teaching
A client recently admitted with new-onset type 2 diabetes will be discharged with a meter for self-monitoring of blood glucose (SMBG) levels. When is the best time for the nurse to explain to the client the proper use of the glucose monitor?
Day of discharge
On admission
When the client states readiness
While performing the test in the hospital
The nurse is assessing the feet of a client with long-term type 2 diabetes. Which
assessment data warrant immediate intervention by the nurse?
1. The client has crumbling toenails.
2. The client has athlete's foot.
3. The client has a necrotic big toe.
4. The client has thickened toenails.
The client has a necrotic big toe.
Which nursing action will the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes?
Assist the client's spouse in choosing appropriate dietary items.
Evaluate the client's use of a home blood glucose monitor.
Inspect the extremities for evidence of poor circulation.
Assist the client with washing the feet and applying moisturizing lotion.
Assist the client with washing the feet and applying moisturizing lotion.
The nurse has just taken change-of-shift report on a group of clients on the medical-surgical unit. Which client does the nurse assess first?
Client taking repaglinide (Prandin) who has nausea and back pain
Client taking glyburide (Diabeta) who is dizzy and sweaty
Client taking metformin (Glucophage) who has abdominal cramps
Client taking pioglitazone (Actos) who has bilateral ankle swelling
Client taking glyburide (Diabeta) who is dizzy and sweaty
Client taking glyburide (Diabeta) who is dizzy and sweaty
A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response?
"It is overwhelming, isn't it?"
"Let's see how much you can learn today, so you are less nervous."
"Let's tackle it piece by piece. What is most scary to you?"
"Many people live with diabetes and do it just fine."
"Let's tackle it piece by piece. What is most scary to you?"
The clinic nurse is providing teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet?
"If I become hyperglycemic, it is a medical emergency."
"If I become hypoglycemic, I could become unconscious."
"Medical personnel may need confirmation of my insurance."
"I may need to be admitted to the hospital suddenly."
"If I become hypoglycemic, I could become unconscious."
The nurse working on a medical surgical endocrine unit has just received change-of-shift report. Which client will the nurse see first?
Client with type 1 diabetes whose insulin pump is beeping "occlusion"
Newly diagnosed client with type 1 diabetes who is reporting thirst
Client with type 2 diabetes who has a blood glucose of 150 mg/dL (8.3 mmol/L)
Client with type 2 diabetes with a blood pressure of 150/90 mm Hg
Which of these clients with diabetes will the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit?
A client with sensory neuropathy who needs teaching about foot care
A client with diabetic ketoacidosis who has an IV running at 250 mL/hr
A client who needs blood glucose monitoring and insulin before each meal
A client who was admitted with fatigue and shortness of breath
A client who needs blood glucose monitoring and insulin before each meal
The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a
client diagnosed with type 1 diabetes at 1600. Which intervention 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.
Rationale: Humulin N peaks in 6 to 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 nurse in the endocrine clinic is providing education for a client who has just been diagnosed with diabetes. Which factor is most important for the nurse to assess before providing instruction to the client about the disease and its management?
Current lifestyle
Educational and literacy level
Sexual orientation
Current energy level
Educational and literacy level
The nurse in the endocrine clinic is reviewing type 1 and type 2 diabetes with a group of nursing students. Which explanation by the students indicates their understanding of the types of diabetes?
Most clients with type 1 diabetes are born with it.
People with type 1 diabetes are often obese.
Those with type 2 diabetes make insulin, but in inadequate amounts.
People with type 2 diabetes do not develop typical diabetic complications.
Those with type 2 diabetes make insulin, but in inadequate amounts.
The nurse is teaching a client about the manifestations and emergency management of hypoglycemia. Which response by the client indicates a correct understanding of what to do if the client feels hungry and shaky?
"I will drink a glass of water."
"I will eat three graham crackers."
"I will give myself 1 mg of glucagon."
"I will sit down and rest."
"I will eat three graham crackers."
The nurse caring for four clients with diabetes has these activities to perform. Which activity is appropriate to delegate to unlicensed assistive personnel (UAP)?
Perform a blood glucose check on a client who requires insulin.
Verify the infusion rate on a continuous infusion insulin pump.
Assess a client who reports tremors and irritability.
Monitor a client who is reporting palpitations and anxiety.
Perform a blood glucose check on a client who requires insulin.
The client diagnosed with type 1 diabetes is receiving Humalog, a rapid-acting insulin,
by sliding scale. The order reads blood glucose level:
<150, zero (0) units;
151 to 200,three (3) units;
201 to 250, six (6) units;
>251, contact health-care provider.
The unlicensed assistive personnel (UAP) reports to the nurse the client's glucometer
reading is 189. How much insulin should the nurse administer to the client?
3 units
The elderly client is admitted to the intensive care department diagnosed with severe
HHNS. 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.
The initial fluid replacement is 0.9%
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 of the heart.
A client with type 2 diabetes controlled with Metformin is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse's best response about why the client needs to take insulin?
Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily."
A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL (6.0 mmol/L), and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action will the nurse take next?
Instruct the client to continue with the current diet and metformin use.
Discuss the need to check blood glucose several times every day.
Talk about the possibility of adding rapid-acting insulin to the regimen.
Ask the client about current dietary intake and medication use.
Ask the client about current dietary
Ask the client about current dietary intake and medication use.
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 ICU?
1. Glucose.
2. Potassium.
3. Calcium.
4. Sodium.
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 received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030 the
unlicensed assistive personnel (UAP) tells the nurse the client has a headache and is
really acting "funny." Which intervention should the nurse implement first?
1. Instruct the UAP to obtain the 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 (1) ampule 50% dextrose intravenously
3. Go to the client's room and assess the client for hypoglycemia.
Regular insulin peaks in 2 to 4 hours.
Therefore, the nurse should think
about the possibility the client is having
a hypoglycemic reaction and should
assess the client. The nurse should not
delegate nursing tasks to a UAP if the
client is unstable
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 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 or orange juice, or eat
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.
A client newly diagnosed with diabetes is not ready to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family?
Select all that apply.
Pathophysiology of diabetes
Causes and treatment of hypoglycemia
Dietary control of blood glucose
Insulin administration
Physical activity and exercise
The client diagnosed with type 2 diabetes is admitted to the intensive care unit with
hyperosmolar hyperglycemic nonketonic syndrome (HHNS) coma. Which
assessment data should the nurse expect the client to exhibit?
1. Kussmaul's respirations.
2. Diarrhea and epigastric pain.
3. Dry mucous membranes.
4. Ketone breath odor
Dry mucous membranes.
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 ketones.
3. Provide the client with a therapeutic diabetic meal.
4. Notify the HCP to obtain an order to decrease insulin
4. Notify the HCP to obtain an order to decrease insulin
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 with type 2 diabetes controlled with biguanide oral diabetic medication is
scheduled for a computed tomography (CT) scan 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. Hold the biguanide medication for 48 hours prior to test.
lactic acidosis > renal problems
met
What are the clinical differences between Hyperosmolar hyperglycemia and diabetic ketoacidosis?
HHS can cause a person to experience hallucinations, confusion, drowsiness, loss of vision, or a coma. Both conditions cause an unsafe level of blood sugar. However, DKA is associated with high levels of ketones in the blood, whereas HHS is not.