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?

Your risk of diabetes is higher than the general population, but it may not occur

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?

Maintain tight glycemic control and prevent hyperglycemia.

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?

A 48-year-old American Indian

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?

Do not share your monitoring equipment.

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?

Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs).

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?

I will take this medicine immediately before I eat.

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?

Review the clients liver function study results.

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 single dose of insulin each day would not match your blood insulin levels and your food intake patterns.

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?

The lower abdomen is the best location because it is closest to the pancreas.

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?

Administer 1 mg of intramuscular glucagon.

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?

Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up.

A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this clients discharge education?

Change the needle every 3 days.

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?

I should look into swimming or water aerobics to get my exercise.

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition?

Increased rate and depth of respiration

A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client?

pH 7.28, HCO3 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take?

Administration of intravenous insulin

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?

One glass of wine is okay with a meal and is counted as two fat exchanges.

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?

Walk at a moderate pace for 1 mile daily.

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?

One acute rejection episode does not mean that you will lose the new organs.

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?

If I develop an infection, I should stop taking my corticosteroid.

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?

Consult the provider to test for ketoacidosis.

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?

Document the finding in the clients chart.

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?

Use a bath thermometer to test the water temperature.

.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?

its for peripheral neuropathy. Do you have burning pain in your feet or hands?

A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client?

Presence of protein in the urine

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?

Proteins

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?

Administer another half-cup of orange juice.

.A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately?

Serum potassium level of 2.5 mmol/L

A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this clients teaching?

Monitor your blood glucose levels at least every 4 hours while sick.

.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?

Glasgow Coma Scale score is unchanged.

.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?

1600

.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?

Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick.

When 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?

tell me what it is about the injections that are concerning you.

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?

Instruct the client to rotate sites for insulin injection.

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?

Metformin (Glucophage)

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?

I should decrease my intake of protein and eliminate carbohydrates from my diet.

.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?

Good control of blood glucose

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?

Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.

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.

3, 1, 2, 8, 7, 4, 6, 5

.A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis:

Vital Signs and Assessment

Blood pressure: 90/62 mm Hg

Pulse: 120 beats/min

Respiratory rate: 28 breaths/min

Urine output: 20 mL/hr via catheter

Which action should the nurse take?

Laboratory Results

Serum potassium: 2.6 mEq/L

Medications

Potassium chloride 40 mEq IV bolus STAT

Increase IV fluid to 100 mL/hr

Increase the intravenous rate and then consult with the provider about the potassium prescription.

At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominal 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)

At 0630: 95 At 1130: 70 At 1630: 47

dietary Intake

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?

Administer dextrose 50% intravenously and reassess the client.

A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes?

(Select all that apply.)

48-year-old woman with a sedentary lifestyle

56-year-old African-American male

Male with a body mass index greater than 25 kg/m2

28-year-old female who gave birth to a baby weighing 9.2 pounds

A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.)

Deep and fast respirations

Tachycardia

Orthostatic hypotension

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.)

Do not walk around barefoot.

Trim toenails straight across with a nail clipper

A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.)

Stroke

Kidney failure

Blindness

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.)

Registered dietitian

Clinical pharmacist

Health care provider