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Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes?
Correct Answer: B. 5.7-6.4%
Glycosylated hemoglobin levels between 5.7%-6.4% are considered as pre-diabetes
A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:
Correct Answer: B. Diaphoresis
A hypoglycemic reaction activates a fight-or-flight response in the body which then triggers the release of epinephrine and norepinephrine resulting in diaphoresis.
Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following, except:
Correct Answer: D. Palpation for increased pulse volume in the arteries of the lower extremities
One of the signs and symptoms of impaired peripheral arterial circulation is the absence of a pulse or a weak pulse in the legs or feet.
A nurse went to a patient’s room to do routine vital signs monitoring and found out that the patient’s bedtime snack was not eaten. This should alert the nurse to check and assess for:
Correct answer: B. Signs of hypoglycemia earlier than expected.
Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m.
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?
Correct Answer: A. Elevated blood glucose level and a low plasma bicarbonate
In diabetic acidosis, the arterial pH is less than 7.35, plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine.
A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to:
Correct answer: D. Convey empathy, trust, and respect toward the client.
The most appropriate intervention is to address the client’s feelings related to anxiety.
A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be:
Correct Answer: A. High risk for deficient fluid volume
Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration.
A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:
Correct Answer: A. Administer regular insulin intravenously
Lack (absolute or relative) of insulin is the primary cause of DK1. Intravenous insulin by continuous infusion is the standard of care.
The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.
Correct Answers: B, C, & D.
The clinical manifestations of hypoglycemia can be classified as either neuroglycopenic or neurogenic.
A client’s blood gases reflect diabetic acidosis. The nurse should expect:
Correct Answer: D. Decreased HCO3
The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:
Correct Answer: C. Increases blood glucose levels
A client with diabetes mellitus states, “I cannot eat big meals; I prefer to snack throughout the day.” The nurse should carefully explain that:
Correct Answer: A. Regulated food intake is basic to control
An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two between meals snacks need to be tailored to the client’s specific needs, with due regard for activity, diet, and therapy.
A client with diabetes mellitus has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse’s primary responsibility to:
Correct Answer: A. Check the client’s serum glucose level
Because the client has diabetes, it is essential that the blood glucose level is determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage.
Which of the following chronic complications is associated with diabetes?
Correct Answer: B. Retinopathy, neuropathy, and coronary artery disease
These are all chronic complications of diabetes.
Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?
Correct Answer: D. IV bolus, followed by continuous infusion.
An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose.
A client is in diabetic ketoacidosis (DKA) secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?
Correct Answer: A. Kussmaul’s respirations and a fruity odor on the breath
Coma and severe acidosis are ushered in with Kussmaul’s respirations (very deep but not labored respirations) and a fruity odor on the breath.
Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal?
Correct Answer: D. The client will have moist clammy skin.
Moist skin is the sign of hypoglycemia, which the client would experience if he injected himself with insulin and did not eat.
A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at the highest risk for developing diabetes?
Correct Answer: C. The 42-year-old client who is 50 pounds overweight
Obesity increases the likelihood of developing diabetes mellitus due to the overstimulation of the endocrine system.
Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include?
Correct Answer: C. The alcohol could predispose you to hypoglycemia.
Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client.
The principal goals of therapy for older patients who have poor glycemic control are:
Correct Answer: D. All of the above.
Older adults with diabetes are at substantial risk for both acute and chronic microvascular and cardiovascular complications of the disease.
Harry is a diabetic patient who is experiencing a reaction to alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following?
Correct Answer: B. Somogyi phenomenon
The Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and an increase in ketones.
An older woman with diabetes mellitus visits the clinic concerning her condition. Which of the following symptoms might an older woman with diabetes mellitus complain?
Correct Answer: D. Perineal itching
Older women might complain of perineal itching due to vaginal candidiasis. In diabetes, blood glucose levels can go abnormally high, which can therefore provide ideal conditions for naturally present yeast to grow and also diminishes the body’s ability to fight infection.
Gregory is a 52-year-old man identified as high-risk for diabetes mellitus. Which laboratory test should a nurse anticipate a physician would order for him? Select all that apply.
Correct Answer: A & B.
When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. An FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal.
According to the National Diabetes Statistics Report, diabetes remains one of the leading causes of death in the United States since 2010. Which of the following factors are risks for the development of diabetes mellitus? Select all that apply.
Correct Answer: A, B, D, & E.
Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels. The main subtypes of DM are Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM), which classically result from defective insulin secretion (T1DM) and/or action (T2DM).
A nurse is caring for a client admitted with diabetic retinopathy. Which of the following would the nurse expect to note on the assessment of this client:
Correct Answer: D. All of the above
Diabetic retinopathy is a complication of diabetes that is characterized by chronic and progressive damage to the retina. Symptoms include blurring of vision (due to macular edema), flashes of lights, and sudden loss of vision (due to retinal detachment).