Deck 45: Management of Clients with Diabetes Mellitus

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."

Answer 1

"I can use oral medications as long as my pancreas can still produce insulin."

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.

Answer 2

3 months.

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.

Answer 3

urine output.

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.

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.

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.

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.

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.

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."

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.

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.

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%.

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.

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.

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.

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.

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."

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.

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.

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.

Question 21

In a client who needs fluid replacement therapy for DKA, the nurse would evaluate the best indicator of rehydration as

A) a balance of intake and output.
B) improving skin turgor.
C) moistness of tongue and mucous membranes.
D) urine output at least 0.5 ml/kg/hr.

Question 22

The nurse explains that diabetic retinopathy, the leading cause of blindness in the United States, results when the retina

A) detaches from the inner chamber wall.
B) hemorrhages and loses it ability to function.
C) is deprived of oxygen.
D) is obstructed by protein plaque.

Question 23

A newly diagnosed diabetic client is crying and says "I can't learn to live with this. It's overwhelming and people with diabetes get their feet cut off and just die!" The best response by the nurse is

A) "I know you are upset, but try to think about learning to cope with this."
B) "Think of your children; they need you to learn to control your disease."
C) "When you're ready, I can teach you to make good decisions about diabetes."
D) "Would you like to have a social worker or chaplain come visit you?"

Question 24

A client is having a second amputation on the same leg for a nonhealing wound. He is visibly upset and states "With one leg, I am not a man anymore and won't be able to provide for my family." Which response by the nurse best demonstrates caring communication?

A) "Have you spoken to your wife about how you feel?"
B) "I can call a social worker to talk to you about vocational rehabilitation."
C) "I am sorry this is happening to you. I can sit with you for a while."
D) "Many war veterans have amputations and still consider themselves men."

Question 25

The nurse suspects hypoglycemia in a client with diabetes who is difficult to arouse. To reverse this condition, the nurse knows that the best therapy would be

A) glucagon.
B) graham crackers.
C) orange juice.
D) 4 teaspoons of granulated sugar.

Question 26

The nurse counsels a client that in the beta-cell destruction process toward type 1 diabetes, the client may experience a "honeymoon period," during which the pancreas

A) becomes desensitized to high levels of blood glucose.
B) compensates with adequate amounts of insulin for 3 to 12 months.
C) produces proinsulin in greater quantities for about 3 months.
D) regenerates and produces adequate amounts of insulin indefinitely.

Question 27

The nurse would counsel a diabetic client who has developed nephropathy that the best dietary alteration to manage this complication is a

A) high-calorie diet.
B) high-fat diet.
C) low-carbohydrate diet.
D) low-protein diet.

Question 28

The nurse would recognize that the trend in the lipid levels of a client with diabetes follows the pattern that accompanies macrovascular disease, which is

A) decreased low-density lipoproteins.
B) decreased very-low-density lipoproteins.
C) increased high-density lipoproteins.
D) increased triglyceride levels.

Question 29

The nurse assesses a diabetic client and finds a blood sugar level of 280 mg/dl, low blood pressure, nausea and vomiting, and erratic pulse. The nurse would suspect the electrolyte abnormality of

A) hypermagnesemia.
B) hypernatremia.
C) hypocalcemia.
D) hypokalemia.

Question 30

The ED nurse who is giving insulin by continuous IV infusion to a client with DKA would plan to monitor the client's blood glucose level every

A) 10 minutes.
B) 30 minutes.
C) 1 hour.
D) 2 hours.

Question 31

In a teaching plan for clients newly diagnosed with diabetes, the nurse would include some basic facts relative to the pathophysiology of diabetes mellitus, such as

A) insulin assists in metabolizing fats for energy.
B) insulin must be present to convert glucose to glycogen.
C) the liver is capable of producing adequate insulin levels.
D) urine output increases to excrete by-products of fat metabolism.

Question 32

The nurse would instruct a client who is on a rowing team to avoid injecting insulin in his arms on rowing practice days because

A) exercise increases the absorption rate of insulin.
B) increased circulation in the arms will dilute the insulin.
C) the arms have increased muscle mass.
D) the arms will become painful.

Question 33

The nurse would encourage the client who is attempting to lose weight to reduce the intake of

A) broccoli.
B) cheese.
C) chicken.
D) oranges.

Question 34

The nurse teaching a diabetic client who has just started insulin therapy would include the instruction to

A) draw up short-acting insulin before longer-acting insulin.
B) inject at a 30-degree angle.
C) routinely aspirate before injecting.
D) shake short-acting insulin vigorously to mix it.

Question 35

A client is being admitted to the nursing unit with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). The nurse understands that compared with the care of DKA clients, the care of HHNK clients differs in that

A) assessments must be constant.
B) insulin is usually administered at a lower rate.
C) parenteral hyperalimentation will be needed.
D) treatment for dehydration will not be needed.

Question 36

For a client with diabetes mellitus scheduled for surgery at 8 AM, the nurse would plan to check the client's blood glucose level on the day of surgery between

A) 12 midnight and 2 AM.
B) 2 and 4 AM.
C) 4 and 6 AM.
D) 7 and 8 AM.

Question 37

A client with diabetes who has properly learned the principles of foot care would be most likely to say

A) "A mirror will be very helpful so I can look at all parts of my feet each day."
B) "I should limit walking barefoot to a half hour a day."
C) "I should wear nice, tight shoes for firm support."
D) "The best method of testing bath temperature is with the toes."

Question 38

A teenage diabetic client is admitted for a fourth episode of profound hypoglycemia in 6 months. Besides assessing the client's knowledge level, the nurse should also question the client about

A) deliberate errors in insulin dosage.
B) how often the client performs quality checks on the glucometer.
C) where the client gets diabetic supplies.
D) whether the client uses human- or animal-based insulin brands.

Question 39

The nurse would be most vigilant in assessing for hypoglycemia in a client taking the oral antidiabetic agent

A) acarbose (Precose).
B) chlorpropamide (Diabinese).
C) metformin (Glucophage).
D) repaglinide (Prandin).

Question 40

The nurse would explain to a client diagnosed with diabetes and hypertension that the most likely prescribed medication will be a(n)

A) angiotensin-converting enzyme (ACE) inhibitor.
B) beta-adrenergic blocker.
C) direct-acting vasodilator.
D) diuretic.

Question 41

The diabetic nurse educator would emphasize to a group class that quality of life in diabetes can be enhanced by

A) becoming a full and active partner in control of diabetes.
B) complying with the prescribed medical regimen.
C) not having too many complications from the disease.
D) taking as few medications to control the diabetes as possible.

Question 42

The nurse teaches a client with type 1 diabetes that in order to prevent complications from exercising, before exercising the client should (Select all that apply)

A) be adequately hydrated.
B) carry a carbohydrate snack.
C) eat a snack if blood glucose level is above 150 mg/dl.
D) not drink water to avoid nausea.

Question 43

For a diabetic client weighing 80 pounds, the nurse would anticipate that the starting dose of insulin will be

A) 72 units.
B) 54 units.
C) 36 units.
D) 18 units.

Question 44

In planning teaching and ongoing care for a new diabetic client, the clinic nurse should base the plan around concepts such as (Select all that apply)

A) continual assessment of client knowledge and skill level.
B) empowering the client to become the expert in his/her care.
C) liberal use of referrals depending on client need.
D) the nurse being the expert in diabetes care.
E) using a multidisciplinary approach.