Patient Education
A nurse is preparing to reinforce teaching with a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following actions is the nurse’s priority in contributing to this plan?
1) Establish short-term, realistic goals for the client.
2) Give the client access to a video about diabetes.
3) Determine what the client knows about managing her diabetes.
4) Evaluate the effectiveness of the client’s admission teaching plan.
3. The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should find out what the client knows before proceeding with the plan.
A nurse is reinforcing discharge teaching about nutrition with a client who has a new diagnosis of diabetes mellitus. Which of the following statements should be included in the teaching?
1) Carbohydrate intake should be limited to 110 g per day.
2) Protein intake has the greatest effect on after-meal blood glucose levels.
3) Carbohydrates should comprise 45 to 65% of daily caloric intake.
4) Proteins should comprise 10% of daily caloric intake.
3. The nurse should instruct clients who have diabetes mellitus to consume 45 to 65% of their daily calories from carbohydrates in order to obtain balanced amounts of protein, fats, and fiber.
What is the only insulin that can be given intravenously?
1. Regular
2. NPH
3. Lantus
4. Lememir
1. Insulins other than regular are in suspensions that could be harmful if administered IV.
A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes?
1. Increased thirst, hunger, and urination
2. Increased weight loss, dehydration, and fatigue
3. Loss of appetite, increased urination, and dehydration
4. Increased weight gain, appetite, and thirst
1. Increased thirst, hunger, and urination
The three classic symptoms of both types of diabetes mellitus are polyuria, polydipsia, and polyphagia. Weight loss, dehydration, and fatigue are additional symptoms.
Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine?
1. Ketones
2. Creatinine
3. Hemoglobin
4. Cholesterol
1. Ketones
Ketones are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not by-products of fat breakdown.
A nurse is collecting data from a client who has diabetes and is overweight. The client tells the nurse that she wants to start an exercise program. Which of the following actions should the nurse take first?
1) Determine the client’s usual pattern of activity.
2) Assist the client to develop a healthy eating plan.
3) Encourage the client to join a support group.
4) Provide the client with a list of signs and symptoms to report to the provider.
1. The first action the nurse should take using the nursing process is to collect data from the client; therefore, the first action the nurse should take is to determine the client’s current activity level in order to plan for future exercise.
A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of:
1. hypoglycemia
2. polyuria
3. blurred vision
4. polydipsia
1. hypoglycemia
The nurse should observe the client receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.
Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin?
1. Administer the total daily dosage in 2 doses.
2. Draw up the drug first, then add regular insulin.
3. Glargine is rapidly absorbed and has a fast onset of action.
4. Do not mix with other insulins.
4. Do not mix with other insulins.
Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period and can be given once a day. When administering glargine insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.
A nurse is reinforcing teaching about the manifestations of hyperglycemia with a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?
1) "I might experience blurry vision at times."
2) "I will be more thirsty than usual."
3) "My breath may have a fruity odor."
4) "My appetite will be decreased."
2. This statement indicates the client understands the teaching as increased thirst is a manifestation of hyperglycemia.
This statement indicates a need for additional teaching because blurred vision is a manifestation of hypoglycemia, rather than hyperglycemia.
This statement indicates a need for additional teaching because blurred vision is a manifestation of hypoglycemia, rather than hyperglycemia.
This statement indicates a need for additional teaching because a decreased appetite is a manifestation of hypoglycemia, rather than hyperglycemia. A client who has hyperglycemia will be hungry despite increased food intake.
An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation?
1. A faulty heater
2. Autonomic neuropathy
3. Peripheral neuropathy
4. Sudomotor neuropathy
3. Peripheral neuropathy
As the neuropathy progresses, the feet become numb. In addition, a decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) and a decreased sensation of light touch may lead to an unsteady gait. Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections.
A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse?
1. "With type 2 diabetes, the body of the pancreas becomes inflamed."
2. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
3. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin."
4. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.
A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client’s morning fasting blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a reading over 200 mg/dL. Which of the following actions should the nurse identify as the priority?
1) Give the client 15 to 20 g of carbohydrate.
2) Check the client’s blood glucose level.
3) Complete an incident report.
4) Notify the nurse manager.
2. The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should immediately check the client’s blood glucose level, expecting it to be low because of the unnecessary dose of insulin. If it is within the expected reference range, the nurse should continue to monitor the client for hypoglycemia.
The nurse will have to complete an incident report detailing the medication error; however, there is another action that is the nurse’s first priority.
It might become necessary to administer a ready source of carbohydrate to counteract the effects of the unnecessary dose of inulin; however, there is another action that is the nurse’s first priority.
The nurse will have to notify the nurse manager about the medication error; however, there is another action that is the nurse’s first priority.
A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client:
1. prefers to take insulin orally.
2. has type 2 diabetes.
3. has type 1 diabetes.
4. is pregnant and has type 2 diabetes.
2. has type 2 diabetes.
Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't ordered oral antidiabetic agents because the effect on the fetus or breast-fed infant is uncertain.
A nurse is collecting data from a client who has type 1 diabetes mellitus and has a blood glucose level of 550 mg/dL. Which of the following data should the nurse collect if diabetic ketoacidosis (DKA) is suspected?
A. Mental status changes
B. Cool, clammy skin
C. Dizziness
D. Nervousness
A. Mental status changes
Manifestations of DKA include mental status changes, nausea, vomiting, increased respiratory rate, abdominal pain, dehydration, and electrolyte abnormalities.
A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client’s symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis?
1. Assess the client's ability to take a deep breath
2. Assess the client's ability to move all extremities
3. Assess the client's breath odor
4. Assess for excessive sweating
3. Assess the client's breath odor
DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue, with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the client’s breath will help the nurse confirm the diagnosis.
A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching?
1. How to control blood glucose through lifestyle modification with diet and exercise
2. How to self-inject insulin
3. How to monitor ketones daily
4. How to recognize signs of diabetic ketoacidosis
1. How to control blood glucose through lifestyle modification with diet and exercise
Persons at high risk for type 2 diabetes receive standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo, or an intensive program of lifestyle modifications. The 16-lesson curriculum of the intensive program of lifestyle modifications focuses on reducing weight by more than 7% of initial body weight and moderate-intensity physical activity. It also includes behavior modification strategies designed to help clients achieve the goals of weight reduction and participation in exercise. These findings demonstrate that type 2 diabetes can be prevented or delayed in persons at high risk for the disease.
Which age-related change may affect diabetes and its management?
1. Hypotension
2. Decreased renal function
3. Increased bowel motility
4. Increased thirst
2. Decreased renal function
Decreased renal function affects the management of diabetes. With decreasing renal function, it takes longer for oral hypoglycemic agents to be excreted by the kidneys, and changes in insulin clearance occur with decreased renal function. Other age-related changes that may affect diabetes and its management include hypertension, decreased bowel motility, and decreased thirst.
The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works?
a. Increases insulin production from the pancreas.
b. Slows the absorption of carbohydrate in the small intestine.
c. Reduces glucose production by the liver and enhances insulin sensitivity.
d. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.
c. Reduces glucose production by the liver and enhances insulin sensitivity.
Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.
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A nurse is reinforcing teaching with a school-age child who has type 1 diabetes mellitus and his parent about illness management. Which of the following instructions should the nurse include?
1) Withhold insulin dose if feeling nauseous.
2) Notify the provider if blood glucose levels are over 350 mg/dL.
3) Test the urine for ketones.
4) Limit fluid intake during meal time.
3. The parent or child should test the urine for ketones and report the presence of them in the urine. Ketonuria can indicate that the child does not have enough glucose for energy and is breaking down fats to provide glucose to cells.
After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias?
1. Serum potassium level
2. Serum calcium level
3. Serum sodium level
4. Serum chloride level
1. Serum potassium level
The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias.
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A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about self-care during illness. Which of the following instructions should the nurse include in the teaching?
1) "Test your blood glucose level every 6 hours."
2) "Administer your usual daily dose of insulin."
3) "Report a blood glucose level greater than 300."
4) "Limit juices, soda, and gelatin."
2) "Administer your usual daily dose of insulin."
The nurse should instruct the client to continue his usual daily dose of insulin during illness and to eat small meals of carbohydrates to maintain blood glucose levels.
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take?
a. Eat a piece of pizza.
b. Drink some diet pop.
c. Eat 15 g of simple carbohydrates.
d. Take an extra dose of rapid-acting insulin.
c. Eat 15 g of simple carbohydrates.
When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing, she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease her blood glucose.
Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness?
1. A 58-year-old patient with diabetic retinopathy
2. A 73-year-old patient who takes propranolol (Inderal)
3. A 19-year-old patient who is on the school track team
4. A 24-year-old patient with a hemoglobin A1C of 8.9%
2. A 73-year-old patient who takes propranolol (Inderal)
Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use â-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
A nurse is caring for a client who has type 2 diabetes mellitus and reports blurred vision, numbness in feet, and has had a wound on the right leg for the last 2 months. The clinic nurse notes that the client's Hemoglobin A1C is 8.1%. Which of the following should the nurse include in the client's plan of care?
1. "The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that your blood sugar level has had too many highs and lows."
2. "The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that your blood sugar level has been too high."
3. "The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that you'll have to start taking insulin."
4. "The symptoms you are experiencing, along with the elevated Hemoglobin A1C, mean that you have been exercising too much."
2. Blurred vision, numbness in feet, a non-healing wound, and an elevated Hemoglobin A1C indicate that the average blood glucose level has been too high.
A patient, who is admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find?
a. Central apnea
b. Hypoventilation
c. Kussmaul respirations
d. Cheyne-Stokes respirations
c. Kussmaul respirations
In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.