New Book
Lewis 9th
1. Which statement by a nurse to a patient newly diagnosed with type
2 diabetes is correct?
a. Insulin is not used to control blood
glucose in patients with type 2 diabetes.
b. Complications of
type 2 diabetes are less serious than those of type 1
diabetes.
c. Changes in diet and exercise may control blood
glucose levels in type 2 diabetes.
d. Type 2 diabetes is usually
diagnosed when the patient is admitted with a
hyperglycemic coma.
ANS: C
For some patients with type 2 diabetes, changes in
lifestyle are sufficient to achieve blood glucose
control.
Insulin is frequently used for type 2 diabetes, complications are
equally severe as for type 1
diabetes, and type 2 diabetes is
usually diagnosed with routine laboratory testing or after a
patient
develops complications such as frequent yeast
infections.
DIF: Cognitive Level: Understand (comprehension) REF:
1166-1167
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
A 48-year-old male patient screened for diabetes at a clinic has a
fasting plasma glucose
level of 120 mg/dL (6.7 mmol/L). The nurse
will plan to teach the patient about
a. self-monitoring of blood
glucose.
b. using low doses of regular insulin.
c. lifestyle
changes to lower blood glucose.
d. effects of oral hypoglycemic medications.
ANS: C
The patient’s impaired fasting glucose indicates
prediabetes, and the patient should be counseled about
lifestyle
changes to prevent the development of type 2 diabetes. The patient
with prediabetes does not
require insulin or oral hypoglycemics
for glucose control and does not need to self-monitor blood
glucose.
DIF: Cognitive Level: Apply (application) REF:
1156
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A 28-year-old male patient with type 1 diabetes reports how he
manages his exercise
and glucose control. Which behavior
indicates that the nurse should implement
additional
teaching?
a. The patient always carries hard
candies when engaging in exercise.
b. The patient goes for a
vigorous walk when his glucose is 200 mg/dL.
c. The patient has a
peanut butter sandwich before going for a bicycle ride.
d. The
patient increases daily exercise when ketones are present in the urine.
ANS: D
When the patient is ketotic, exercise may result in an
increase in blood glucose level. Type 1 diabetic
patients should
be taught to avoid exercise when ketosis is present. The other
statements are correct.
DIF: Cognitive Level: Apply (application)
REF: 1167
TOP: Nursing Process: Assessment MSC: NCLEX:
Physiological Integrity
The nurse is assessing a 22-year-old patient experiencing the onset
of symptoms of type
1 diabetes. Which question is most
appropriate for the nurse to ask?
a. “Are you anorexic?”
b.
“Is your urine dark colored?”
c. “Have you lost weight
lately?”
d. “Do you crave sugary drinks?”
ANS: C
Weight loss occurs because the body is no longer able to
absorb glucose and starts to break down protein
and fat for
energy. The patient is thirsty but does not necessarily crave
sugar-containing fluids. Increased
appetite is a classic symptom
of type 1 diabetes. With the classic symptom of polyuria, urine will
be very
dilute.
DIF: Cognitive Level: Apply (application)
REF: 1156
TOP: Nursing Process: Assessment MSC: NCLEX:
Physiological Integrity
A patient with type 2 diabetes is scheduled for a follow-up visit in
the clinic several
months from now. Which test will the nurse
schedule to evaluate the effectiveness of treatment for
the
patient?
a. Urine dipstick for glucose
b. Oral glucose
tolerance test
c. Fasting blood glucose level
d.
Glycosylated hemoglobin level
ANS: D
The glycosylated hemoglobin (A1C or HbA1C) test shows the
overall control of glucose over 90 to 120
days. A fasting blood
level indicates only the glucose level at one time. Urine glucose
testing is not an
accurate reflection of blood glucose level and
does not reflect the glucose over a prolonged time. Oral
glucose
tolerance testing is done to diagnose diabetes, but is not used for
monitoring glucose control once
diabetes has been
diagnosed.
DIF: Cognitive Level: Apply (application) REF:
1157
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A 55-year-old female patient with type 2 diabetes has a nursing
diagnosis of imbalanced
nutrition: more than body requirements.
Which goal is most important for this patient?
a. The patient
will reach a glycosylated hemoglobin level of less than 7%.
b.
The patient will follow a diet and exercise plan that results in
weight loss.
c. The patient will choose a diet that distributes
calories throughout the day.
d. The patient will state the
reasons for eliminating simple sugars in the diet.
ANS: A
The complications of diabetes are related to elevated
blood glucose, and the most important patient
outcome is the
reduction of glucose to near-normal levels. The other outcomes also
are appropriate but
are not as high in priority.
DIF:
Cognitive Level: Apply (application) REF: 1157
OBJ: Special
Questions: Prioritization TOP: Nursing Process: Planning
MSC:
NCLEX: Physiological Integrity
A 38-year-old patient who has type 1 diabetes plans to swim laps
daily at 1:00 PM. The
clinic nurse will plan to teach the patient
to
a. check glucose level before, during, and after
swimming.
b. delay eating the noon meal until after the swimming
class.
c. increase the morning dose of neutral protamine Hagedorn
(NPH) insulin.
d. time the morning insulin injection so that the
peak occurs while swimming.
ANS: A
The change in exercise will affect blood glucose, and the
patient will need to monitor glucose carefully to
determine the
need for changes in diet and insulin administration. Because exercise
tends to decrease
blood glucose, patients are advised to eat
before exercising. Increasing the morning NPH or timing
the
insulin to peak during exercise may lead to hypoglycemia,
especially with the increased exercise.
DIF: Cognitive Level:
Apply (application) REF: 1168
TOP: Nursing Process: Planning MSC:
NCLEX: Physiological Integrity
The nurse determines a need for additional instruction when the
patient with newly
diagnosed type 1 diabetes says which of the
following?
a. “I can have an occasional alcoholic drink if I
include it in my meal plan.”
b. “I will need a bedtime snack
because I take an evening dose of NPH insulin.”
c. “I can choose
any foods, as long as I use enough insulin to cover the
calories.”
d. “I will eat something at meal times to prevent
hypoglycemia, even if I am not
hungry.”
ANS: C
Most patients with type 1 diabetes need to plan diet
choices very carefully. Patients who are using
intensified
insulin therapy have considerable flexibility in diet choices but
still should restrict dietary
intake of items such as fat,
protein, and alcohol. The other patient statements are correct and
indicate good
understanding of the diet instruction.
DIF:
Cognitive Level: Apply (application) REF: 1165-1166
TOP: Nursing
Process: Evaluation MSC: NCLEX: Physiological Integrity
In order to assist an older diabetic patient to engage in moderate
daily exercise, which
action is most important for the nurse to
take?
a. Determine what type of activities the patient
enjoys.
b. Remind the patient that exercise will improve
self-esteem.
c. Teach the patient about the effects of exercise
on glucose level.
d. Give the patient a list of activities that
are moderate in intensity.
ANS: A
Because consistency with exercise is important,
assessment for the types of exercise that the patient
finds
enjoyable is the most important action by the nurse in
ensuring adherence to an exercise program. The
other actions will
also be implemented but are not the most important in improving
compliance.
DIF: Cognitive Level: Apply (application) REF:
1186
OBJ: Special Questions: Prioritization TOP: Nursing Process:
Implementation
MSC: NCLEX: Physiological Integrity
Which statement by the patient indicates a need for additional
instruction in
administering insulin?
a. “I need to rotate
injection sites among my arms, legs, and abdomen each day.”
b. “I
can buy the 0.5 mL syringes because the line markings will be easier
to see.”
c. “I should draw up the regular insulin first after
injecting air into the NPH bottle.”
d. “I do not need to aspirate
the plunger to check for blood before injecting insulin.”
ANS: A
Rotating sites is no longer recommended because there is
more consistent insulin absorption when the
same site is used
consistently. The other patient statements are accurate and indicate
that no additional
instruction is needed.
DIF: Cognitive
Level: Apply (application) REF: 1160-1161
TOP: Nursing Process:
Evaluation MSC: NCLEX: Health Promotion and Maintenance
Which patient action indicates good understanding of the nurse’s
teaching about
administration of aspart (NovoLog)
insulin?
a. The patient avoids injecting the insulin into the
upper abdominal area.
b. The patient cleans the skin with soap
and water before insulin administration.
c. The patient stores
the insulin in the freezer after administering the prescribed
dose.
d. The patient pushes the plunger down while removing the
syringe from the injection
site.
ANS: B
Cleaning the skin with soap and water or with alcohol is
acceptable. Insulin should not be frozen. The
patient should
leave the syringe in place for about 5 seconds after injection to be
sure that all the insulin
has been injected. The upper abdominal
area is one of the preferred areas for insulin injection.
DIF:
Cognitive Level: Apply (application) REF: 1161
TOP: Nursing
Process: Evaluation MSC: NCLEX: Physiological Integrity
A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time
will it be most
important for the nurse to monitor for symptoms
of hypoglycemia?
a. 10:00 AM
b. 12:00 AM
c. 2:00
PM
d. 4:00 PM
ANS: A
The rapid-acting insulins peak in 1 to 3 hours. The
patient is not at a high risk for hypoglycemia at the
other
listed times, although hypoglycemia may occur.
DIF: Cognitive
Level: Understand (comprehension) REF: 1159
TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity
Which patient action indicates a good understanding of the nurse’s
teaching about the
use of an insulin pump?
a. The patient
programs the pump for an insulin bolus after eating.
b. The
patient changes the location of the insertion site every week.
c.
The patient takes the pump off at bedtime and starts it again each
morning.
d. The patient plans for a diet that is less flexible
when using the insulin pump.
ANS: A
In addition to the basal rate of insulin infusion, the
patient will adjust the pump to administer a bolus after
each
meal, with the dosage depending on the oral intake. The insertion site
should be changed every 2 or
3 days. There is more flexibility in
diet and exercise when an insulin pump is used. The pump will
deliver
a basal insulin rate 24 hours a day.
DIF: Cognitive
Level: Apply (application) REF: 1162
TOP: Nursing Process:
Evaluation MSC: NCLEX: Health Promotion and Maintenance
A 32-year-old patient with diabetes is starting on intensive insulin
therapy. Which type
of insulin will the nurse discuss using for
mealtime coverage?
a. Lispro (Humalog)
b. Glargine
(Lantus)
c. Detemir (Levemir)
d. NPH (Humulin N)
ANS: A
Rapid- or short-acting insulin is used for mealtime
coverage for patients receiving intensive insulin
therapy. NPH,
glargine, or detemir will be used as the basal insulin.
DIF:
Cognitive Level: Apply (application) REF: 1158
TOP: Nursing
Process: Planning MSC: NCLEX: Physiological Integrity
Which information will the nurse include when teaching a 50-year-old
patient who has
type 2 diabetes about glyburide (Micronase,
DiaBeta, Glynase)?
a. Glyburide decreases glucagon secretion from
the pancreas.
b. Glyburide stimulates insulin production and
release from the pancreas.
c. Glyburide should be taken even if
the morning blood glucose level is low.
d. Glyburide should not
be used for 48 hours after receiving IV contrast media.
ANS: B
The sulfonylureas stimulate the production and release of
insulin from the pancreas. If the glucose level is
low, the
patient should contact the health care provider before taking the
glyburide, because
hypoglycemia can occur with this class of
medication. Metformin should be held for 48 hours
after
administration of IV contrast media, but this is not
necessary for glyburide. Glucagon secretion is not
affected by
glyburide.
DIF: Cognitive Level: Apply (application) REF:
1163
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
The nurse has been teaching a patient with type 2 diabetes about
managing blood
glucose levels and taking glipizide (Glucotrol).
Which patient statement indicates a need for
additional
teaching?
a. “If I overeat at a meal, I will still take the usual
dose of medication.”
b. “Other medications besides the Glucotrol
may affect my blood sugar.”
c. “When I am ill, I may have to take
insulin to control my blood sugar.”
d. “My diabetes won’t cause
complications because I don’t need insulin.”
ANS: D
The patient should understand that type 2 diabetes places
the patient at risk for many complications and
that good glucose
control is as important when taking oral agents as when using insulin.
The other
statements are accurate and indicate good understanding
of the use of glipizide.
DIF: Cognitive Level: Apply
(application) REF: 1158
TOP: Nursing Process: Evaluation MSC:
NCLEX: Physiological Integrity
When a patient who takes metformin (Glucophage) to manage type 2
diabetes develops
an allergic rash from an unknown cause, the
health care provider prescribes prednisone
(Deltasone). The nurse
will anticipate that the patient may
a. need a diet higher in
calories while receiving prednisone.
b. develop acute
hypoglycemia while taking the prednisone.
c. require
administration of insulin while taking prednisone.
d. have rashes
caused by metformin-prednisone interactions.
ANS: C
Glucose levels increase when patients are taking
corticosteroids, and insulin may be required to control
blood
glucose. Hypoglycemia is not a side effect of prednisone. Rashes are
not an adverse effect caused
by taking metformin and prednisone
simultaneously. The patient may have an increased appetite
when
taking prednisone, but will not need a diet that is higher
in calories.
DIF: Cognitive Level: Apply (application) REF:
1175
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00
AM. At 1:00 PM,
the patient has been away from the nursing unit
for 2 hours, missing the lunch delivery while
awaiting a chest
x-ray. To prevent hypoglycemia, the best action by the nurse is
to
a. save the lunch tray for the patient’s later return to the
unit.
b. ask that diagnostic testing area staff to start a 5%
dextrose IV.
c. send a glass of milk or orange juice to the
patient in the diagnostic testing area.
d. request that if
testing is further delayed, the patient be returned to the unit to eat.
ANS: D
Consistency for mealtimes assists with regulation of
blood glucose, so the best option is for the patient to
have
lunch at the usual time. Waiting to eat until after the procedure is
likely to cause hypoglycemia.
Administration of an IV solution is
unnecessarily invasive for the patient. A glass of milk or juice
will
keep the patient from becoming hypoglycemic but will cause a
rapid rise in blood glucose because of the
rapid absorption of
the simple carbohydrate in these items.
DIF: Cognitive Level:
Apply (application) REF: 1166
TOP: Nursing Process:
Implementation MSC: NCLEX: Physiological Integrity
The nurse identifies a need for additional teaching when the patient
who is selfmonitoring
blood glucose
a. washes the puncture
site using warm water and soap.
b. chooses a puncture site in the
center of the finger pad.
c. hangs the arm down for a minute
before puncturing the site.
d. says the result of 120 mg
indicates good blood sugar control.
ANS: B
The patient is taught to choose a puncture site at the
side of the finger pad because there are fewer nerve
endings
along the side of the finger pad. The other patient actions indicate
that teaching has been
effective.
DIF: Cognitive Level:
Apply (application) REF: 1169
TOP: Nursing Process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
The nurse is preparing to teach a 43-year-old man who is newly
diagnosed with type 2
diabetes about home management of the
disease. Which action should the nurse take first?
a. Ask the
patient’s family to participate in the diabetes education
program.
b. Assess the patient’s perception of what it means to
have diabetes mellitus.
c. Demonstrate how to check glucose using
capillary blood glucose monitoring.
d. Discuss the need for the
patient to actively participate in diabetes management.
ANS: B
Before planning teaching, the nurse should assess the
patient’s interest in and ability to self-manage the
diabetes.
After assessing the patient, the other nursing actions may be
appropriate, but planning needs to
be individualized to each
patient.
DIF: Cognitive Level: Apply (application) REF:
1172
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion
and Maintenance
An unresponsive patient with type 2 diabetes is brought to the
emergency department
and diagnosed with hyperosmolar
hyperglycemic syndrome (HHS). The nurse will anticipate the
need
to
a. give a bolus of 50% dextrose.
b. insert a large-bore
IV catheter.
c. initiate oxygen by nasal cannula.
d.
administer glargine (Lantus) insulin.
ANS: B
HHS is initially treated with large volumes of IV fluids
to correct hypovolemia. Regular insulin is
administered, not a
long-acting insulin. There is no indication that the patient requires
oxygen. Dextrose
solutions will increase the patient’s blood
glucose and would be contraindicated.
DIF: Cognitive Level: Apply
(application) REF: 1178
TOP: Nursing Process: Planning MSC:
NCLEX: Physiological Integrity
A 26-year-old female with type 1 diabetes develops a sore throat and
runny nose after
caring for her sick toddler. The patient calls
the clinic for advice about her symptoms and a blood
glucose
level of 210 mg/dL despite taking her usual glargine (Lantus) and
lispro (Humalog)
insulin. The nurse advises the patient
to
a. use only the lispro insulin until the symptoms are
resolved.
b. limit intake of calories until the glucose is less
than 120 mg/dL.
c. monitor blood glucose every 4 hours and notify
the clinic if it continues to rise.
d. decrease intake of
carbohydrates until glycosylated hemoglobin is less than 7%.
ANS: C
Infection and other stressors increase blood glucose
levels and the patient will need to test blood
glucose
frequently, treat elevations appropriately with lispro
insulin, and call the health care provider if glucose
levels
continue to be elevated. Discontinuing the glargine will contribute to
hyperglycemia and may lead
to diabetic ketoacidosis (DKA).
Decreasing carbohydrate or caloric intake is not appropriate because
the
patient will need more calories when ill. Glycosylated
hemoglobin testing is not used to evaluate shortterm
alterations
in blood glucose.
DIF: Cognitive Level: Apply (application) REF:
1171-1172
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
The health care provider suspects the Somogyi effect in a 50-year-old
patient whose
6:00 AM blood glucose is 230 mg/dL. Which action
will the nurse teach the patient to take?
a. Avoid snacking at
bedtime.
b. Increase the rapid-acting insulin dose.
c. Check
the blood glucose during the night
d. Administer a larger dose of
long-acting insulin.
ANS: C
If the Somogyi effect is causing the patient’s increased
morning glucose level, the patient will experience
hypoglycemia
between 2:00 and 4:00 AM. The dose of insulin will be reduced, rather
than increased. A
bedtime snack is used to prevent hypoglycemic
episodes during the night.
DIF: Cognitive Level: Apply
(application) REF: 1163
TOP: Nursing Process: Planning MSC:
NCLEX: Physiological Integrity
Which action should the nurse take after a 36-year-old patient
treated with
intramuscular glucagon for hypoglycemia regains
consciousness?
a. Assess the patient for symptoms of
hyperglycemia.
b. Give the patient a snack of peanut butter and
crackers.
c. Have the patient drink a glass of orange juice or
nonfat milk.
d. Administer a continuous infusion of 5% dextrose
for 24 hours.
ANS: B
Rebound hypoglycemia can occur after glucagon
administration, but having a meal containing
complex
carbohydrates plus protein and fat will help prevent
hypoglycemia. Orange juice and nonfat milk will
elevate blood
glucose rapidly, but the cheese and crackers will stabilize blood
glucose. Administration of
IV glucose might be used in patients
who were unable to take in nutrition orally. The patient should
be
assessed for symptoms of hypoglycemia after glucagon
administration.
DIF: Cognitive Level: Apply (application) REF:
1179
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
Which question during the assessment of a diabetic patient will help
the nurse identify
autonomic neuropathy?
a. “Do you feel
bloated after eating?”
b. “Have you seen any skin
changes?”
c. “Do you need to increase your insulin dosage when
you are stressed?”
d. “Have you noticed any painful new
ulcerations or sores on your feet?”
ANS: A
Autonomic neuropathy can cause delayed gastric emptying,
which results in a bloated feeling for the
patient. The other
questions are also appropriate to ask but would not help in
identifying autonomic
neuropathy.
DIF: Cognitive Level:
Apply (application) REF: 1183
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
Which information will the nurse include in teaching a female patient
who has
peripheral arterial disease, type 2 diabetes, and sensory
neuropathy of the feet and legs?
a. Choose flat-soled leather
shoes.
b. Set heating pads on a low temperature.
c. Use
callus remover for corns or calluses.
d. Soak feet in warm water
for an hour each day.
ANS: A
The patient is taught to avoid high heels and that
leather shoes are preferred. The feet should be washed,
but not
soaked, in warm water daily. Heating pad use should be avoided.
Commercial callus and corn
removers should be avoided. The
patient should see a specialist to treat these problems.
DIF:
Cognitive Level: Apply (application) REF: 1184
TOP: Nursing
Process: Implementation MSC: NCLEX: Physiological Integrity
Which finding indicates a need to contact the health care provider
before the nurse
administers metformin (Glucophage)?
a. The
patient’s blood glucose level is 174 mg/dL.
b. The patient has
gained 2 lb (0.9 kg) since yesterday.
c. The patient is scheduled
for a chest x-ray in an hour.
d. The patient’s blood urea
nitrogen (BUN) level is 52 mg/dL.
ANS: D
The BUN indicates possible renal failure, and metformin
should not be used in patients with renal failure.
The other
findings are not contraindications to the use of metformin.
DIF:
Cognitive Level: Apply (application) REF: 1163
TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity
A diabetic patient who has reported burning foot pain at night
receives a new
prescription. Which information should the nurse
teach the patient about amitriptyline (Elavil)?
a. Amitriptyline
decreases the depression caused by your foot pain.
b.
Amitriptyline helps prevent transmission of pain impulses to the
brain.
c. Amitriptyline corrects some of the blood vessel changes
that cause pain.
d. Amitriptyline improves sleep and makes you
less aware of nighttime pain.
ANS: B
Tricyclic antidepressants decrease the transmission of
pain impulses to the spinal cord and brain.
Tricyclic
antidepressants also improve sleep quality and are used for
depression, but that is not the major
purpose for their use in
diabetic neuropathy. The blood vessel changes that contribute to
neuropathy are
not affected by tricyclic
antidepressants.
DIF: Cognitive Level: Apply (application) REF:
1183
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
Which information is most important for the nurse to report to the
health care provider
before a patient with type 2 diabetes is
prepared for a coronary angiogram?
a. The patient’s most recent
HbA1C was 6.5%.
b. The patient’s admission blood glucose is 128
mg/dL.
c. The patient took the prescribed metformin (Glucophage)
today.
d. The patient took the prescribed captopril (Capoten)
this morning.
ANS: C
To avoid lactic acidosis, metformin should be
discontinued a day or 2 before the coronary arteriogram
and
should not be used for 48 hours after IV contrast media are
administered. The other patient data will
also be reported but do
not indicate any need to reschedule the procedure.
DIF: Cognitive
Level: Apply (application) REF: 1163
TOP: Nursing Process:
Assessment MSC: NCLEX: Physiological Integrity
Which action by a patient indicates that the home health nurse’s
teaching about
glargine and regular insulin has been
successful?
a. The patient administers the glargine 30 minutes
before each meal.
b. The patient’s family prefills the syringes
with the mix of insulins weekly.
c. The patient draws up the
regular insulin and then the glargine in the same syringe.
d. The
patient disposes of the open vials of glargine and regular insulin
after 4 weeks.
ANS: D
Insulin can be stored at room temperature for 4 weeks.
Glargine should not be mixed with other insulins
or prefilled and
stored. Short-acting regular insulin is administered before meals,
while glargine is given
once daily.
DIF: Cognitive Level:
Apply (application) REF: 1160
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
A 26-year-old patient with diabetes rides a bicycle to and from work
every day. Which
site should the nurse teach the patient to
administer the morning insulin?
a. thigh.
b.
buttock.
c. abdomen.
d. upper arm.
ANS: C
Patients should be taught not to administer insulin into
a site that will be exercised because exercise will
increase the
rate of absorption. The thigh, buttock, and arm are all exercised by
riding a bicycle.
DIF: Cognitive Level: Apply (application) REF:
1160
TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
The nurse is interviewing a new patient with diabetes who receives
rosiglitazone
(Avandia) through a restricted access medication
program. What is most important for the nurse to
report
immediately to the health care provider?
a. The patient’s blood
pressure is 154/92.
b. The patient has a history of
emphysema.
c. The patient’s blood glucose is 86 mg/dL.
d.
The patient has chest pressure when walking.
ANS: D
Rosiglitazone can cause myocardial ischemia. The nurse
should immediately notify the health care
provider and expect
orders to discontinue the medication. There is no urgent need to
discuss the other data
with the health care provider.
DIF:
Cognitive Level: Apply (application) REF: 1163
TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity
The nurse is taking a health history from a 29-year-old pregnant
patient at the first
prenatal visit. The patient reports no
personal history of diabetes but has a parent who is
diabetic.
Which action will the nurse plan to take first?
a.
Teach the patient about administering regular insulin.
b.
Schedule the patient for a fasting blood glucose level.
c.
Discuss an oral glucose tolerance test for the twenty-fourth week of
pregnancy.
d. Provide teaching about an increased risk for fetal
problems with gestational
diabetes.
ANS: B
Patients at high risk for gestational diabetes should be
screened for diabetes on the initial prenatal visit.
An oral
glucose tolerance test may also be used to check for diabetes, but it
would be done before the
twenty-fourth week. The other actions
may also be needed (depending on whether the patient
develops
gestational diabetes), but they are not the first
actions that the nurse should take.
DIF: Cognitive Level: Apply
(application) REF: 1157
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a
serum glucose
level of 732 mg/dL and serum potassium level of 3.1
mEq/L. Which action prescribed by the health
care provider should
the nurse take first?
a. Place the patient on a cardiac
monitor.
b. Administer IV potassium supplements.
c. Obtain
urine glucose and ketone levels.
d. Start an insulin infusion at
0.1 units/kg/hr.
ANS: A
Hypokalemia can lead to potentially fatal dysrhythmias
such as ventricular tachycardia and ventricular
fibrillation,
which would be detected with electrocardiogram (ECG) monitoring.
Because potassium must
be infused over at least 1 hour, the nurse
should initiate cardiac monitoring before infusion of
potassium.
Insulin should not be administered without cardiac
monitoring because insulin infusion will further
decrease
potassium levels. Urine glucose and ketone levels are not urgently
needed to manage the
patient’s care.
DIF: Cognitive Level:
Apply (application) REF: 1176
OBJ: Special Questions:
Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX:
Physiological Integrity
A 54-year-old patient is admitted with diabetic ketoacidosis. Which
admission order
should the nurse implement first?
a. Infuse
1 liter of normal saline per hour.
b. Give sodium bicarbonate 50
mEq IV push.
c. Administer regular insulin 10 U by IV
push.
d. Start a regular insulin infusion at 0.1 units/kg/hr.
ANS: A
The most urgent patient problem is the hypovolemia
associated with diabetic ketoacidosis (DKA), and the
priority is
to infuse IV fluids. The other actions can be done after the infusion
of normal saline is initiated.
DIF: Cognitive Level: Apply
(application) REF: 1177
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
A female patient is scheduled for an oral glucose tolerance test.
Which information
from the patient’s health history is most
important for the nurse to communicate to the health
care
provider?
a. The patient uses oral
contraceptives.
b. The patient runs several days a week.
c.
The patient has been pregnant three times.
d. The patient has a
family history of diabetes.
ANS: A
Oral contraceptive use may falsely elevate oral glucose
tolerance test (OGTT) values. Exercise and a
family history of
diabetes both can affect blood glucose but will not lead to misleading
information from
the OGTT. History of previous pregnancies may
provide informational about gestational glucose
tolerance, but
will not lead to misleading information from the OGTT.
DIF:
Cognitive Level: Apply (application) REF: 1157
OBJ: Special
Questions: Prioritization TOP: Nursing Process: Assessment
MSC:
NCLEX: Physiological Integrity
A patient who was admitted with diabetic ketoacidosis secondary to a
urinary tract
infection has been weaned off an insulin drip 30
minutes ago. The patient reports feeling
lightheaded and sweaty.
Which action should the nurse take first?
a. Infuse dextrose 50%
by slow IV push.
b. Administer 1 mg glucagon
subcutaneously.
c. Obtain a glucose reading using a finger
stick.
d. Have the patient drink 4 ounces of orange juice.
ANS: C
The patient’s clinical manifestations are consistent with
hypoglycemia and the initial action should be to
check the
patient’s glucose with a finger stick or order a stat blood glucose.
If the glucose is low, the
patient should ingest a rapid-acting
carbohydrate, such as orange juice. Glucagon or dextrose 50%
might
be given if the patient’s symptoms become worse or if the
patient is unconscious.
DIF: Cognitive Level: Apply (application)
REF: 1179
OBJ: Special Questions: Prioritization TOP: Nursing
Process: Implementation
MSC: NCLEX: Physiological Integrity
Which laboratory value reported to the nurse by the unlicensed
assistive personnel
(UAP) indicates the most urgent need for the
nurse’s assessment of the patient?
a. Bedtime glucose of 140
mg/dL
b. Noon blood glucose of 52 mg/dL
c. Fasting blood
glucose of 130 mg/dL
d. 2-hr postprandial glucose of 220 mg/dL
ANS: B
The nurse should assess the patient with a blood glucose
level of 52 mg/dL for symptoms of
hypoglycemia and give the
patient a carbohydrate-containing beverage such as orange juice. The
other
values are within an acceptable range or not immediately
dangerous for a diabetic patient.
DIF: Cognitive Level: Apply
(application) REF: 1154
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
When a patient with type 2 diabetes is admitted for a
cholecystectomy, which nursing
action can the nurse delegate to a
licensed practical/vocational nurse (LPN/LVN)?
a. Communicate the
blood glucose level and insulin dose to the circulating nurse
in
surgery.
b. Discuss the reason for the use of insulin
therapy during the immediate postoperative
period.
c.
Administer the prescribed lispro (Humalog) insulin before transporting
the patient
to surgery.
d. Plan strategies to minimize the
risk for hypoglycemia or hyperglycemia during the
postoperative period.
ANS: C
LPN/LVN education and scope of practice includes
administration of insulin. Communication about
patient status
with other departments, planning, and patient teaching are skills that
require RN education
and scope of practice.
DIF: Cognitive
Level: Apply (application) REF: 1185
OBJ: Special Questions:
Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and
Effective Care Environment
An active 28-year-old male with type 1 diabetes is being seen in the
endocrine clinic.
Which finding may indicate the need for a
change in therapy?
a. Hemoglobin A1C level 6.2%
b. Blood
pressure 146/88 mmHg
c. Heart rate at rest 58
beats/minute
d. High density lipoprotein (HDL) level 65 mg/dL
ANS: B
To decrease the incidence of macrovascular and
microvascular problems in patients with diabetes, the
goal blood
pressure is usually 130/80. An A1C less than 6.5%, a low resting heart
rate (consistent with
regular aerobic exercise in a young adult),
and an HDL level of 65 mg/dL all indicate that the
patient’s
diabetes and risk factors for vascular disease are well
controlled.
DIF: Cognitive Level: Apply (application) REF:
1181
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A 34-year-old has a new diagnosis of type 2 diabetes. The nurse will
discuss the need
to schedule a dilated eye exam
a. every 2
years.
b. as soon as possible.
c. when the patient is 39
years old.
d. within the first year after diagnosis.
ANS: B
Because many patients have some diabetic retinopathy when
they are first diagnosed with type 2 diabetes,
a dilated eye exam
is recommended at the time of diagnosis and annually thereafter.
Patients with type 1
diabetes should have dilated eye exams
starting 5 years after they are diagnosed and then annually.
DIF:
Cognitive Level: Apply (application) REF: 1182
TOP: Nursing
Process: Planning MSC: NCLEX: Physiological Integrity
After the nurse has finished teaching a patient who has a new
prescription for
exenatide (Byetta), which patient statement
indicates that the teaching has been effective?
a. “I may feel
hungrier than usual when I take this medicine.”
b. “I will not
need to worry about hypoglycemia with the Byetta.”
c. “I should
take my daily aspirin at least an hour before the Byetta.”
d. “I
will take the pill at the same time I eat breakfast in the morning.”
ANS: C
Since exenatide slows gastric emptying, oral medications
should be taken at least an hour before the
exenatide to avoid
slowing absorption. Exenatide is injected and increases feelings of
satiety.
Hypoglycemia can occur with this medication.
DIF:
Cognitive Level: Apply (application) REF: 1165
TOP: Nursing
Process: Evaluation MSC: NCLEX: Physiological Integrity
A few weeks after an 82-year-old with a new diagnosis of type 2
diabetes has been
placed on metformin (Glucophage) therapy and
taught about appropriate diet and exercise, the
home health nurse
makes a visit. Which finding by the nurse is most important to discuss
with the
health care provider?
a. Hemoglobin A1C level is
7.9%.
b. Last eye exam was 18 months ago.
c. Glomerular
filtration rate is decreased.
d. Patient has questions about the
prescribed diet.
ANS: C
The decrease in renal function may indicate a need to
adjust the dose of metformin or change to a
different medication.
In older patients, the goal for A1C may be higher in order to avoid
complications
associated with hypoglycemia. The nurse will plan
on scheduling the patient for an eye exam and
addressing the
questions about diet, but the biggest concern is the patient’s
decreased renal function.
DIF: Cognitive Level: Apply
(application) REF: 1186
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
The nurse has administered 4 oz of orange juice to an alert patient
whose blood
glucose was 62 mg/dL. Fifteen minutes later, the
blood glucose is 67 mg/dL. Which action should
the nurse take
next?
a. Give the patient 4 to 6 oz more orange juice.
b.
Administer the PRN glucagon (Glucagon) 1 mg IM.
c. Have the
patient eat some peanut butter with crackers.
d. Notify the
health care provider about the hypoglycemia.
ANS: A
The “rule of 15” indicates that administration of quickly
acting carbohydrates should be done 2 to 3 times
for a conscious
patient whose glucose remains less than 70 mg/dL before notifying the
health care
provider. More complex carbohydrates and fats may be
used once the glucose has stabilized. Glucagon
should be used if
the patient’s level of consciousness decreases so that oral
carbohydrates can no longer
be given.
DIF: Cognitive Level:
Apply (application) REF: 1179
OBJ: Special Questions:
Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX:
Physiological Integrity
Which nursing action can the nurse delegate to unlicensed assistive
personnel (UAP)
who are working in the diabetic clinic?
a.
Measure the ankle-brachial index.
b. Check for changes in skin
pigmentation.
c. Assess for unilateral or bilateral foot
drop.
d. Ask the patient about symptoms of depression.
ANS: A
Checking systolic pressure at the ankle and brachial
areas and calculating the ankle-brachial index is a
procedure
that can be done by UAP who have been trained in the procedure. The
other assessments
require more education and critical thinking
and should be done by the registered nurse (RN).
DIF: Cognitive
Level: Apply (application) REF: 15-16 | 1185
OBJ: Special
Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX:
Safe and Effective Care Environment
After change-of-shift report, which patient will the nurse assess
first?
a. 19-year-old with type 1 diabetes who was admitted with
possible dawn
phenomenon
b. 35-year-old with type 1 diabetes
whose most recent blood glucose reading was 230
mg/dL
c.
60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin
turgor
and dry oral mucosa
d. 68-year-old with type 2
diabetes who has severe peripheral neuropathy and
complains of
burning foot pain
ANS: C
The patient’s diagnosis of HHS and signs of dehydration
indicate that the nurse should rapidly assess for
signs of shock
and determine whether increased fluid infusion is needed. The other
patients also need
assessment and intervention but do not have
life-threatening complications.
DIF: Cognitive Level: Analyze
(analysis) REF: 1178
OBJ: Special Questions: Multiple Patients;
Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Safe
and Effective Care Environment
After change-of-shift report, which patient should the nurse assess
first?
a. 19-year-old with type 1 diabetes who has a hemoglobin
A1C of 12%
b. 23-year-old with type 1 diabetes who has a blood
glucose of 40 mg/dL
c. 40-year-old who is pregnant and whose oral
glucose tolerance test is 202 mg/dL
d. 50-year-old who uses
exenatide (Byetta) and is complaining of acute abdominal
pain
ANS: B
Because the brain requires glucose to function, untreated
hypoglycemia can cause unconsciousness,
seizures, and death. The
nurse will rapidly assess and treat the patient with low blood
glucose. The other
patients also have symptoms that require
assessments and/or interventions, but they are not at
immediate
risk for life-threatening complications.
DIF:
Cognitive Level: Analyze (analysis) REF: 1179
OBJ: Special
Questions: Prioritization; Multiple Patients TOP: Nursing Process:
Planning
MSC: NCLEX: Safe and Effective Care Environment
To monitor for complications in a patient with type 2 diabetes, which
tests will the nurse
in the diabetic clinic schedule at least
annually (select all that apply)?
a. Chest x-ray
b. Blood
pressure
c. Serum creatinine
d. Urine for
microalbuminuria
e. Complete blood count (CBC)
f.
Monofilament testing of the foot
ANS: B, C, D, F
Blood pressure, serum creatinine, urine testing
for microalbuminuria, and monofilament testing of the
foot are
recommended at least annually to screen for possible microvascular and
macrovascular
complications of diabetes. Chest x-ray and CBC
might be ordered if the diabetic patient presents with
symptoms
of respiratory or infectious problems but are not routinely included
in screening.
DIF: Cognitive Level: Apply (application) REF:
1161
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
In which order will the nurse take these steps to prepare NPH 20
units and regular
insulin 2 units using the same syringe? (Put a
comma and a space between each answer choice [A,
B, C, D,
E]).
a. Rotate NPH vial.
b. Withdraw regular
insulin.
c. Withdraw 20 units of NPH.
d. Inject 20 units of
air into NPH vial.
e. Inject 2 units of air into regular insulin vial.
ANS:
A, D, E, B, C
When mixing regular insulin with NPH, it
is important to avoid contact between the regular insulin and
the
additives in the NPH that slow the onset, peak, and duration of
activity in the longer-acting insulin.
DIF: Cognitive Level:
Understand (comprehension) REF: 1181
OBJ: Special Questions:
Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX:
Physiological Integrity
NEW BOOK
BRUNNER & SUDDARTH 14TH ED
A community health nurse has witnessed significant shifts in patterns
of disease over the course of a
four-decade career. Which of the
following focuses most clearly demonstrates the changing pattern
of
disease in the United States?
A) Type 1 diabetes
management
B) Treatment of community-acquired pneumonia
C)
Rehabilitation from traumatic brain injuries
D) Management of
acute Staphylococcus aureus infections
Ans: A
Feedback:
Test Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
12
Management of chronic diseases such as diabetes is a priority
focus of the current health care
environment. This supersedes the
treatment of acute infections and rehabilitation needs.
A nurse has been working with Mrs. Griffin, a 71-year-old patient whose poorly controlled type 1
diabetes has led to numerous health problems. Over the past several years Mrs. Griffin has had several
admissions to the hospital medical unit, and the nurse has often carried out health promotion
interventions. Who is ultimately responsible for maintaining and promoting Mrs. Griffins health?
- A) The medical nurse
- B) The community health nurse who has also worked with Mrs. Griffin
- C) Mrs. Griffins primary care provider
- D) Mrs. Griffin
Ans: D
Feedback:
American society places a great importance
on health and the responsibility that each of us has to
maintain
and promote our own health. Therefore, the other options are incorrect.
A 20-year-old man newly diagnosed with type 1 diabetes needs to learn
how to self-administer insulin.
When planning the appropriate
educational interventions and considering variables that will affect
his
learning, the nurse should prioritize which of the following factors?
A) Patients expected lifespan
B) Patients gender
C)
Patients occupation
D) Patients culture
Ans: D
Feedback:
One of the major variables that influences
a patients readiness to learn is the patients culture, because
it
affects how a person learns and what information is learned.
Other variables include illness states,
values, emotional
readiness, and physical readiness. Lifespan, occupation, and gender
are variables that
are usually less salient.
You are the oncoming nurse and you have just taken end-of-shift
report on your patients. One of your
patients newly diagnosed
with diabetes was admitted with diabetic ketoacidosis. Which behavior
best
demonstrates this patients willingness to learn?
A) The
patient requests a visit from the hospitals diabetic
educator.
Test Bank - Brunner & Suddarth's Textbook of
Medical-Surgical Nursing 14e (Hinkle 2017) 71
B) The patient sets
aside a dessert brought in by a family member.
C) The patient
wants a family member to meet with the dietician to discuss
meals.
D) The patient readily allows the nurse to measure his
blood glucose level.
Ans: A
Feedback:
Emotional readiness also affects the
motivation to learn. A person who has not accepted an
existing
illness or the threat of illness is not motivated to
learn. The patients wiliness to learn is expressed
through the
action of seeking information on his or her own accord. Seeking
information shows an
emotional readiness to learn. The other
options do not as clearly demonstrate a willingness to learn.
You are the clinic nurse providing patient education to a teenage
girl who was diagnosed 6 months ago
with type 1 diabetes. Her
hemoglobin A1C results suggest she has not been adhering to her
prescribed
treatment regimen. As the nurse, what variables do you
need to assess to help this patient better adhere
to her
treatment regimen? Select all that apply.
A) Variables that
affect the patients ability to obtain resources
B) Variables that
affect the patients ability to teach her friends about
diabetes
C) Variables that affect the patients ability to cure
her disease
D) Variables that affect the patients ability to
maintain a healthy social environment
E) Variables that affect
the patients ability to adopt specific behaviors
Ans: A, D, E
Feedback:
Nurses success with health education
is determined by ongoing assessment of the variables that affect
a
patients ability to adopt specific behaviors, to obtain
resources, and to maintain a healthy social
environment. The
patients ability to teach her friends about her condition is not a
variable that the nurse
would likely assess when educating the
patient about her treatment regimen. Type 1 diabetes is not
curable.
Nurses who are providing patient education often use motivators for
learning with patients who are
struggling with behavioral changes
necessary to adhere to a treatment regimen. When working with
a
15-year-old boy who has diabetes, which of the following
motivators is most likely to be effective?
A) A learning
contract
B) A star chart
C) A point system
D) A
food-reward system
Ans: A
Feedback:
Test Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 80
Using a
learning contract or agreement can also be a motivator for learning.
Such a contract is based on
assessment of patient needs; health
care data; and specific, measurable goals. Young adults would
not
respond well to the use of star charts, point systems, or
food as reward for behavioral change. These
types of motivators
would work better with children.
You are taking a health history on an adult patient who is new to the
clinic. While performing your
assessment, the patient informs you
that her mother has type 1 diabetes. What is the primary
significance
of this information to the health history?
A)
The patient may be at risk for developing diabetes.
B) The
patient may need teaching on the effects of diabetes.
C) The
patient may need to attend a support group for individuals with
diabetes.
D) The patient may benefit from a dietary regimen that
tracks glucose intake.
Ans: A
Feedback:
Nurses incorporate a genetics focus into
the health assessments of family history to assess for
geneticsrelated
risk factors. The information aids the nurse in
determining if the patient may be predisposed to
Test Bank -
Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e
(Hinkle 2017) 85
diseases that are genetic in origin. The results
of diabetes testing would determine whether dietary
changes,
support groups or health education would be needed.
you are the nurse caring for a patient who is Native American who
arrives at the clinic for treatment
related to type 2 diabetes.
Which question would best provide you with information about the role
of
food in the patients cultural practices and identify how the
patients food preferences could be related to
his
problem?
A) Do you feel any of your cultural practices have a
negative impact on your disease process?
B) What types of foods
are served as a part of your cultural practices, and how are they
prepared?
C) As a nonnative, I am unaware of your cultural
practices. Could you teach me a few practices that
may affect
your care?
D) Tell me about foods that are important in your
culture and how you feel they influence your
diabetes.
Ans: D
Feedback:
The beliefs and practices that have been
shared from generation to generation are known as cultural
or
ethnic patterns. Food plays a significant role in both
cultural practices and type 2 diabetes. By asking the
question,
Tell me about the foods that are important in your culture and how you
feel they influence
your diabetes, the nurse demonstrates a
cultural awareness to the client and allows an
open-ended
discussion of the disease process and its relationship
to cultural practice. An overemphasis on negatives
can inhibit
assessment and communication. Assessing the types and preparation of
foods specific to
cultural practices without relating it to
diabetes is inadequate. The question, As a nonnative, I
am
unaware of your cultural practices. Could you teach me a few
practices that may affect your care?
focuses on care and fails to
address the significance of food in cultural practice or diabetes.
You are the nurse caring for a 72-year-old woman who is recovering
from a hemicolectomy on the
postsurgical unit. The surgery was
very stressful and prolonged, and you note on the chart that her
blood
sugars are elevated, yet diabetes does not appear in her
previous medical history. To what do you
attribute this elevation
in blood sugars?
A) It is a temporary result of increased
secretion of antidiuretic hormone.
B) She must have had diabetes
prior to surgery that was undiagnosed.
C) She has suffered
pancreatic trauma during her abdominal surgery.
D) The blood
sugars are probably a result of the fight-or-flight reaction.
Ans: D
Feedback:
During stressful situations, ACTH
stimulates the release of cortisol from the adrenal gland,
which
creates protein catabolism releasing amino acids and
stimulating the liver to convert amino acids to
glucose; the
result is elevated blood sugars. Antidiuretic hormone is released
during stressful situations
and stimulates reabsorption of water
in the distal and collecting tubules of the kidney. Assuming
the
Test Bank - Brunner & Suddarth's Textbook of
Medical-Surgical Nursing 14e (Hinkle 2017) 105
patient had
diabetes prior to surgery demonstrates a lack of understanding of
stress-induced
hyperglycemia. No evidence presented in the
question other than elevated blood sugars would support
a
diagnosis of diabetes.
The nurse is admitting a Native American patient with uncontrolled
hypertension and type 1 diabetes to
the unit. During the initial
assessment, the patient informs the nurse that he has been seeking
assistance
and care from the shaman in his community. The nurse
recognizes that the patients blood pressure and
his blood sugar
level are elevated upon admission. What is the nurses best response to
the patients
indication that his care provider is a
shaman?
A) Thank you for providing the information about the
shaman, but we will keep that information and
approach separate
from your current hospitalization.
B) It seems that the care
provided by your shaman is not adequately managing your hypertension
and
diabetes, so we will try researched medical
approaches.
C) Dont worry about insulting your shaman, as he will
understand his approach to your hypertension
and diabetes was not
working after your doctor tells him how sick you were in the
hospital.
D) I understand that you value the care provided by the
shaman, but we would like you to consider
medications and dietary
changes that may lower your blood pressure and blood sugar levels.
Ans: D
Feedback:
Native American patients may seek
assistance from a shaman or medicine man or woman. The
nurses
best approach is not to disregard the patients belief in
folk healers or try to undermine trust in the
healers. Nurses
should make an effort to accommodate the patients beliefs while also
advocating the
treatment proposed by health science. The nurses
best response incorporating these strategies is, I
understand
that you value the care provided by the shaman, but we would like you
to consider
medications and dietary changes that may improve your
blood pressure and blood sugar levels.
A medical-surgical nurse is teaching a patient about the health
implications of her recently diagnosed
type 2 diabetes. The nurse
should teach the patient to be proactive with her glycemic control in
order to
reduce her risk of what health problem?
A)
Arthritis
B) Renal failure
C) Pancreatic cancer
D) Asthma
Ans: B
Feedback:
One chronic disease can lead to the
development of other chronic conditions. Diabetes, for example,
can
eventually lead to neurologic and vascular changes that may
result in visual, cardiac, and kidney disease
and erectile
dysfunction. Diabetes is not often linked to cancer, arthritis, or asthma.
A patient has recently been diagnosed with type 2 diabetes. The
patient is clinically obese and has a
sedentary lifestyle. How
can the nurse best begin to help the patient increase his activity
level?
A) Set up appointment times at a local fitness center for
the patient to attend.
B) Have a family member ensure the patient
follows a suggested exercise plan.
C) Construct an exercise
program and have the patient follow it.
D) Identify barriers with
the patient that inhibit his lifestyle change.
Ans: D
Feedback:
Nurses cannot expect that sedentary
patients are going to develop a sudden passion for exercise and
that
they will easily rearrange their day to accommodate
time-consuming exercise plans. The patient may not
be ready or
willing to accept this lifestyle change. This is why it is important
that the nurse and patient
identify barriers to change.
You are caring for a young woman who has Down syndrome and who has
just been diagnosed with type
2 diabetes. What consideration
should you prioritize when planning this patients nursing
care?
A) How her new diagnosis affects her health
attitudes
B) How her diabetes affects the course of her Down
syndrome
C) How her chromosomal disorder affects her glucose
metabolism
D) How her developmental disability influences her
health management
Ans: D
Feedback:
It is important to consider the
interaction between existing disabilities and new diagnoses. Cognitive
and
motor deficits would greatly affect diabetes management.
Diabetes would not likely affect her attitude or
the course of
her Down syndrome. Chromosomal disorders such as Down syndrome do not
affect
glucose metabolism.
You are presenting patient teaching to a 48-year-old man who was just
diagnosed with type 2 diabetes.
The patient has a BMI of 35 and
leads a sedentary lifestyle. You give the patient information on the
risk
factors for his diagnosis and begin talking with him about
changing behaviors around diet and exercise.
You know that
further patient teaching is necessary when your patient tells you
what?
A) I need to start slow on an exercise program approved by
my doctor.
B) I know theres a chance I could have avoided this if
Id always eaten better and exercised more.
C) There is nothing
that can be done anyway, because chronic diseases like diabetes cannot
be
prevented.
D) I want to have a plan in place before I
start making a lot of changes to my lifestyle.
Ans: C
Feedback:
The major causes of chronic diseases are
known, and if these risk factors were eliminated, at least
over
80% of heart disease, stroke, and type 2 diabetes would be
prevented. In addition, over 40% of cancers
would be prevented.
The other listed options are accurate statements.
The nurse admitting a patient who is insulin dependent to the
same-day surgical suite for carpal tunnel
surgery. How should
this patients diagnosis of type 1 diabetes affect the care that the
nurse plans?
A) The nurse should administer a bolus of dextrose
IV solution preoperatively.
B) The nurse should keep the patient
NPO for at least 8 hours preoperatively.
C) The nurse should
initiate a subcutaneous infusion of long-acting insulin.
D) The
nurse should assess the patients blood glucose levels vigilantly.
Ans: D
Feedback:
The patient with diabetes who is
undergoing surgery is at risk for hypoglycemia and
hyperglycemia.
Close glycemic monitoring is necessary. Dextrose
infusion and prolonged NPO status are
contraindicated. There is
no specific need for an insulin infusion preoperatively.
The nurse is planning the care of a patient who has type 1 diabetes
and who will be undergoing knee
replacement surgery. This
patients care plan should reflect an increased risk of what
postsurgical
complications? Select all that apply.
A)
Hypoglycemia
B) Delirium
C) Acidosis
D)
Glucosuria
E) Fluid overload
Ans: A, C, D
Feedback:
Hypoglycemia may develop during
anesthesia or postoperatively from inadequate carbohydrates
or
excessive administration of insulin. Hyperglycemia, which can
increase the risk for surgical wound
infection, may result from
the stress of surgery, which can trigger increased levels of
catecholamine.
Other risks are acidosis and glucosuria. Risks of
fluid overload and delirium are not normally increased.
The clinic nurse is caring for a 57-year-old client who reports
experiencing leg pain whenever she walks
several blocks. The
patient has type 1 diabetes and has smoked a pack of cigarettes every
day for the
past 40 years. The physician diagnoses intermittent
claudication. The nurse should provide what
instruction about
long-term care to the client?
A) Be sure to practice meticulous
foot care.
B) Consider cutting down on your smoking.
C)
Reduce your activity level to accommodate your limitations.
D)
Try to make sure you eat enough protein.
Ans: A
Feedback:
The patient with peripheral vascular disease or diabetes should receive education or reinforcement about
skin and foot care. Intermittent claudication and other chronic peripheral vascular diseases reduce
oxygenation to the feet, making them susceptible to injury and poor healing; therefore, meticulous foot
care is essential. The patient should stop smokingnot just cut downbecause nicotine is a vasoconstrictor.
Daily walking benefits the patient with intermittent claudication. Increased protein intake will not
alleviate the patients symptoms.
A patient with poorly controlled diabetes has developed end-stage
renal failure and consequent anemia.
When reviewing this patients
treatment plan, the nurse should anticipate the use of what
drug?
A) Magnesium sulfate
B) Epoetin alfa
C)
Low-molecular weight heparin
D) Vitamin K
Ans: B
Feedback:
The availability of recombinant
erythropoietin (epoetin alfa [Epogen, Procrit], darbepoetin
alfa
[Aranesp]) has dramatically altered the management of anemia
in end-stage renal disease. Heparin,
vitamin K, and magnesium are
not indicated in the treatment of renal failure or the consequent anemia.
A patient with type 1 diabetes has told the nurse that his most
recent urine test for ketones was positive.
What is the nurses
most plausible conclusion based on this assessment finding?
A)
The patient should withhold his next scheduled dose of
insulin.
B) The patient should promptly eat some protein and
carbohydrates.
C) The patients insulin levels are
inadequate.
D) The patient would benefit from a dose of metformin (Glucophage).
Ans: C
Feedback:
Ketones in the urine signal that there is
a deficiency of insulin and that control of type 1 diabetes
is
deteriorating. Withholding insulin or eating food would
exacerbate the patients ketonuria. Metformin
will not cause
short-term resolution of hyperglycemia.
A patient presents to the clinic complaining of symptoms that suggest
diabetes. What criteria would
support checking blood levels for
the diagnosis of diabetes?
A) Fasting plasma glucose greater than
or equal to 126 mg/dL
B) Random plasma glucose greater than 150
mg/dL
C) Fasting plasma glucose greater than 116 mg/dL on 2
separate occasions
D) Random plasma glucose greater than 126 mg/dL
Ans: A
Feedback:
Criteria for the diagnosis of diabetes
include symptoms of diabetes plus random plasma glucose
greater
than or equal to 200 mg/dL, or a fasting plasma glucose
greater than or equal to 126 mg/dL.
A patient newly diagnosed with type 2 diabetes is attending a
nutrition class. What general guideline
would be important to
teach the patients at this class?
A) Low fat generally indicates
low sugar.
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B) Protein should
constitute 30% to 40% of caloric intake.
C) Most calories should
be derived from carbohydrates.
D) Animal fats should be
eliminated from the diet.
Ans: C
Feedback:
Currently, the ADA and the Academy of
Nutrition and Dietetics (formerly the American
Dietetic
Association) recommend that for all levels of caloric
intake, 50% to 60% of calories should be derived
from
carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from
protein.Low fat does not
automatically mean low sugar. Dietary
animal fat does not need to be eliminated from the diet.
A nurse is providing health education to an adolescent newly
diagnosed with type 1 diabetes mellitus
and her family. The nurse
teaches the patient and family that which of the following
nonpharmacologic
measures will decrease the bodys need for
insulin?
A) Adequate sleep
B) Low stimulation
C)
Exercise
D) Low-fat diet
Ans: C
Feedback:
Exercise lowers blood glucose, increases
levels of HDLs, and decreases total cholesterol and
triglyceride
levels. Low fat intake and low levels of stimulation
do not reduce a patients need for insulin. Adequate
sleep is
beneficial in reducing stress, but does not have an effect that is
pronounced as that of exercise.
A medical nurse is caring for a patient with type 1 diabetes. The
patients medication administration
record includes the
administration of regular insulin three times daily. Knowing that the
patients lunch
tray will arrive at 11:45, when should the nurse
administer the patients insulin?
A) 10:45
B) 11:15
C)
11:45
D) 11:50
Ans: B
Feedback:
Regular insulin is usually administered
2030 min before a meal. Earlier administration creates a risk
for
hypoglycemia; later administration creates a risk for hyperglycemia.
A patient has just been diagnosed with type 2 diabetes. The physician
has prescribed an oral antidiabetic
agent that will inhibit the
production of glucose by the liver and thereby aid in the control of
blood
glucose. What type of oral antidiabetic agent did the
physician prescribe for this patient?
A) A sulfonylurea
B) A
biguanide
C) A thiazolidinedione
D) An alpha glucosidase inhibitor
Ans: B
Feedback:
Sulfonylureas exert their primary action
by directly stimulating the pancreas to secrete insulin
and
therefore require a functioning pancreas to be effective.
Biguanides inhibit the production of glucose by
the liver and are
in used in type 2 diabetes to control blood glucose levels.
Thiazolidinediones enhance
insulin action at the receptor site
without increasing insulin secretion from the beta cells of the
pancreas.
Alpha glucosidase inhibitors work by delaying the
absorption of glucose in the intestinal system,
resulting in a
lower postprandial blood glucose level.
A diabetes nurse educator is teaching a group of patients with type 1
diabetes about sick day rules. What
guideline applies to periods
of illness in a diabetic patient?
A) Do not eliminate insulin
when nauseated and vomiting.
B) Report elevated glucose levels
greater than 150 mg/dL.
C) Eat three substantial meals a day, if
possible.
D) Reduce food intake and insulin doses in times of illness.
Ans: A
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Feedback:
The
most important issue to teach patients with diabetes who become ill is
not to eliminate insulin doses
when nausea and vomiting occur.
Rather, they should take their usual insulin or oral hypoglycemic
agent
dose, then attempt to consume frequent, small portions of
carbohydrates. In general, blood sugar levels
will rise but
should be reported if they are greater than 300 mg/dL.
The nurse is discussing macrovascular complications of diabetes with
a patient. The nurse would address
what topic during this
dialogue?
A) The need for frequent eye examinations for patients
with diabetes
B) The fact that patients with diabetes have an
elevated risk of myocardial infarction
C) The relationship
between kidney function and blood glucose levels
D) The need to
monitor urine for the presence of albumin
Ans: B
Feedback:
Myocardial infarction and stroke are
considered macrovascular complications of diabetes, while
the
effects on vision and renal function are considered to be microvascular.
A school nurse is teaching a group of high school students about risk
factors for diabetes. Which of the
following actions has the
greatest potential to reduce an individuals risk for developing
diabetes?
A) Have blood glucose levels checked annually.
B)
Stop using tobacco in any form.
C) Undergo eye examinations
regularly.
D) Lose weight, if obese.
Ans: D
Feedback:
Obesity is a major modifiable risk factor
for diabetes. Smoking is not a direct risk factor for the
disease.
Eye examinations are necessary for persons who have been
diagnosed with diabetes, but they do not
screen for the disease
or prevent it. Similarly, blood glucose checks do not prevent the diabetes.
A 15-year-old child is brought to the emergency department with
symptoms of hyperglycemia and is
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subsequently diagnosed with diabetes. Based on the fact that
the childs pancreatic beta cells are being
destroyed, the patient
would be diagnosed with what type of diabetes?
A) Type 1
diabetes
B) Type 2 diabetes
C) Noninsulin-dependent
diabetes
D) Prediabetes
Ans: A
Feedback:
Beta cell destruction is the hallmark of
type 1 diabetes. Noninsulin-dependent diabetes is synonymous
with
type 2 diabetes, which involves insulin resistance and impaired
insulin secretion, but not beta cell
destruction. Prediabetes is
characterized by normal glucose metabolism, but a previous history
of
hyperglycemia, often during illness or pregnancy.
A newly admitted patient with type 1 diabetes asks the nurse what
caused her diabetes. When the nurse
is explaining to the patient
the etiology of type 1 diabetes, what process should the nurse
describe?
A) The tissues in your body are resistant to the action
of insulin, making the glucose levels in your
blood
increase.
B) Damage to your pancreas causes an increase in the
amount of glucose that it releases, and there is
not enough
insulin to control it.
C) The amount of glucose that your body
makes overwhelms your pancreas and decreases your
production of
insulin.
D) Destruction of special cells in the pancreas causes a
decrease in insulin production. Glucose levels
rise because
insulin normally breaks it down.
Ans: D
Feedback:
Type 1 diabetes is characterized by the
destruction of pancreatic beta cells, resulting in decreased
insulin
production, unchecked glucose production by the liver,
and fasting hyperglycemia. Also, glucose
derived from food cannot
be stored in the liver and remains circulating in the blood, which
leads to
postprandial hyperglycemia. Type 2 diabetes involves
insulin resistance and impaired insulin secretion.
The body does
not make glucose.
An occupational health nurse is screening a group of workers for
diabetes. What statement should the
nurse interpret as suggestive
of diabetes?
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A) Ive always been
a fan of sweet foods, but lately Im turned off by them.
B)
Lately, I drink and drink and cant seem to quench my thirst.
C)
No matter how much sleep I get, it seems to take me hours to wake
up.
D) When I went to the washroom the last few days, my urine
smelled odd.
Ans: B
Feedback:
Classic clinical manifestations of
diabetes include the three Ps: polyuria, polydipsia, and
polyphagia.
Lack of interest in sweet foods, fatigue, and
foul-smelling urine are not suggestive of diabetes.
A diabetes nurse educator is presenting the American Diabetes
Association (ADA) recommendations for
levels of caloric intake.
What do the ADAs recommendations include?
A) 10% of calories from
carbohydrates, 50% from fat, and the remaining 40% from
protein
B) 10% to 20% of calories from carbohydrates, 20% to 30%
from fat, and the remaining 50% to 60%
from protein
Test
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14e (Hinkle 2017) 965
C) 20% to 30% of calories from
carbohydrates, 50% to 60% from fat, and the remaining 10% to
20%
from protein
D) 50% to 60% of calories from
carbohydrates, 20% to 30% from fat, and the remaining 10% to
20%
from protein
Ans: D
Feedback:
Currently, the ADA and the Academy of
Nutrition and Dietetics (formerly the American
Dietetic
Association) recommend that for all levels of caloric
intake, 50% to 60% of calories come from
carbohydrates, 20% to
30% from fat, and the remaining 10% to 20% from protein.
A diabetes educator is teaching a patient about type 2 diabetes. The
educator recognizes that the patient
understands the primary
treatment for type 2 diabetes when the patient states what?
A) I
read that a pancreas transplant will provide a cure for my
diabetes.
B) I will take my oral antidiabetic agents when my
morning blood sugar is high.
C) I will make sure to follow the
weight loss plan designed by the dietitian.
D) I will make sure I
call the diabetes educator when I have questions about my insulin.
Ans: C
Feedback:
Insulin resistance is associated with
obesity; thus the primary treatment of type 2 diabetes is weight
loss.
Oral antidiabetic agents may be added if diet and exercise
are not successful in controlling blood glucose
levels. If
maximum doses of a single category of oral agents fail to reduce
glucose levels to satisfactory
levels, additional oral agents may
be used. Some patients may require insulin on an ongoing basis or
on
a temporary basis during times of acute psychological stress,
but it is not the central component of type 2
treatment. Pancreas
transplantation is associated with type 1 diabetes.
An older adult patient with type 2 diabetes is brought to the
emergency department by his daughter. The
patient is found to
have a blood glucose level of 623 mg/dL. The patients daughter reports
that the
patient recently had a gastrointestinal virus and has
been confused for the last 3 hours. The diagnosis
of
hyperglycemic hyperosmolar syndrome (HHS) is made. What
nursing action would be a priority?
A) Administration of
antihypertensive medications
B) Administering sodium bicarbonate
intravenously
C) Reversing acidosis by administering
insulin
D) Fluid and electrolyte replacement
Ans: D
Feedback:
The overall approach to HHS includes fluid
replacement, correction of electrolyte imbalances, and
insulin
administration. Antihypertensive medications are not indicated, as
hypotension generally
accompanies HHS due to dehydration. Sodium
bicarbonate is not administered to patients with HHS, as
their
plasma bicarbonate level is usually normal. Insulin administration
plays a less important role in the
treatment of HHS because it is
not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).
A nurse is caring for a patient with type 1 diabetes who is being
discharged home tomorrow. What is the
best way to assess the
patients ability to prepare and self-administer insulin?
A) Ask
the patient to describe the process in detail.
B) Observe the
patient drawing up and administering the insulin.
C) Provide a
health education session reviewing the main points of insulin
delivery.
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D) Review the
patients first hemoglobin A1C result after discharge.
Ans: B
Feedback:
Nurses should assess the patients ability
to perform diabetes related self-care as soon as possible
during
the hospitalization or office visit to determine whether
the patient requires further diabetes teaching.
While consulting
a home care nurse is beneficial, an initial assessment should be
performed during the
hospitalization or office visit. Nurses
should directly observe the patient performing the skills such
as
insulin preparation and infection, blood glucose monitoring,
and foot care. Simply questioning the
patient about these skills
without actually observing performance of the skill is not sufficient.
Further
education does not guarantee learning.
An elderly patient comes to the clinic with her daughter. The patient
is a diabetic and is concerned about
foot care. The nurse goes
over foot care with the patient and her daughter as the nurse realizes
that foot
care is extremely important. Why would the nurse feel
that foot care is so important to this patient?
A) An elderly
patient with foot ulcers experiences severe foot pain due to the
diabetic polyneuropathy.
B) Avoiding foot ulcers may mean the
difference between institutionalization and continued
independent
living.
C) Hypoglycemia is linked with a risk for falls; this
risk is elevated in older adults with diabetes.
D)
Oral
antihyperglycemics have the possible adverse effect of decreased
circulation to the lower
extremities.
Ans: B
Feedback:
The nurse recognizes that providing
information on the long-term complicationsespecially foot and
eye
problemsassociated with diabetes is important. Avoiding
amputation through early detection of foot
ulcers may mean the
difference between institutionalization and continued independent
living for the
elderly person with diabetes. While the nurse
recognizes that hypoglycemia is a dangerous situation and
may
lead to falls, hypoglycemia is not directly connected to the
importance of foot care. Decrease in
circulation is related to
vascular changes and is not associated with drugs administered for diabetes.
A diabetic educator is discussing sick day rules with a newly
diagnosed type 1 diabetic. The educator is
aware that the patient
will require further teaching when the patient states what?
A) I
will not take my insulin on the days when I am sick, but I will
certainly check my blood sugar
every 2 hours.
B) If I cannot
eat a meal, I will eat a soft food such as soup, gelatin, or pudding
six to eight times a
day.
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C) I will call the doctor if I am not able to keep liquids in
my body due to vomiting or diarrhea.
D) I will call the doctor if
my blood sugar is over 300 mg/dL or if I have ketones in my urine.
Ans: A
Feedback:
The nurse must explanation the sick day
rules again to the patient who plans to stop taking insulin
when
sick. The nurse should emphasize that the patient should
take insulin agents as usual and test ones blood
sugar and urine
ketones every 3 to 4 hours. In fact, insulin-requiring patients may
need supplemental
doses of regular insulin every 3 to 4 hours.
The patient should report elevated glucose levels (greater
than
300 mg/dL or as otherwise instructed) or urine ketones to the
physician. If the patient is not able to
eat normally, the
patient should be instructed to substitute soft foods such a gelatin,
soup, and pudding.
If vomiting, diarrhea, or fever persists, the
patient should have an intake of liquids every 30 to 60
minutes
to prevent dehydration.
Which of the following patients with type 1 diabetes is most likely
to experience adequate glucose
control?
A) A patient who
skips breakfast when his glucose reading is greater than 220
mg/dL
B) A patient who never deviates from her prescribed dose of
insulin
C) A patient who adheres closely to a meal plan and meal
schedule
D) A patient who eliminates carbohydrates from his daily intake
Ans: C
Feedback:
The therapeutic goal for diabetes
management is to achieve normal blood glucose levels
without
hypoglycemia. Therefore, diabetes management involves
constant assessment and modification of the
treatment plan by
health professionals and daily adjustments in therapy (possibly
including insulin) by
patients. For patients who require insulin
to help control blood glucose levels, maintaining consistency
in
the amount of calories and carbohydrates ingested at meals is
essential. In addition, consistency in the
approximate time
intervals between meals, and the snacks, help maintain overall glucose
control.
Skipping meals is never advisable for person with type 1 diabetes.
A 28-year-old pregnant woman is spilling sugar in her urine. The
physician orders a glucose tolerance
test, which reveals
gestational diabetes. The patient is shocked by the diagnosis, stating
that she is
conscientious about her health, and asks the nurse
what causes gestational diabetes. The nurse should
explain that
gestational diabetes is a result of what etiologic factor?
A)
Increased caloric intake during the first trimester
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B) Changes in osmolality and fluid
balance
C) The effects of hormonal changes during
pregnancy
D) Overconsumption of carbohydrates during the first
two trimesters
Ans: C
Feedback:
Hyperglycemia and eventual gestational
diabetes develops during pregnancy because of the secretion
of
placental hormones, which causes insulin resistance. The
disease is not the result of food intake or
changes in osmolality.
A medical nurse is aware of the need to screen specific patients for
their risk of hyperglycemic
hyperosmolar syndrome (HHS). In what
patient population does hyperosmolar nonketotic syndrome
most
often occur?
A) Patients who are obese and who have no known
history of diabetes
B) Patients with type 1 diabetes and poor
dietary control
C) Adolescents with type 2 diabetes and sporadic
use of antihyperglycemics
D) Middle-aged or older people with
either type 2 diabetes or no known history of diabetes
Ans: D
Feedback:
HHS occurs most often in older people (50
to 70 years of age) who have no known history of diabetes or
who
have type 2 diabetes.
A nurse is caring for a patient newly diagnosed with type 1 diabetes.
The nurse is educating the patient
about self-administration of
insulin in the home setting. The nurse should teach the patient to do
which
of the following?
A) Avoid using the same injection
site more than once in 2 to 3 weeks.
B) Avoid mixing more than
one type of insulin in a syringe.
C) Cleanse the injection site
thoroughly with alcohol prior to injecting.
D) Inject at a 45 angle.
Ans: A
Feedback:
To prevent lipodystrophy, the patient
should try not to use the same site more than once in 2 to 3
weeks.
Mixing different types of insulin in a syringe is
acceptable, within specific guidelines, and the needle is
usually
inserted at a 90 angle. Cleansing the injection site with alcohol is optional.
A patient with type 2 diabetes achieves adequate glycemic control
through diet and exercise. Upon being
admitted to the hospital
for a cholecystectomy, however, the patient has required insulin
injections on
two occasions. The nurse would identify what likely
cause for this short-term change in treatment?
A) Alterations in
bile metabolism and release have likely caused hyperglycemia.
B)
Stress has likely caused an increase in the patients blood sugar
levels.
C) The patient has likely overestimated her ability to
control her diabetes using nonpharmacologic
measures.
D) The
patients volatile fluid balance surrounding surgery has likely caused
unstable blood sugars.
Ans: B
Feedback:
During periods of physiologic stress, such
as surgery, blood glucose levels tend to increase, because
levels
of stress hormones (epinephrine, norepinephrine, glucagon, cortisol,
and growth hormone)
increase. The patients need for insulin is
unrelated to the action of bile, the patients overestimation
of
previous blood sugar control, or fluid imbalance.
A physician has explained to a patient that he has developed diabetic
neuropathy in his right foot. Later
that day, the patient asks
the nurse what causes diabetic neuropathy. What would be the nurses
best
response?
A) Research has shown that diabetic
neuropathy is caused by fluctuations in blood sugar that
have
gone on for years.
B) The cause is not known for sure
but it is thought to have something to do with ketoacidosis.
C)
The cause is not known for sure but it is thought to involve elevated
blood glucose levels over a
period of years.
D) Research has
shown that diabetic neuropathy is caused by a combination of elevated
glucose levels
and elevated ketone levels.
Ans: C
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Feedback:
The
etiology of neuropathy may involve elevated blood glucose levels over
a period of years. High
blood sugars (rather than fluctuations or
variations in blood sugars) are thought to be
responsible.
Ketones and ketoacidosis are not direct causes of neuropathies.
A patient with type 2 diabetes has been managing his blood glucose
levels using diet and metformin
(Glucophage). Following an
ordered increase in the patients daily dose of metformin, the nurse
should
prioritize which of the following assessments?
A)
Monitoring the patients neutrophil levels
B) Assessing the
patient for signs of impaired liver function
C) Monitoring the
patients level of consciousness and behavior
D) Reviewing the
patients creatinine and BUN levels
Ans: D
Feedback:
Metformin has the potential to be
nephrotoxic; consequently, the nurse should monitor the patients
renal
function. This drug does not typically affect patients
neutrophils, liver function, or cognition.
A patient with a longstanding diagnosis of type 1 diabetes has a
history of poor glycemic control. The
nurse recognizes the need
to assess the patient 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
Feedback:
Decreased sensations of pain and
temperature place patients 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.
A patient has been brought to the emergency department by paramedics
after being found unconscious.
The patients Medic Alert bracelet
indicates that the patient has type 1 diabetes and the patients
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
Feedback:
In hospitals and emergency departments,
for patients 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 patients condition.
A diabetic 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
Feedback:
The following teaching points should be
included in information provided to the patient 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.
A nurse is teaching basic survival skills to a patient newly
diagnosed with type 1 diabetes. What topic
should the nurse
address?
A) Signs and symptoms of diabetic nephropathy
B)
Management of diabetic ketoacidosis
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C) Effects of surgery and pregnancy on blood sugar
levels
D) Recognition of hypoglycemia and hyperglycemia
Ans: D
Feedback:
It is imperative that newly diagnosed
patients know the signs and symptoms and management of
hypoand
hyperglycemia. The other listed topics are valid points
for education, but are not components of the
patients immediate
survival skills following a new diagnosis.
A nurse is conducting a class on how to self-manage insulin regimens.
A patient asks how long a vial of
insulin can be stored at room
temperature before it goes bad. What would be the nurses 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
Feedback:
If a vial of insulin will be used up
within 1 month, it may be kept at room temperature.
A patient has received a diagnosis of type 2 diabetes. The diabetes
nurse has made contact with the
patient and will implement a
program of health education. What is the nurses priority
action?
A)
Ensure that the patient understands the basic
pathophysiology of diabetes.
B) Identify the patients body mass
index.
C) Teach the patient survival skills for diabetes.
D)
Assess the patients readiness to learn.
Ans: D
Feedback:
Test Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 973
Before
initiating diabetes education, the nurse assesses the patients (and
familys) readiness to learn. This
must precede other physiologic
assessments (such as BMI) and providing health education.
A student with diabetes tells the school nurse that he is feeling
nervous and hungry. The nurse assesses
the child and finds he 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
Feedback:
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. After initial treatment, the
nurse should follow 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
additional sugar may
result in a sharp rise in blood sugar that
will last for several hours.
A patient 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 patients initial
phase
of treatment?
A) Monitoring the patient for
dysrhythmias
B) Maintaining and monitoring the patients fluid
balance
C) Assessing the patients level of consciousness
D)
Assessing the patient for signs and symptoms of venous thromboembolism
Ans: B
Feedback:
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 patient for dysrhythmias, decreased
LOC and VTE, but restoration and maintenance of fluid balance
is
the highest priority.
A patient has been living with type 2 diabetes for several years, and
the nurse realizes that the patient is
likely to have minimal
contact with the health care system. In order to ensure that the
patient maintains
adequate blood sugar control over the long
term, the nurse should recommend which of the following?
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
Feedback:
Participation in support groups is
encouraged for patients 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 patients circumstances.
A patient 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 patient?
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
Feedback:
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 patient should gently, not vigorously,
pat feet dry to avoid injury.
A diabetes nurse is assessing a patients knowledge of self-care
skills. What would be the most
appropriate way for the educator
to assess the patients knowledge of nutritional therapy in
diabetes?
A) Ask the patient to describe an optimally healthy
meal.
Test Bank - Brunner & Suddarth's Textbook of
Medical-Surgical Nursing 14e (Hinkle 2017) 975
B) Ask the patient
to keep a food diary and review it with the nurse.
C) Ask the
patients family what he typically eats.
D) Ask the patient to
describe a typical days food intake.
Ans: B
Feedback:
Reviewing the patients actual food intake
is the most accurate method of gauging the patients diet.
The most recent blood work of a patient with a longstanding diagnosis
of type 1 diabetes has shown the
presence of microalbuminuria.
What is the nurses most appropriate action?
A) Teach the patient
about actions to slow the progression of nephropathy.
B) Ensure
that the patient receives a comprehensive assessment of liver
function.
C) Determine whether the patient has been using expired
insulin.
D) Administer a fluid challenge and have the test repeated.
Ans: A
Feedback:
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 patients liver function is not likely affected.
There is no indication
for the use of a fluid challenge.
A nurse is assessing a patient who has diabetes for the presence of
peripheral neuropathy. The nurse
should question the patient
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
Feedback:
Although approximately half of patients
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.
A diabetic patient calls the clinic complaining of having a flu bug.
The nurse tells him to take his regular
dose of insulin. What
else should the nurse tell the patient?
A) Make sure to stick to
your normal diet.
B) Try to eat small amounts of carbs, if
possible.
C) Ensure that you check your blood glucose every
hour.
D) For now, check your urine for ketones every 8 hours.
Ans: B
Feedback:
For prevention of DKA related to illness,
the patient should attempt to consume frequent small portions
of
carbohydrates (including foods usually avoided, such as juices,
regular sodas, and gelatin). Drinking
fluids every hour is
important to prevent dehydration. Blood glucose and urine ketones must
be assessed
every 3 to 4 hours.
A patient is brought to the emergency department by the paramedics.
The patient is a type 2 diabetic and
is experiencing 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, D, E
Feedback:
Test Bank - Brunner &
Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
977
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, hypernatremia and increased osmolarity
occur.
Leukocytosis does not take place.
B&S
left off at pg 979
NEW BOOK
IGNATAVICIUS 9TH ED
A nurse is teaching a client with diabetes mellitus who asks, Why is
it necessary to maintain my blood
glucose levels no lower than
about 60 mg/dL? How should the nurse respond?
a. Glucose is the
only fuel used by the body to produce the energy that it
needs.
b. Your brain needs a constant supply of glucose because
it cannot store it.
c. Without a minimum level of glucose, your
body does not make red blood cells.
d. Glucose in the blood
prevents the formation of lactic acid and prevents
acidosis.
ANS: B
Because the brain cannot synthesize or store significant
amounts of glucose, a continuous supply from the
bodys
circulation is needed to meet the fuel demands of the central nervous
system. The nurse would want to
educate the client to prevent
hypoglycemia. The body can use other sources of fuel, including fat
and protein,
and glucose is not involved in the production of red
blood cells. Glucose in the blood will encourage
glucose
metabolism but is not directly responsible for lactic
acid formation.
DIF:Remembering/Knowledge REF: 1281
KEY:
Diabetes mellitus| hypoglycemia MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Physiological
Integrity: Physiological Adaptation
A nurse reviews laboratory results for a client with diabetes
mellitus who presents with polyuria, lethargy,
and a blood
glucose of 560 mg/dL. Which laboratory result should the nurse
correlate with the clients
polyuria?
a. Serum sodium: 163
mEq/L
b. Serum creatinine: 1.6 mg/dL
c. Presence of urine
ketone bodies
d. Serum osmolarity: 375
mOsm/kg
ANS: D
Hyperglycemia causes hyperosmolarity of extracellular
fluid. This leads to polyuria from an osmotic diuresis.
The
clients serum osmolarity is high. The clients sodium would be expected
to be high owing to dehydration.
Serum creatinine and urine
ketone bodies are not related to the
polyuria.
DIF:Applying/Application REF: 1282
KEYiabetes
mellitus| hyperglycemia
MSC:Integrated Process: Nursing Process:
Analysis
NOT: Client Needs Category: Physiological Integrity:
Reduction of Risk Potential
After teaching a young adult client who is newly diagnosed with type
1 diabetes mellitus, the nurse assesses
the clients
understanding. Which statement made by the client indicates a correct
understanding of the need for
eye examinations?
a. At my
age, I should continue seeing the ophthalmologist as I usually
do.
b. I will see the eye doctor when I have a vision problem and
yearly after age
Test Bank - Medical-Surgical Nursing: Concepts
for Interprofessional Collaborative Care 9e 527
40.
c. My
vision will change quickly. I should see the ophthalmologist twice a
year.
d. Diabetes can cause blindness, so I should see the
ophthalmologist yearly.
ANS: D
Diabetic retinopathy is a leading cause of blindness in
North America. All clients with diabetes, regardless of
age,
should be examined by an ophthalmologist (rather than an optometrist
or optician) at diagnosis and at
least yearly
thereafter.
DIF:Applying/Application REF: 1283
KEY: Diabetes
mellitus| health screening MSC: Integrated Process:
Teaching/Learning
NOT:Client Needs Category: Health Promotion
A nurse assesses a client who has a 15-year history of diabetes and
notes decreased tactile sensation in both
feet. Which action
should the nurse take first?
a. Document the finding in the
clients chart.
b. Assess tactile sensation in the
clients
hands.
c. Examine the clients feet for signs of
injury.
d. Notify the health care provider.
ANS: C
Diabetic neuropathy is common when the disease is of long
duration. The client is at great risk for injury in any
area with
decreased sensation because he or she is less able to feel injurious
events. Feet are common locations
for neuropathy and injury, so
the nurse should inspect them for any signs of injury. After
assessment, the nurse
should document findings in the clients
chart. Testing sensory perception in the hands may or may not
be
needed. The health care provider can be notified after
assessment and documentation have been
completed.
DIF:Applying/Application REF: 1301
KEYiabetes
mellitus| neuropathy
MSC:Integrated Process: Nursing Process:
Analysis
NOT: Client Needs Category: Physiological Integrity:
Reduction of Risk Potential
A nurse cares for a client who has a family history of diabetes
mellitus. The client states, My father has type
1 diabetes
mellitus. Will I develop this disease as well? How should the nurse
respond?
a. Your risk of diabetes is higher than the general
population, but it may not
occur.
b. No genetic risk is
associated with the development of type 1 diabetes mellitus.
c.
The risk for becoming a diabetic is 50% because of how it is
inherited.
d. Female children do not inherit diabetes mellitus,
but male children will.
ANS: A
Risk for type 1 diabetes is determined by inheritance of
genes coding for HLA-DR and HLA-DQ tissue types.
Clients who have
one parent with type 1 diabetes are at increased risk for its
development. Diabetes (type 1)
seems to require interaction
between inherited risk and environmental factors, so not everyone with
these genes
develops diabetes. The other statements are not
accurate.
Test Bank - Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care 9e
528
DIF:Understanding/Comprehension REF: 1287
KEY: Diabetes
mellitus| genetics MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Safe and Effective
Care Environment: Management of Care
A nurse teaches a client who is diagnosed with diabetes mellitus.
Which statement should the nurse include
in this clients plan of
care to delay the onset of microvascular and macrovascular
complications?
a. Maintain tight glycemic control and
prevent
hyperglycemia.
b. Restrict your fluid intake to no
more than 2 liters a day.
c. Prevent hypoglycemia by eating a
bedtime snack.
d. Limit your intake of protein to prevent ketoacidosis.
ANS: A
Hyperglycemia is a critical factor in the pathogenesis of
long-term diabetic complications. Maintaining tight
glycemic
control will help delay the onset of complications. Restricting fluid
intake is not part of the treatment
plan for clients with
diabetes. Preventing hypoglycemia and ketosis, although important, are
not as important
as maintaining daily glycemic
control.
DIF:Applying/Application REF: 1281
KEY: Diabetes
mellitus| hyperglycemia MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
A nurse assesses clients who are at risk for diabetes mellitus. Which
client is at greatest risk?
a. A 29-year-old Caucasian
b. A
32-year-old African-
American
c. A 44-year-old Asian
d.
A 48-year-old American Indian
ANS: D
Diabetes is a particular problem among African Americans,
Hispanics, and American Indians. The incidence
of diabetes
increases in all races and ethnic groups with age. Being both an
American Indian and middle-aged
places this client at highest
risk.
DIF:Understanding/Comprehension REF: 1287
KEYiabetes
mellitus| health screening
MSC:Integrated Process: Nursing
Process: Assessment
NOT: Client Needs Category: Safe and
Effective Care Environment: Management of Care
A nurse teaches a client about self-monitoring of blood glucose
levels. Which statement should the nurse
include in this clients
teaching to prevent bloodborne infections?
a. Wash your hands
after completing each test.
b. Do not share your monitoring
equipment.
c. Blot excess blood from the strip with a
cotton
ball.
Test Bank - Medical-Surgical Nursing: Concepts
for Interprofessional Collaborative Care 9e 529
d. Use gloves
when monitoring your blood glucose.
ANS: B
Small particles of blood can adhere to the monitoring
device, and infection can be transported from one user
to
another. Hepatitis B in particular can survive in a dried
state for about a week. The client should be taught to
avoid
sharing any equipment, including the lancet holder. The client should
be taught to wash his or her hands
before testing. The client
would not need to blot excess blood away from the strip or wear
gloves.
DIF:Applying/Application REF: 1298
KEYiabetes
mellitus| insulin| medication safety
MSC:Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Safe and Effective
Care Environment: Safety and Infection Control
A nurse teaches a client with type 2 diabetes mellitus who is
prescribed glipizide (Glucotrol). Which
statement should the
nurse include in this clients teaching?
a. Change positions
slowly when you get out of bed.
b. Avoid taking nonsteroidal
anti-inflammatory drugs
(NSAIDs).
c. If you miss a dose of
this drug, you can double the next dose.
d. Discontinue the
medication if you develop a urinary infection.
ANS: B
NSAIDs potentiate the hypoglycemic effects of
sulfonylurea agents. Glipizide is a sulfonylurea. The
other
statements are not applicable to
glipizide.
DIF:Applying/Application REF: 1290
KEYiabetes
mellitus| oral antidiabetic agents| medication
safety
MSC:Integrated Process: Nursing Process:
Implementation
NOT: Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
After teaching a client with type 2 diabetes mellitus who is
prescribed nateglinide (Starlix), the nurse
assesses the clients
understanding. Which statement made by the client indicates a correct
understanding of the
prescribed therapy?
a. Ill take this
medicine during each of my meals.
b. I must take this medicine in
the morning when I
wake.
c. I will take this medicine before
I go to bed.
d. I will take this medicine immediately before I eat.
ANS: D
Nateglinide is an insulin secretagogue that is designed
to increase meal-related insulin secretion. It should be
taken
immediately before each meal. The medication should not be taken
without eating as it will decrease the
clients blood glucose
levels. The medication should be taken before meals instead of during
meals.
DIF:Applying/Application REF: 1292
Test Bank -
Medical-Surgical Nursing: Concepts for Interprofessional Collaborative
Care 9e 530
KEYiabetes mellitus| oral antidiabetic agents|
medication safety
MSC:Integrated Process: Nursing Process:
Evaluation
NOT: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
A nurse cares for a client who is prescribed pioglitazone (Actos).
After 6 months of therapy, the client
reports that his urine has
become darker since starting the medication. Which action should the
nurse take?
a. Assess for pain or burning with urination.
b.
Review the clients liver function study
results.
c. Instruct
the client to increase water intake.
d. Test a sample of urine
for occult blood.
ANS: B
Thiazolidinediones (including pioglitazone) can affect
liver function; liver function should be assessed at the
start of
therapy and at regular intervals while the client continues to take
these drugs. Dark urine is one
indicator of liver impairment
because bilirubin is increased in the blood and is excreted in the
urine. The nurse
should check the clients most recent liver
function studies. The nurse does not need to assess for pain
or
burning with urination and does not need to check the urine
for occult blood. The client does not need to be
told to increase
water intake.
DIF:Applying/Application REF: 1292
KEYiabetes
mellitus| oral antidiabetic agents| medication
safety
MSC:Integrated Process: Nursing Process:
Assessment
NOT: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
A nurse cares for a client with diabetes mellitus who asks, Why do I
need to administer more than one
injection of insulin each day?
How should the nurse respond?
a. You need to start with multiple
injections until you become more proficient at self-injection.
b.
A single dose of insulin each day would not match your blood insulin
levels and your food intake patterns.
c. A regimen of a single
dose of insulin injected each day would require that you eat fewer
carbohydrates.
d. A single dose of insulin would be too large to
be absorbed, predictably putting you at risk for insulin
shock.
ANS: B
Even when a single injection of insulin contains a
combined dose of different-acting insulin types, the timing
of
the actions and the timing of food intake may not match well enough to
prevent wide variations in blood
glucose levels. One dose of
insulin would not be appropriate even if the client decreased
carbohydrate intake.
Additional injections are not required to
allow the client practice with injections, nor will one dose increase
the
clients risk of insulin shock.
DIF:Applying/Application
REF: 1294
KEYiabetes mellitus| insulin| medication
safety
MSC:Integrated Process: Teaching/Learning
NOT: Client
Needs Category: Physiological Integrity: Pharmacological and
Parenteral Therapies
After teaching a client with diabetes mellitus to inject insulin, the
nurse assesses the clients understanding.
Test Bank -
Medical-Surgical Nursing: Concepts for Interprofessional Collaborative
Care 9e 531
Which statement made by the client indicates a need
for additional teaching?
a. The lower abdomen is the best
location because it is closest to the pancreas.
b. I can reach my
thigh the best, so I will use the different areas of my
thighs.
c. By rotating the sites in one area, my chance of having
a reaction is decreased.
d. Changing injection sites from the
thigh to the arm will change absorption
rates.
ANS: A
The abdominal site has the fastest rate of absorption
because of blood vessels in the area, not because of
its
proximity to the pancreas. The other statements are accurate
assessments of insulin administration.
DIF:Applying/Application
REF: 1294
KEYiabetes mellitus| insulin| medication
safety
MSC:Integrated Process: Teaching/Learning
NOT: Client
Needs Category: Physiological Integrity: Pharmacological and
Parenteral Therapies
A nurse assesses a client with diabetes mellitus and notes the client
only responds to a sternal rub by
moaning, has capillary blood
glucose of 33 g/dL, and has an intravenous line that is infiltrated
with 0.45%
normal saline. Which action should the nurse take
first?
a. Administer 1 mg of intramuscular glucagon.
b.
Encourage the client to drink orange juice.
c. Insert a new
intravenous access line.
d. Administer 25 mL dextrose 50% (D50) IV
push.
ANS: A
The clients blood glucose level is dangerously low. The
nurse needs to administer glucagon IM immediately to
increase the
clients blood glucose level. The nurse should insert a new IV after
administering the glucagon and
can use the new IV site for future
doses of D50 if the clients blood glucose level does not rise. Once
the client
is awake, orange juice may be administered orally
along with a form of protein such as a peanut
butter.
DIF:Applying/Application REF: 1301
KEYiabetes
mellitus| hypoglycemia
MSC:Integrated Process: Nursing Process:
Evaluation
NOT: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
A nurse cares for a client with diabetes mellitus who is visually
impaired. The client asks, Can I ask my
niece to prefill my
syringes and then store them for later use when I need them? How
should the nurse
respond?
a. Yes. Prefilled syringes can be
stored for 3 weeks in the refrigerator in a vertical position with the
needle
pointing up.
b. Yes. Syringes can be filled with
insulin and stored for a month in a location that is protected from
light.
c. Insulin reacts with plastic, so prefilled syringes are
okay, but you will need to use glass syringes.
d. No. Insulin
syringes cannot be prefilled and stored for any length of time outside
of the container.
: A
Insulin is relatively stable when stored in a cool, dry
place away from light. When refrigerated, prefilled
plastic
syringes are stable for up to 3 weeks. They should be
stored in the refrigerator in the vertical position with
the
needle pointing up to prevent suspended insulin particles
from clogging the needle.
DIF:Remembering/Knowledge REF:
1296
KEYiabetes mellitus| insulin| medication
safety
MSC:Integrated Process: Teaching/Learning
NOT: Client
Needs Category: Physiological Integrity: Pharmacological and
Parenteral Therapies
A nurse teaches a client who is prescribed an insulin pump. Which
statement should the nurse include in
this clients discharge
education?
a. Test your urine daily for ketones.
b. Use only
buffered insulin in your pump.
c. Store the insulin in the
freezer until you need
it.
d. Change the needle every 3 days.
ANS: D
Having the same needle remain in place through the skin
for longer than 3 days drastically increases the risk
for
infection in or through the delivery system. Having an insulin pump
does not require the client to test for
ketones in the urine.
Insulin should not be frozen. Insulin is not
buffered.
DIF:Applying/Application REF: 1295
KEYiabetes
mellitus| insulin| medication safety
MSC:Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Safe and Effective
Care Environment: Safety and Infection Control
After teaching a client who has diabetes mellitus and proliferative
retinopathy, nephropathy, and peripheral
neuropathy, the nurse
assesses the clients understanding. Which statement made by the client
indicates a
correct understanding of the teaching?
a. I have
so many complications; exercising is not recommended.
b. I will
exercise more frequently because I have so
many
complications.
c. I used to run for exercise; I will
start training for a marathon.
d. I should look into swimming or
water aerobics to get my exercise.
ANS: D
Exercise is not contraindicated for this client, although
modifications based on existing pathology are
necessary to
prevent further injury. Swimming or water aerobics will give the
client exercise without the worry
of having the correct shoes or
developing a foot injury. The client should not exercise too
vigorously.
DIF:Applying/Application REF: 1298
KEY: Diabetes
mellitus| exercise MSC: Integrated Process:
Teaching/Learning
NOT:Client Needs Category: Health Promotion and Maintenance
An emergency department nurse assesses a client with ketoacidosis.
Which clinical manifestation should
the nurse correlate with this
condition?
a. Increased rate and depth of respiration
b.
Extremity tremors followed by seizure
activity
c. Oral
temperature of 102 F (38.9 C)
d. Severe orthostatic hypotension
ANS: A
Ketoacidosis decreases the pH of the blood, stimulating
the respiratory control areas of the brain to buffer the
effects
of increasing acidosis. The rate and depth of respiration are
increased (Kussmaul respirations) in an
attempt to excrete more
acids by exhalation. Tremors, elevated temperature, and orthostatic
hypotension are
not associated with
ketoacidosis.
DIF:Applying/Application REF: 1313
KEYiabetes
mellitus| hyperglycemia
MSC:Integrated Process: Nursing Process:
Assessment
NOT: Client Needs Category: Physiological Integrity:
Physiological Adaptation
A nurse assesses a client who has diabetes mellitus. Which arterial
blood gas values should the nurse
identify as potential
ketoacidosis in this client?
a. pH 7.38, HCO3 22 mEq/L, PCO2 38
mm Hg, PO2 98 mm Hg
b. pH 7.28, HCO3 18 mEq/L, PCO2 28 mm Hg, PO2
98 mm Hg
c. pH 7.48, HCO3 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm
Hg
d. pH 7.32, HCO3 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg
ANS: B
When the lungs can no longer offset acidosis, the pH
decreases to below normal. A client who has diabetic
ketoacidosis
would present with arterial blood gas values that show primary
metabolic acidosis with decreased
bicarbonate levels and a
compensatory respiratory alkalosis with decreased carbon dioxide
levels.
DIF:Applying/Application REF: 1313
KEYiabetes
mellitus| hyperglycemia
MSC:Integrated Process: Nursing Process:
Analysis
NOT: Client Needs Category: Physiological Integrity:
Reduction of Risk Potential
A nurse cares for a client experiencing diabetic ketoacidosis who
presents with Kussmaul respirations.
Which action should the
nurse take?
a. Administration of oxygen via face mask
b.
Intravenous administration of 10%
glucose
c. Implementation
of seizure precautions
d. Administration of intravenous insulin
ANS: D
The rapid, deep respiratory efforts of Kussmaul
respirations are the bodys attempt to reduce the acids
produced
by using fat rather than glucose for fuel. Only the
administration of insulin will reduce this type of respiration
by
assisting glucose to move into cells and to be used for fuel instead
of fat. The client who is in ketoacidosis
may not experience any
respiratory impairment and therefore does not need additional oxygen.
Giving the
client glucose would be contraindicated. The client
does not require seizure precautions.
DIF:Applying/Application
REF: 1313
KEYiabetes mellitus| hyperglycemia| respiratory
distress/failure
MSC:Integrated Process: Nursing Process:
Implementation
NOT: Client Needs Category: Physiological
Integrity: Physiological Adaptation
A nurse cares for a client who has type 1 diabetes mellitus. The
client asks, Is it okay for me to have an
occasional glass of
wine? How should the nurse respond?
a. Drinking any wine or
alcohol will increase your insulin requirements.
b. Because of
poor kidney function, people with diabetes should
avoid
alcohol.
c. You should not drink alcohol because it
will make you hungry and overeat.
d. One glass of wine is okay
with a meal and is counted as two fat exchanges.
ANS: D
Under normal circumstances, blood glucose levels will not
be affected by moderate use of alcohol when
diabetes is well
controlled. Because alcohol can induce hypoglycemia, it should be
ingested with or shortly
after a meal. One alcoholic beverage is
substituted for two fat exchanges when caloric intake is
calculated.
Kidney function is not impacted by alcohol intake.
Alcohol is not associated with increased hunger
or
overeating.
DIF:Applying/Application REF:
1300
KEYiabetes mellitus| nutritional
requirements
MSC:Integrated Process: Teaching/Learning
NOT:
Client Needs Category: Physiological Integrity: Basic Care and Comfort
A nurse teaches a client with type 1 diabetes mellitus. Which
statement should the nurse include in this
clients teaching to
decrease the clients insulin needs?
a. Limit your fluid intake to
2 liters a day.
b. Animal organ meat is high in insulin.
c.
Limit your carbohydrate intake to 80 grams a
day.
d. Walk at
a moderate pace for 1 mile daily.
ANS: D
Moderate exercise such as walking helps regulate blood
glucose levels on a daily basis and results in lowered
insulin
requirements for clients with type 1 diabetes mellitus. Restricting
fluids and eating organ meats will not
reduce insulin needs.
People with diabetes need at least 130 grams of carbohydrates each
day.
DIF:Applying/Application REF: 1318
A nurse cares for a client who is diagnosed with acute rejection 2
months after receiving a simultaneous
pancreas-kidney transplant.
The client states, I was doing so well with my new organs, and the
thought of
having to go back to living on hemodialysis and taking
insulin is so depressing. How should the nurse respond?
a.
Following the drug regimen more closely would have prevented
this.
b. One acute rejection episode does not mean that you will
lose the new organs.
c. Dialysis is a viable treatment option for
you and may save your life.
d. Since you are on the national
registry, you can receive a second
transplantation.
ANS: B
An episode of acute rejection does not automatically mean
that the client will lose the transplant.
Pharmacologic
manipulation of host immune responses at this time can limit damage to
the organ and allow
the graft to be maintained. The other
statements either belittle the client or downplay his or her concerns.
The
client may not be a candidate for additional organ
transplantation.
DIF:Applying/Application REF:
1304
KEYiabetes mellitus| pancreas-kidney
transplant
MSC:Integrated Process: Caring
NOT: Client Needs
Category: Psychosocial Integrity
After teaching a client who is recovering from pancreas
transplantation, the nurse assesses the clients
understanding.
Which statement made by the client indicates a need for additional
education?
a. If I develop an infection, I should stop taking my
corticosteroid.
b. If I have pain over the transplant site, I
will call the surgeon
immediately.
c. I should avoid people
who are ill or who have an infection.
d. I should take my
cyclosporine exactly the way I was taught.
ANS: A
Immunosuppressive agents should not be stopped without
the consultation of the transplantation physician,
even if an
infection is present. Stopping immunosuppressive therapy endangers the
transplanted organ. The
other statements are correct. Pain over
the graft site may indicate rejection. Anti-rejection drugs
cause
immunosuppression, and the client should avoid crowds and
people who are ill. Changing the routine of
antirejection
medications may cause them to not work
optimally.
DIF:Applying/Application REF: 1303
KEYiabetes
mellitus| pancreas-kidney transplant
MSC:Integrated Process:
Nursing Process: Evaluation
NOT: Client Needs Category:
Physiological Integrity: Reduction of Risk Potential
A nurse assesses a client with diabetes mellitus 3 hours after a
surgical procedure and notes the clients
breath has a fruity
odor. Which action should the nurse take?
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Care 9e 536
a. Encourage the client to use an
incentive
spirometer.
b. Increase the clients intravenous
fluid flow rate.
c. Consult the provider to test for
ketoacidosis.
d. Perform meticulous pulmonary hygiene care.
ANS: C
The stress of surgery increases the action of
counterregulatory hormones and suppresses the action of
insulin,
predisposing the client to ketoacidosis and metabolic
acidosis. One manifestation of ketoacidosis is a fruity
odor to
the breath. Documentation should occur after all assessments have been
completed. Using an incentive
spirometer, increasing IV fluids,
and performing pulmonary hygiene will not address this clients
problem.
DIF:Applying/Application REF: 1310
KEYiabetes
mellitus| hyperglycemia| postoperative nursing
MSC:Integrated
Process: Nursing Process: Implementation
NOT: Client Needs
Category: Physiological Integrity: Reduction of Risk Potential
A preoperative nurse assesses a client who has type 1 diabetes
mellitus prior to a surgical procedure. The
clients blood glucose
level is 160 mg/dL. Which action should the nurse take?
a.
Document the finding in the clients chart.
b. Administer a bolus
of regular insulin IV.
c. Call the surgeon to cancel the
procedure.
d. Draw blood gases to assess the metabolic
state.
ANS: A
Clients who have type 1 diabetes and are having surgery
have been found to have fewer complications, lower
rates of
infection, and better wound healing if blood glucose levels are
maintained at between 140 and 180
mg/dL throughout the
perioperative period. The nurse should document the finding and
proceed with other
operative care. The need for a bolus of
insulin, canceling the procedure, or drawing arterial blood gases is
not
required.
DIF:Applying/Application REF:
1302
KEYiabetes mellitus| preoperative
nursing
MSC:Integrated Process: Nursing Process:
Analysis
NOT: Client Needs Category: Physiological Integrity:
Reduction of Risk Potential
A nurse teaches a client with diabetes mellitus who is experiencing
numbness and reduced sensation. Which
statement should the nurse
include in this clients teaching to prevent injury?
a. Examine
your feet using a mirror every day.
b. Rotate your insulin
injection sites every week.
c. Check your blood glucose level
before each meal.
d. Use a bath thermometer to test the water
temperature.
ANS: D
Test Bank - Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care 9e 537
Clients with
diminished sensory perception can easily experience a burn injury when
bathwater is too hot.
Instead of checking the temperature of the
water by feeling it, they should use a thermometer. Examining
the
feet daily does not prevent injury, although daily foot
examinations are important to find problems so they can
be
addressed. Rotating insulin and checking blood glucose levels will not
prevent injury.
DIF:Applying/Application REF: 1307
KEY:
Diabetes mellitus| foot care MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Safe and Effective
Care Environment: Safety and Infection Control
A nurse reviews the medication list of a client with a 20-year
history of diabetes mellitus. The client holds
up the bottle of
prescribed duloxetine (Cymbalta) and states, My cousin has depression
and is taking this drug.
Do you think Im depressed? How should
the nurse respond?
a. Many people with long-term diabetes become
depressed after a while.
b. Its for peripheral neuropathy. Do you
have burning pain in your feet or
hands?
c. This
antidepressant also has anti-inflammatory properties for diabetic
pain.
d. No. Many medications can be used for several different disorders.
ANS: B
Damage along nerves causes peripheral neuropathy and
leads to burning pain along the nerves. Many drugs,
including
duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The
nurse should assess the client
for this condition and then should
provide an explanation of why this drug is being used. This
medication,
although it is used for depression, is not being used
for that reason in this case. Duloxetine does not have
antiinflammatory
properties. Telling the client that many
medications are used for different disorders does not
provide the
client with enough information to be
useful.
DIF:Applying/Application REF: 1308
KEY: Diabetes
mellitus| neuropathy MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
A nurse assesses a client with diabetes mellitus. Which clinical
manifestation should alert the nurse to
decreased kidney function
in this client?
a. Urine specific gravity of 1.033
b.
Presence of protein in the urine
c. Elevated capillary blood
glucose
level
d. Presence of ketone bodies in the urine
ANS: B
Renal dysfunction often occurs in the client with
diabetes. Proteinuria is a result of renal dysfunction.
Specific
gravity is elevated with dehydration. Elevated capillary
blood glucose levels and ketones in the urine are
consistent with
diabetes mellitus but are not specific to renal
function.
DIF:Applying/Application REF: 1308
KEYiabetes
mellitus| renal failure
MSC:Integrated Process: Nursing Process: Analysis
A nurse develops a dietary plan for a client with diabetes mellitus
and new-onset microalbuminuria. Which
component of the clients
diet should the nurse decrease?
a. Carbohydrates
b.
Proteins
c. Fats
d. Total calories
ANS: B
Restriction of dietary protein to 0.8 g/kg of body weight
per day is recommended for clients with
microalbuminuria to delay
progression to renal failure. The clients diet does not need to be
decreased in
carbohydrates, fats, or total
calories.
DIF:Remembering/Knowledge REF: 1309
KEYiabetes
mellitus| nutritional requirements
MSC:Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Physiological
Integrity: Basic Care and Comfort
A nurse assesses a client who has diabetes mellitus and notes the
client is awake and alert, but shaky,
diaphoretic, and weak. Five
minutes after administering a half-cup of orange juice, the clients
clinical
manifestations have not changed. Which action should the
nurse take next?
a. Administer another half-cup of orange
juice.
b. Administer a half-ampule of dextrose
50%
intravenously.
c. Administer 10 units of regular insulin
subcutaneously.
d. Administer 1 mg of glucagon intramuscularly.
ANS: A
This client is experiencing mild hypoglycemia. For mild
hypoglycemic manifestations, the nurse should
administer oral
glucose in the form of orange juice. If the symptoms do not resolve
immediately, the treatment
should be repeated. The client does
not need intravenous dextrose, insulin, or
glucagon.
DIF:Applying/Application REF: 1310
KEYiabetes
mellitus| hypoglycemia
MSC:Integrated Process: Nursing Process:
Implementation
NOT: Client Needs Category: Safe and Effective
Care Environment: Management of Care
A nurse reviews the laboratory results of a client who is receiving
intravenous insulin. Which should alert
the nurse to intervene
immediately?
a. Serum chloride level of 98 mmol/L
b. Serum
calcium level of 8.8 mg/dL
c. Serum sodium level of 132
mmol/L
d. Serum potassium level of 2.5
mmol/L
ANS: D
Insulin activates the sodium-potassium ATPase pump,
increasing the movement of potassium from the
extracellular fluid
into the intracellular fluid, resulting in hypokalemia. In
hyperglycemia, hypokalemia can
also result from excessive urine
loss of potassium. The chloride level is normal. The calcium and
sodium levels
are slightly low, but this would not be related to
hyperglycemia and insulin
administration.
DIF:Applying/Application REF:
1305
KEYiabetes mellitus| insulin| medication
safety
MSC:Integrated Process: Nursing Process:
Implementation
NOT: Client Needs Category: Physiological
Integrity: Physiological Adaptation
A nurse teaches a client with diabetes mellitus about sick day
management. Which statement should the
nurse include in this
clients teaching?
a. When ill, avoid eating or drinking to reduce
vomiting and diarrhea.
b. Monitor your blood glucose levels at
least every 4 hours while sick.
c. If vomiting, do not use
insulin or take your oral antidiabetic agent.
d. Try to continue
your prescribed exercise regimen even if you are
sick.
ANS: B
When ill, the client should monitor his or her blood
glucose at least every 4 hours. The client should continue
taking
the medication regimen while ill. The client should continue to eat
and drink as tolerated but should not
exercise while
sick.
DIF:Applying/Application REF: 1315
KEY: Diabetes
mellitus| hyperglycemia MSC: Integrated Process:
Teaching/Learning
NOT:Client Needs Category: Health Promotion and Maintenance
A nurse assesses a client who is being treated for
hyperglycemic-hyperosmolar state (HHS). Which
clinical
manifestation indicates to the nurse that the therapy
needs to be adjusted?
a. Serum potassium level has
increased.
b. Blood osmolarity has decreased.
c. Glasgow
Coma Scale score is unchanged.
d. Urine remains negative for ketone
bodies.
ANS: C
A slow but steady improvement in central nervous system
functioning is the best indicator of therapy
effectiveness for
HHS. Lack of improvement in the level of consciousness may indicate
inadequate rates of
fluid replacement. The Glasgow Coma Scale
assesses the clients state of consciousness against criteria of
a
scale including best eye, verbal, and motor responses. An
increase in serum potassium, decreased blood
osmolality, and
urine negative for ketone bodies do not indicate adequacy of
treatment.
DIF:Applying/Application REF: 1310
KEYiabetes
mellitus| hyperglycemia
A nurse cares for a client who has diabetes mellitus. The nurse
administers 6 units of regular insulin and 10
units of NPH
insulin at 0700. At which time should the nurse assess the client for
potential problems related to
the NPH insulin?
a.
0800
b. 1600
c. 2000
d. 2300
NS: B
Neutral protamine Hagedorn (NPH) is an intermediate-acting
insulin with an onset of 1.5 hours, peak of 4 to
12 hours, and
duration of action of 22 hours. Checking the client at 0800 would be
too soon. Checking the
client at 2000 and 2300 would be too late.
The nurse should check the client at
1600.
DIF:Applying/Application REF: 1294
KEYiabetes
mellitus| insulin| medication safety
MSC:Integrated Process:
Nursing Process: Planning
NOT: Client Needs Category:
Physiological Integrity: Pharmacological and Parenteral Therapies
After teaching a client with type 2 diabetes mellitus, the nurse
assesses the clients understanding. Which
statement made by the
client indicates a need for additional teaching?
a. I need to
have an annual appointment even if my glucose levels are in good
control.
b. Since my diabetes is controlled with diet and
exercise, I must be seen only if I am sick.
c. I can still
develop complications even though I do not have to take insulin at
this time.
d. If I have surgery or get very ill, I may have to
receive insulin injections for a short
time.
ANS: B
Clients with diabetes need to be seen at least annually
to monitor for long-term complications, including visual
changes,
microalbuminuria, and lipid analysis. The client may develop
complications and may need insulin in
the
future.
DIF:Applying/Application REF: 1299
KEYiabetes
mellitus| patient education
MSC:Integrated Process:
Teaching/Learning
NOT:Client Needs Category: Health Promotion and Maintenance
hen teaching a client recently diagnosed with type 1 diabetes
mellitus, the client states, I will never be
able to stick myself
with a needle. How should the nurse respond?
a. I can give your
injections to you while you are here in the hospital.
b. Everyone
gets used to giving themselves injections. It really does not
hurt.
c. Your disease will not be managed properly if you refuse
to administer the
shots.
Test Bank - Medical-Surgical
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541
d. Tell me what it is about the injections that are
concerning you.
ANS: D
Devote as much teaching time as possible to insulin
injection and blood glucose monitoring. Clients with
newly
diagnosed diabetes are often fearful of giving themselves injections.
If the client is worried about giving
the injections, it is best
to try to find out what specifically is causing the concern, so it can
be addressed.
Giving the injections for the client does not
promote self-care ability. Telling the client that others
give
themselves injections may cause the client to feel bad.
Stating that you dont know another way to manage the
disease is
dismissive of the clients concerns.
DIF:Applying/Application REF:
1318
KEYiabetes mellitus| insulin| psychosocial
response
MSC:Integrated Process: Caring
NOT: Client Needs
Category: Psychosocial Integrity
A nurse assesses a client with diabetes mellitus who self-administers
subcutaneous insulin. The nurse notes
a spongy, swelling area at
the site the client uses most frequently for insulin injection. Which
action should the
nurse take?
a. Apply ice to the site to
reduce inflammation.
b. Consult the provider for a new
administration route.
c. Assess the client for other signs of
cellulitis.
d. Instruct the client to rotate sites for insulin
injection.
ANS: D
The clients tissue has been damaged from continuous use
of the same site. The client should be educated to
rotate sites.
The damaged tissue is not caused by cellulitis or any type infection,
and applying ice may cause
more damage to the tissue. Insulin can
only be administered subcutaneously and intravenously. It would not
be
appropriate or practical to change the administration
route.
DIF:Applying/Application REF: 1319
KEYiabetes
mellitus| insulin| medication safety
MSC:Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Physiological
Integrity: Physiological Adaptation
A nurse reviews the medication list of a client recovering from a
computed tomography (CT) scan with IV
contrast to rule out small
bowel obstruction. Which medication should alert the nurse to contact
the provider
and withhold the prescribed dose?
a.
Pioglitazone (Actos)
b. Glimepiride (Amaryl)
c. Glipizide
(Glucotrol)
d. Metformin
(Glucophage)
ANS: D
Glucophage should not be administered when the kidneys
are attempting to excrete IV contrast from the body.
Test Bank -
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Care 9e 542
This combination would place the client at high risk
for kidney failure. The nurse should hold the metformin
dose and
contact the provider. The other medications are safe to administer
after receiving IV contrast.
DIF:Applying/Application REF:
1290
KEYiabetes mellitus| oral antidiabetic medications|
medication safety
MSC:Integrated Process: Nursing Process:
Analysis
NOT: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
After teaching a client who is newly diagnosed with type 2 diabetes
mellitus, the nurse assesses the clients
understanding. Which
statement made by the client indicates a need for additional
teaching?
a. I should increase my intake of vegetables with
higher amounts of dietary fiber.
b. My intake of saturated fats
should be no more than 10% of my total calorie
intake.
c. I
should decrease my intake of protein and eliminate carbohydrates from
my diet.
d. My intake of water is not restricted by my treatment
plan or medication regimen.
ANS: C
The client should not completely eliminate carbohydrates
from the diet, and should reduce protein if
microalbuminuria is
present. The client should increase dietary intake of complex
carbohydrates, including
vegetables, and decrease intake of fat.
Water does not need to be restricted unless kidney failure is
present.
DIF:Applying/Application REF: 1302
KEYiabetes
mellitus| nutritional requirements
MSC:Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Physiological
Integrity: Basic Care and Comfort
A nurse reviews laboratory results for a client with diabetes
mellitus who is prescribed an intensified
insulin
regimen:
Fasting blood glucose: 75
mg/dL
Postprandial blood glucose: 200 mg/dL
Hemoglobin A1c
level: 5.5%
How should the nurse interpret these laboratory
findings?
a. Increased risk for developing ketoacidosis
b.
Good control of blood glucose
c. Increased risk for
developing
hyperglycemia
d. Signs of insulin resistance
ANS: B
The client is maintaining blood glucose levels within the
defined ranges for goals in an intensified regimen.
Because the
clients glycemic control is good, he or she is not at higher risk for
ketoacidosis or hyperglycemia
and is not showing signs of insulin
resistance.
Test Bank - Medical-Surgical Nursing: Concepts for
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543
DIF:Applying/Application REF: 1294
KEYiabetes mellitus|
laboratory values
MSC:Integrated Process: Nursing Process:
Evaluation
NOT: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
A nurse prepares to administer insulin to a client at 1800. The
clients medication administration record
contains the following
information:
Insulin glargine: 12 units daily at
1800
Regular insulin: 6 units QID at 0600, 1200, 1800,
2400
Based on the clients medication administration record, which
action should the nurse take?
a. Draw up and inject the insulin
glargine first, and then draw up and inject the regular
insulin.
b. Draw up and inject the insulin glargine first, wait
20 minutes, and then draw up and inject the
regular
insulin.
c. First draw up the dose of regular
insulin, then draw up the dose of insulin glargine in the same
syringe, mix,
and inject the two insulins together.
d. First
draw up the dose of insulin glargine, then draw up the dose of regular
insulin in the same syringe, mix,
and inject the two insulins together.
ANS: A
Insulin glargine must not be diluted or mixed with any
other insulin or solution. Mixing results in an
unpredictable
alteration in the onset of action and time to peak action. The correct
instruction is to draw up and
inject first the glargine and then
the regular insulin right afterward.
DIF:Applying/Application
REF: 1294
KEYiabetes mellitus| insulin| medication
safety
MSC:Integrated Process: Nursing Process:
Implementation
NOT: Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
A nurse prepares to administer prescribed regular and NPH insulin.
Place the nurses actions in the correct
order to administer these
medications.
1. Inspect bottles for expiration dates.
2.
Gently roll the bottle of NPH between the hands.
3. Wash your
hands.
4. Inject air into the regular insulin.
5. Withdraw
the NPH insulin.
6. Withdraw the regular insulin.
7. Inject
air into the NPH bottle.
8. Clean rubber stoppers with an alcohol
swab.
a. 1, 3, 8, 2, 4, 6, 7, 5
Test Bank - Medical-Surgical
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544
b. 3, 1, 2, 8, 7, 4, 6, 5
c. 8, 1, 3, 2, 4, 6, 7,
5
d. 2, 3, 1, 8, 7, 5, 4, 6
ANS: B
After washing hands, it is important to inspect the
bottles and then to roll the NPH to mix the insulin.
Rubber
stoppers should be cleaned with alcohol after rolling the
NPH and before sticking a needle into either bottle. It
is
important to inject air into the NPH bottle before placing the needle
in a regular insulin bottle to avoid
mixing of regular and NPH
insulin. The shorter-acting insulin is always drawn up
first.
DIF:Applying/Application REF: 1296
KEYiabetes
mellitus| insulin| medication safety
MSC:Integrated Process:
Nursing Process: Implementation
NOT: Client Needs Category:
Physiological Integrity: Pharmacological and Parenteral Therapies
44.A nurse reviews the chart and new prescriptions for a client with
diabetic ketoacidosis:
Vital Signs and Assessment
Laboratory
Results
Medications
Blood pressure: 90/62 mm
Hg
Pulse: 120 beats/min
Respiratory rate: 28
breaths/min
Urine output: 20 mL/hr via
catheter
Serum
potassium: 2.6
mEq/L
Potassium chloride 40 mEq IV
bolus
STAT
Increase IV fluid to 100 mL/hr
Which action
should the nurse take?
a. Administer the potassium and then
consult with the provider about the fluid order.
b. Increase the
intravenous rate and then consult with the provider about the
potassium
prescription.
c. Administer the potassium first
before increasing the infusion flow rate.
d. Increase the
intravenous flow rate before administering the potassium.
ANS: B
The client is acutely ill and is severely dehydrated and
hypokalemic. The client requires more IV fluids and
potassium.
However, potassium should not be infused unless the urine output is at
least 30 mL/hr. The nurse
should first increase the IV rate and
then consult with the provider about the
potassium.
DIF:Applying/Application REF: 1313
KEYiabetes
mellitus| medication safety| electrolyte imbalance
MSC:Integrated
Process: Nursing Process: Analysis
NOT: Client Needs Category:
Safe and Effective Care Environment: Management of Care
At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is
recovering from an abdominal
Test Bank - Medical-Surgical
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545
hysterectomy 2 days ago. The nurse notes that the client is
confused and diaphoretic. The nurse reviews the
assessment data
provided in the chart below:
Capillary Blood Glucose
Testing
(AC/HS)
Dietary
Intake
At 0630: 95
At
1130: 70
At 1630: 47
Breakfast: 10% eaten client states she
is not
hungry
Lunch: 5% eaten client is nauseous; vomits
once
After reviewing the clients assessment data, which action is
appropriate at this time?
a. Assess the clients oxygen saturation
level and administer oxygen.
b. Reorient the client and apply a
cool washcloth to the clients
forehead.
c. Administer
dextrose 50% intravenously and reassess
d. Provide a glass of orange juice and encourage the client to eat dinner
ANS: C
The clients symptoms are related to hypoglycemia. Since
the client has not been tolerating food, the nurse
should
administer dextrose intravenously. The clients oxygen level could be
checked, but based on the
information provided, this is not the
priority. The client will not be reoriented until the glucose level
rises.
DIF:Applying/Application REF: 1314
KEYiabetes
mellitus| hypoglycemia
MSC:Integrated Process: Nursing Process:
Implementation
NOT: Client Needs Category: Safe and Effective
Care Environment: Management of Care
A nurse assesses clients at a health fair. Which clients should the
nurse counsel to be tested for diabetes?
(Select all that
apply.)
a. 56-year-old African-American male
b. Female with
a 30-pound weight gain during pregnancy
c. Male with a history of
pancreatic trauma
d. 48-year-old woman with a sedentary
lifestyle
e. Male with a body mass index greater than 25
kg/m2
f. 28-year-old female who gave birth to a baby weighing 9.2
pounds
ANS: A, D, E, F
Risk factors for type 2 diabetes include certain
ethnic/racial groups (African Americans, American
Indians,
Hispanics), obesity and physical inactivity, and giving
birth to large babies. Pancreatic trauma and a
30-pound
gestational weight gain are not risk
factors.
DIF:Applying/Application REF: 1287
A nurse assesses a client who is experiencing diabetic ketoacidosis
(DKA). For which manifestations should
the nurse monitor the
client? (Select all that apply.)
a. Deep and fast
respirations
b. Decreased urine output
c.
Tachycardia
d. Dependent pulmonary
crackles
e.
Orthostatic hypotension
ANS: A, C, E
DKA leads to dehydration, which is manifested by
tachycardia and orthostatic hypotension. Usually clients
have
Kussmaul respirations, which are fast and deep. Increased urinary
output (polyuria) is severe. Because of
diuresis and dehydration,
peripheral edema and crackles do not
occur.
DIF:Applying/Application REF: 1313
KEYiabetes
mellitus| hyperglycemia
MSC:Integrated Process: Nursing Process:
Assessment
NOT: Client Needs Category: Physiological Integrity:
Physiological Adaptation
A nurse teaches a client with diabetes mellitus about foot care.
Which statements should the nurse include in
this clients
teaching? (Select all that apply.)
a. Do not walk around
barefoot.
b. Soak your feet in a tub each evening.
c. Trim
toenails straight across with a nail
clipper.
d. Treat any
blisters or sores with Epsom salts.
e. Wash your feet every other day.
ANS: A, C
Clients who have diabetes mellitus are at high risk
for wounds on the feet secondary to peripheral neuropathy
and
poor arterial circulation. The client should be instructed to not walk
around barefoot or wear sandals with
open toes. These actions
place the client at higher risk for skin breakdown of the feet. The
client should be
instructed to trim toenails straight across with
a nail clipper. Feet should be washed daily with lukewarm
water
and soap, but feet should not be soaked in the tub. The
client should contact the provider immediately if
blisters or
sores appear and should not use home remedies to treat these
wounds.
DIF:Understanding/Comprehension REF: 1307
KEY:
Diabetes mellitus| foot care MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Safe and Effective
Care Environment: Safety and Infection Control
nurse provides diabetic education at a public health fair. Which
disorders should the nurse include as
complications of diabetes
mellitus? (Select all that apply.)
Test Bank - Medical-Surgical
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547
a. Stroke
b. Kidney failure
c. Blindness
d.
Respiratory
failure
e. Cirrhosis
ANS: A, B, C
Complications of diabetes mellitus are caused by
macrovascular and microvascular changes.
Macrovascular
complications include coronary artery disease,
cerebrovascular disease, and peripheral vascular
disease.
Microvascular complications include nephropathy,
retinopathy, and neuropathy. Respiratory failure and
cirrhosis
are not complications of diabetes
mellitus.
DIF:Understanding/Comprehension REF: 1283
KEY:
Diabetes mellitus| health screening MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Physiological
Integrity: Physiological Adaptation
A nurse collaborates with the interdisciplinary team to develop a
plan of care for a client who is newly
diagnosed with diabetes
mellitus. Which team members should the nurse include in this
interdisciplinary team
meeting? (Select all that apply.)
a.
Registered dietitian
b. Clinical pharmacist
c. Occupational
therapist
d. Health care provider
e. Speech-language pathologist
ANS: A, B, D
When planning care for a client newly diagnosed
with diabetes mellitus, the nurse should collaborate with
a
registered dietitian, clinical pharmacist, and health care
provider. The focus of treatment for a newly diagnosed
client
would be nutrition, medication therapy, and education. The nurse could
also consult with a diabetic
educator. There is no need for
occupational therapy or speech therapy at this
time.
DIF:Applying/Application REF: 1307
KEYiabetes
mellitus| collaboration
MSC:Integrated Process: Communication and
Documentation
NOT: Client Needs Category: Safe and Effective Care
Environment: Management of Care