2 1. Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?a. Insulin is not used to control blood glucose in patients with type 2 diabetes.b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma. ANS: CFor some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucosecontrol. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patientdevelops complications such as frequent yeast infections.DIF: Cognitive Level: Understand (comprehension) REF: 1166-1167 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 3 A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucoselevel of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient abouta. self-monitoring of blood glucose.b. using low doses of regular insulin.c. lifestyle changes to lower blood glucose. d. effects of oral hypoglycemic medications. ANS: CThe patient’s impaired fasting glucose indicates prediabetes, and the patient should be counseled aboutlifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does notrequire insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.DIF: Cognitive Level: Apply (application) REF: 1156 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 4 A 28-year-old male patient with type 1 diabetes reports how he manages his exerciseand glucose control. Which behavior indicates that the nurse should implement additionalteaching?a. The patient always carries hard candies when engaging in exercise.b. The patient goes for a vigorous walk when his glucose is 200 mg/dL.c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine. ANS: DWhen the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabeticpatients should be taught to avoid exercise when ketosis is present. The other statements are correct.DIF: Cognitive Level: Apply (application) REF: 1167 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 5 The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type1 diabetes. Which question is most appropriate for the nurse to ask?a. “Are you anorexic?”b. “Is your urine dark colored?”c. “Have you lost weight lately?” d. “Do you crave sugary drinks?” ANS: CWeight loss occurs because the body is no longer able to absorb glucose and starts to break down proteinand fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increasedappetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be verydilute.DIF: Cognitive Level: Apply (application) REF: 1156 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 6 A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic severalmonths from now. Which test will the nurse schedule to evaluate the effectiveness of treatment forthe patient?a. Urine dipstick for glucoseb. Oral glucose tolerance testc. Fasting blood glucose level d. Glycosylated hemoglobin level ANS: DThe glycosylated hemoglobin (A1C or HbA1C) test shows the overall control of glucose over 90 to 120days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not anaccurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oralglucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control oncediabetes has been diagnosed.DIF: Cognitive Level: Apply (application) REF: 1157 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 7 A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalancednutrition: more than body requirements. Which goal is most important for this patient?a. The patient will reach a glycosylated hemoglobin level of less than 7%.b. The patient will follow a diet and exercise plan that results in weight loss.c. The patient will choose a diet that distributes calories throughout the day. d. The patient will state the reasons for eliminating simple sugars in the diet. ANS: AThe complications of diabetes are related to elevated blood glucose, and the most important patientoutcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate butare not as high in priority.DIF: Cognitive Level: Apply (application) REF: 1157OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 8 A 38-year-old patient who has type 1 diabetes plans to swim laps daily at 1:00 PM. Theclinic nurse will plan to teach the patient toa. check glucose level before, during, and after swimming.b. delay eating the noon meal until after the swimming class.c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming. ANS: AThe change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully todetermine the need for changes in diet and insulin administration. Because exercise tends to decreaseblood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing theinsulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.DIF: Cognitive Level: Apply (application) REF: 1168 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 9 The nurse determines a need for additional instruction when the patient with newlydiagnosed type 1 diabetes says which of the following?a. “I can have an occasional alcoholic drink if I include it in my meal plan.”b. “I will need a bedtime snack because I take an evening dose of NPH insulin.”c. “I can choose any foods, as long as I use enough insulin to cover the calories.”d. “I will eat something at meal times to prevent hypoglycemia, even if I am not hungry.” ANS: CMost patients with type 1 diabetes need to plan diet choices very carefully. Patients who are usingintensified insulin therapy have considerable flexibility in diet choices but still should restrict dietaryintake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate goodunderstanding of the diet instruction.DIF: Cognitive Level: Apply (application) REF: 1165-1166 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 10 In order to assist an older diabetic patient to engage in moderate daily exercise, whichaction is most important for the nurse to take?a. Determine what type of activities the patient enjoys.b. Remind the patient that exercise will improve self-esteem.c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity. ANS: ABecause consistency with exercise is important, assessment for the types of exercise that the patient findsenjoyable is the most important action by the nurse in ensuring adherence to an exercise program. Theother actions will also be implemented but are not the most important in improving compliance.DIF: Cognitive Level: Apply (application) REF: 1186OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 11 Which statement by the patient indicates a need for additional instruction inadministering insulin?a. “I need to rotate injection sites among my arms, legs, and abdomen each day.”b. “I can buy the 0.5 mL syringes because the line markings will be easier to see.”c. “I should draw up the regular insulin first after injecting air into the NPH bottle.” d. “I do not need to aspirate the plunger to check for blood before injecting insulin.” ANS: ARotating sites is no longer recommended because there is more consistent insulin absorption when thesame site is used consistently. The other patient statements are accurate and indicate that no additionalinstruction is needed.DIF: Cognitive Level: Apply (application) REF: 1160-1161 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 12 Which patient action indicates good understanding of the nurse’s teaching aboutadministration of aspart (NovoLog) insulin?a. The patient avoids injecting the insulin into the upper abdominal area.b. The patient cleans the skin with soap and water before insulin administration.c. The patient stores the insulin in the freezer after administering the prescribed dose.d. The patient pushes the plunger down while removing the syringe from the injection site. ANS: BCleaning the skin with soap and water or with alcohol is acceptable. Insulin should not be frozen. Thepatient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulinhas been injected. The upper abdominal area is one of the preferred areas for insulin injection.DIF: Cognitive Level: Apply (application) REF: 1161 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 13 A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be mostimportant for the nurse to monitor for symptoms of hypoglycemia?a. 10:00 AMb. 12:00 AMc. 2:00 PM d. 4:00 PM ANS: AThe rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at theother listed times, although hypoglycemia may occur.DIF: Cognitive Level: Understand (comprehension) REF: 1159 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 14 Which patient action indicates a good understanding of the nurse’s teaching about theuse of an insulin pump?a. The patient programs the pump for an insulin bolus after eating.b. The patient changes the location of the insertion site every week.c. The patient takes the pump off at bedtime and starts it again each morning. d. The patient plans for a diet that is less flexible when using the insulin pump. ANS: AIn addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus aftereach meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or3 days. There is more flexibility in diet and exercise when an insulin pump is used. The pump will delivera basal insulin rate 24 hours a day.DIF: Cognitive Level: Apply (application) REF: 1162 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 15 A 32-year-old patient with diabetes is starting on intensive insulin therapy. Which typeof insulin will the nurse discuss using for mealtime coverage?a. Lispro (Humalog)b. Glargine (Lantus)c. Detemir (Levemir) d. NPH (Humulin N) ANS: ARapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulintherapy. NPH, glargine, or detemir will be used as the basal insulin.DIF: Cognitive Level: Apply (application) REF: 1158 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 16 Which information will the nurse include when teaching a 50-year-old patient who hastype 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)?a. Glyburide decreases glucagon secretion from the pancreas.b. Glyburide stimulates insulin production and release from the pancreas.c. Glyburide should be taken even if the morning blood glucose level is low. d. Glyburide should not be used for 48 hours after receiving IV contrast media. ANS: BThe sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level islow, the patient should contact the health care provider before taking the glyburide, becausehypoglycemia can occur with this class of medication. Metformin should be held for 48 hours afteradministration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is notaffected by glyburide.DIF: Cognitive Level: Apply (application) REF: 1163 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 17 The nurse has been teaching a patient with type 2 diabetes about managing bloodglucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need foradditional teaching?a. “If I overeat at a meal, I will still take the usual dose of medication.”b. “Other medications besides the Glucotrol may affect my blood sugar.”c. “When I am ill, I may have to take insulin to control my blood sugar.” d. “My diabetes won’t cause complications because I don’t need insulin.” ANS: DThe patient should understand that type 2 diabetes places the patient at risk for many complications andthat good glucose control is as important when taking oral agents as when using insulin. The otherstatements are accurate and indicate good understanding of the use of glipizide.DIF: Cognitive Level: Apply (application) REF: 1158 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 18 When a patient who takes metformin (Glucophage) to manage type 2 diabetes developsan allergic rash from an unknown cause, the health care provider prescribes prednisone(Deltasone). The nurse will anticipate that the patient maya. need a diet higher in calories while receiving prednisone.b. develop acute hypoglycemia while taking the prednisone.c. require administration of insulin while taking prednisone. d. have rashes caused by metformin-prednisone interactions. ANS: CGlucose levels increase when patients are taking corticosteroids, and insulin may be required to controlblood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect causedby taking metformin and prednisone simultaneously. The patient may have an increased appetite whentaking prednisone, but will not need a diet that is higher in calories.DIF: Cognitive Level: Apply (application) REF: 1175 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 19 A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM,the patient has been away from the nursing unit for 2 hours, missing the lunch delivery whileawaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is toa. save the lunch tray for the patient’s later return to the unit.b. ask that diagnostic testing area staff to start a 5% dextrose IV.c. send a glass of milk or orange juice to the patient in the diagnostic testing area. d. request that if testing is further delayed, the patient be returned to the unit to eat. ANS: DConsistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient tohave 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 patient. A glass of milk or juice willkeep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of therapid absorption of the simple carbohydrate in these items.DIF: Cognitive Level: Apply (application) REF: 1166 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 20 The nurse identifies a need for additional teaching when the patient who is selfmonitoringblood glucosea. washes the puncture site using warm water and soap.b. chooses a puncture site in the center of the finger pad.c. hangs the arm down for a minute before puncturing the site. d. says the result of 120 mg indicates good blood sugar control. ANS: BThe patient is taught to choose a puncture site at the side of the finger pad because there are fewer nerveendings along the side of the finger pad. The other patient actions indicate that teaching has beeneffective.DIF: Cognitive Level: Apply (application) REF: 1169 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 21 The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2diabetes about home management of the disease. Which action should the nurse take first?a. Ask the patient’s family to participate in the diabetes education program.b. Assess the patient’s perception of what it means to have diabetes mellitus.c. Demonstrate how to check glucose using capillary blood glucose monitoring. d. Discuss the need for the patient to actively participate in diabetes management. ANS: BBefore planning teaching, the nurse should assess the patient’s interest in and ability to self-manage thediabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs tobe individualized to each patient.DIF: Cognitive Level: Apply (application) REF: 1172 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 22 An unresponsive patient with type 2 diabetes is brought to the emergency departmentand diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate theneed toa. give a bolus of 50% dextrose.b. insert a large-bore IV catheter.c. initiate oxygen by nasal cannula. d. administer glargine (Lantus) insulin. ANS: BHHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin isadministered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrosesolutions will increase the patient’s blood glucose and would be contraindicated.DIF: Cognitive Level: Apply (application) REF: 1178 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 23 A 26-year-old female with type 1 diabetes develops a sore throat and runny nose aftercaring for her sick toddler. The patient calls the clinic for advice about her symptoms and a bloodglucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog)insulin. The nurse advises the patient toa. use only the lispro insulin until the symptoms are resolved.b. limit intake of calories until the glucose is less than 120 mg/dL.c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%. ANS: CInfection and other stressors increase blood glucose levels and the patient will need to test blood glucosefrequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucoselevels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may leadto diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because thepatient will need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate shorttermalterations in blood glucose.DIF: Cognitive Level: Apply (application) REF: 1171-1172 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 24 The health care provider suspects the Somogyi effect in a 50-year-old patient whose6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?a. Avoid snacking at bedtime.b. Increase the rapid-acting insulin dose.c. Check the blood glucose during the night d. Administer a larger dose of long-acting insulin. ANS: CIf the Somogyi effect is causing the patient’s increased morning glucose level, the patient will experiencehypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced, rather than increased. Abedtime snack is used to prevent hypoglycemic episodes during the night.DIF: Cognitive Level: Apply (application) REF: 1163 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 25 Which action should the nurse take after a 36-year-old patient treated withintramuscular glucagon for hypoglycemia regains consciousness?a. Assess the patient for symptoms of hyperglycemia.b. Give the patient a snack of peanut butter and crackers.c. Have the patient drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours. ANS: BRebound hypoglycemia can occur after glucagon administration, but having a meal containing complexcarbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk willelevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration ofIV glucose might be used in patients who were unable to take in nutrition orally. The patient should beassessed for symptoms of hypoglycemia after glucagon administration.DIF: Cognitive Level: Apply (application) REF: 1179 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 26 Which question during the assessment of a diabetic patient will help the nurse identifyautonomic neuropathy?a. “Do you feel bloated after eating?”b. “Have you seen any skin changes?”c. “Do you need to increase your insulin dosage when you are stressed?” d. “Have you noticed any painful new ulcerations or sores on your feet?” ANS: AAutonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for thepatient. The other questions are also appropriate to ask but would not help in identifying autonomicneuropathy.DIF: Cognitive Level: Apply (application) REF: 1183 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 27 Which information will the nurse include in teaching a female patient who hasperipheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs?a. Choose flat-soled leather shoes.b. Set heating pads on a low temperature.c. Use callus remover for corns or calluses. d. Soak feet in warm water for an hour each day. ANS: AThe patient 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 cornremovers should be avoided. The patient should see a specialist to treat these problems.DIF: Cognitive Level: Apply (application) REF: 1184 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 28 Which finding indicates a need to contact the health care provider before the nurseadministers metformin (Glucophage)?a. The patient’s blood glucose level is 174 mg/dL.b. The patient has gained 2 lb (0.9 kg) since yesterday.c. The patient is scheduled for a chest x-ray in an hour. d. The patient’s blood urea nitrogen (BUN) level is 52 mg/dL. ANS: DThe BUN indicates possible renal failure, and metformin should not be used in patients with renal failure.The other findings are not contraindications to the use of metformin.DIF: Cognitive Level: Apply (application) REF: 1163 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 29 A diabetic patient who has reported burning foot pain at night receives a newprescription. Which information should the nurse teach the patient about amitriptyline (Elavil)?a. Amitriptyline decreases the depression caused by your foot pain.b. Amitriptyline helps prevent transmission of pain impulses to the brain.c. Amitriptyline corrects some of the blood vessel changes that cause pain. d. Amitriptyline improves sleep and makes you less aware of nighttime pain. ANS: BTricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain.Tricyclic antidepressants also improve sleep quality and are used for depression, but that is not the majorpurpose for their use in diabetic neuropathy. The blood vessel changes that contribute to neuropathy arenot affected by tricyclic antidepressants.DIF: Cognitive Level: Apply (application) REF: 1183 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 30 Which information is most important for the nurse to report to the health care providerbefore a patient with type 2 diabetes is prepared for a coronary angiogram?a. The patient’s most recent HbA1C was 6.5%.b. The patient’s admission blood glucose is 128 mg/dL.c. The patient took the prescribed metformin (Glucophage) today. d. The patient took the prescribed captopril (Capoten) this morning. ANS: CTo avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogramand should not be used for 48 hours after IV contrast media are administered. The other patient data willalso be reported but do not indicate any need to reschedule the procedure.DIF: Cognitive Level: Apply (application) REF: 1163 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 31 Which action by a patient indicates that the home health nurse’s teaching aboutglargine and regular insulin has been successful?a. The patient administers the glargine 30 minutes before each meal.b. The patient’s family prefills the syringes with the mix of insulins weekly.c. The patient draws up the regular insulin and then the glargine in the same syringe. d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks. ANS: DInsulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulinsor prefilled and stored. Short-acting regular insulin is administered before meals, while glargine is givenonce daily.DIF: Cognitive Level: Apply (application) REF: 1160 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 32 A 26-year-old patient with diabetes rides a bicycle to and from work every day. Whichsite should the nurse teach the patient to administer the morning insulin?a. thigh.b. buttock.c. abdomen. d. upper arm. ANS: CPatients should be taught not to administer insulin into a site that will be exercised because exercise willincrease the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.DIF: Cognitive Level: Apply (application) REF: 1160 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 33 The nurse is interviewing a new patient with diabetes who receives rosiglitazone(Avandia) through a restricted access medication program. What is most important for the nurse toreport immediately to the health care provider?a. The patient’s blood pressure is 154/92.b. The patient has a history of emphysema.c. The patient’s blood glucose is 86 mg/dL. d. The patient has chest pressure when walking. ANS: DRosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health careprovider and expect orders to discontinue the medication. There is no urgent need to discuss the other datawith the health care provider.DIF: Cognitive Level: Apply (application) REF: 1163 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 34 The nurse is taking a health history from a 29-year-old pregnant patient at the firstprenatal visit. The patient reports no personal history of diabetes but has a parent who is diabetic.Which action will the nurse plan to take first?a. Teach the patient about administering regular insulin.b. Schedule the patient for a fasting blood glucose level.c. Discuss an oral glucose tolerance test for the twenty-fourth week of pregnancy.d. Provide teaching about an increased risk for fetal problems with gestational diabetes. ANS: BPatients 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 thetwenty-fourth week. The other actions may also be needed (depending on whether the patient developsgestational diabetes), but they are not the first actions that the nurse should take.DIF: Cognitive Level: Apply (application) REF: 1157OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 35 A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucoselevel of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the healthcare provider should the nurse take first?a. Place the patient on a cardiac monitor.b. Administer IV potassium supplements.c. Obtain urine glucose and ketone levels. d. Start an insulin infusion at 0.1 units/kg/hr. ANS: AHypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricularfibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium mustbe infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium.Insulin should not be administered without cardiac monitoring because insulin infusion will furtherdecrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage thepatient’s care.DIF: Cognitive Level: Apply (application) REF: 1176OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 36 A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission ordershould the nurse implement first?a. Infuse 1 liter of normal saline per hour.b. Give sodium bicarbonate 50 mEq IV push.c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/hr. ANS: AThe most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and thepriority is to infuse IV fluids. The other actions can be done after the infusion of normal saline is initiated.DIF: Cognitive Level: Apply (application) REF: 1177OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 37 A female patient is scheduled for an oral glucose tolerance test. Which informationfrom the patient’s health history is most important for the nurse to communicate to the health careprovider?a. The patient uses oral contraceptives.b. The patient runs several days a week.c. The patient has been pregnant three times. d. The patient has a family history of diabetes. ANS: AOral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values. Exercise and afamily history of diabetes both can affect blood glucose but will not lead to misleading information fromthe OGTT. History of previous pregnancies may provide informational about gestational glucosetolerance, but will not lead to misleading information from the OGTT.DIF: Cognitive Level: Apply (application) REF: 1157OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 38 A patient who was admitted with diabetic ketoacidosis secondary to a urinary tractinfection has been weaned off an insulin drip 30 minutes ago. The patient reports feelinglightheaded and sweaty. Which action should the nurse take first?a. Infuse dextrose 50% by slow IV push.b. Administer 1 mg glucagon subcutaneously.c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice. ANS: CThe patient’s clinical manifestations are consistent with hypoglycemia and the initial action should be tocheck the patient’s glucose with a finger stick or order a stat blood glucose. If the glucose is low, thepatient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% mightbe given if the patient’s symptoms become worse or if the patient is unconscious.DIF: Cognitive Level: Apply (application) REF: 1179OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 39 Which laboratory value reported to the nurse by the unlicensed assistive personnel(UAP) indicates the most urgent need for the nurse’s assessment of the patient?a. Bedtime glucose of 140 mg/dLb. Noon blood glucose of 52 mg/dLc. Fasting blood glucose of 130 mg/dL d. 2-hr postprandial glucose of 220 mg/dL ANS: BThe nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms ofhypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice. The othervalues are within an acceptable range or not immediately dangerous for a diabetic patient.DIF: Cognitive Level: Apply (application) REF: 1154OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 40 When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursingaction can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?a. Communicate the blood glucose level and insulin dose to the circulating nurse insurgery.b. Discuss the reason for the use of insulin therapy during the immediate postoperativeperiod.c. Administer the prescribed lispro (Humalog) insulin before transporting the patientto surgery.d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period. ANS: CLPN/LVN education and scope of practice includes administration of insulin. Communication aboutpatient status with other departments, planning, and patient teaching are skills that require RN educationand scope of practice.DIF: Cognitive Level: Apply (application) REF: 1185OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 41 An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic.Which finding may indicate the need for a change in therapy?a. Hemoglobin A1C level 6.2%b. Blood pressure 146/88 mmHgc. Heart rate at rest 58 beats/minute d. High density lipoprotein (HDL) level 65 mg/dL ANS: BTo decrease the incidence of macrovascular and microvascular problems in patients with diabetes, thegoal blood pressure is usually 130/80. An A1C less than 6.5%, a low resting heart rate (consistent withregular aerobic exercise in a young adult), and an HDL level of 65 mg/dL all indicate that the patient’sdiabetes and risk factors for vascular disease are well controlled.DIF: Cognitive Level: Apply (application) REF: 1181 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 42 A 34-year-old has a new diagnosis of type 2 diabetes. The nurse will discuss the needto schedule a dilated eye exama. every 2 years.b. as soon as possible.c. when the patient is 39 years old. d. within the first year after diagnosis. ANS: BBecause many patients have some diabetic retinopathy when they are first diagnosed with type 2 diabetes,a dilated eye exam is recommended at the time of diagnosis and annually thereafter. Patients with type 1diabetes should have dilated eye exams starting 5 years after they are diagnosed and then annually.DIF: Cognitive Level: Apply (application) REF: 1182 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 43 After the nurse has finished teaching a patient who has a new prescription forexenatide (Byetta), which patient statement indicates that the teaching has been effective?a. “I may feel hungrier than usual when I take this medicine.”b. “I will not need to worry about hypoglycemia with the Byetta.”c. “I should take my daily aspirin at least an hour before the Byetta.” d. “I will take the pill at the same time I eat breakfast in the morning.” ANS: CSince exenatide slows gastric emptying, oral medications should be taken at least an hour before theexenatide to avoid slowing absorption. Exenatide is injected and increases feelings of satiety.Hypoglycemia can occur with this medication.DIF: Cognitive Level: Apply (application) REF: 1165 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 44 A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has beenplaced on metformin (Glucophage) therapy and taught about appropriate diet and exercise, thehome health nurse makes a visit. Which finding by the nurse is most important to discuss with thehealth care provider?a. Hemoglobin A1C level is 7.9%.b. Last eye exam was 18 months ago.c. Glomerular filtration rate is decreased. d. Patient has questions about the prescribed diet. ANS: CThe decrease in renal function may indicate a need to adjust the dose of metformin or change to adifferent medication. In older patients, the goal for A1C may be higher in order to avoid complicationsassociated with hypoglycemia. The nurse will plan on scheduling the patient for an eye exam andaddressing the questions about diet, but the biggest concern is the patient’s decreased renal function.DIF: Cognitive Level: Apply (application) REF: 1186OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 45 The nurse has administered 4 oz of orange juice to an alert patient whose bloodglucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action shouldthe nurse take next?a. Give the patient 4 to 6 oz more orange juice.b. Administer the PRN glucagon (Glucagon) 1 mg IM.c. Have the patient eat some peanut butter with crackers. d. Notify the health care provider about the hypoglycemia. ANS: AThe “rule of 15” indicates that administration of quickly acting carbohydrates should be done 2 to 3 timesfor a conscious patient whose glucose remains less than 70 mg/dL before notifying the health careprovider. More complex carbohydrates and fats may be used once the glucose has stabilized. Glucagonshould be used if the patient’s level of consciousness decreases so that oral carbohydrates can no longerbe given.DIF: Cognitive Level: Apply (application) REF: 1179OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 46 Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP)who are working in the diabetic clinic?a. Measure the ankle-brachial index.b. Check for changes in skin pigmentation.c. Assess for unilateral or bilateral foot drop. d. Ask the patient about symptoms of depression. ANS: AChecking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial index is aprocedure that can be done by UAP who have been trained in the procedure. The other assessmentsrequire more education and critical thinking and should be done by the registered nurse (RN).DIF: Cognitive Level: Apply (application) REF: 15-16 | 1185OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 47 After change-of-shift report, which patient will the nurse assess first?a. 19-year-old with type 1 diabetes who was admitted with possible dawnphenomenonb. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230mg/dLc. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgorand dry oral mucosad. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain ANS: CThe patient’s diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess forsigns of shock and determine whether increased fluid infusion is needed. The other patients also needassessment and intervention but do not have life-threatening complications.DIF: Cognitive Level: Analyze (analysis) REF: 1178OBJ: Special Questions: Multiple Patients; Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 48 After change-of-shift report, which patient should the nurse assess first?a. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%b. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dLc. 40-year-old who is pregnant and whose oral glucose tolerance test is 202 mg/dLd. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain ANS: BBecause the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness,seizures, and death. The nurse will rapidly assess and treat the patient with low blood glucose. The otherpatients also have symptoms that require assessments and/or interventions, but they are not at immediaterisk for life-threatening complications.DIF: Cognitive Level: Analyze (analysis) REF: 1179OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 49 To monitor for complications in a patient with type 2 diabetes, which tests will the nursein the diabetic clinic schedule at least annually (select all that apply)?a. Chest x-rayb. Blood pressurec. Serum creatinined. Urine for microalbuminuriae. Complete blood count (CBC) f. Monofilament testing of the foot ANS: B, C, D, FBlood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of thefoot are recommended at least annually to screen for possible microvascular and macrovascularcomplications of diabetes. Chest x-ray and CBC might be ordered if the diabetic patient presents withsymptoms of respiratory or infectious problems but are not routinely included in screening.DIF: Cognitive Level: Apply (application) REF: 1161 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 50 In which order will the nurse take these steps to prepare NPH 20 units and regularinsulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A,B, C, D, E]).a. Rotate NPH vial.b. Withdraw regular insulin.c. Withdraw 20 units of NPH.d. Inject 20 units of air into NPH vial. e. Inject 2 units of air into regular insulin vial. ANS:A, D, E, B, CWhen mixing regular insulin with NPH, it is important to avoid contact between the regular insulin andthe additives in the NPH that slow the onset, peak, and duration of activity in the longer-acting insulin.DIF: Cognitive Level: Understand (comprehension) REF: 1181OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity BRUNNER & SUDDARTH 14TH ED 52 A community health nurse has witnessed significant shifts in patterns of disease over the course of afour-decade career. Which of the following focuses most clearly demonstrates the changing pattern ofdisease in the United States?A) Type 1 diabetes managementB) Treatment of community-acquired pneumoniaC) Rehabilitation from traumatic brain injuries D) Management of acute Staphylococcus aureus infections Ans: AFeedback:Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 12Management of chronic diseases such as diabetes is a priority focus of the current health care environment. This supersedes the treatment of acute infections and rehabilitation needs. 53 A nurse has been working with Mrs. Griffin, a 71-year-old patient whose poorly controlled type 1 diabetes has led to numerous health problems. Over the past several years Mrs. Griffin has had several admissions to the hospital medical unit, and the nurse has often carried out health promotion interventions. Who is ultimately responsible for maintaining and promoting Mrs. Griffins health?
Ans: DFeedback:American society places a great importance on health and the responsibility that each of us has to maintain and promote our own health. Therefore, the other options are incorrect. 54 A 20-year-old man newly diagnosed with type 1 diabetes needs to learn how to self-administer insulin.When planning the appropriate educational interventions and considering variables that will affect his learning, the nurse should prioritize which of the following factors? A) Patients expected lifespanB) Patients genderC) Patients occupation D) Patients culture Ans: DFeedback:One of the major variables that influences a patients readiness to learn is the patients culture, because itaffects how a person learns and what information is learned. Other variables include illness states,values, emotional readiness, and physical readiness. Lifespan, occupation, and gender are variables that are usually less salient. 55 You are the oncoming nurse and you have just taken end-of-shift report on your patients. One of yourpatients newly diagnosed with diabetes was admitted with diabetic ketoacidosis. Which behavior bestdemonstrates this patients willingness to learn?A) The patient requests a visit from the hospitals diabetic educator.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 71B) The patient sets aside a dessert brought in by a family member.C) The patient wants a family member to meet with the dietician to discuss meals. D) The patient readily allows the nurse to measure his blood glucose level. Ans: AFeedback:Emotional readiness also affects the motivation to learn. A person who has not accepted an existingillness or the threat of illness is not motivated to learn. The patients wiliness to learn is expressedthrough the action of seeking information on his or her own accord. Seeking information shows an emotional readiness to learn. The other options do not as clearly demonstrate a willingness to learn. 56 You are the clinic nurse providing patient education to a teenage girl who was diagnosed 6 months agowith type 1 diabetes. Her hemoglobin A1C results suggest she has not been adhering to her prescribedtreatment regimen. As the nurse, what variables do you need to assess to help this patient better adhereto her treatment regimen? Select all that apply.A) Variables that affect the patients ability to obtain resourcesB) Variables that affect the patients ability to teach her friends about diabetesC) Variables that affect the patients ability to cure her diseaseD) Variables that affect the patients ability to maintain a healthy social environment E) Variables that affect the patients ability to adopt specific behaviors Ans: A, D, EFeedback:Nurses success with health education is determined by ongoing assessment of the variables that affect apatients ability to adopt specific behaviors, to obtain resources, and to maintain a healthy socialenvironment. The patients ability to teach her friends about her condition is not a variable that the nursewould likely assess when educating the patient about her treatment regimen. Type 1 diabetes is not curable. 57 Nurses who are providing patient education often use motivators for learning with patients who arestruggling with behavioral changes necessary to adhere to a treatment regimen. When working with a15-year-old boy who has diabetes, which of the following motivators is most likely to be effective?A) A learning contractB) A star chartC) A point system D) A food-reward system Ans: AFeedback:Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 80Using a learning contract or agreement can also be a motivator for learning. Such a contract is based onassessment of patient needs; health care data; and specific, measurable goals. Young adults would notrespond well to the use of star charts, point systems, or food as reward for behavioral change. These types of motivators would work better with children. 58 You are taking a health history on an adult patient who is new to the clinic. While performing yourassessment, the patient informs you that her mother has type 1 diabetes. What is the primary significanceof this information to the health history?A) The patient may be at risk for developing diabetes.B) The patient may need teaching on the effects of diabetes.C) The patient may need to attend a support group for individuals with diabetes. D) The patient may benefit from a dietary regimen that tracks glucose intake. Ans: AFeedback:Nurses incorporate a genetics focus into the health assessments of family history to assess for geneticsrelatedrisk factors. The information aids the nurse in determining if the patient may be predisposed toTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 85diseases that are genetic in origin. The results of diabetes testing would determine whether dietary changes, support groups or health education would be needed. 59 you are the nurse caring for a patient who is Native American who arrives at the clinic for treatmentrelated to type 2 diabetes. Which question would best provide you with information about the role offood in the patients cultural practices and identify how the patients food preferences could be related tohis problem?A) Do you feel any of your cultural practices have a negative impact on your disease process?B) What types of foods are served as a part of your cultural practices, and how are they prepared?C) As a nonnative, I am unaware of your cultural practices. Could you teach me a few practices thatmay affect your care?D) Tell me about foods that are important in your culture and how you feel they influence your diabetes. Ans: DFeedback:The beliefs and practices that have been shared from generation to generation are known as cultural orethnic patterns. Food plays a significant role in both cultural practices and type 2 diabetes. By asking thequestion, Tell me about the foods that are important in your culture and how you feel they influenceyour diabetes, the nurse demonstrates a cultural awareness to the client and allows an open-endeddiscussion of the disease process and its relationship to cultural practice. An overemphasis on negativescan inhibit assessment and communication. Assessing the types and preparation of foods specific tocultural practices without relating it to diabetes is inadequate. The question, As a nonnative, I amunaware of your cultural practices. Could you teach me a few practices that may affect your care? focuses on care and fails to address the significance of food in cultural practice or diabetes. 60 You are the nurse caring for a 72-year-old woman who is recovering from a hemicolectomy on thepostsurgical unit. The surgery was very stressful and prolonged, and you note on the chart that her bloodsugars are elevated, yet diabetes does not appear in her previous medical history. To what do youattribute this elevation in blood sugars?A) It is a temporary result of increased secretion of antidiuretic hormone.B) She must have had diabetes prior to surgery that was undiagnosed.C) She has suffered pancreatic trauma during her abdominal surgery. D) The blood sugars are probably a result of the fight-or-flight reaction. Ans: DFeedback:During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, whichcreates protein catabolism releasing amino acids and stimulating the liver to convert amino acids toglucose; the result is elevated blood sugars. Antidiuretic hormone is released during stressful situationsand stimulates reabsorption of water in the distal and collecting tubules of the kidney. Assuming theTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 105patient had diabetes prior to surgery demonstrates a lack of understanding of stress-inducedhyperglycemia. No evidence presented in the question other than elevated blood sugars would support a diagnosis of diabetes. 61 The nurse is admitting a Native American patient with uncontrolled hypertension and type 1 diabetes tothe unit. During the initial assessment, the patient informs the nurse that he has been seeking assistanceand care from the shaman in his community. The nurse recognizes that the patients blood pressure andhis blood sugar level are elevated upon admission. What is the nurses best response to the patientsindication that his care provider is a shaman?A) Thank you for providing the information about the shaman, but we will keep that information andapproach separate from your current hospitalization.B) It seems that the care provided by your shaman is not adequately managing your hypertension anddiabetes, so we will try researched medical approaches.C) Dont worry about insulting your shaman, as he will understand his approach to your hypertensionand diabetes was not working after your doctor tells him how sick you were in the hospital.D) I understand that you value the care provided by the shaman, but we would like you to consider medications and dietary changes that may lower your blood pressure and blood sugar levels. Ans: DFeedback:Native American patients may seek assistance from a shaman or medicine man or woman. The nursesbest approach is not to disregard the patients belief in folk healers or try to undermine trust in thehealers. Nurses should make an effort to accommodate the patients beliefs while also advocating thetreatment proposed by health science. The nurses best response incorporating these strategies is, Iunderstand that you value the care provided by the shaman, but we would like you to consider medications and dietary changes that may improve your blood pressure and blood sugar levels. 62 A medical-surgical nurse is teaching a patient about the health implications of her recently diagnosedtype 2 diabetes. The nurse should teach the patient to be proactive with her glycemic control in order toreduce her risk of what health problem?A) ArthritisB) Renal failureC) Pancreatic cancer D) Asthma Ans: BFeedback:One chronic disease can lead to the development of other chronic conditions. Diabetes, for example, caneventually lead to neurologic and vascular changes that may result in visual, cardiac, and kidney disease and erectile dysfunction. Diabetes is not often linked to cancer, arthritis, or asthma. 63 A patient has recently been diagnosed with type 2 diabetes. The patient is clinically obese and has asedentary lifestyle. How can the nurse best begin to help the patient increase his activity level?A) Set up appointment times at a local fitness center for the patient to attend.B) Have a family member ensure the patient follows a suggested exercise plan.C) Construct an exercise program and have the patient follow it. D) Identify barriers with the patient that inhibit his lifestyle change. Ans: DFeedback:Nurses cannot expect that sedentary patients are going to develop a sudden passion for exercise and thatthey will easily rearrange their day to accommodate time-consuming exercise plans. The patient may notbe ready or willing to accept this lifestyle change. This is why it is important that the nurse and patient identify barriers to change. 64 You are caring for a young woman who has Down syndrome and who has just been diagnosed with type2 diabetes. What consideration should you prioritize when planning this patients nursing care?A) How her new diagnosis affects her health attitudesB) How her diabetes affects the course of her Down syndromeC) How her chromosomal disorder affects her glucose metabolism D) How her developmental disability influences her health management Ans: DFeedback:It is important to consider the interaction between existing disabilities and new diagnoses. Cognitive andmotor deficits would greatly affect diabetes management. Diabetes would not likely affect her attitude orthe course of her Down syndrome. Chromosomal disorders such as Down syndrome do not affect glucose metabolism. 65 You are presenting patient teaching to a 48-year-old man who was just diagnosed with type 2 diabetes.The patient has a BMI of 35 and leads a sedentary lifestyle. You give the patient information on the riskfactors for his diagnosis and begin talking with him about changing behaviors around diet and exercise.You know that further patient teaching is necessary when your patient tells you what?A) I need to start slow on an exercise program approved by my doctor.B) I know theres a chance I could have avoided this if Id always eaten better and exercised more.C) There is nothing that can be done anyway, because chronic diseases like diabetes cannot beprevented. D) I want to have a plan in place before I start making a lot of changes to my lifestyle. Ans: CFeedback:The major causes of chronic diseases are known, and if these risk factors were eliminated, at least over80% of heart disease, stroke, and type 2 diabetes would be prevented. In addition, over 40% of cancers would be prevented. The other listed options are accurate statements. 66 The nurse admitting a patient who is insulin dependent to the same-day surgical suite for carpal tunnelsurgery. How should this patients diagnosis of type 1 diabetes affect the care that the nurse plans?A) The nurse should administer a bolus of dextrose IV solution preoperatively.B) The nurse should keep the patient NPO for at least 8 hours preoperatively.C) The nurse should initiate a subcutaneous infusion of long-acting insulin. D) The nurse should assess the patients blood glucose levels vigilantly. Ans: DFeedback:The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia.Close glycemic monitoring is necessary. Dextrose infusion and prolonged NPO status are contraindicated. There is no specific need for an insulin infusion preoperatively. 67 The nurse is planning the care of a patient who has type 1 diabetes and who will be undergoing kneereplacement surgery. This patients care plan should reflect an increased risk of what postsurgicalcomplications? Select all that apply.A) HypoglycemiaB) DeliriumC) AcidosisD) Glucosuria E) Fluid overload Ans: A, C, DFeedback:Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates orexcessive administration of insulin. Hyperglycemia, which can increase the risk for surgical woundinfection, may result from the stress of surgery, which can trigger increased levels of catecholamine. Other risks are acidosis and glucosuria. Risks of fluid overload and delirium are not normally increased. 68 The clinic nurse is caring for a 57-year-old client who reports experiencing leg pain whenever she walksseveral blocks. The patient has type 1 diabetes and has smoked a pack of cigarettes every day for thepast 40 years. The physician diagnoses intermittent claudication. The nurse should provide whatinstruction about long-term care to the client?A) Be sure to practice meticulous foot care.B) Consider cutting down on your smoking.C) Reduce your activity level to accommodate your limitations. D) Try to make sure you eat enough protein. Ans: A Feedback: The patient with peripheral vascular disease or diabetes should receive education or reinforcement about skin and foot care. Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing; therefore, meticulous foot care is essential. The patient should stop smokingnot just cut downbecause nicotine is a vasoconstrictor. Daily walking benefits the patient with intermittent claudication. Increased protein intake will not alleviate the patients symptoms. 69 A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia.When reviewing this patients treatment plan, the nurse should anticipate the use of what drug?A) Magnesium sulfateB) Epoetin alfaC) Low-molecular weight heparin D) Vitamin K Ans: BFeedback:The availability of recombinant erythropoietin (epoetin alfa [Epogen, Procrit], darbepoetin alfa[Aranesp]) has dramatically altered the management of anemia in end-stage renal disease. Heparin, vitamin K, and magnesium are not indicated in the treatment of renal failure or the consequent anemia. 70 A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive.What is the nurses most plausible conclusion based on this assessment finding?A) The patient should withhold his next scheduled dose of insulin.B) The patient should promptly eat some protein and carbohydrates.C) The patients insulin levels are inadequate. D) The patient would benefit from a dose of metformin (Glucophage). Ans: CFeedback:Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes isdeteriorating. Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin will not cause short-term resolution of hyperglycemia. 71 A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria wouldsupport checking blood levels for the diagnosis of diabetes?A) Fasting plasma glucose greater than or equal to 126 mg/dLB) Random plasma glucose greater than 150 mg/dLC) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D) Random plasma glucose greater than 126 mg/dL Ans: AFeedback:Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL. 72 A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guidelinewould be important to teach the patients at this class?A) Low fat generally indicates low sugar.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 960B) Protein should constitute 30% to 40% of caloric intake.C) Most calories should be derived from carbohydrates. D) Animal fats should be eliminated from the diet. Ans: CFeedback:Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American DieteticAssociation) recommend that for all levels of caloric intake, 50% to 60% of calories should be derivedfrom carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet. 73 A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitusand her family. The nurse teaches the patient and family that which of the following nonpharmacologicmeasures will decrease the bodys need for insulin?A) Adequate sleepB) Low stimulationC) Exercise D) Low-fat diet Ans: CFeedback:Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceridelevels. Low fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise. 74 A medical nurse is caring for a patient with type 1 diabetes. The patients medication administrationrecord includes the administration of regular insulin three times daily. Knowing that the patients lunchtray will arrive at 11:45, when should the nurse administer the patients insulin?A) 10:45B) 11:15C) 11:45 D) 11:50 Ans: BFeedback:Regular insulin is usually administered 2030 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia. 75 A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabeticagent that will inhibit the production of glucose by the liver and thereby aid in the control of bloodglucose. What type of oral antidiabetic agent did the physician prescribe for this patient?A) A sulfonylureaB) A biguanideC) A thiazolidinedione D) An alpha glucosidase inhibitor Ans: BFeedback:Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin andtherefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose bythe liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhanceinsulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas.Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level. 76 A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. Whatguideline applies to periods of illness in a diabetic patient?A) Do not eliminate insulin when nauseated and vomiting.B) Report elevated glucose levels greater than 150 mg/dL.C) Eat three substantial meals a day, if possible. D) Reduce food intake and insulin doses in times of illness. Ans: ATest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 962Feedback:The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doseswhen nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agentdose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL. 77 The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would addresswhat topic during this dialogue?A) The need for frequent eye examinations for patients with diabetesB) The fact that patients with diabetes have an elevated risk of myocardial infarctionC) The relationship between kidney function and blood glucose levels D) The need to monitor urine for the presence of albumin Ans: BFeedback:Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and renal function are considered to be microvascular. 78 A school nurse is teaching a group of high school students about risk factors for diabetes. Which of thefollowing actions has the greatest potential to reduce an individuals risk for developing diabetes?A) Have blood glucose levels checked annually.B) Stop using tobacco in any form.C) Undergo eye examinations regularly. D) Lose weight, if obese. Ans: DFeedback:Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease.Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes. 79 A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and isTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 963subsequently diagnosed with diabetes. Based on the fact that the childs pancreatic beta cells are beingdestroyed, the patient would be diagnosed with what type of diabetes?A) Type 1 diabetesB) Type 2 diabetesC) Noninsulin-dependent diabetes D) Prediabetes Ans: AFeedback:Beta cell destruction is the hallmark of type 1 diabetes. Noninsulin-dependent diabetes is synonymouswith type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta celldestruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy. 80 A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurseis explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?A) The tissues in your body are resistant to the action of insulin, making the glucose levels in yourblood increase.B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there isnot enough insulin to control it.C) The amount of glucose that your body makes overwhelms your pancreas and decreases yourproduction of insulin.D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down. Ans: DFeedback:Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulinproduction, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucosederived from food cannot be stored in the liver and remains circulating in the blood, which leads topostprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not make glucose. 81 An occupational health nurse is screening a group of workers for diabetes. What statement should thenurse interpret as suggestive of diabetes?Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 964A) Ive always been a fan of sweet foods, but lately Im turned off by them.B) Lately, I drink and drink and cant seem to quench my thirst.C) No matter how much sleep I get, it seems to take me hours to wake up. D) When I went to the washroom the last few days, my urine smelled odd. Ans: BFeedback:Classic clinical manifestations of diabetes include the three Ps: polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes. 82 A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations forlevels of caloric intake. What do the ADAs recommendations include?A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from proteinB) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60%from proteinTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 965C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20%from proteinD) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein Ans: DFeedback:Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American DieteticAssociation) recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. 83 A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patientunderstands the primary treatment for type 2 diabetes when the patient states what?A) I read that a pancreas transplant will provide a cure for my diabetes.B) I will take my oral antidiabetic agents when my morning blood sugar is high.C) I will make sure to follow the weight loss plan designed by the dietitian. D) I will make sure I call the diabetes educator when I have questions about my insulin. Ans: CFeedback:Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss.Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucoselevels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactorylevels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or ona temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes. 84 An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. Thepatient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that thepatient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis ofhyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?A) Administration of antihypertensive medicationsB) Administering sodium bicarbonate intravenouslyC) Reversing acidosis by administering insulin D) Fluid and electrolyte replacement Ans: DFeedback:The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, andinsulin administration. Antihypertensive medications are not indicated, as hypotension generallyaccompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, astheir plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA). 85 A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is thebest way to assess the patients ability to prepare and self-administer insulin?A) Ask the patient to describe the process in detail.B) Observe the patient drawing up and administering the insulin.C) Provide a health education session reviewing the main points of insulin delivery.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 966 D) Review the patients first hemoglobin A1C result after discharge. Ans: BFeedback:Nurses should assess the patients ability to perform diabetes related self-care as soon as possible duringthe hospitalization or office visit to determine whether the patient requires further diabetes teaching.While consulting a home care nurse is beneficial, an initial assessment should be performed during thehospitalization or office visit. Nurses should directly observe the patient performing the skills such asinsulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning thepatient about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning. 86 An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned aboutfoot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that footcare is extremely important. Why would the nurse feel that foot care is so important to this patient?A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.B) Avoiding foot ulcers may mean the difference between institutionalization and continuedindependent living.C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.D)Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities. Ans: BFeedback:The nurse recognizes that providing information on the long-term complicationsespecially foot and eyeproblemsassociated with diabetes is important. Avoiding amputation through early detection of footulcers may mean the difference between institutionalization and continued independent living for theelderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation andmay lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs administered for diabetes. 87 A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator isaware that the patient will require further teaching when the patient states what?A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugarevery 2 hours.B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times aday.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 967C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea. D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine. Ans: AFeedback:The nurse must explanation the sick day rules again to the patient who plans to stop taking insulin whensick. The nurse should emphasize that the patient should take insulin agents as usual and test ones bloodsugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplementaldoses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greaterthan 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able toeat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding.If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60 minutes to prevent dehydration. 88 Which of the following patients with type 1 diabetes is most likely to experience adequate glucosecontrol?A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dLB) A patient who never deviates from her prescribed dose of insulinC) A patient who adheres closely to a meal plan and meal schedule D) A patient who eliminates carbohydrates from his daily intake Ans: CFeedback:The therapeutic goal for diabetes management is to achieve normal blood glucose levels withouthypoglycemia. Therefore, diabetes management involves constant assessment and modification of thetreatment plan by health professionals and daily adjustments in therapy (possibly including insulin) bypatients. For patients who require insulin to help control blood glucose levels, maintaining consistencyin the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in theapproximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes. 89 A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerancetest, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she isconscientious about her health, and asks the nurse what causes gestational diabetes. The nurse shouldexplain that gestational diabetes is a result of what etiologic factor?A) Increased caloric intake during the first trimesterTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 968B) Changes in osmolality and fluid balanceC) The effects of hormonal changes during pregnancy D) Overconsumption of carbohydrates during the first two trimesters Ans: CFeedback:Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion ofplacental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality. 90 A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemichyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndromemost often occur?A) Patients who are obese and who have no known history of diabetesB) Patients with type 1 diabetes and poor dietary controlC) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes Ans: DFeedback:HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes. 91 A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patientabout self-administration of insulin in the home setting. The nurse should teach the patient to do whichof the following?A) Avoid using the same injection site more than once in 2 to 3 weeks.B) Avoid mixing more than one type of insulin in a syringe.C) Cleanse the injection site thoroughly with alcohol prior to injecting. D) Inject at a 45 angle. Ans: AFeedback:To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks.Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90 angle. Cleansing the injection site with alcohol is optional. 92 A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon beingadmitted to the hospital for a cholecystectomy, however, the patient has required insulin injections ontwo occasions. The nurse would identify what likely cause for this short-term change in treatment?A) Alterations in bile metabolism and release have likely caused hyperglycemia.B) Stress has likely caused an increase in the patients blood sugar levels.C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologicmeasures. D) The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars. Ans: BFeedback:During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, becauselevels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone)increase. The patients need for insulin is unrelated to the action of bile, the patients overestimation of previous blood sugar control, or fluid imbalance. 93 A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Laterthat day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses bestresponse?A) Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that havegone on for years.B) The cause is not known for sure but it is thought to have something to do with ketoacidosis.C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over aperiod of years.D) Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels. Ans: CTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 970Feedback:The etiology of neuropathy may involve elevated blood glucose levels over a period of years. Highblood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies. 94 A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin(Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse shouldprioritize which of the following assessments?A) Monitoring the patients neutrophil levelsB) Assessing the patient for signs of impaired liver functionC) Monitoring the patients level of consciousness and behavior D) Reviewing the patients creatinine and BUN levels Ans: DFeedback:Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patients renal function. This drug does not typically affect patients neutrophils, liver function, or cognition. 95 A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. Thenurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy.Peripheral neuropathy constitutes a risk for what nursing diagnosis?A) InfectionB) Acute painC) Acute confusion D) Impaired urinary elimination Ans: AFeedback:Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injuryand undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function. 96 A patient has been brought to the emergency department by paramedics after being found unconscious.The patients Medic Alert bracelet indicates that the patient has type 1 diabetes and the patients bloodglucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?A) IV administration of 50% dextrose in waterB) Subcutaneous administration of 10 units of HumalogC) Subcutaneous administration of 12 to 15 units of regular insulin D) IV bolus of 5% dextrose in 0.45% NaCl Ans: AFeedback:In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate and insulin would exacerbate the patients condition. 97 A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providinginformation on the prevention and management of hypoglycemia, what action should the nurse promote?A) Always carry a form of fast-acting sugar.B) Perform exercise prior to eating whenever possible.C) Eat a meal or snack every 8 hours. D) Check blood sugar at least every 24 hours. Ans: AFeedback:The following teaching points should be included in information provided to the patient on how toprevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly. 98 A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topicshould the nurse address?A) Signs and symptoms of diabetic nephropathyB) Management of diabetic ketoacidosisTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 972C) Effects of surgery and pregnancy on blood sugar levels D) Recognition of hypoglycemia and hyperglycemia Ans: DFeedback:It is imperative that newly diagnosed patients know the signs and symptoms and management of hypoandhyperglycemia. The other listed topics are valid points for education, but are not components of the patients immediate survival skills following a new diagnosis. 99 A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial ofinsulin can be stored at room temperature before it goes bad. What would be the nurses best answer?A) If you are going to use up the vial within 1 month it can be kept at room temperature.B) If a vial of insulin will be used up within 21 days, it may be kept at room temperature.C) If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature. D) If a vial of insulin will be used up within 1 week, it may be kept at room temperature. Ans: AFeedback: If a vial of insulin will be used up within 1 month, it may be kept at room temperature. 100 A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with thepatient and will implement a program of health education. What is the nurses priority action?A)Ensure that the patient understands the basic pathophysiology of diabetes.B) Identify the patients body mass index.C) Teach the patient survival skills for diabetes. D) Assess the patients readiness to learn. Ans: DFeedback:Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 973Before initiating diabetes education, the nurse assesses the patients (and familys) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education. 101 A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assessesthe child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8mmol/L). What should the school nurse administer?A) A combination of protein and carbohydrates, such as a small cup of yogurtB) Two teaspoons of sugar dissolved in a cup of apple juiceC) Half of a cup of juice, followed by cheese and crackers D) Half a sandwich with a protein-based filling Ans: CFeedback:Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucosetablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snackincluding starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It isunnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar injuice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may result in a sharp rise in blood sugar that will last for several hours. 102 A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) fordiabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phaseof treatment?A) Monitoring the patient for dysrhythmiasB) Maintaining and monitoring the patients fluid balanceC) Assessing the patients level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism Ans: BFeedback:In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration,electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitorthe patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority. 103 A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient islikely to have minimal contact with the health care system. In order to ensure that the patient maintainsadequate blood sugar control over the long term, the nurse should recommend which of the following?A) Participation in a support group for persons with diabetesB) Regular consultation of websites that address diabetes managementC) Weekly telephone check-ins with an endocrinologist D) Participation in clinical trials relating to antihyperglycemics Ans: AFeedback:Participation in support groups is encouraged for patients who have had diabetes for many years as wellas for those who are newly diagnosed. This is more interactive and instructive than simply consultingwebsites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on patients circumstances. 104 A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priorityinstruction for the nurse to give the patient?A) Examine feet weekly for redness, blisters, and abrasions.B) Avoid the use of moisturizing lotions.C) Avoid hot-water bottles and heating pads. D) Dry feet vigorously after each bath. Ans: CFeedback:High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes,soaking the feet, and shaving calluses, should be avoided.Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling,redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the patient should gently, not vigorously, pat feet dry to avoid injury. 105 A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the mostappropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes?A) Ask the patient to describe an optimally healthy meal.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 975B) Ask the patient to keep a food diary and review it with the nurse.C) Ask the patients family what he typically eats. D) Ask the patient to describe a typical days food intake. Ans: BFeedback: Reviewing the patients actual food intake is the most accurate method of gauging the patients diet. 106 The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown thepresence of microalbuminuria. What is the nurses most appropriate action?A) Teach the patient about actions to slow the progression of nephropathy.B) Ensure that the patient receives a comprehensive assessment of liver function.C) Determine whether the patient has been using expired insulin. D) Administer a fluid challenge and have the test repeated. Ans: AFeedback:Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such,educational interventions addressing this microvascular complication are warranted. Expired insulindoes not cause nephropathy, and the patients liver function is not likely affected. There is no indication for the use of a fluid challenge. 107 A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurseshould question the patient about what sign or symptom that would suggest the possible development ofperipheral neuropathy?A) Persistently cold feetB) Pain that does not respond to analgesiaC) Acute pain, unrelieved by rest D) The presence of a tingling sensation Ans: DFeedback:Although approximately half of patients with diabetic neuropathy do not have symptoms, initialsymptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication. 108 A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regulardose of insulin. What else should the nurse tell the patient?A) Make sure to stick to your normal diet.B) Try to eat small amounts of carbs, if possible.C) Ensure that you check your blood glucose every hour. D) For now, check your urine for ketones every 8 hours. Ans: BFeedback:For prevention of DKA related to illness, the patient should attempt to consume frequent small portionsof carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinkingfluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours. 109 A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic andis experiencing HHS. The nurse should identify what components of HHS? Select all that apply.A) LeukocytosisB) GlycosuriaC) DehydrationD) Hypernatremia E) Hyperglycemia Ans: B, C, D, EFeedback:Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 977In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water andelectrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to theextracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place. 112 A nurse is teaching a client with diabetes mellitus who asks, Why is it necessary to maintain my bloodglucose levels no lower than about 60 mg/dL? How should the nurse respond?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. ANS: BBecause the brain cannot synthesize or store significant amounts of glucose, a continuous supply from thebodys circulation is needed to meet the fuel demands of the central nervous system. The nurse would want toeducate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein,and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucosemetabolism but is not directly responsible for lactic acid formation.DIF:Remembering/Knowledge REF: 1281KEY: Diabetes mellitus| hypoglycemia MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 113 A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy,and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the clientspolyuria?a. Serum sodium: 163 mEq/Lb. Serum creatinine: 1.6 mg/dLc. Presence of urine ketone bodiesd. Serum osmolarity: 375 mOsm/kg ANS: DHyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis.The clients serum osmolarity is high. The clients sodium would be expected to be high owing to dehydration.Serum creatinine and urine ketone bodies are not related to the polyuria.DIF:Applying/Application REF: 1282KEYiabetes mellitus| hyperglycemiaMSC:Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 114 After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assessesthe clients understanding. Which statement made by the client indicates a correct understanding of the need foreye examinations?a. At my age, I should continue seeing the ophthalmologist as I usually do.b. I will see the eye doctor when I have a vision problem and yearly after ageTest Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 52740.c. My vision will change quickly. I should see the ophthalmologist twice a year. d. Diabetes can cause blindness, so I should see the ophthalmologist yearly. ANS: DDiabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless ofage, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and atleast yearly thereafter.DIF:Applying/Application REF: 1283KEY: Diabetes mellitus| health screening MSC: Integrated Process: Teaching/Learning NOT:Client Needs Category: Health Promotion 115 A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in bothfeet. Which action should the nurse take first?a. Document the finding in the clients chart.b. Assess tactile sensation in the clientshands.c. Examine the clients feet for signs of injury. d. Notify the health care provider. ANS: CDiabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in anyarea with decreased sensation because he or she is less able to feel injurious events. Feet are common locationsfor neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurseshould document findings in the clients chart. Testing sensory perception in the hands may or may not beneeded. The health care provider can be notified after assessment and documentation have been completed.DIF:Applying/Application REF: 1301KEYiabetes mellitus| neuropathyMSC:Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 116 A nurse cares for a client who has a family history of diabetes mellitus. The client states, My father has type1 diabetes mellitus. Will I develop this disease as well? How should the nurse respond?a. Your risk of diabetes is higher than the general population, but it may notoccur.b. No genetic risk is associated with the development of type 1 diabetes mellitus.c. The risk for becoming a diabetic is 50% because of how it is inherited. d. Female children do not inherit diabetes mellitus, but male children will. ANS: ARisk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types.Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1)seems to require interaction between inherited risk and environmental factors, so not everyone with these genesdevelops diabetes. The other statements are not accurate.Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 528DIF:Understanding/Comprehension REF: 1287KEY: Diabetes mellitus| genetics MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 117 A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse includein this clients plan of care to delay the onset of microvascular and macrovascular complications?a. Maintain tight glycemic control and preventhyperglycemia.b. Restrict your fluid intake to no more than 2 liters a day.c. Prevent hypoglycemia by eating a bedtime snack. d. Limit your intake of protein to prevent ketoacidosis. ANS: AHyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tightglycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatmentplan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as importantas maintaining daily glycemic control.DIF:Applying/Application REF: 1281KEY: Diabetes mellitus| hyperglycemia MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 118 A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?a. A 29-year-old Caucasianb. A 32-year-old African-Americanc. A 44-year-old Asian d. A 48-year-old American Indian ANS: DDiabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidenceof diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-agedplaces this client at highest risk.DIF:Understanding/Comprehension REF: 1287KEYiabetes mellitus| health screeningMSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 119 A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurseinclude in this clients teaching to prevent bloodborne infections?a. Wash your hands after completing each test.b. Do not share your monitoring equipment.c. Blot excess blood from the strip with a cottonball.Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 529 d. Use gloves when monitoring your blood glucose. ANS: BSmall particles of blood can adhere to the monitoring device, and infection can be transported from one user toanother. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught toavoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her handsbefore testing. The client would not need to blot excess blood away from the strip or wear gloves.DIF:Applying/Application REF: 1298KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 120 A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Whichstatement should the nurse include in this clients teaching?a. Change positions slowly when you get out of bed.b. Avoid taking nonsteroidal anti-inflammatory drugs(NSAIDs).c. If you miss a dose of this drug, you can double the next dose. d. Discontinue the medication if you develop a urinary infection. ANS: BNSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The otherstatements are not applicable to glipizide.DIF:Applying/Application REF: 1290KEYiabetes mellitus| oral antidiabetic agents| medication safetyMSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 121 After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurseassesses the clients understanding. Which statement made by the client indicates a correct understanding of theprescribed therapy?a. Ill take this medicine during each of my meals.b. I must take this medicine in the morning when Iwake.c. I will take this medicine before I go to bed. d. I will take this medicine immediately before I eat. ANS: DNateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should betaken immediately before each meal. The medication should not be taken without eating as it will decrease theclients blood glucose levels. The medication should be taken before meals instead of during meals.DIF:Applying/Application REF: 1292Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 530KEYiabetes mellitus| oral antidiabetic agents| medication safetyMSC:Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 122 A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the clientreports that his urine has become darker since starting the medication. Which action should the nurse take?a. Assess for pain or burning with urination.b. Review the clients liver function studyresults.c. Instruct the client to increase water intake. d. Test a sample of urine for occult blood. ANS: BThiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at thestart of therapy and at regular intervals while the client continues to take these drugs. Dark urine is oneindicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurseshould check the clients most recent liver function studies. The nurse does not need to assess for pain orburning with urination and does not need to check the urine for occult blood. The client does not need to betold to increase water intake.DIF:Applying/Application REF: 1292KEYiabetes mellitus| oral antidiabetic agents| medication safetyMSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 123 A nurse cares for a client with diabetes mellitus who asks, Why do I need to administer more than oneinjection of insulin each day? How should the nurse respond?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.c. A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates.d. A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock. ANS: BEven when a single injection of insulin contains a combined dose of different-acting insulin types, the timingof the actions and the timing of food intake may not match well enough to prevent wide variations in bloodglucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake.Additional injections are not required to allow the client practice with injections, nor will one dose increase theclients risk of insulin shock.DIF:Applying/Application REF: 1294KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 124 After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the clients understanding.Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 531Which statement made by the client indicates a need for additional teaching?a. The lower abdomen is the best location because it is closest to the pancreas.b. I can reach my thigh the best, so I will use the different areas of my thighs.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. ANS: AThe abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of itsproximity to the pancreas. The other statements are accurate assessments of insulin administration.DIF:Applying/Application REF: 1294KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 125 A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub bymoaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45%normal saline. Which action should the nurse take first?a. Administer 1 mg of intramuscular glucagon.b. Encourage the client to drink orange juice.c. Insert a new intravenous access line.d. Administer 25 mL dextrose 50% (D50) IV push. ANS: AThe clients blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately toincrease the clients blood glucose level. The nurse should insert a new IV after administering the glucagon andcan use the new IV site for future doses of D50 if the clients blood glucose level does not rise. Once the clientis awake, orange juice may be administered orally along with a form of protein such as a peanut butter.DIF:Applying/Application REF: 1301KEYiabetes mellitus| hypoglycemiaMSC:Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 126 A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, Can I ask myniece to prefill my syringes and then store them for later use when I need them? How should the nurserespond?a. Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needlepointing up.b. Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light.c. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes. d. No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container. : AInsulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plasticsyringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with theneedle pointing up to prevent suspended insulin particles from clogging the needle.DIF:Remembering/Knowledge REF: 1296KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 127 A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include inthis clients discharge education?a. Test your urine daily for ketones.b. Use only buffered insulin in your pump.c. Store the insulin in the freezer until you needit. d. Change the needle every 3 days. ANS: DHaving the same needle remain in place through the skin for longer than 3 days drastically increases the riskfor infection in or through the delivery system. Having an insulin pump does not require the client to test forketones in the urine. Insulin should not be frozen. Insulin is not buffered.DIF:Applying/Application REF: 1295KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 128 After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheralneuropathy, the nurse assesses the clients understanding. Which statement made by the client indicates acorrect understanding of the teaching?a. I have so many complications; exercising is not recommended.b. I will exercise more frequently because I have so manycomplications.c. I used to run for exercise; I will start training for a marathon. d. I should look into swimming or water aerobics to get my exercise. ANS: DExercise is not contraindicated for this client, although modifications based on existing pathology arenecessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worryof having the correct shoes or developing a foot injury. The client should not exercise too vigorously.DIF:Applying/Application REF: 1298KEY: Diabetes mellitus| exercise MSC: Integrated Process: Teaching/Learning NOT:Client Needs Category: Health Promotion and Maintenance 129 An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation shouldthe nurse correlate with this condition?a. Increased rate and depth of respirationb. Extremity tremors followed by seizureactivityc. Oral temperature of 102 F (38.9 C) d. Severe orthostatic hypotension ANS: AKetoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer theeffects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in anattempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension arenot associated with ketoacidosis.DIF:Applying/Application REF: 1313KEYiabetes mellitus| hyperglycemiaMSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 130 A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurseidentify as potential ketoacidosis in this client?a. pH 7.38, HCO3 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hgb. pH 7.28, HCO3 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hgc. pH 7.48, HCO3 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg d. pH 7.32, HCO3 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg ANS: BWhen the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabeticketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreasedbicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels.DIF:Applying/Application REF: 1313KEYiabetes mellitus| hyperglycemiaMSC:Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 131 A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations.Which action should the nurse take?a. Administration of oxygen via face maskb. Intravenous administration of 10%glucose c. Implementation of seizure precautions d. Administration of intravenous insulin ANS: DThe rapid, deep respiratory efforts of Kussmaul respirations are the bodys attempt to reduce the acids producedby using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respirationby assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosismay not experience any respiratory impairment and therefore does not need additional oxygen. Giving theclient glucose would be contraindicated. The client does not require seizure precautions.DIF:Applying/Application REF: 1313KEYiabetes mellitus| hyperglycemia| respiratory distress/failureMSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 132 A nurse cares for a client who has type 1 diabetes mellitus. The client asks, Is it okay for me to have anoccasional glass of wine? How should the nurse respond?a. Drinking any wine or alcohol will increase your insulin requirements.b. Because of poor kidney function, people with diabetes should avoidalcohol.c. You should not 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. ANS: DUnder normal circumstances, blood glucose levels will not be affected by moderate use of alcohol whendiabetes is well controlled. Because alcohol can induce hypoglycemia, it should be ingested with or shortlyafter a meal. One alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated.Kidney function is not impacted by alcohol intake. Alcohol is not associated with increased hunger orovereating.DIF:Applying/Application REF: 1300KEYiabetes mellitus| nutritional requirementsMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 133 A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in thisclients teaching to decrease the clients insulin needs?a. Limit your fluid intake to 2 liters a day.b. Animal organ meat is high in insulin.c. Limit your carbohydrate intake to 80 grams aday. d. Walk at a moderate pace for 1 mile daily. ANS: DModerate exercise such as walking helps regulate blood glucose levels on a daily basis and results in loweredinsulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will notreduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day. DIF:Applying/Application REF: 1318 134 A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneouspancreas-kidney transplant. The client states, I was doing so well with my new organs, and the thought ofhaving to go back to living on hemodialysis and taking insulin is so depressing. How should the nurse respond?a. Following the drug regimen more closely would have prevented this.b. One acute rejection episode does not mean that you will lose the new organs.c. Dialysis is a viable treatment option for you and may save your life.d. Since you are on the national registry, you can receive a second transplantation. ANS: BAn episode of acute rejection does not automatically mean that the client will lose the transplant.Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allowthe graft to be maintained. The other statements either belittle the client or downplay his or her concerns. Theclient may not be a candidate for additional organ transplantation.DIF:Applying/Application REF: 1304KEYiabetes mellitus| pancreas-kidney transplantMSC:Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity 135 After teaching a client who is recovering from pancreas transplantation, the nurse assesses the clientsunderstanding. Which statement made by the client indicates a need for additional education?a. If I develop an infection, I should stop taking my corticosteroid.b. If I have pain over the transplant site, I will call the surgeonimmediately.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. ANS: AImmunosuppressive agents should not be stopped without the consultation of the transplantation physician,even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. Theother statements are correct. Pain over the graft site may indicate rejection. Anti-rejection drugs causeimmunosuppression, and the client should avoid crowds and people who are ill. Changing the routine of antirejectionmedications may cause them to not work optimally.DIF:Applying/Application REF: 1303KEYiabetes mellitus| pancreas-kidney transplantMSC:Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 136 A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the clientsbreath has a fruity odor. Which action should the nurse take?Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 536a. Encourage the client to use an incentivespirometer.b. Increase the clients intravenous fluid flow rate.c. Consult the provider to test for ketoacidosis. d. Perform meticulous pulmonary hygiene care. ANS: CThe stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin,predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a fruityodor to the breath. Documentation should occur after all assessments have been completed. Using an incentivespirometer, increasing IV fluids, and performing pulmonary hygiene will not address this clients problem.DIF:Applying/Application REF: 1310KEYiabetes mellitus| hyperglycemia| postoperative nursingMSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 137 A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. Theclients blood glucose level is 160 mg/dL. Which action should the nurse take?a. Document the finding in the clients chart.b. Administer a bolus of regular insulin IV.c. Call the surgeon to cancel the procedure.d. Draw blood gases to assess the metabolic state. ANS: AClients who have type 1 diabetes and are having surgery have been found to have fewer complications, lowerrates of infection, and better wound healing if blood glucose levels are maintained at between 140 and 180mg/dL throughout the perioperative period. The nurse should document the finding and proceed with otheroperative care. The need for a bolus of insulin, canceling the procedure, or drawing arterial blood gases is notrequired.DIF:Applying/Application REF: 1302KEYiabetes mellitus| preoperative nursingMSC:Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 138 A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Whichstatement should the nurse include in this clients teaching to prevent injury?a. Examine your feet using a mirror every day.b. Rotate your insulin injection sites every week.c. Check your blood glucose level before each meal.d. Use a bath thermometer to test the water temperature. ANS: DTest Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 537Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot.Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining thefeet daily does not prevent injury, although daily foot examinations are important to find problems so they canbe addressed. Rotating insulin and checking blood glucose levels will not prevent injury.DIF:Applying/Application REF: 1307KEY: Diabetes mellitus| foot care MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 139 A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holdsup the bottle of prescribed duloxetine (Cymbalta) and states, My cousin has depression and is taking this drug.Do you think Im depressed? How should the nurse respond?a. Many people with long-term diabetes become depressed after a while.b. Its for peripheral neuropathy. Do you have burning pain in your feet orhands?c. This antidepressant also has anti-inflammatory properties for diabetic pain. d. No. Many medications can be used for several different disorders. ANS: BDamage along nerves causes peripheral neuropathy and leads to burning pain along the nerves. Many drugs,including duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The nurse should assess the clientfor this condition and then should provide an explanation of why this drug is being used. This medication,although it is used for depression, is not being used for that reason in this case. Duloxetine does not have antiinflammatoryproperties. Telling the client that many medications are used for different disorders does notprovide the client with enough information to be useful.DIF:Applying/Application REF: 1308KEY: Diabetes mellitus| neuropathy MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 140 A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse todecreased kidney function in this client?a. Urine specific gravity of 1.033b. Presence of protein in the urinec. Elevated capillary blood glucoselevel d. Presence of ketone bodies in the urine ANS: BRenal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specificgravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine areconsistent with diabetes mellitus but are not specific to renal function.DIF:Applying/Application REF: 1308KEYiabetes mellitus| renal failure MSC:Integrated Process: Nursing Process: Analysis 141 A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Whichcomponent of the clients diet should the nurse decrease?a. Carbohydratesb. Proteinsc. Fats d. Total calories ANS: BRestriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients withmicroalbuminuria to delay progression to renal failure. The clients diet does not need to be decreased incarbohydrates, fats, or total calories.DIF:Remembering/Knowledge REF: 1309KEYiabetes mellitus| nutritional requirementsMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 142 A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky,diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the clients clinicalmanifestations have not changed. Which action should the nurse take next?a. Administer another half-cup of orange juice.b. Administer a half-ampule of dextrose 50%intravenously.c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly. ANS: AThis client is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse shouldadminister oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatmentshould be repeated. The client does not need intravenous dextrose, insulin, or glucagon.DIF:Applying/Application REF: 1310KEYiabetes mellitus| hypoglycemiaMSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 143 A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alertthe nurse to intervene immediately?a. Serum chloride level of 98 mmol/Lb. Serum calcium level of 8.8 mg/dLc. Serum sodium level of 132 mmol/Ld. Serum potassium level of 2.5 mmol/L ANS: DInsulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from theextracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia canalso result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levelsare slightly low, but this would not be related to hyperglycemia and insulin administration.DIF:Applying/Application REF: 1305KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 144 A nurse teaches a client with diabetes mellitus about sick day management. Which statement should thenurse include in this clients teaching?a. When ill, avoid eating or drinking to reduce vomiting and diarrhea.b. Monitor your blood glucose levels at least every 4 hours while sick.c. If vomiting, do not use insulin or take your oral antidiabetic agent.d. Try to continue your prescribed exercise regimen even if you are sick. ANS: BWhen ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continuetaking the medication regimen while ill. The client should continue to eat and drink as tolerated but should notexercise while sick.DIF:Applying/Application REF: 1315KEY: Diabetes mellitus| hyperglycemia MSC: Integrated Process: Teaching/Learning NOT:Client Needs Category: Health Promotion and Maintenance 145 A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinicalmanifestation indicates to the nurse that the therapy needs to be adjusted?a. Serum potassium level has increased.b. Blood osmolarity has decreased.c. Glasgow Coma Scale score is unchanged.d. Urine remains negative for ketone bodies. ANS: CA slow but steady improvement in central nervous system functioning is the best indicator of therapyeffectiveness for HHS. Lack of improvement in the level of consciousness may indicate inadequate rates offluid replacement. The Glasgow Coma Scale assesses the clients state of consciousness against criteria of ascale including best eye, verbal, and motor responses. An increase in serum potassium, decreased bloodosmolality, and urine negative for ketone bodies do not indicate adequacy of treatment.DIF:Applying/Application REF: 1310 KEYiabetes mellitus| hyperglycemia 146 A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related tothe NPH insulin?a. 0800b. 1600c. 2000 d. 2300 NS: BNeutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking theclient at 2000 and 2300 would be too late. The nurse should check the client at 1600.DIF:Applying/Application REF: 1294KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Nursing Process: Planning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 147 After teaching a client with type 2 diabetes mellitus, the nurse assesses the clients understanding. Whichstatement made by the client indicates a need for additional teaching?a. I need to have an annual appointment even if my glucose levels are in good control.b. Since my diabetes is controlled with diet and exercise, I must 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. ANS: BClients with diabetes need to be seen at least annually to monitor for long-term complications, including visualchanges, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin inthe future.DIF:Applying/Application REF: 1299KEYiabetes mellitus| patient educationMSC:Integrated Process: Teaching/Learning NOT:Client Needs Category: Health Promotion and Maintenance 148 hen teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, I will never beable to stick myself with a needle. How should the nurse respond?a. I can give your injections to you while you are here in the hospital.b. Everyone gets used to giving themselves injections. It really does not hurt.c. Your disease will not be managed properly if you refuse to administer theshots.Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 541 d. Tell me what it is about the injections that are concerning you. ANS: DDevote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients withnewly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about givingthe injections, it is best to try to find out what specifically is causing the concern, so it can be addressed.Giving the injections for the client does not promote self-care ability. Telling the client that others givethemselves injections may cause the client to feel bad. Stating that you dont know another way to manage thedisease is dismissive of the clients concerns.DIF:Applying/Application REF: 1318KEYiabetes mellitus| insulin| psychosocial responseMSC:Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity 149 A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notesa spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should thenurse take?a. Apply ice to the site to reduce inflammation.b. Consult the provider for a new administration route.c. Assess the client for other signs of cellulitis.d. Instruct the client to rotate sites for insulin injection. ANS: DThe clients tissue has been damaged from continuous use of the same site. The client should be educated torotate sites. The damaged tissue is not caused by cellulitis or any type infection, and applying ice may causemore damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not beappropriate or practical to change the administration route.DIF:Applying/Application REF: 1319KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 150 A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IVcontrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the providerand withhold the prescribed dose?a. Pioglitazone (Actos)b. Glimepiride (Amaryl)c. Glipizide (Glucotrol)d. Metformin (Glucophage) ANS: DGlucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body.Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 542This combination would place the client at high risk for kidney failure. The nurse should hold the metformindose and contact the provider. The other medications are safe to administer after receiving IV contrast.DIF:Applying/Application REF: 1290KEYiabetes mellitus| oral antidiabetic medications| medication safetyMSC:Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 151 After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the clientsunderstanding. Which statement made by the client indicates a need for additional teaching?a. I should increase my intake of vegetables with higher amounts of dietary fiber.b. My intake of saturated fats should be no more than 10% of my total calorieintake.c. I should decrease my intake of protein and eliminate carbohydrates from my diet. d. My intake of water is not restricted by my treatment plan or medication regimen. ANS: CThe client should not completely eliminate carbohydrates from the diet, and should reduce protein ifmicroalbuminuria is present. The client should increase dietary intake of complex carbohydrates, includingvegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.DIF:Applying/Application REF: 1302KEYiabetes mellitus| nutritional requirementsMSC:Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 152 A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulinregimen:Fasting blood glucose: 75 mg/dLPostprandial blood glucose: 200 mg/dLHemoglobin A1c level: 5.5%How should the nurse interpret these laboratory findings?a. Increased risk for developing ketoacidosisb. Good control of blood glucosec. Increased risk for developinghyperglycemia d. Signs of insulin resistance ANS: BThe client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen.Because the clients glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemiaand is not showing signs of insulin resistance.Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 543DIF:Applying/Application REF: 1294KEYiabetes mellitus| laboratory valuesMSC:Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 153 A nurse prepares to administer insulin to a client at 1800. The clients medication administration recordcontains the following information:Insulin glargine: 12 units daily at 1800Regular insulin: 6 units QID at 0600, 1200, 1800, 2400Based on the clients medication administration record, which action should the nurse take?a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.b. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regularinsulin.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. ANS: AInsulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in anunpredictable alteration in the onset of action and time to peak action. The correct instruction is to draw up andinject first the glargine and then the regular insulin right afterward.DIF:Applying/Application REF: 1294KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 154 A nurse prepares to administer prescribed regular and NPH insulin. Place the nurses actions in the correctorder to administer these medications.1. Inspect bottles for expiration dates.2. Gently roll the bottle of NPH between the hands.3. Wash your hands.4. Inject air into the regular insulin.5. Withdraw the NPH insulin.6. Withdraw the regular insulin.7. Inject air into the NPH bottle.8. Clean rubber stoppers with an alcohol swab.a. 1, 3, 8, 2, 4, 6, 7, 5Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 544b. 3, 1, 2, 8, 7, 4, 6, 5c. 8, 1, 3, 2, 4, 6, 7, 5 d. 2, 3, 1, 8, 7, 5, 4, 6 ANS: BAfter washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubberstoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. Itis important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoidmixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first.DIF:Applying/Application REF: 1296KEYiabetes mellitus| insulin| medication safetyMSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 155 44.A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis:Vital Signs and Assessment LaboratoryResultsMedicationsBlood pressure: 90/62 mm HgPulse: 120 beats/minRespiratory rate: 28 breaths/minUrine output: 20 mL/hr viacatheterSerum potassium: 2.6mEq/LPotassium chloride 40 mEq IV bolusSTATIncrease IV fluid to 100 mL/hrWhich action should the nurse take?a. Administer the potassium and then consult with the provider about the fluid order.b. Increase the intravenous rate and then consult with the provider about the potassiumprescription.c. Administer the potassium first before increasing the infusion flow rate. d. Increase the intravenous flow rate before administering the potassium. ANS: BThe client is acutely ill and is severely dehydrated and hypokalemic. The client requires more IV fluids andpotassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurseshould first increase the IV rate and then consult with the provider about the potassium.DIF:Applying/Application REF: 1313KEYiabetes mellitus| medication safety| electrolyte imbalanceMSC:Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 156 At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominalTest Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 545hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews theassessment data provided in the chart below:Capillary Blood Glucose Testing(AC/HS)DietaryIntakeAt 0630: 95At 1130: 70At 1630: 47Breakfast: 10% eaten client states she is nothungryLunch: 5% eaten client is nauseous; vomits onceAfter reviewing the clients assessment data, which action is appropriate at this time?a. Assess the clients oxygen saturation level and administer oxygen.b. Reorient the client and apply a cool washcloth to the clientsforehead. c. Administer dextrose 50% intravenously and reassess d. Provide a glass of orange juice and encourage the client to eat dinner ANS: CThe clients symptoms are related to hypoglycemia. Since the client has not been tolerating food, the nurseshould administer dextrose intravenously. The clients oxygen level could be checked, but based on theinformation provided, this is not the priority. The client will not be reoriented until the glucose level rises.DIF:Applying/Application REF: 1314KEYiabetes mellitus| hypoglycemiaMSC:Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 157 A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes?(Select all that apply.)a. 56-year-old African-American maleb. Female with a 30-pound weight gain during pregnancyc. Male with a history of pancreatic traumad. 48-year-old woman with a sedentary lifestylee. Male with a body mass index greater than 25 kg/m2f. 28-year-old female who gave birth to a baby weighing 9.2 pounds ANS: A, D, E, FRisk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians,Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-poundgestational weight gain are not risk factors. DIF:Applying/Application REF: 1287 158 A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations shouldthe nurse monitor the client? (Select all that apply.)a. Deep and fast respirationsb. Decreased urine outputc. Tachycardiad. Dependent pulmonarycrackles e. Orthostatic hypotension ANS: A, C, EDKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clientshave Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because ofdiuresis and dehydration, peripheral edema and crackles do not occur.DIF:Applying/Application REF: 1313KEYiabetes mellitus| hyperglycemiaMSC:Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 159 A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include inthis clients teaching? (Select all that apply.)a. Do not walk around barefoot.b. Soak your feet in a tub each evening.c. Trim toenails straight across with a nailclipper.d. Treat any blisters or sores with Epsom salts. e. Wash your feet every other day. ANS: A, CClients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathyand poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals withopen toes. These actions place the client at higher risk for skin breakdown of the feet. The client should beinstructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm waterand soap, but feet should not be soaked in the tub. The client should contact the provider immediately ifblisters or sores appear and should not use home remedies to treat these wounds.DIF:Understanding/Comprehension REF: 1307KEY: Diabetes mellitus| foot care MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 160 nurse provides diabetic education at a public health fair. Which disorders should the nurse include ascomplications of diabetes mellitus? (Select all that apply.)Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 547a. Strokeb. Kidney failurec. Blindnessd. Respiratoryfailure e. Cirrhosis ANS: A, B, CComplications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascularcomplications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease.Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure andcirrhosis are not complications of diabetes mellitus.DIF:Understanding/Comprehension REF: 1283KEY: Diabetes mellitus| health screening MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 161 A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newlydiagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary teammeeting? (Select all that apply.)a. Registered dietitianb. Clinical pharmacistc. Occupational therapistd. Health care provider e. Speech-language pathologist ANS: A, B, DWhen planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with aregistered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosedclient would be nutrition, medication therapy, and education. The nurse could also consult with a diabeticeducator. There is no need for occupational therapy or speech therapy at this time.DIF:Applying/Application REF: 1307KEYiabetes mellitus| collaborationMSC:Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care |
A nurse is providing teaching to a client who has diabetes mellitus about carbohydrate intake
Postagens relacionadas
direito autoral © 2024 comojogaruno Inc.
