Chapter 57Diabetes Mellitus: Nursing Management My Nursing Test Banks

Chapter 57Diabetes Mellitus: Nursing Management

MULTIPLE CHOICE

1.A client is diagnosed with the type of diabetes in which the plasma beta cells fail to respond to insulin. Which type of diabetes is this client experiencing?

1.

Gestational diabetes

2.

Impaired glucose tolerance

3.

Type 1 diabetes mellitus

4.

Type 2 diabetes mellitus

ANS: 3

Type 1 diabetes mellitus results from a defect or failure of the beta cells of the pancreas. The loss of beta cells causes a lack of insulin. The other options produce insulin.

PTS:1DIF:AnalyzeREF:Type 1 Diabetes

2.The nurse has instructed a client about type 2 diabetes mellitus. Which of the following statements would indicate the client understands the instructions?

1.

It happens to everyone who has gained weight.

2.

I have to watch what I eat and exercise.

3.

I will never have to take insulin.

4.

The cells that make insulin were destroyed.

ANS: 2

Persons with type 2 diabetes control their blood glucose levels with diet, exercise, and medications. Type 1 diabetes mellitus is characterized by a destruction of beta cells. Not every person who gains weight develops diabetes mellitus. Insulin is not  necessary for the client diagnosed with type 2 diabetes at first, but as the beta cells continue to deteriorate, insulin may be necessary.

PTS: 1 DIF: Analyze REF: Type 2 Diabetes; Planning and Implementation

3.The nurse should instruct a client that the length of time insulin can be stored at room temperature is:

1.

2 weeks.

2.

3 weeks.

3.

4 weeks.

4.

5 weeks.

ANS: 3

An insulin vial that is currently in use can be stored at room temperature as long as 4 weeks. The other choices are incorrect lengths of time to store insulin.

PTS: 1 DIF: Apply REF: Insulin

4.The nurse is preparing short-acting and long-acting insulin for administration to a client. The purpose for the clients being prescribed these types of insulin would be to:

1.

make it easier for the client to self-administer the insulin.

2.

reduce the clients appetite.

3.

mimic the bodys own insulin pattern.

4.

help reduce the clients body weight.

ANS: 3

NPH insulin is usually given twice daily and is mixed with regular insulin to mimic the bodys own insulin pattern. Mixing two insulins is not done to make it easier for the client to administer the insulin, to reduce the clients appetite, or to help reduce the clients body weight.

PTS: 1 DIF: Analyze REF: Insulin

5.A client is prescribed insulin to be given through an intravenous access line. The nurse realizes that which of the following insulins can be administered intravenously?

1.

Glargine

2.

Lispro

3.

NPH

4.

Regular

ANS: 4

Regular insulin may be given intravenously or subcutaneously. All other insulins are given subcutaneously.

PTS: 1 DIF: Analyze REF: Insulin

6.Which of the following should the nurse instruct a client when teaching how to self-administer insulin?

1.

The insulin bottle must be shaken.

2.

The long-acting insulin is clear.

3.

Refrigerated insulin is best for injection.

4.

The blood glucose level should be checked prior to administration.

ANS: 4

Insulin bottles should not be shaken but rolled to make sure the precipitate is mixed. The long-acting insulin is cloudy. The insulin should be at room temperature for administration, and the blood glucose level should be checked prior to administration.

PTS: 1 DIF: Apply REF: Insulin

7.A client should not be prescribed tolazamide if the client is sensitive to:

1.

penicillin.

2.

shellfish.

3.

strawberries.

4.

hypoglycemia

ANS: 4

Tolazamide is a first generation sulfonylurea, and can cause a high incidence of hypoglycemia. This medication is used sparingly in the United States today because there are second-generation sulfonylureas that are more effective. Tolazamide can be used if the client is sensitive to penicillin, shellfish, or strawberries.

PTS:1DIF:ApplyREF:Oral Medications

8.A client is prescribed meglitinide as oral treatment for type 2 diabetes mellitus. Which of the following should the nurse instruct as a possible side effect of this medication?

1.

Diarrhea

2.

Constipation

3.

Flatulence

4.

Hunger

ANS: 3

The most common side effect of meglitinide is flatulence, which can cause the client minor discomfort. The nurse should instruct the client regarding this side effect. Meglitinide does not cause diarrhea, constipation, or hunger.

PTS:1DIF:ApplyREF:Oral Medications

9.A client diagnosed with type 1 diabetes mellitus administers a dose of NPH insulin at 7:00 a.m. At which of the following times would this client exhibit hypoglycemia?

1.

0800

2.

0900

3.

1000

4.

1400

ANS: 4

NPH insulin peaks in 4 to 12 hours. During these hours, the client may experience a hypoglycemic episode. The other choices identify times that are before the peak times for the insulin.

PTS: 1 DIF: Apply REF: Table 57-6 Types of Insulin

10.The nurse is instructing a client diagnosed with type 2 diabetes mellitus on dietary intake. Which of the following statements indicates that the client understands the instructions?

1.

Its okay to skip a meal if I make it up later.

2.

Keeping to the diet plan will keep my blood sugars at a regular level.

3.

When I am in a hurry, I should take my medications without testing.

4.

When I go out to dinner, its okay to share a couple of bottles of wine.

ANS: 2

The diet plan is individualized for each client. The food plan will have an emphasis on maintaining blood glucose levels, lowering blood pressure, and reducing weight since there is a high incidence of obesity in clients with type 2 diabetes. Alcohol can be part of a diet plan if in moderation. Sharing  a couple of bottles of wine would not be alcohol in moderation. The food plan is combined with exercise, blood glucose testing, and medications (if needed). The client should be instructed to not skip meals. The client should be instructed to not take any medication prior to testing. The client should be instructed that alcohol intake should be in moderation.

PTS: 1 DIF: Analyze REF: Controlling Diabetes (Secondary Prevention)

11.The nurse is instructing a client diagnosed with type 2 diabetes mellitus on diagnostic tests used to evaluate the control of the disorder. The nurse should instruct the client on which of the following diagnostic tests that will provide this information?

1.

Fasting plasma glucose

2.

Glycosylated hemoglobin

3.

Random plasma glucose

4.

Two-hour oral glucose tolerance test

ANS: 2

The glycosylated hemoglobin (hemoglobin A1c) test measures the amount of glucose attached to hemoglobin molecules and red blood cells over their life span of approximately 120 days. This test provides information about long-term control. The other options give current glucose information.

PTS:1DIF:ApplyREFiagnostic Tests

12.The nurse is instructing a client on the speed in which some insulins take effect. During these instructions, the nurse should include that which of the following insulins has the fastest peak?

1.

Glargine

2.

Lispro

3.

NPH

4.

Regular

ANS: 2

Lispro (Humalog) is classified as an ultra-short-acting insulin that peaks in 30 to 90 minutes after subcutaneous injection. Regular is a short-acting insulin that peaks in 2 to 4 hours. NPH peaks in 4 to 12 hours. Glargine takes effect in 2 to 4 hours and has no peak.

PTS: 1 DIF: Apply REF: Table 57-6 Types of Insulin

13.A client is instructed to rotate the sites of insulin injections because it will help prevent:

1.

a decrease in absorption.

2.

an allergic reaction.

3.

lipodystrophy.

4.

skin breakdown.

ANS: 3

The rotation of sites is used to prevent lipodystrophy, a localized complication of insulin administration characterized by changes in the subcutaneous fat at the site of the injection. The other options are not why site rotation is used.

PTS: 1 DIF: Apply REF: Insulin

14.When discussing exercise with a client diagnosed with type 2 diabetes mellitus, the client is correct in stating:

1.

I will exercise when I can.

2.

I will exercise once a week for 30 minutes.

3.

I will try to exercise every day.

4.

I should exercise for at least 60 minutes when I exercise.

ANS: 3

Clients should work toward a goal of 30 minutes of exercise daily. The intensity of exercise should allow for both breathing and talking with ease during the exercise. The other statements are incorrect and would indicate that the client needs additional instruction regarding exercise.

PTS: 1 DIF: Analyze REF: Exercise

15.A client diagnosed with type 2 diabetes mellitus becomes diaphoretic and irritable during exercise. The blood glucose level at this time is 53 mg/dL. Which of the following should the client be instructed to do when this occurs?

1.

Ingest 5 to 10 g of a simple carbohydrate.

2.

Ingest 10 to 15 g of a simple carbohydrate.

3.

Ingest 15 to 25 g of a simple carbohydrate.

4.

Call paramedics.

ANS: 2

If the client becomes hypoglycemic during exercise, the client should be instructed to stop and monitor the blood glucose level every 15 minutes until the level is greater than 89 mg/dL. The client should ingest 15 grams of a carbohydrate such as milk, juice, soft drink, or glucose tablets. The treatment can be repeated in 15 minutes if ineffective.

PTS: 1 DIF: Apply REF: Exercise

16.The nurse is instructing a client diagnosed with type 2 diabetes mellitus on daily foot care. Which of the following statements indicate the client needs further instruction?

1.

I will check my feet every day.

2.

I will cut my toenails with scissors.

3.

I will keep my appointments with my podiatrist.

4.

I will make sure my shoes fit.

ANS: 2

Clients and their family members knowledge and practice of foot care should be assessed regularly. Clients should be instructed to wash their feet daily with warm water and mild soap. The feet should be patted dry, particularly between the toes. The feet should be examined daily for cuts, blisters, and reddened areas. Toenails should be cut with clippers, not scissors. The shoes of a client diagnosed with type 2 diabetes mellitus should fit properly to prevent foot problems.

PTS:1DIF:Analyze

REF: Peripheral Vascular Complications of the Lower Extremities: Planning and Implementation

MULTIPLE RESPONSE

1.The nurse is assessing a client diagnosed with type 2 diabetes mellitus for symptoms associated with diabetic ketoacidosis. Which of the following will the nurse most likely assess in this client? (Select all that apply.)

1.

Dehydration

2.

Fruity breath odor

3.

Hypertension

4.

Bradycardia

5.

Kussmaul breathing

6.

Abdominal pain

ANS: 1, 2, 5, 6

The client diagnosed with diabetic ketoacidosis will experience dehydration, fruity breath odor, Kussmaul respirations, and abdominal pain. The client will also have hypotension and not hypertension. The clients heart rate will be tachycardic and not bradycardic.

PTS:1DIF:Apply

REFiabetic Ketoacidosis: Assessment with Clinical Manifestations

2.An elderly client being treated for type 2 diabetes mellitus begins to experience lethargy, weakness, and polyuria while recovering from cataract surgery. The nurse would suspect the client is developing hyperosmolar hyperglycemic nonketotic syndrome when which of the following is assessed? (Select all that apply.)

1.

Blood glucose level 450 mg/dL

2.

No ketones in the urine

3.

Serum sodium 145 mEq/L

4.

Serum osmolality 320 mOsm/kg

5.

Blood pressure 120/68 mmHg

6.

Heart rate 78 beats per minute

ANS: 1, 2, 3, 4

Assessment findings consistent with hyperosmolar hyperglycemic nonketotic syndrome include a blood glucose level greater than 400 mg/dL, absence of ketones in the urine, serum sodium greater than 140 mEq/L, and serum osmolality greater than 310 mOsm/kg. The blood pressure of 120/68 mmHg is within normal limits. The heart rate of 78 beats per minute is within normal limits.

PTS:1DIF:Analyze

REF: Hyperosmolar Hyperglycemic Nonketotic Syndrome: Assessment with Clinical Manifestations

3.The nurse is instructing a client diagnosed with type 2 diabetes mellitus on activities to reduce the onset of macrovascular complications. Which of the following should the nurse include in these instructions? (Select all that apply.)

1.

Attain a normal body weight

2.

Stop smoking

3.

Increase activity

4.

Keep blood pressure under control

5.

Decrease fat intake

6.

Ingest alcohol every day

ANS: 1, 2, 3, 4, 5

Macrovascular complications associated with type 2 diabetes mellitus can be controlled by addressing the modifiable risk factors. The risk factors include obesity, smoking, sedentary lifestyle, high blood pressure, and fat intake. This is what the nurse should include in the instructions to this client. The client should not be instructed to ingest alcohol every day.

PTS: 1 DIF: Apply REF: Angiopathy or Vessel Disease

4.A client is being evaluated for the diagnosis of gastroparesis. Which of the following will the nurse most likely assess in this client? (Select all that apply.)

1.

Constipation

2.

Gastroesophageal reflux

3.

Feelings of fullness

4.

Vomiting

5.

Nausea

6.

Anorexia

ANS: 2, 3, 4, 5, 6

Gastroparesis presents as anorexia, nausea and vomiting, feelings of fullness, and gastroesophageal reflux. Constipation is not a presenting sign of gastroparesis.

PTS: 1 DIF: Analyze REF: Autonomic Neuropathies

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