Question 1

Which of the following information should the nurse include when teaching a client who has type 2 diabetes about glyburide?

Accepted Answer

The sulphonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the client should contact the health care provider before taking the glyburide because hypoglycemia can occur with this category of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide.

Question 2

The nurse is caring for a client with newly diagnosed type 2 diabetes mellitus who asks the nurse what "type 2" means in relation to diabetes. Which of the following statements by the nurse about type 2 diabetes is correct?

Accepted Answer

For some clients, changes in lifestyle are sufficient for blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a client develops complications such as frequent yeast infections.

Question 3

The nurse is caring for a client with diabetes who received 34 units of NPH insulin at 7:00 18. The nurse is caring for a client with diabetes who received 34 units of NPH insulin at7:00 A.M. and is away from the nursing unit, awaiting diagnostic testing when lunch trays are distributed. Which of the following actions is best to prevent hypoglycemia?

Accepted Answer

Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the client to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the client. A glass of juice will keep the client from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in this item.

Question 4

The nurse is assessing a client's technique of self-monitoring of blood glucose (SMBG) as part of diabetes management. Which of the following actions indicate a need for further teaching?

Accepted Answer

The client is taught to choose a puncture site at the side of the finger pad. The other client actions indicate that teaching has been effective.

Question 5

To evaluate the effectiveness of treatment for a client with type 2 diabetes who is scheduled for a follow-up visit in the clinic, which of the following tests will the nurse plan to schedule for the client?

Accepted Answer

The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90-120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control once diabetes has been diagnosed.

Question 6

Which of the following actions by a client with type 1 diabetes indicates that the nurse should implement teaching about exercise and glucose control?

Accepted Answer

When the client is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic clients should be taught to avoid exercise when ketosis is present. The other statements are correct.

Question 7

The nurse is caring for a client who received aspart insulin at 8:00 A.M. Which of the following times is most important for the nurse to monitor for symptoms of hypoglycemia?

Accepted Answer

The rapid-acting insulins peak in 60-90 minutes. The client is not at a high risk for hypoglycemia at the other listed times although hypoglycemia may occur.

Question 8

Which of the following client actions indicate a good understanding of the nurse's teaching about the use of an insulin pump?

Accepted Answer

In addition to the basal rate of insulin infusion, the client will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used. The pump will deliver a basal insulin rate 24 hours a day.

Question 9

Aclient who has type 1 diabetes plans to take a swimming class daily at 1:00 P.M. Which of the following instructions should the nurse teach to the client?

Accepted Answer

The change in exercise will affect blood glucose, and the client will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, clients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

Question 10

The nurse has completed teaching a client with type 2 diabetes about taking gliclazide. Which of the following client statements indicate a need for additional teaching?

Accepted Answer

The client should understand that type 2 diabetes places the client at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of gliclazide.

Question 11

The nurse is assessing a client who is experiencing the onset of symptoms of type 1 diabetes. Which of the following questions is best for the nurse to ask?

Accepted Answer

Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The client is thirsty but does not necessarily crave
sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.

Question 12

The nurse is caring for a client who has just been diagnosed with type 2 diabetes and has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which of the following client goals is most important?

Accepted Answer

The complications of diabetes are related to elevated blood glucose, and the most important client outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.

Question 13

The nurse is teaching the client to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. Which of the following statements by the client indicates a need for additional instruction?

Accepted Answer

Rotating sites are no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other client statements are accurate and indicate that no additional instruction is needed.

Question 14

After the nurse has finished teaching a client about self-administration of the prescribed aspart insulin, which of the following client actions indicate good understanding of the teaching?

Accepted Answer

The use of an alcohol swab on the site before self-injection is no longer recommended. Routine hygiene such as washing with soap and rinsing with water is adequate. Insulin should not be frozen. The client should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.

Question 15

A client with type 2 diabetes that is well-controlled with metformin develops an allergic rash to an antibiotic and the health care provider prescribes prednisone. Which of the following information should the nurse anticipate while the client is takingthe prednisone?

Accepted Answer

Glucose levels increase when clients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not an adverse effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The client may have an increased appetite when taking prednisone but will not need a diet that is higher in calories.

Question 16

Which of the following actions should the nurse take first when teaching a client who is newly diagnosed with type 2 diabetes about home management of the disease?

Accepted Answer

Before planning education, the nurse should assess the client's interest in and ability to self-manage the diabetes. After assessing the client, the other nursing actions may be appropriate, but planning needs to be individualized to each client.

Question 17

The nurse is assessing a client for diabetes at a clinic who has a fasting plasma glucose level of 6.7 mmol/L. Which of the following information should the nurse include in the plan of care?

Accepted Answer

The client's impaired fasting glucose indicates prediabetes and the client should be counselled about lifestyle changes to prevent the development of type 2 diabetes. The client with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

Question 18

Which of the following actions is most important for the nurse to take in order to assist a client with diabetes to engage in moderate daily exercise?

Accepted Answer

Since consistency with exercise is important, assessment for the types of exercise that the client finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions will also be implemented but are not the most important in improving compliance.

Question 19

The nurse is teaching about meal coverage to a client with diabetes who has just started on intensive insulin therapy. Which of the following types of insulin should the nurse discuss with the client?

Accepted Answer

Rapid- or short-acting insulin is used for mealtime coverage for clients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.

Question 20

The nurse is caring for a client with newly diagnosed type 1 diabetes who has received diet instruction. Which of the following client statements indicate a need for additional instruction?

Accepted Answer

Most clients with type 1 diabetes need to plan diet choices very carefully. Clients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other client statements are correct and indicate good understanding of the diet instruction.

Quiz 52: Nursing Management Diabetes Mellitus