The client, an 18-year-old female, 54 tall, weighing 113 kg, comes to the clinic for a wound on her lower leg that has not healed for the last two (2) weeks. Which disease process would the nurse suspect that the client has developed? 1. Type 1 diabetes. 2. Type 2 diabetes. 3. Gestational diabetes. 4. Acanthosis nigricans.
2. Type 2 diabetes is a disorder that usually occurs around the age of 40, but it is now being detected in children and young adults as a result of obesity and sedentary lifestyles. Wounds that do not heal are a hallmark sign of Type 2 diabetes. This client weighs 248.6 pounds and is short.
The client diagnosed with Type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result? 1. This result is below normal levels. 2. This result is within acceptable levels. 3. This result is above recommended levels. 4. This result is dangerously high.
3. This result parallels a serum blood glucose level of approximately 180 to 200 mg/dL. An A1c is a blood test that reflects average blood glucose levels over a period of 2–3 months; clients with elevated blood glucose levels are at risk for developing long-term complications.
The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with Type 1 diabetes at 1600. Which action should the nurse implement? 1. Ensure the client eats the bedtime snack. 2. Determine how much food the client ate at lunch. 3. Perform a glucometer reading at 0700. 4. Offer the client protein after administering insulin.
1. Humulin N peaks in 6–8 hours, making the client at risk for hypoglycemia around midnight, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia.
The client diagnosed with Type 1 diabetes is receiving Humalog, a rapid-acting insulin, by sliding scale. The order reads blood glucose level: 150, 0 units; 151–200, 3 units; 201–250, 6 units; 251, contact health-care provider. The unlicensed nursing assistant reports to the nurse that the client’s glucometer reading is 189. How much insulin should the nurse administer to the client?
Three (3) units. The client’s result is 189, which is between 151 and 200, so the nurse should administer 3 units of Humalog insulin subcutaneously.
The nurse is discussing the importance of exercising to a client diagnosed with Type 2 diabetes whose diabetes is well controlled with diet and exercise. Which information should the nurse include in the teaching about diabetes? 1. Eat a simple carbohydrate snack before exercising. 2. Carry peanut butter crackers when exercising. 3. Encourage the client to walk 20 minutes three (3) times a week. 4. Perform warmup and cooldown exercises.
4. All clients who exercise should perform warmup and cooldown exercises to help prevent muscle strain and injury.
The nurse is caring for a client with long-term Type 2 diabetes and is assessing the feet. Which assessment data would warrant immediate intervention by the nurse? 1. The client has crumbling toenails. 2. The client has athlete’s feet. 3. The client has a necrotic big toe. 4. The client has thickened toenails.
3. A necrotic big toe indicates “dead” tissue. The client does not feel pain in the lower extremity and does not realize there has been an injury and therefore does not seek treatment. Increased blood glucose levels decrease oxygen supply that is needed to heal the wound and increase the risk for developing an infection.
The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with Type 2 diabetes that must be controlled with 70/30-combination insulin. Which intervention should be included in the plan of care? 1. Assess the client’s ability to read small print. 2. Monitor the client’s serum PT level. 3. Teach the client how to perform a hemoglobin A1c test daily. 4. Instruct the client to check the feet weekly.
1. Age-related visual changes and diabetic retinopathy occur that could lead to the client having difficulty in reading and drawing up insulin dosage accurately.
The client with Type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a computed tomography (CT) with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement? 1. Provide a high-fat diet 24 hours prior to test. 2. Hold the biguanide medication for 48 hours prior to test. 3. Obtain an informed consent form for the test. 4. Administer pancreatic enzymes prior to the test.
2. Biguanide medication must be held for a test with contrast medium because it increases the risk of lactic acidosis, which leads to renal problems.
The diabetic educator is teaching a class on diabetes Type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion? Select all that apply. 1. Take diabetic medication even if unable to eat the client’s normal diabetic diet. 2. If unable to eat, drink liquids that are equal to the client’s normal caloric intake. 3. It is not necessary to notify the health-care provider if ketones are in the urine. 4. Test blood glucose levels and test urine ketones once a day and keep a record. 5. Call the health-care provider if glucose levels are higher than 180 mg/dL.
1. The most important issue to teach clients is to take insulin even if they are unable to eat. Glucose levels are increased with illness and stress. 2. The client should drink liquids such as regular cola, orange juice, or regular gelatin, which provide enough glucose to prevent hypoglycemia when receiving insulin. 5. The HCP should be notified if the blood glucose level is this high. Regular insulin may need to be prescribed to keep the blood glucose level within acceptable range.
The client received 10 units of Humulin R, a fast acting insulin, at 0700. At 1030 the unlicensed nursing assistant tells the nurse the client has a headache and is really acting “funny.” Which action should the nurse implement first? 1. Instruct the assistant to obtain blood glucose level. 2. Have the client drink eight (8) ounces of orange juice. 3. Go to the client’s room and assess the client for hypoglycemia. 4. Prepare to administer one amp 50% Dextrose intravenously.
3. Regular insulin peaks in 2–4 hours. Therefore, the nurse should think about the possibility that the client is having a hypoglycemic reaction and should assess the client. The nurse should not delegate nursing tasks to an assistant if the client is unstable.
The nurse at a freestanding health clinic is caring for a 56-year-old client who is homeless and is a Type 2 diabetic controlled with insulin. Which action is an example of client advocacy? 1. Ask the client if he has somewhere he can go and live. 2. Arrange for someone to give him his insulin at a local homeless shelter. 3. Notify Adult Protective Services about the client’s situation. 4. Ask the health-care provider to take the client off insulin because he is homeless.
2. Client advocacy focuses support on the client’s autonomy. Even if the nurse disagrees with his living on the street, it is the client’s right. Arranging for someone to give him his insulin provides for his needs and allows his choices.
The nurse is developing a care plan for the client diagnosed with Type 1 diabetes. The nurse identifies the problem “high risk for hyperglycemia related to noncompliance with the medication regimen.” Which statement would be an appropriate short-term goal for the client? 1. The client will have a blood glucose level between 90 and 140 mg/dL. 2. The client will demonstrate appropriate insulin injection technique. 3. The nurse will monitor the client’s blood glucose levels four times a day. 4. The client will maintain normal kidney function with 30 mL/hr urine output.
1. The short-term goal must address the response part of the nursing diagnosis, which is “high risk for hyperglycemia,” and this blood glucose level is within acceptable ranges for a client who is noncompliant.
The client diagnosed with Type 2 diabetes is admitted to the intensive care department with hyperosmolar hyperglycemic nonketonic state coma (HHS). Which assessment data would the nurse expect the client to exhibit? 1. Kussmaul’s respirations. 2. Diarrhea and epigastric pain. 3. Dry mucous membranes. 4. Ketone breath odor
3. Dry mucous membranes are a result of the hyperglycemia and occur with both HHS and DKA.
The elderly client is admitted to the intensive care department diagnosed with severe HHS. Which collaborative intervention should the nurse include in the plan of care? 1. Infuse 0.9% normal saline intravenously. 2. Administer intermediate-acting insulin. 3. Perform blood glucometer checks daily. 4. Monitor arterial blood gas results.
1. The initial fluid replacement is O.9% normal saline (an isotonic solution) intravenously, followed by 0.45% saline. The rate depends on the client’s fluid volume status and physical health, especially that of the heart.
Which electrolyte replacement should the nurse anticipate being ordered by the health-care provider in the client diagnosed with DKA who has just been admitted to the ICD? 1. Glucose. 2. Potassium. 3. Calcium. 4. Sodium.
2. The client in DKA loses potassium from increased urinary output, acidosis, catabolic state, and vomiting. Replacement is essential for preventing cardiac dysrhythmias secondary to hypokalemia.
The client diagnosed with HHS was admitted yesterday with a blood glucose level of 780 mg/dL. The client’s blood glucose level is now 300 mg/dL. Which intervention should the nurse implement? 1. Increase the regular insulin IV drip. 2. Check the client’s urine for urinary ketones. 3. Provide the client with a therapeutic diabetic meal. 4. Notify the HCP to obtain an order to decrease insulin therapy.
4. When the glucose level is decreased to around 300 mg/dL, the regular insulin infusion therapy is decreased. Subcutaneous insulin will be administered per sliding scale.
The client diagnosed with Type 1 diabetes is found lying unconscious on the floor of the bathroom. Which intervention should the nurse implement first? 1. Administer 50% dextrose IVP. 2. Notify the health-care provider. 3. Move the client to the ICD. 4. Check the serum glucose level.
1. The nurse should assume the client is hypoglycemic and administer IVP dextrose, which will rouse the client immediately. If the collapse is the result of hyperglycemia, this additional dextrose will not further injure the client.
Which assessment data indicate that the client diagnosed with diabetic ketoacidosis is responding to the medical treatment? 1. The client has tented skin turgor and dry mucous membranes. 2. The client is alert and oriented to date, time, and place. 3. The client’s ABGs results are pH 7.29, PaCO2 44, HCO3 15. 4. The client’s serum potassium level is 3.3 mEq/L.
2. The client’s level of consciousness can be altered because of dehydration and acidosis. If the client’s sensorium is intact, the client is getting better and responding to the medical treatment.
The nursing assistant on the medical floor tells the primary nurse that the client diagnosed with DKA wants something else to eat for lunch. What action should the nurse implement? 1. Instruct the assistant to get the client additional food. 2. Notify the dietician about the client’s request. 3. Ask the assistant to obtain a glucometer reading. 4. Tell the assistant that the client cannot have anything else.
2. The client will not be compliant with the diet if he or she is still hungry. Therefore, the nurse should request the dietician to talk to the client to try and adjust the meals so that the client will adhere to the diet
The client diagnosed with Type 2 diabetes comes to the emergency department. The client’s blood glucose is 680 mg/dL and the client is diagnosed with HHS. Which question should the nurse ask the client to determine the cause of this acute complication? 1. When is the last time you took your insulin? 2. When did you have your last meal? 3. Have you had some type of infection lately? 4. How long have you had diabetes?
3. The most common precipitating factor is infection. The manifestations may be slow to appear, with onset ranging from 24 hours to 2 weeks.
The nurse is discussing ways to prevent diabetic ketoacidosis with the client diagnosed with Type 1 diabetes. Which instruction would be most important to discuss with the client? 1. Refer the client to the American Diabetes Association. 2. Do not take any over-the-counter medications. 3. Take the prescribed insulin even when unable to eat because of illness. 4. Be sure to get your annual flu and pneumonia vaccines.
3. Illness increases blood glucose levels; therefore the client must take insulin and drink high-carbohydrate fluids such as regular Jell-O, regular popsicles, and orange juice.
The charge nurse is making client assignments in the intensive care department. Which client should be assigned to the most experienced nurse? 1. The client with Type 2 diabetes who has a blood glucose level of 348 mg/dL. 2. The client diagnosed with Type 1 diabetes who is experiencing hypoglycemia. 3. The client with DKA who has multifocal premature ventricular contractions. 4. The client with HHS who has a plasma osmolarity of 290 mOsm/L.
3. Multifocal PVCs, which are secondary to hypokalemia and which can occur in clients with DKA, are an emergency and can be life threatening. This client needs an experienced nurse.
Which arterial blood gas would the nurse expect in the client diagnosed with diabetic ketoacidosis? 1. pH 7.34, PaO2 99, PaCO2 48, HCO3 24. 2. pH 7.38, PaO2 95, PaCO2 40, HCO3 22. 3. pH 7.46, PaO2 85, PaCO2 30, HCO3 26. 4. pH 7.30, PaO2 90, PaCO2 30, HCO3 18.
4. This ABG indicates metabolic acidosis, which is what is expected in a client that is in diabetic ketoacidosis.
The client is admitted to the ICD diagnosed with DKA. Which interventions should the nurse implement? Select all that apply. 1. Maintain adequate ventilation. 2. Assess fluid volume status. 3. Administer intravenous potassium. 4. Check for urinary ketones. 5. Monitor intake and output.
1. The nurse should always address the airway when a client is seriously ill. 2. The client must be assessed for fluid volume deficit and then for fluid volume excess after fluid replacement is started. 3. The electrolyte imbalance of primary concern is depletion of potassium. 4. Ketones are excreted in the urine; levels are documented from negative to large amount. Ketones should be monitored frequently. 5. The nurse must ensure that the client’s fluid intake and output are equal
The client is admitted to the medical department with a diagnosis of R/O acute pancreatitis. Which laboratory value should the nurse monitor to confirm this diagnosis? 1. Creatinine and BUN. 2. Troponin and CPK-MB. 3. Serum amylase and lipase. 4. Serum bilirubin and calcium.
3. Serum amylase increases within 2 to 12 hours of the onset of acute pancreatitis to 2 to 3 times normal and returns to normal in 3 to 4 days; lipase elevates and remains elevated for 7 to 14 days.
Which client problem has priority for the client diagnosed with acute pancreatitis? 1. Risk for fluid volume deficit. 2. Alteration in comfort. 3. Imbalanced nutrition: less than body requirements. 4. Knowledge deficit.
2. Autodigestion of the pancreas results in severe epigastric pain, accompanied by nausea, vomiting, abdominal tenderness, and muscle guarding.
The nurse is preparing to administer A.M. medications to the following clients. Which medication should the nurse question before administering? 1. Pancreatic enzymes to the client who has finished breakfast. 2. The pain medication, morphine, to the client who has a respiratory rate of 20. 3. The loop diuretic to the client who has a serum potassium level of 3.9 mEq/L. 4. The beta blocker to the client who has an apical pulse of 68 bpm.
1. Pancreatic enzymes must be administered with meals to enhance the digestion of starches and fats in the gastrointestinal tract.
The client is diagnosed with acute pancreatitis. Which health-care provider’s admitting order should the nurse question? 1. Bed rest with bathroom privileges. 2. Initiate IV therapy at D5W 125 mL/hr. 3. Weigh client daily. 4. Low-fat, low-carbohydrate diet.
4. The client will be NPO, which will decrease stimulation of the pancreatic enzymes, which will result in decreased autodigestion of the pancreas, therefore decreasing pain.
The nurse is completing discharge teaching to the client diagnosed with acute pancreatitis. Which instruction should the nurse discuss with the client? 1. Instruct the client to decrease alcohol intake. 2. Explain the need to avoid all stress. 3. Discuss the importance of stopping smoking. 4. Teach the correct way to take pancreatic enzymes.
3. Smoking stimulates the pancreas to release pancreatic enzymes and should be stopped.
The male client diagnosed with chronic pancreatitis calls and reports to the clinic nurse that he has been having a lot of “gas,” along with frothy and very foul-smelling stools. Which action should the nurse take? 1. Explain that this is common for chronic pancreatitis. 2. Ask the client to bring in a stool specimen to the clinic. 3. Arrange an appointment with the HCP for today. 4. Discuss the need to decrease fat in the diet so that this won’t happen.
3. Steatorrhea (fatty, frothy, foul-smelling stool) is caused by a decrease in pancreatic enzyme secretion and indicates impaired digestion and possibly an increase in the severity of the pancreatitis. The client should see the HCP.