Deck 67: Care of Patients With Diabetes Mellitus

Question 1

A client has been taught to inject insulin.Which statement made by the client indicates a need for further teaching?

A) "The abdominal site is best because it is closest to the pancreas."
B) "I can reach my thigh the best, so I will use different areas of the same thigh."
C) "By rotating the sites in one area, my chance of having a reaction is decreased."
D) "Changing injection sites from the thigh to the arm will change absorption rates."

Answer 1

"The abdominal site is best because it is closest to the pancreas."

Question 2

Which statement made by a client with type 2 diabetes taking nateglinide (Starlix)indicates understanding of this therapy?

A) "I'll take this medicine with my meals."
B) "I'll take this medicine right before I eat."
C) "I'll take this medicine just before I go to bed."
D) "I'll take this medicine when I wake up in the morning."

Answer 2

"I'll take this medicine right before I eat."

Question 3

A client who has type 2 diabetes is prescribed glipizide (Glucotrol).Which precautions does the nurse include in the teaching plan related to this medication?

A) "Change positions slowly when you get up."
B) "Avoid taking nonsteroidal anti-inflammatory drugs."
C) "If you miss a dose of this drug, you can double the next dose."
D) "Discontinue the medication if you develop an infection."

Answer 3

"Avoid taking nonsteroidal anti-inflammatory drugs."

Question 4

A client with diabetes has frequent blood glucose readings higher than 300 mg/dL.Which action does the nurse teach the client about self-care?

A) Check urine ketones when blood glucose readings are high.
B) Increase the insulin dose after two high glucose readings in a row.
C) Change the diet to include a 10% increase in protein.
D) Work out on the treadmill whenever glucose readings are high.

Question 5

Which client is at greatest risk for undiagnosed diabetes mellitus?

A) Young, muscular white man
B) Young African-American man
C) Middle-aged Asian woman
D) Middle-aged American Indian woman

Question 6

A client with diabetes is prescribed insulin glargine once daily and regular insulin four times daily.One dose of regular insulin is scheduled at the same time as the glargine.How does the nurse instruct the client to administer the two doses of insulin?

A) "Draw up and inject the insulin glargine first, then draw up and inject the regular insulin."
B) "Draw up and inject the insulin glargine first, wait 20 minutes, then draw up and inject the regular insulin."
C) "First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together."
D) "First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix, and inject the two insulins together."

Question 7

During assessment of a client with a 15-year history of diabetes,the nurse notes that the client has decreased tactile sensation in both feet.Which action does the nurse take first?

A) Document the finding in the client's chart.
B) Test sensory perception in the client's hands.
C)Examine the client's feet for signs of injury.
D) Notify the health care provider.

Question 8

A client with untreated diabetes mellitus has polyuria,is lethargic,and has a blood glucose of 560 mg/dL.The nurse correlates the polyuria with which finding?

A) Serum sodium, 163 mEq/L
B) Serum creatinine, 1.6 mg/dL
C) Presence of urine ketone bodies
D) Serum osmolarity, 375 mOsm/kg

Question 9

In preparing a staff in-service presentation about diabetes mellitus,the nurse includes which information?

A) Diabetes increases the risk for development of epilepsy.
B) The cure for diabetes is the administration of insulin.
C) Diabetes increases the risk for development of cardiovascular disease.
D) Carbohydrate metabolism is altered in diabetes, but protein metabolism is normal.

Question 10

A client has newly diagnosed diabetes.To delay the onset of microvascular and macrovascular complications in this client,the nurse stresses that the client take which action?

A) Control hyperglycemia.
B) Prevent hypoglycemia.
C) Restrict fluid intake.
D) Prevent ketosis.

Question 11

The client with type 2 diabetes has recently been changed from the oral antidiabetic agents glyburide (Micronase)and metformin (Glucophage)to glyburide-metformin (Glucovance).The nurse includes which information in the teaching about this medication?

A) "Glucovance is more effective than glyburide and metformin."
B) "Glucovance contains a combination of glyburide and metformin."
C) "Glucovance is a new oral insulin and replaces all other oral antidiabetic agents."
D) "Your diabetes is improving and you now need only one drug."

Question 12

The nurse is monitoring a client with hypoglycemia.Glucagon provides which function?

A) It enhances the activity of insulin, restoring blood glucose levels to normal more quickly after a high-calorie meal.
B) It is a storage form of glucose and can be broken down for energy when blood glucose levels are low.
C) It converts excess glucose into glycogen, lowering blood glucose levels in times of excess.
D) It prevents hypoglycemia by promoting release of glucose from liver storage sites.

Question 13

A client's father has type 1 diabetes mellitus.The client asks if she is in danger of developing the disease as well.Which is the nurse's best response?

A) "Your risk of diabetes is higher than that of the general population, but it may not occur."
B) "No genetic risk is associated with the development of type 1 diabetes."
C) "The risk for becoming diabetic is 50% because of how it is inherited."
D) "Female children do not inherit diabetes, but male children will."

Question 14

A client with diabetes asks why more than one injection of insulin is required each day.Which is the nurse's best response?

A) "You need to start with multiple injections until you become more proficient at self-injection."
B) "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns closely enough."
C) "A regimen of a single dose of insulin injected each day would require that you could eat no more than one meal each day."
D) "A single dose of insulin would be too large to be absorbed predictably, so you would be in danger of unexpected insulin shock."

Question 15

A client who has been taking pioglitazone (Actos)for 6 months reports to the nurse that his urine has become darker since starting the medication.Which is the nurse's first action?

A) Review results of liver enzyme studies.
B) Document the report in the client's chart.
C) Instruct the client to increase water intake.
D) Test a sample of urine for occult blood.

Question 16

A client who has used insulin for diabetes control for 20 years has a spongy swelling at the site used most frequently for insulin injection.Which is the nurse's best action?

A) Apply ice to this area for 20 minutes.
B) Document the finding in the client's chart.
C) Assess the client for other signs of cellulitis.
D) Instruct the client to use a different site for injection.

Question 17

A client with diabetes has a serum creatinine of 1.9 mg/dL.The nurse correlates which urinalysis finding with this client?

A) Ketone bodies in the urine during acidosis
B) Glucose in the urine during hyperglycemia
C) Protein in the urine during a random urinalysis
D) White blood cells in the urine during a random urinalysis

Question 18

A young adult client newly diagnosed with type 1 diabetes mellitus has been taught about self-care.Which statement by the client indicates a good understanding of needed eye examinations?

A) "At my age, I should continue seeing the ophthalmologist as I usually do."
B) "I will see the eye doctor whenever I have a vision problem and yearly after age 40."
C) "My vision will change quickly now. I should see the ophthalmologist twice a year."
D) "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

Question 19

The nurse is teaching a client about self-monitoring of blood glucose levels.To prevent bloodborne infection,which statement by the nurse is best?

A) "Wash your hands after completing the test."
B) "Do not share your monitoring equipment."
C) "Blot excess blood from the strip."
D) "Use gloves during monitoring."

Question 20

A client with diabetes asks the nurse why it is necessary to maintain blood glucose levels no lower than about 60 mg/dL.Which is the nurse's best response?

A) "Glucose is the only fuel used by the body to produce the energy that it needs."
B) "Your brain needs a constant supply of glucose because it cannot store it."
C) "Without a minimum level of glucose, your body does not make red blood cells."
D) "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."

Question 21

Three hours after surgery,the nurse notes that the breath of the client with type 1 diabetes has a "fruity" odor.Which is the nurse's best first action?

A) Document the finding in the client's chart.
B) Increase the IV fluid flow rate.
C) Test the serum for ketone bodies.
D) Perform pulmonary hygiene.

Question 22

Two months after a simultaneous pancreas-kidney (SPK)transplantation,a client is diagnosed as being in acute rejection.The client states,"I was doing so well with my new organs,and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." Which is the nurse's best response?

A) "You should have followed your drug regimen better."
B) "You should be glad that at least dialysis treatment is an option for you."
C) "One acute rejection episode does not mean that you will lose the new organs."
D) "Our center is high on the list for obtaining organs from the national registry."

Question 23

A client with diabetes is visually impaired and wants to know whether syringes can be prefilled and stored for later use.Which is the nurse's best response?

A) "Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up."
B) "Yes. Prefilled syringes can be stored for up to 3 weeks in the refrigerator, placed in a horizontal position."
C) "Insulin reacts with plastic, so prefilled syringes are okay, but they must be made of glass."
D) "No. Insulin cannot be stored for any length of time outside of the container."

Question 24

A client has been newly diagnosed with diabetes mellitus.Which statement made by the client indicates a need for further teaching regarding nutrition therapy?

A) "I should be sure to eat moderate to high amounts of fiber."
B) "Saturated fats should make up no more than 7% of my total calorie intake."
C) "I should try to keep my diet free from carbohydrates."
D) "My intake of plain water each day is not restricted."

Question 25

The nurse is teaching a client with diabetes about self-care.Which activity does the nurse teach that can decrease insulin needs?

A) Reducing intake of liquids to 2 L/day
B) Eating animal organ meats high in insulin
C) Limiting carbohydrate intake to 100 g/day
D) Walking 1 mile each day

Question 26

A client is learning to inject insulin.Which action is important for the nurse to teach the client?

A) "Do not use needles more than twice before discarding."
B) "Massage the site for 1 full minute after injection."
C) "Try to make the injection deep enough to enter muscle."
D) "Keep the vial you are using in the pantry or the bedroom drawer."

Question 27

A client on an intensified insulin regimen consistently has a fasting blood glucose level between 70 and 80 mg/dL,a postprandial blood glucose level below 200 mg/dL,and a hemoglobin A_1c level of 5.5%.Which is the nurse's interpretation of these findings?

A) Increased risk for developing ketoacidosis
B) Increased risk for developing hyperglycemia
C) Signs of insulin resistance
D) Good control of blood glucose

Question 28

A client in the emergency department has been diagnosed with ketoacidosis.Which manifestation does the nurse correlate with this condition?

A) Increased rate and depth of respiration
B) Extremity tremors followed by seizure activity
C) Oral temperature of 102° F (38.9° C)
D) Severe orthostatic hypotension

Question 29

A client with diabetes has proliferative retinopathy,nephropathy,and peripheral neuropathy.Which statement by the client indicates a good understanding of the disease and exercise?

A) "Because I have so many complications, I guess exercise is not a good idea."
B) "I have so many complications that I better exercise hard to keep from getting worse."
C) "I love to walk outside, but I probably better avoid doing that now."
D) "I should look into swimming or water aerobics to get my exercise."

Question 30

Which statement made by a client getting ready for discharge after pancreas transplantation indicates a need for further teaching about the prescribed drug regimen?

A) "If I develop an infection, I should stop taking my corticosteroid."
B) "If I have pain over the transplant, I will call the surgeon immediately."
C) "I should avoid people who are ill or who have an infection."
D) "I should take my cyclosporine exactly the way I was taught."

Question 31

The home care nurse visits an older client with diabetes.For which nutritional problem does the nurse monitor this client?

A) Obesity
B) Malnutrition
C) Alcoholism
D) Hyperglycemia

Question 32

The nurse correlates which laboratory value with inadequate functioning of a transplanted pancreas?

A) Total white blood cell count5000/mm³
B) 50% decrease in urine amylase level
C) Blood urea nitrogen30 mg/dL
D) Elevated bilirubin level

Question 33

A client has a new insulin pump.Which is the nurse's priority instruction in teaching the client?

A) "Test your urine daily for ketones."
B) "Use only buffered insulin."
C) "Keep the insulin frozen until you need it."
D) "Change the needle every 3 days."

Question 34

A client newly diagnosed with type 2 diabetes tells the nurse that since increasing fiber intake,he is having loose stools,flatulence,and abdominal cramping.Which is the nurse's best response?

A) "Decrease your intake of water and other fluids until your stools firm up."
B) "Decrease your intake of fiber now and gradually add it back into your diet."
C) "You must have allergies to high-fiber foods and will need to avoid them."
D) "Taking an antacid 1 hour before or 2 hours after meals will help this problem."

Question 35

The nurse is teaching a client with diabetes about exercise.Which statement by the client indicates a need for further teaching?

A) "I won't exercise if I find ketones in my urine."
B) "If my blood glucose is over 200, I should not exercise."
C) "Exercise will help me keep my blood glucose down."
D) "My risks for heart disease can be modified with exercise."

Question 36

A client has diabetic ketoacidosis and manifests Kussmaul respirations.What action by the nurse takes priority?

A) Administration of oxygen by mask or nasal cannula
B) Intravenous administration of 10% glucose
C) Implementation of seizure precautions
D) Administration of intravenous insulin

Question 37

The nurse determines that which arterial blood gas values are consistent with ketoacidosis in the client with diabetes?

A) pH 7.38, HCO₃^- 22 mEq/L, PCO₂ 38 mm Hg, PO₂ 98 mm Hg
B) pH 7.28, HCO₃^- 18 mEq/L, PCO₂ 28 mm Hg, PO₂ 98 mm Hg
C) pH 7.48, HCO₃^- 28 mEq/L, PCO₂ 38 mm Hg, PO₂ 98 mm Hg
D) pH 7.28, HCO₃^- 22 mEq/L, PCO₂ 58 mm Hg, PO₂ 88 mm Hg

Question 38

The nurse has been reviewing options for insulin therapy with several clients.For which client does the nurse choose to recommend the pen-type injector insulin delivery system?

A) Older adult client who lives at home alone but has periods of confusion
B) Client on an intensive regimen with frequent, small insulin doses
C) Client from the low-vision clinic who has trouble seeing the syringe
D) "Brittle" client who has frequent episodes of hypoglycemia

Question 39

To reduce complications of diabetes,the nurse teaches a client with normal kidney function to modify intake of which nutritional group?

A) Fats
B) Fiber
C) Proteins
D) Carbohydrates

Question 40

A client with type 1 diabetes asks whether an occasional glass of wine is allowed in the diet.Which is the nurse's best response?

A) "Drinking any wine or alcohol will increase your insulin requirements."
B) "Because of poor kidney function, people diagnosed with diabetes should avoid alcohol at all times."
C) "You shouldn't drink alcohol because it will make you hungry and overeat."
D) "One glass of wine is okay with a meal and is counted as two fat exchanges."

Question 41

A client is being treated for hyperglycemic-hyperosmolar state (HHS).Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted?

A) Serum potassium level has increased from 2.8 to 3.2 mEq/L.
B) Blood osmolarity has decreased from 350 to 330 mOsm.
C) Score on the Glasgow Coma Scale is unchanged from 3 hours ago.
D) Urine has remained negative for ketone bodies for the past 3 hours.

Question 42

Which statement by a client with type 2 diabetes indicates a need for further teaching about diabetic management and follow-up care?

A) "I need to have an annual appointment, even if my glucose levels are in good control."
B) "Because my diabetes is controlled with diet and exercise, I have to be seen only if I am sick."
C) "I can still develop complications, even though I do not have to take insulin at this time."
D) "If I have surgery or get very ill, I may have to receive insulin injections for a short time."

Question 43

A client with a 20-year history of diabetes mellitus is reviewing his medications with the nurse.The client holds up the bottle of duloxetine (Cymbalta)and states,"My cousin has depression and is on this drug.Do you think I'm depressed?" What is the nurse's best response?

A) "Many people with long-term diabetes become depressed after a while."
B) "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?"
C) "This antidepressant also has anti-inflammatory properties for diabetic pain."
D) "That is possible, but most medications are used for several different things."

Question 44

A client has been taught about lifestyle changes to help manage newly diagnosed diabetes mellitus type 2.Which statement by the client indicates good understanding?

A) "Weight gain may lead to type 1 diabetes and I would need insulin."
B) "I may not need to take medications if my weight is maintained."
C) "I do not have to check my blood glucose if my weight is in the proper range."
D) "My vision and foot pain may go away if I lose some weight."

Question 45

The nurse has given a client an injection of glucagon.Which action does the nurse take next?

A) Apply pressure to the injection site.
B) Position the client on his or her side.
C) Have a padded tongue blade available.
D) Elevate the head of the bed.

Question 46

The nurse has been teaching a client about a new diagnosis of diabetes mellitus.Which statement by the client indicates a good understanding of self-management?

A) "After bathing each day, I will inspect my feet and rub lotion between my toes and on my heels."
B) "I can store 3 months' worth of insulin at room temperature as long as the bottles are not open."
C) "My medical alert bracelet is important to identify me as having diabetes if I am unconscious."
D) "If I travel eastward to see my family, I should plan on using more insulin on the day I travel."

Question 47

A client has long-standing diabetes mellitus.Which finding alerts the nurse to decreased kidney function in this client?

A) Urine specific gravity of 1.033
B) Presence of glucose in the urine
C) Presence of ketone bodies in the urine
D) Sustained elevation in blood pressure

Question 48

A client with type 1 diabetes has a blood glucose level of 160 mg/dL on arrival at the operating room.Which is the nurse's best action?

A) Document the finding in the client's chart.
B) Administer a bolus of regular insulin IV.
C) Call the physician to cancel the operation.
D) Draw blood gases to assess the metabolic state.

Question 49

A client with a history of diabetes mellitus has new onset of microalbuminuria.Which component of the diet must the client reduce?

A) Percentage of total calories derived from carbohydrates
B) Percentage of total calories derived from proteins
C) Percentage of total calories derived from fats
D) Total caloric intake

Question 50

A client is receiving IV insulin for hyperglycemia.Which laboratory value requires immediate intervention by the nurse?

A) Serum chloride level of 98 mmol/L
B) Serum calcium level of 8.8 mg/dL
C) Serum sodium level of 132 mmol/L
D) Serum potassium level of 2.5 mmol/L

Question 51

The nurse administers 6 units of regular insulin and 10 units NPH insulin at 7 AM.At what time does the nurse assess the client for problems related to the NPH insulin?

A) 8 AM
B) 4 PM
C) 8 PM
D) 11 PM

Question 52

Which statement made by a diabetic client who has a urinary tract infection indicates that teaching was effective regarding antibiotic therapy?

A) "If my temperature is normal for 3 days in a row, I can stop taking my medicine."
B) "If my temperature goes above 100° F (37.8° C), I should double the dose."
C) "Even if I feel completely well, I should take the medication until it is gone."
D) "When my urine no longer burns, I will no longer need to take the antibiotics."

Question 53

The nurse is performing health screening in a local mall.Which people does the nurse counsel to be tested for diabetes?

A) African-American or American Indian
B) Person with history of pancreatic trauma
C) Woman with a 30-pound weight gain during pregnancy
D) Male with a body mass index greater than 25 kg/m²
E) Middle-aged woman with physical inactivity most days of the week
F) Young woman who gave birth to a baby weighing more than 9 pounds

Question 54

The nurse is teaching a client about sick day management.Which statement by the nurse is most accurate?

A) "Continue your prescribed exercise regimen even if you are sick."
B) "Avoid eating or drinking to reduce vomiting and diarrhea."
C) "Do not use insulin or take your oral antidiabetic agent if you vomit."
D) "Monitor your blood glucose levels at least every 4 hours."

Question 55

A diabetic client has numbness and reduced sensation.Which intervention does the nurse teach this client to prevent injury?

A) "Examine your feet daily using a mirror."
B) "Rotate your insulin injection sites."
C) "Wear white socks instead of colored socks."
D) "Use a bath thermometer to test the water temperature."

Question 56

A client recently diagnosed with type 1 diabetes tells the nurse,"I will never be able to stick myself with a needle." Which is the nurse's best response?

A) "Try not to worry about it. We will give you your injections here in the hospital."
B) "Everyone gets used to giving themselves injections. It really does not hurt."
C) "I am not sure how your disease can be managed if you refuse to give yourself the shots."
D) "Tell me what it is about the injections that is concerning you."

Question 57

The nurse is teaching a client with type 2 diabetes about acute complications.Which teaching point by the nurse is most accurate?

A) Ketosis is less prevalent among obese adults owing to the protective effects of fat.
B) People with type 2 diabetes have normal lipid metabolism, so ketones are not made.
C) Insulin produced in type 2 diabetes prevents fat catabolism but not hyperglycemia.
D) Oral antidiabetic agents do not promote the breakdown of fat for fuel (lipolysis).

Question 58

The nurse is caring for a critically ill client who has diabetic ketoacidosis (DKA).The nurse finds the following assessment data: blood pressure,90/62; pulse,120 beats/min; respirations,28 breaths/min; urine output,20 mL/1 hour per catheter; serum potassium,2.6 mEq/L.The health care provider orders a 40 mEq potassium bolus and an increase in the IV flow rate.Which action by the nurse is most appropriate?

A) Give the potassium after increasing the IV flow rate.
B) Increase the IV rate; consult the provider about the potassium.
C) Increase the IV rate; hold the potassium for now.
D) Infuse the potassium first before increasing the IV flow rate.

Question 59

The home care nurse finds a client who has diabetes awake and alert,but shaky,diaphoretic,and weak.The nurse gives the client cup of orange juice.The client's clinical manifestations have not changed 5 minutes later.Which is the nurse's best next action?

A) Give the client anothercup of orange juice.
B) Call the rescue squad for transportation to the hospital.
C) Administer 10 units of regular insulin subcutaneously.
D) Administer 1 mg glucagon intramuscularly.

Question 60

A client was admitted with diabetic ketoacidosis (DKA).Which manifestations does the nurse monitor the client most closely for?

A) Shallow slow respirations and respiratory alkalosis
B) Decreased urine output and hyperkalemia
C) Tachycardia and orthostatic hypotension
D) Peripheral edema and dependent pulmonary crackles

Question 61

In mixing regular and NPH insulin,the nurse completes the following actions.Place these actions in the correct order.(Separate letters by a comma and space as follows: a,b,c,d.)

A) Inspect bottles for expiration dates.
B) Gently roll bottle of NPH in hands.
C) Wash your hands.
D) Inject air into the regular insulin.
E) Withdraw the NPH insulin.
F) Withdraw the regular insulin.
G) Inject air into the NPH bottle.
H) Clean rubber stoppers with an alcohol swab.