and viral infections. Being​ overweight, consuming a​ high-fat diet, and being female are risk factors for type 2 diabetes mellitus in children.
Which is a preventive measure to decrease the risk of developing type 2 diabetes mellitus during​ childhood?

Gaining weight
Increasing activity
Receiving age appropriate immunizations
Increasing high fat foods
Increasing activity

A preventive measure to decrease the risk of developing type 2 diabetes mellitus during childhood is increasing activity. Other preventive measures include maintaining an appropriate BMI and decreasing high calorie foods. A​ high-fat diet is a risk factor for developing type 2 diabetes mellitus during childhood. While it is important to receive​ age-appropriate immunizations, this does not decrease the risk of developing type 2 diabetes mellitus.
Which finding confirms a diagnosis of diabetes mellitus in​ children?

Weight and height greater than 95th percentile for age
HbA1C that is greater than or equal to​ 6.5%
Blood pressure of​ 130/90 mmHg
Fasting glucose less than or equal to 126​ mg/dL
HbA1C that is greater than or equal to​ 6.5%

An HbA1C that is greater than or equal to​ 6.5% is a diagnostic finding that confirms the diagnosis of diabetes mellitus in children. A fasting plasma glucose of 126​ gm/dL or higher confirms the presence of diabetes.​ Weight, height, and blood pressure are not findings that support the diagnosis of diabetes mellitus in children.
Which​ substance, if mixed with an oral hypoglycemic​ agent, can cause profound hypoglycemia for adolescents diagnosed with diabetes​ mellitus?

Glucose supplements
Marijuana
Alcohol
Sports drink
Alcohol

Profound hypoglycemia can occur when oral hypoglycemic agents are mixed with alcohol consumption. Adolescent clients should be educated not to consume alcohol in conjunction with this pharmacologic therapy for diabetes mellitus.​ Marijuana, glucose​ supplements, and sports drinks are not known to cause this reaction when mixed with oral hypoglycemic agents.
Place each nursing implementation in the correct column for each condition.
Diabetic ketoacidosis (DK) or
Hypoglycemia

Administer an insulin infusion

If blood glucose is less than 70​ mg/dL, give glucose rapidly

Reintroduce oral feedings when child is alert

Teach parents signs and symptoms of condition and how to treat

Administer subcutaneous insulin injections

For the unconscious​ child, administer glucagon by injection

Administer IV fluid boluses
Administer an insulin infusion- DK

If blood glucose is less than 70​ mg/dL, give glucose rapidly- hypoglycemia

Reintroduce oral feedings when child is alert- DK

Teach parents signs and symptoms of condition and how to treat- hypoglycemia

Administer subcutaneous insulin injections- DK

For the unconscious​ child, administer glucagon by injection- hypoglycemia

Administer IV fluid boluses- DK
Which intervention is appropriate for a​ child, diagnosed with type 1 diabetes​ mellitus, who requires routine insulin​ administration?
Administer by IM injection
Provide glucose tablets of hyperglycemia
Rotate injection sites
Recommend a diet high in carbohydrates
Rotate injection sites

An appropriate nursing intervention for a client diagnosed with type 1 diabetes​ mellitus, who requires routine insulin​ administration, is to rotate the injection sites. Insulin is administered by the subcutaneous​ route, not the intramuscular route. Glucose tablets are provided to treat​ hypoglycemia, not hyperglycemia. A​ high- carbohydrate diet is not appropriate for a client with type 1 diabetes mellitus
Eight-year-old Holly Keaton has recently been diagnosed with type 1 diabetes mellitus. Her mother says she has missed some insulin doses recently. Holly has flushed ears and​ cheeks, and has been complaining of nausea and abdominal pain. Which condition is most urgent to rule​ out?
Type 2 diabetes mellitus
Diabetic ketoacidosis
Acanthosis nigricans
Hypoglycemia
Diabetic ketoacidosis

Children with new onset type 1 diabetes mellitus​ (DM) are at greatest risk for developing diabetic ketoacidosis​ (DKA). DKA can be caused by missing insulin​ doses, incorrect administration of​ insulin, illness,​ trauma, or surgery. Some of the clinical manifestations of DKA are abdominal​ pain, nausea and​ vomiting, and flushed ears and cheeks. Type 2 DM is not a complication of type 1​ DM; it has different causes and symptoms. Acanthosis nigricans​ (hyperpigmentation and thickening of the​ skin) is a symptom of type 2 DM.
The school nurse is assessing a​ 10-year-old student diagnosed with type 1 diabetes mellitus. The student complains of symptoms of​ hypoglycemia, which is confirmed by a glucose level check. What should the nurse do for her until her mother comes for​ her?
Administer glucose tablets
Encourage vigorous physical activity
Administer glucagon
Administer an IV infusion of dextrose
Administer glucose tablets

In a hospital​ setting, you might administer an intravenous​ (IV) infusion of dextrose.​ However, treatment in a clinic or school setting for a conscious child would involve administering glucose immediately from a​ low-fat carbohydrate snack or​ drink, sugar​ gel, glucose​ tablets, or glucose paste. Only if the child is unconscious would you administer glucagon. Vigorous physical activity is not appropriate for a child with hypoglycemia.
Ten-year-old Jeffrey Brooks is diagnosed with type 2 diabetes mellitus. Which nursing intervention is not appropriate for you to complete during outpatient​ visits?
Check HbA1C levels to determine average blood glucose over the past 3 months
Emphasize the importance of annual evaluations to monitor for potential complications
Assess​ height, weight, and​ BMI, and plot on appropriate growth curve for age and gender
Monitor glucose and administer insulin injections daily
Monitor glucose and administer insulin injections daily

Clients must learn to monitor glucose and administer insulin daily. If the client is unable to perform these​ tasks, the parents must do it for him. This is not an intervention that will be performed on a daily basis by the nurse in an outpatient clinic. For outpatient​ visits, you will assess​ height, weight, and body mass index​ (BMI), and plot on appropriate growth curve for age and​ gender; check HbA1C levels to determine average blood glucose over the past 3​ months; and emphasize the importance of annual evaluations to monitor for potential complications.
The nurse is teaching a family about diabetic ketoacidosis​ (DKA). Which statement by the family indicates understanding of the symptoms that occur with​ DKA?
Two separate glucose readings of greater than 400​ mg/dL
Four separate glucose readings greater than 200​ mg/dL
A single glucose reading of 400​ mg/dL
Three separate glucose readings greater than 200​ mg/dL
Two separate glucose readings of greater than 400​ mg/dL

A single blood glucose reading does not indicate ketoacidosis. Two separate blood glucose readings of greater than 400​ mg/dL would be an indicator of ketoacidosis. Three or four separate glucose readings greater than 200​ mg/dL indicate the need for better management of blood glucose​ levels, but are not indicative of DKA.
The nurse is planning care for a​ school-age client diagnosed with type 2 diabetes mellitus​ (DM). Which task will the nurse plan at the first annual visit for this​ child?

Assess dietary needs
Administer influenza vaccine
Administer a psychosocial assessment
Establish baseline hemoglobin A1C
Administer influenza vaccine

During the first annual​ check-up for a child diagnosed with type 2​ DM, the nurse would plan to administer an influenza vaccine per the plan of care. The nurse would draw labs to establish hemoglobin A1C and administer a psychosocial assessment during the initial visit after diagnosis. Assessing dietary needs would occur at the first quarterly visit after diagnosis.
The nurse is caring for a child with type 1 diabetes mellitus​ (DM) who is experiencing hypoglycemia. In reviewing the child​'s ​history, what item most likely caused the​ hypoglycemia?

Inaccurate insulin dose
Lack of growth
Too many calories
Decreased exercise
Inaccurate insulin dose

An inaccurate insulin​ dose, specifically a dose that is too​ large, can cause hypoglycemia. Too few​ calories, not too many​ calories, often cause hypoglycemia. Increased exercise without proper nutrition often causes hypoglycemia. Rapid growth​ spurts, not a lack of​ growth, often causes hypoglycemia.
The nurse is caring for a child who is diagnosed with type 2 diabetes mellitus​ (DM). Which assessment finding specifically supports the diagnosis of type 2 DM vs type 1​ DM?

Polyuria
Acanthosis nigricans
Ketosis
Blurred vision
Acanthosis nigricans

Acanthosis​ nigricans, hyperpigmentation and thickening of the​ skin, is a clinical manifestation that occurs only in type 2 DM. Blurred​ vision, polyuria, and ketosis are more likely to occur in clients who have type 1 DM.
The school nurse is caring for a child who is experiencing hypoglycemia. The child is unconscious. What treatment options are most appropriate for this​ child?
​(Select all that​ apply.)

Glucagon
​Low-fat carbohydrate snack
Insulin injection
Glucose tablets
Sugar gel or paste
Glucagon
Sugar gel or paste

A​ low-fat carbohydrate snack is not appropriate for an unconscious child experiencing hypoglycemia. An insulin injection is given to treat​ hyperglycemia, not hypoglycemia. Glucose tablets are not appropriate for an unconscious child experiencing hypoglycemia. Glucagon is an appropriate treatment option for an unconscious child experiencing hypoglycemia in a school setting. Sugar gel or paste onto the gums is an appropriate treatment option for an unconscious child experiencing hypoglycemia in a school setting.
The nurse is caring for a child who is hospitalized for the treatment of diabetic ketoacidosis​ (DKA). The child​'s parents ask why their child is receiving potassium. What is the best answer for the nurse to provide to this child​'s ​parents?

​"Potassium is administered to treat​ hypokalemia."
​"Potassium is administered to treat cerebral​ edema."
​"Potassium is administered to treat​ acidosis."
​"Potassium is administered to decrease blood glucose​ levels."
​"Potassium is administered to treat​ hypokalemia."

​Insulin, not​ potassium, is administered to decrease blood glucose levels. Potassium is not given to treat acidosis. Sodium bicarbonate would be administered to treat acidosis.​ Mannitol, not​ potassium, is administered to treat cerebral edema. Potassium is administered to treat hypokalemia.
A nurse is caring for a client who has blood glucose of 52 mg/dL. The client is lethargic but arousable.
Which of the following actions should the nurse perform first?
A. Recheck blood glucose in 15 min.
B. Provide a carbohydrate and protein food.
C. Provide 4 oz grape juice.
D. Report findings to the provider.
A. INCORRECT: Blood glucose is rechecked in 15 min after a rapidly absorbed carbohydrate is
ingested, but is not the priority nursing action.
B. INCORRECT: A carbohydrate and protein food is given to the client if the next meal is more than
1 hr away after the blood glucose returns to a normal range. This is not the priority nursing action.
C. CORRECT: The client's acute need for a rapidly absorbed carbohydrate, such as grape juice, takes
priority when treating the blood glucose of 52 mg/dL.
D. INCORRECT: Reporting the findings to the provider is not the priority action.
A nurse is preparing to administer a morning dose of aspart insulin (NovoLog) to a client who has
type 1 diabetes mellitus. Which of the following is an appropriate action by the nurse?
A. Check the client's blood glucose immediately after breakfast.
B. Administer the insulin when breakfast arrives.
C. Hold breakfast for 1 hr after insulin administration.
D. Clarify the prescription because insulin should not be administered at this time.
A. INCORRECT: Blood glucose should be checked prior to insulin administration to prevent an
episode of hypoglycemia.
B. CORRECT: Administer aspart insulin when breakfast arrives to avoid a hypoglycemic episode.
Aspart insulin is rapid-acting, and should be administered 5 to 10 min before breakfast.
C. INCORRECT: Aspart insulin is rapid-acting and is administered 5 to 10 min before breakfast.
Breakfast should be available at the time of the injection.
D. INCORRECT: Aspart insulin is administered at breakfast time and may be prescribed for
administration 2 to 3 times a day.
A nurse is preparing to administer the morning doses of glargine (Lantus) insulin and regular (Humulin R)
insulin to a client who has a blood glucose of 278 mg/dL. Which of the following is an appropriate
nursing action?
A. Draw up the regular insulin and then the glargine insulin in the same syringe.
B. Draw up the glargine insulin then the regular insulin in the same syringe.
C. Draw up and administer regular and glargine insulin in separate syringes.
D. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin.
A. INCORRECT: These insulins are not compatible. They should not be drawn up in the same syringe.
B. INCORRECT: These insulins are not compatible. They should not be drawn up in the same syringe.
C. CORRECT: Administer each insulin as a separate injection. These insulins are not compatible and
should not be drawn up in the same syringe.
D. INCORRECT: These insulins should be administered at the same time. Regular insulin is short‑acting
and should lower the blood glucose level in a short period of time. Glargine insulin is long‑acting
and administered once a day
A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes
mellitus. Which of the following should the nurse include in the information? (Select all that apply.)
A. Eat less meat and processed foods.
B. Decrease intake of saturated fats.
C. Increase daily fiber intake.
D. Limit saturated fat intake to 15% of daily caloric intake.
E. Include omega-3 fatty acids in the diet.
A. CORRECT: Healthy nutrition should include decreasing the consumption of meats and processed
foods, which can prevent diabetes and hyperlipidemia.
B. CORRECT: Healthy nutrition should include lowering LDL by decreasing intake of saturated fats,
which can prevent diabetes and hyperlipidemia.
C. CORRECT: Healthy nutrition should include increasing dietary fiber to control weight gain and
decrease the risk of diabetes and hyperlipidemia.
D. INCORRECT: The recommendation for saturated fat intake is no more than 7% of total daily
caloric intake.
E. CORRECT: Healthy nutrition should include omega-3 fatty acids for secondary prevention of
diabetes and heart disease.
A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information
should the nurse include in the teaching? (Select all that apply.)
A. Remove calluses using over-the-counter remedies.
B. Apply lotion between toes.
C. Perform nail care after bathing.
D. Trim toenails straight across.
E. Wear closed-toe shoes.
A. INCORRECT: A podiatrist should remove calluses or corns. Commercial over-the-counter remedies
may increase the risk for tissue injury and an infection.
B. INCORRECT: Applying lotion between the toes increases moisture for growth of micro-organisms,
which can lead to infection.
C. CORRECT: Perform nail care after bathing, when toenails are soft and easier to trim.
D. CORRECT: Trim toenails straight across to prevent injury to soft tissue of the toes.
E. CORRECT: Wear closed-toe shoes to prevent injury to soft tissue of the toes and feet.
A nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following data confirms this diagnosis? (select all that apply)

A. Evidence of recent MI

B. BUN 35 mg/dL

C. Takes a calcium channel blocker

D. age 77 years old

E. no insulin production
A. evidence of recent MI
B. BUN 35 mg/dL
C. takes a calcium channel blocker
D. age 77

The client who has type 2 diabetes mellitus and had a MI is at risk for developing HHS. This is due to increased hormone production during illness or stress, which can stimulate the liver to produce glucose and decrease the effects of insulin
The client who has type 2 diabetes mellitus may be at risk for developing HHS when the BUN is 35 mg/dL b/c it is an indication of decreased kidney function and inability of the kidney to filter high levels of blood glucose into the urine
A calcium channel blocker is one of several meds that increase risk
The older adult client is at risk for developing type 2 diabetes and may be unaware of associated symptoms, increasing risk for HHS
A nurse is assessing a client who has DKA and ketones in the urine. Which of the following are expected findings? (select all that apply)

A. Weight gain

B. fruity odor of breath

C. Abdominal pain

D. Kussmaul Respirations

E. Metabolic acidosis
B. fruity odor of breath
C. abdominal pain
D. Kussmaul Respirations
E. metabolic acidosis

fruity odor of breath is a manifestation of elevated ketone levels. Abdominal pain is a GI manifestation of increased ketones and acidosis. Kussmaul respirations are an attempt to excrete carbon dioxide and acid when in metabolic acidosis. Metabolic acidosis is caused from glucose, protein, and fat breakdown, which produces ketones
A nurse is reviewing laboratory reports of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following is an expected finding?

A. Serum pH 7.2

B. Serum osmolarity 350 mOsm/L

C. Serum potassium 3.8 mg/dL

D. Serum creatinine 0.8 mg/dL
B. Serum Osmolarity 350 mOsm/L

a client who has HHS would have a serum osmolarity greater than 320 mOsm/L


pH of 7.2 is an indication of DKA. Potassium 3.8 is within expected reference range. A client who has HHS would have decreased potassium due to diuresis. Creatinine 0.8 is within range. A client who has HHS would have a level greater than 1.5 mg/dL
A nurse is preparing to administer IV fluids to a client who has DKA. Which of the following is an appropriate nursing action?

A. admin an IV infusion of regular insulin at 0.3 U/kg/hr

B. admin an IV infusion of .45% sodium chloride

C. rapidly admin an IV infusion of 0.9% sodium chloride

D. add glucose to the IV infusion when serum glucose is 350 mg/dL
C. rapidly admin an IV infusion of 0.9% sodium chloride

The nurse should rapidly admin an IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain blood perfusion to vital organs


admin 0.1 unit/kg/hr, not 0.3. administration of 0.45% follows the isotonic fluid. Add glucose when levels are at 250 mg/dL, not 350
A nurse is providing discharge teaching to a client who experienced DKA. which of the following should the nurse include in teaching? (select all that apply)

A. drink 3 L of fluids daily

B. monitor blood glucose every 4hr when ill

C. Admin insulin as prescribed when ill

D. Notify the provider when blood glucose is 200 mg/dL

E. Report ketones in the urine after 24 hr of illness
A. drink 3 L of fluids daily
B. monitor blood glucose every 4hr when ill
C. admin insulin as prescribed when ill
E. report ketones in urine after 24 hr of illness

Drinking 3L of fluids daily may prevent dehydration if client develops DKA. Blood glucose tends to increase during illness so monitor often. Illness often causes blood glucose to increase. admin regular doses of insulin. The provider should be notified if there are ketones in urine after 24 hr of illness


notify the provider when blood glucose is greater than 240 mg/dL, not 200 mg/dL
Which of the following statements is correct?
Gestational diabetes (GD) is triggered by a viral infection.
GD occurs primarily in the 1st trimester.
GD occurs primarily in women over 40.
GD increases the risk of type II diabetes later in life.
GD increases the risk of type II diabetes later in life.
When should Glucotrol be administered?
30 min before meals
30 min after meals
when a meal has been skipped
only in an emergency, like DKA
30 min before meals
A teenager has Type I DM. What will help decrease his need for insulin?
sleep
exercise
stress
low carb diet
exercise
What type of renal stones are the most common, occurring in 60% of renal cases?
Petosky stones
Cystine stones
Sodium stones
Calculi stones
Calculi stones

Lewis had the answer in class for this as cystine stones, but the book says cystine is the least common.
What diagnostic tool is used to assess urinary retention?
Urinalysis
Specific Gravity
Cystoscope
Bladder scan
Bladder scan
Which medication prescribed for urinary urgency and frequency?
Furosemide
Bumetanide
Oxybutynin
Bethanechol
Oxybutynin
A post-menopausal patient is concerned about osteoporosis. Which patient teaching is a true statement?
Weight-bearing exercise is helpful to prevent osteoporosis.
Hormone replacement therapy should be initiated ASAP.
You should first determine if you are at risk for osteoporosis.
Post-menopause decline is too rapid for preventative meausres.
Weight-bearing exercise is helpful to prevent osteoporosis.
Which 80 year old Asian male is most at risk for osteoporosis?
Having a BMI >40%
Smoking one pack a day for 50 years
Only drinking skim milk for his entire life
Using corticosteroids due to a chronic lung disorder.
Using corticosteroids due to a chronic lung disorder.
Lantus insulin 250u in 250mL of 0.9% saline at 6 mL/hr. How many units/hr should you infuse?
60 units
0.6 units
6 units
0 units
0 units
Students also viewed