a
26. A client with a long-standing diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the client for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis?
A. Infection
B. Acute pain
C. Acute confusion
D. Impaired urinary elimination
ANS: A
Rationale: Decreased sensations of pain and temperature place clients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function.
31. A client has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the client and will implement a program of health education. What is the nurse's priority action?
A. Ensure that the client understands the basic pathophysiology of diabetes.
B. Identify the client's body mass index.
C. Teach the client "survival skills" for diabetes.
D. Assess the client's readiness to learn.
ANS: D
Rationale: Before initiating diabetes education, the nurse assesses the client's (and family's) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.
36. The most recent blood work of a client with a long-standing diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action?
A. Teach the client about actions to slow the progression of nephropathy.
B. Ensure that the client receives a comprehensive assessment of liver function.
C. Determine whether the client has been using expired insulin.
D. Administer a fluid challenge and have the test repeated.
ANS: A
Rationale: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the client's liver function is not likely affected. There is no indication for the use of a fluid challenge.
27. A client has been brought to the emergency department by paramedics after being found unconscious. The client's MedicAlert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?
A. IV administration of 50% dextrose in water
B. Subcutaneous administration of 10 units of Humalog
C. Subcutaneous administration of 12 to 15 units of regular insulin
D. IV bolus of 5% dextrose in 0.45% NaCl
ANS: A
Rationale: In hospitals and emergency departments, for clients who are unconscious or cannot swallow, 25 to 50 mL 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 client's condition.
32. A student with diabetes reports feeling nervous and hungry. The school nurse assesses the student and finds the child has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer?
A. A combination of protein and carbohydrates, such as a small cup of yogurt
B. Two teaspoons of sugar dissolved in a cup of apple juice
C. Half of a cup of juice, followed by cheese and crackers
D. Half a sandwich with a protein-based filling
ANS: C
Rationale: Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. Initial treatment should be followed with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and the additional sugar may result in a sharp rise in blood sugar that will last for several hours.
37. A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy?
A. Persistently cold feet
B. Pain that does not respond to analgesia
C. Acute pain, unrelieved by rest
D. The presence of a tingling sensation
ANS: D
Rationale: Although approximately half of clients with diabetic neuropathy do not have symptoms, initial symptoms 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.
28. A nurse is working for the summer at a camp for adolescents with diabetes. When providing information 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: A
Rationale: The following teaching points should be included in information provided to the client on how to prevent 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.
33. A client with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the client's initial phase of treatment?
A. Monitoring the client for dysrhythmias
B. Maintaining and monitoring the client's fluid balance
C. Assessing the client's level of consciousness
D. Assessing the client for signs and symptoms of venous thromboembolism
ANS: B
Rationale: 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 monitor the client for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.
38. A client with diabetes is asking the nurse what causes diabetic ketoacidosis (DKA). Which of the following is a correct statement by the nurse?
A. "DKA can be caused by taking too much insulin.”
B. "DKA can be caused by taking too little insulin." C. "DKA can happen without a cause."
D. "DKA will not happen with type 1 diabetes."
ANS: B
Rationale: Three main causes of DKA are decreased or missed dose of insulin, illness or infection, and undiagnosed and untreated diabetes. DKA may be the initial manifestation of type 1 diabetes. For prevention of DKA related to illness, the client should attempt to consume frequent small portions of carbohydrates. Drinking fluid every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours, and the client should take the usual dose of insulin.
29. A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. What topic should the nurse address?
A. Signs and symptoms of diabetic nephropathy
B. Management of diabetic ketoacidosis
C. Effects of surgery and pregnancy on blood sugar levels
D. Recognition of hypoglycemia and hyperglycemia
ANS: D
Rationale: It is imperative that newly diagnosed clients know the signs and symptoms and management of hypo- and hyperglycemia. The other listed topics are valid points for education, but are not components of the client's immediate "survival skills" following a new diagnosis.
34. A client has been living with type 2 diabetes for several years, and the nurse realizes that the client is likely to have minimal contact with the health care system. In order to ensure that the client maintains adequate blood sugar control over the long term, what should the nurse recommend?
A. Participation in a support group for persons with diabetes
B. Regular consultation of websites that address diabetes management
C. Weekly telephone "check-ins" with an endocrinologist
D. Participation in clinical trials relating to antihyperglycemics
ANS: A
Rationale: Participation in support groups is encouraged for clients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. 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 clients' circumstances.
39. A client is brought to the emergency department. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply.
A. Leukocytosis
B. Glycosuria
C. Dehydration
D. Hypernatremia
E. Hyperglycemia
ANS: B, C, E
Rationale: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hyponatremia and increased osmolarity occur. Leukocytosis does not take place.
30. A nurse is conducting a class on how to self-manage insulin regimens. A client asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's 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: A
Rationale: If a vial of insulin will be used up within 1 month, it may be kept at room temperature.
35. A client with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client?
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: C
Rationale: 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 client should gently, not vigorously, pat feet dry to avoid injury.