Question 1

Which of the following laboratory values, noted by the nurse when reviewing the chart of a hospitalized client with diabetes, indicates the need for rapid assessment of the client?

Accepted Answer

The nurse should assess the client with a blood glucose level of 2.9 mmol/L for symptoms of hypoglycemia as the normal range is 4-6 mmol/L. The other values are within an acceptable range for a diabetic client.

Question 2

The nurse is admitting a client with diabetic ketoacidosis (DKA) who has a serum potassium level of 2.9 mmol/L. Which of the following actions prescribed by the health care provider should the nurse take first?

Accepted Answer

Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Since potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring, since insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the client's care.

Question 3

The nurse is caring for a client with type 2 diabetes who has sensory neuropathy of the feet and legs and peripheral arterial disease. Which of the following information will the nurse include in client teaching?

Accepted Answer

The client is taught to avoid high heels and that leather shoes are preferred. The feet
should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The client should see a specialist to treat these problems.

Question 4

Which of the following client teaching information is most important for the nurse to communicate to a client with gestational diabetes?

Accepted Answer

Women should be screened postpartum to determine their glucose status. The 2008 CDA guidelines recommend a 75-g oral glucose tolerance test (OGTT) be done between 6 weeks and 6 months postpartum. Delivery may affect blood glucose levels. Exercise is not to be avoided. Monitoring of blood glucose will continue into the postpartum period until levels are within normal limits.

Question 5

A client with type 1 diabetes who is on glargine and lispro insulin has called the clinic to report symptoms of a sore throat, cough, fever, and blood glucose level of 11.7 mmol/L. Which of the following information should the nurse tell the client?

Accepted Answer

Infection and other stressors increase blood glucose levels and the client will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA).
Decreasing carbohydrate or caloric intake is not appropriate because the client will need more calories when ill. Glycosylated hemoglobins are not used to test for short-term alterations in blood glucose.

Question 6

A diagnosis of hyperglycemic hyperosmolar state (HHS) is made for a client with type 2 diabetes who is brought to the emergency department in an unresponsive state. Which of the following actions should the nurse anticipate?

Accepted Answer

HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the client requires oxygen. Dextrose solutions will increase the client's blood glucose and would be contraindicated.

Question 7

The nurse is admitting a client with type 2 diabetes for an outpatient coronary arteriogram. Which of the following information obtained by the nurse is most important to report to the health care provider before the procedure?

Accepted Answer

To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogram and should not be used for 48 hours after IV contrast media are administered. The other client data will also be reported but do not indicate any need to reschedule the procedure.

Question 8

The nurse is assessing a client who is recovering from an episode of diabetic ketoacidosis and the client reports feeling anxious, nervous, and sweaty. Which of the following actions should the nurse take first?

Accepted Answer

The client's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the client's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the client should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the client's symptoms become worse or if the client is unconscious. Administration of lispro would drop the client's glucose further.

Question 9

Which of the following information about a client who receives rosiglitazone is most important for the nurse to report immediately to the health care provider?

Accepted Answer

Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. There is no urgent need to discuss the other data with the health care provider.

Question 10

The nurse obtains the following information about a client before administration of metformin. Which of the following findings indicate a need to contact the health care provider before giving the metformin?

Accepted Answer

The BUN indicates impending renal failure and metformin should not be used in clients with renal or hepatic impairment. The other findings are not contraindications to the use of metformin.

Question 11

The nurse is preparing to assess a client who is pregnant and has no personal history of diabetes but does have a parent with diabetes. Which of the following actions should the nurse plan to take on this initial prenatal visit?

Accepted Answer

Clients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be used to check for diabetes, but it would be done before the twenty-fourth week. The other actions may also be needed (depending on whether the client develops gestational diabetes), but they are not the first actions that the nurse should take.

Question 12

The health care provider suspects the Somogyi effect in a client whose 7:00 A.M. blood glucose is 12.2 mmol/L. Which action should the nurse plan to take?

Accepted Answer

If the Somogyi effect is causing the client's increased morning glucose level, the client will experience hypoglycemia between 2 and 4 A.M. The dose of insulin will be reduced, rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night.

Question 13

Which of the following questions by the nurse will help identify autonomic neuropathy in a client with diabetes?

Accepted Answer

Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the client. The other questions are also appropriate to ask, but would not help in identifying autonomic neuropathy.

Question 14

Which of the following hormones are considered as counter-regulatory hormones? (Select all that apply.)

Accepted Answer

Other hormones (glucagon, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are often referred to as counter-regulatory hormones. Insulin is not a counter-regulatory hormone.

Question 15

The nurse is teaching a client with diabetes who rides a bicycle to work every day about morning administration of insulin. Which of the following sites should the nurse tell the client to use to administer the morning insulin?

Accepted Answer

Clients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.

Question 16

The home health nurse is providing teaching to a client and family about how to use glargine and regular insulin safely. Which of the following actions by the client indicates that the teaching has been successful?

Accepted Answer

Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals, while glargine is given once daily.

Question 17

The nurse administers intramuscular glucagon to a client who is unresponsive for treatment of hypoglycemia. Which of the following actions should the nurse take after the client regains consciousness?

Accepted Answer

Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. A starch snack is recommended. Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and crackers will stabilize blood sugar. Administration of glucose intravenously might be used in clients who were unable to take in nutrition orally. The client should be assessed for symptoms of hypoglycemia after glucagon administration.

Question 18

Amitriptyline is prescribed for a diabetic client who has burning foot pain at night. Which of the following information should the nurse include when teaching the client about the new medication?

Accepted Answer

Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain. Tricyclics also improve sleep quality and are used for depression, but that is not the major purpose for their use in diabetic neuropathy. The blood vessel changes that contribute to neuropathy are not affected by tricyclics.

Question 19

The nurse is admitting a client with diabetic ketoacidosis. Which of the following prescriptions should the nurse implement first?

Accepted Answer

The most urgent client problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be accomplished after the infusion of normal saline is initiated.

Quiz 52: Nursing Management Diabetes Mellitus