Question 1

The nurse teaching a type 2 diabetic client how to manage the disease while on a prescribed diet and taking an oral antidiabetic agent would recognize that the client has an accurate understanding of diabetes management when the client states
A) "I can use oral medications as long as my pancreas can still produce insulin."
B) "I must decrease my total daily fat intake to less than 45% of my total calories."
C) "I must exercise at least 1 hour daily to help bring down my sugar."
D) "I'm really happy I can take insulin pills; it's much easier than an injection."

Accepted Answer

Oral antidiabetic agents are not insulin and can work only if the pancreatic beta cells are able to produce insulin. Oral hypoglycemic agents are effective in clients with type 2 diabetes after nutrition and exercise therapy have failed. Clients should exercise for 20 to 45 minutes at the desired heart rate at least three times a week. The general recommendation for the U.S. population is to decrease total dietary fat to 30% or less of total calories.

Question 2

The nurse explains to a client that the results of a glycosylated hemoglobin study provide information about the client's control of blood sugar over the last
A) week.
B) month.
C) 3 months.
D) 6 months.

Accepted Answer

The results of the glycosylated hemoglobin test show a diabetic client's average blood glucose control over the past 3 months. Also known as the A1C, the test should be done semi-annually on people who have met their goals for glucose control and quarterly in clients who have not met their primary goal for glycemic control.

Question 3

A client admitted to the hospital 3 hours ago for treatment of acidosis has an order for parenteral potassium in his IV infusion. Before hanging the potassium, the nurse would assess for
A) chest pain.
B) elevation in blood glucose level.
C) tachypnea.
D) urine output.

Accepted Answer

The nurse should frequently assess and measure urine output. Potassium should not be administered to a client with low urine output because dangerous hyperkalemia may develop. The other three options are not assessments needed specifically to administer potassium.

Question 4

The nurse is preparing to care for a client with DKA being admitted from the emergency department (ED). The nurse would anticipate using an intravenous (IV) solution of
A) half-strength saline.
B) isotonic saline.
C) Ringer's solution.
D) serum albumin.

Accepted Answer

IV infusions of isotonic saline are started immediately. Usually the client receives 1000 ml of isotonic solution in the first hour, followed by 2000 to 8000 ml more over the next 24 hours.

Question 5

The nurse tells a client that the regular insulin the client has taken this morning will begin to act in
A) a few minutes.
B) 30 minutes to 1 hour.
C) 2 to 4 hours.
D) 6 to 8 hours.

Accepted Answer

The onset of action of short-acting, regular insulin is 30 minutes to 1 hour.

Question 6

A nurse warns a newly-admitted diabetic client that to avoid injury related to a common diabetic complication, the client should
A) always call for help before getting up.
B) keep needed items within easy reach.
C) only ambulate with assistance.
D) wear house shoes while out of bed.

Accepted Answer

Neuropathy is the most common of the diabetic complications, affecting nearly 60% of diabetic clients. Polyneuropathy involves both sensory and autonomic nerves, with sensory nerve impairment being more common. Sensory polyneuropathy often affects the lower extremities, causing tingling, numbness, burning, and/or sensory loss. This complication is a major factor in injuries to the feet. Once a diabetic client's foot is injured, the client is at high risk of infection, poor wound healing, and often amputation. Wearing some sort of shoes while ambulating in the hospital (and at home) can help prevent foot injuries.

Question 7

Evaluating a young man with type 1 diabetes, the nurse would consider a classic clinical manifestation of diabetes to be the client's
A) excessive thirst.
B) gradual weight gain.
C) overwhelming fatigue.
D) recurrent blurred vision.

Accepted Answer

The cardinal manifestations of diabetes type 1 are polyuria, polydipsia, and polyphagia. Clients might manifest blurred vision with diabetic retinopathy. Type 2 diabetic clients are frequently obese; however, this is not a manifestation but rather a risk factor. Fatigue can also be present.

Question 8

The nurse caring for a client admitted for treatment of diabetic ketoacidosis (DKA) assesses Kussmaul's respirations, which are
A) fast and deep.
B) irregular and gasping.
C) rapid and short.
D) slow and shallow.

Accepted Answer

Respirations increase in rate and depth (Kussmaul's respirations) in clients with DKA, and the breath has a "fruity" or acetone odor.

Question 9

A client who is newly diagnosed with diabetes is in the hospital for initial management of the disease. The nurse is administering an injection of NPH insulin at 7 AM. While the nurse is in the room, the client asks if s/he can go to the cafeteria with family around 2 PM, when they visit. The best response by the nurse is
A) "No, I'd rather you wait until after 5, then you can go."
B) "No, we need to monitor everything you eat for the next few days."
C) "Sure, just be certain you don't eat or drink anything while you're there."
D) "That's fine; let's talk about what kind of snack you can get there."

Accepted Answer

The peak action for intermediate-acting NPH is 4 to 10 hours after administration. In a client newly diagnosed with diabetes, monitoring the client during insulin peak is critical to be able to promptly recognize hypoglycemia. If the client were off the floor when hypoglycemia occurred, he/she might be injured and treatment would be delayed.

Question 10

The nurse caring for a client with a history of experiencing the Somogyi effect would monitor the client's blood sugar level between
A) 2 AM and 7 AM.
B) 10 AM and 3 PM.
C) 12 PM and 6 PM.
D) 5 PM and 12 AM.

Accepted Answer

Nocturnal rebound hyperglycemia (Somogyi phenomenon) should be investigated by monitoring blood glucose levels between 2 and 4 AM and again at 7 AM.

Question 11

As a cost-saving measure, the hospital administration wants to delete everything but 3- ml and 10-ml syringes from floor stock. The best response by the nurse manager on the endocrine floor would be to
A) agree with the plan because 3-ml syringes have 0.1-ml measurement marks.
B) conduct a literature search to determine the best practice in this area.
C) object but plan education to teach the staff how to give insulin with a 3-ml syringe.
D) object, pointing out that insulin can only be given in an insulin syringe.

Accepted Answer

Insulin can only be given with an insulin syringe, pen, jet, or inhaler. They are the only syringes designed to measure insulin accurately.

Question 12

In a teaching plan about dietary concerns for a diabetic client, the nurse would include that the new guidelines for the percentage of calories from carbohydrates is
A) 10%.
B) 25%.
C) 60%.
D) 75%.

Accepted Answer

Clinical guidelines suggest that 50% to 60% of the calories in the diet should consist of carbohydrates, either in simple or in complex form.

Question 13

For a client with DKA receiving insulin to correct hyperglycemia, the nurse knows that the most appropriate route of administration would be
A) intradermal.
B) intramuscular.
C) intravenous.
D) subcutaneous.

Accepted Answer

Insulin should never be given subcutaneously to a client with DKA, because the subcutaneous tissues are dehydrated and poorly perfused with blood from dehydration and hypovolemic shock. Traditionally, the hyperglycemia associated with DKA is treated with an IV bolus of regular insulin, with an insulin drip then started.

Question 14

A diabetic client had gallbladder surgery 2 days ago. The nurse changing the dressing should use which intervention specifically related to the client's diabetes?
A) Dispose of the soiled dressings in an appropriate manner.
B) Use strict aseptic technique to avoid infection.
C) Record the amount, type, and characteristics of the drainage.
D) Only use paper tape to avoid skin injury.

Accepted Answer

All options are good postoperative nursing care interventions. However, the diabetic client is more susceptible to infection than other clients and dressing changes should be done with strict technique. Diabetic clients have impaired polymorphonuclear leukocyte function and damaged vascular systems that cannot carry sufficient oxygen, WBCs, nutrients, and antibodies to the infected site.

Question 15

The nurse must carefully monitor the client who is being aggressively treated for DKA for the common, immediate complication of
A) dehydration.
B) premature ventricular contractions.
C) pulmonary infarction.
D) respiratory tract infection.

Accepted Answer

Clients with DKA lose fluids from several sources. Severe dehydration resulting from these fluid losses may be followed by hypovolemic shock and lactic acidosis.

Question 16

The nurse participating in a screening program for persons at risk for diabetes should have a high index of suspicion for a(n)
A) 44-year-old man who is 6 feet tall and weighs 190 pounds.
B) adolescent whose mother has type 2 diabetes.
C) young man complaining of weight loss and joint pain.
D) young woman who has had two babies weighing 7 pounds each.

Accepted Answer

Screening of high-risk individuals should include those who have first-degree relatives with type 2 diabetes; obese individuals; members of high-risk races; persons older than 40 years with any other risk factor; individuals with hypertension or hyperlipidemia; those with previous impaired glucose tolerance (IGT); women with previous gestational diabetes mellitus (GDM) or history of a baby weighing greater than 9 pounds; and individuals with a history of recurrent infections.

Question 17

A client frustrated with self-monitoring his blood glucose levels tells the nurse he wants an insulin pump. The nurse's most helpful response would be
A) "Pumps don't monitor blood glucose levels. You will still need to do that yourself."
B) "The pump must be calibrated several times a day, but you will not need to monitor your blood glucose levels anymore."
C) "Pumps are still experimental, and there are many problems associated with them."
D) "If you are willing to make a commitment to good aseptic technique, you should like the pump."

Accepted Answer

Insulin pumps often improve blood glucose control by means of continuous subcutaneous insulin infusion. However, pumps do not have a built-in feedback mechanism for monitoring blood glucose levels.

Question 18

The nurse evaluating the laboratory studies of a 46-year-old client would recognize that the laboratory report most suggestive of the presence of diabetes mellitus is
A) a glucose tolerance test that takes 2 hours to return to normal.
B) fasting blood glucose level of 151 mg/dl.
C) high urine ketone levels with +2 glycosuria.
D) random ("casual") blood glucose level of 80 mg.

Accepted Answer

A fasting blood glucose level greater than 126 mg/dl is diagnostic of diabetes. "Fasting" is defined as no caloric intake for at least 8 hours. A glucose tolerance test that returns to normal in 2 hours is a normal finding. The presence of ketones in the urine does indicate that the body is using fat for energy, but this could be from several causes. Urine glucose testing is not reliable. A casual blood glucose test should be less than 200 mg/dl.

Question 19

A client with diabetes mellitus recently discharged from the hospital calls the nursing unit to report that she is nauseated and cannot remember what she has to do about her insulin injection. The nurse should remind the client to
A) call the physician at once.
B) omit her insulin until she is able to eat her normal diet.
C) review the material she was given at the hospital.
D) take her insulin and monitor her blood sugar frequently.

Accepted Answer

More frequent self-monitoring of blood glucose level, often every 2 to 4 hours, is important during illness. The client should not stop taking insulin, even if vomiting and unable to eat. Additional regular insulin may be needed, depending on blood glucose level.

Question 20

The nurse counseling a client with diabetes about establishing an exercise program would encourage
A) playing tennis.
B) running.
C) swimming.
D) walking.

Accepted Answer

The client should be helped to choose an exercise regimen and to set reasonable goals, because any increase in activity level is beneficial. Walking is usually well tolerated.

Quiz 45: Management of Clients with Diabetes Mellitus

The nurse teaching a type 2 diabetic client how to manage the disease while on a prescribed diet and taking an oral antidiabetic agent would recognize that the client has an accurate understanding of diabetes management when the client states

The nurse explains to a client that the results of a glycosylated hemoglobin study provide information about the client's control of blood sugar over the last

A client admitted to the hospital 3 hours ago for treatment of acidosis has an order for parenteral potassium in his IV infusion. Before hanging the potassium, the nurse would assess for

The nurse is preparing to care for a client with DKA being admitted from the emergency department (ED) . The nurse would anticipate using an intravenous (IV) solution of

The nurse tells a client that the regular insulin the client has taken this morning will begin to act in

A nurse warns a newly-admitted diabetic client that to avoid injury related to a common diabetic complication, the client should

Evaluating a young man with type 1 diabetes, the nurse would consider a classic clinical manifestation of diabetes to be the client's

The nurse caring for a client admitted for treatment of diabetic ketoacidosis (DKA) assesses Kussmaul's respirations, which are

The nurse caring for a client with a history of experiencing the Somogyi effect would monitor the client's blood sugar level between

As a cost-saving measure, the hospital administration wants to delete everything but 3- ml and 10-ml syringes from floor stock. The best response by the nurse manager on the endocrine floor would be to

In a teaching plan about dietary concerns for a diabetic client, the nurse would include that the new guidelines for the percentage of calories from carbohydrates is

For a client with DKA receiving insulin to correct hyperglycemia, the nurse knows that the most appropriate route of administration would be

A diabetic client had gallbladder surgery 2 days ago. The nurse changing the dressing should use which intervention specifically related to the client's diabetes?

The nurse must carefully monitor the client who is being aggressively treated for DKA for the common, immediate complication of

The nurse participating in a screening program for persons at risk for diabetes should have a high index of suspicion for a(n)

A client frustrated with self-monitoring his blood glucose levels tells the nurse he wants an insulin pump. The nurse's most helpful response would be

The nurse evaluating the laboratory studies of a 46-year-old client would recognize that the laboratory report most suggestive of the presence of diabetes mellitus is

A client with diabetes mellitus recently discharged from the hospital calls the nursing unit to report that she is nauseated and cannot remember what she has to do about her insulin injection. The nurse should remind the client to

The nurse counseling a client with diabetes about establishing an exercise program would encourage