Chapter 45: Management of Clients with Diabetes Mellitus Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 45: Management of Clients with Diabetes Mellitus

MULTIPLE CHOICE

1. As a cost-saving measure, the hospital administration wants to delete everything but 3- ml and 10-ml syringes from floor stock. The best response by the nurse manager on the endocrine floor would be to

a.

agree with the plan because 3-ml syringes have 0.1-ml measurement marks.

b.

conduct a literature search to determine the best practice in this area.

c.

object but plan education to teach the staff how to give insulin with a 3-ml syringe.

d.

object, pointing out that insulin can only be given in an insulin syringe.

ANS: D

Insulin can only be given with an insulin syringe, pen, jet, or inhaler. They are the only syringes designed to measure insulin accurately.

DIF: Application/Applying REF: p. 1082 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Error Prevention

2. The nurse participating in a screening program for persons at risk for diabetes should have a high index of suspicion for a(n)

a.

44-year-old man who is 6 feet tall and weighs 190 pounds.

b.

adolescent whose mother has type 2 diabetes.

c.

young man complaining of weight loss and joint pain.

d.

young woman who has had two babies weighing 7 pounds each.

ANS: B

Screening of high-risk individuals should include those who have first-degree relatives with type 2 diabetes; obese individuals; members of high-risk races; persons older than 40 years with any other risk factor; individuals with hypertension or hyperlipidemia; those with previous impaired glucose tolerance (IGT); women with previous gestational diabetes mellitus (GDM) or history of a baby weighing greater than 9 pounds; and individuals with a history of recurrent infections.

DIF: Analysis/Analyzing REF: p. 1064 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health Screening

3. A client with diabetes mellitus recently discharged from the hospital calls the nursing unit to report that she is nauseated and cannot remember what she has to do about her insulin injection. The nurse should remind the client to

a.

call the physician at once.

b.

omit her insulin until she is able to eat her normal diet.

c.

review the material she was given at the hospital.

d.

take her insulin and monitor her blood sugar frequently.

ANS: D

More frequent self-monitoring of blood glucose level, often every 2 to 4 hours, is important during illness. The client should not stop taking insulin, even if vomiting and unable to eat. Additional regular insulin may be needed, depending on blood glucose level.

DIF: Application REF: p. 1081 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

4. Evaluating a young man with type 1 diabetes, the nurse would consider a classic clinical manifestation of diabetes to be the clients

a.

excessive thirst.

b.

gradual weight gain.

c.

overwhelming fatigue.

d.

recurrent blurred vision.

ANS: A

The cardinal manifestations of diabetes type 1 are polyuria, polydipsia, and polyphagia. Clients might manifest blurred vision with diabetic retinopathy. Type 2 diabetic clients are frequently obese; however, this is not a manifestation but rather a risk factor. Fatigue can also be present.

DIF: Comprehension/Understanding REF: p. 1067 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

5. The nurse evaluating the laboratory studies of a 46-year-old client would recognize that the laboratory report most suggestive of the presence of diabetes mellitus is

a.

a glucose tolerance test that takes 2 hours to return to normal.

b.

fasting blood glucose level of 151 mg/dl.

c.

high urine ketone levels with +2 glycosuria.

d.

random (casual) blood glucose level of 80 mg.

ANS: B

A fasting blood glucose level greater than 126 mg/dl is diagnostic of diabetes. Fasting is defined as no caloric intake for at least 8 hours. A glucose tolerance test that returns to normal in 2 hours is a normal finding. The presence of ketones in the urine does indicate that the body is using fat for energy, but this could be from several causes. Urine glucose testing is not reliable. A casual blood glucose test should be less than 200 mg/dl.

DIF: Comprehension/Understanding REF: p. 1067 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

6. The nurse explains to a client that the results of a glycosylated hemoglobin study provide information about the clients control of blood sugar over the last

a.

week.

b.

month.

c.

3 months.

d.

6 months.

ANS: C

The results of the glycosylated hemoglobin test show a diabetic clients average blood glucose control over the past 3 months. Also known as the A1C, the test should be done semi-annually on people who have met their goals for glucose control and quarterly in clients who have not met their primary goal for glycemic control.

DIF: Comprehension/Understanding REF: p. 1070 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

7. In a teaching plan about dietary concerns for a diabetic client, the nurse would include that the new guidelines for the percentage of calories from carbohydrates is

a.

10%.

b.

25%.

c.

60%.

d.

75%.

ANS: C

Clinical guidelines suggest that 50% to 60% of the calories in the diet should consist of carbohydrates, either in simple or in complex form.

DIF: Comprehension/Understanding REF: p. 1080 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

8. The nurse teaching a type 2 diabetic client how to manage the disease while on a prescribed diet and taking an oral antidiabetic agent would recognize that the client has an accurate understanding of diabetes management when the client states

a.

I can use oral medications as long as my pancreas can still produce insulin.

b.

I must decrease my total daily fat intake to less than 45% of my total calories.

c.

I must exercise at least 1 hour daily to help bring down my sugar.

d.

Im really happy I can take insulin pills; its much easier than an injection.

ANS: A

Oral antidiabetic agents are not insulin and can work only if the pancreatic beta cells are able to produce insulin. Oral hypoglycemic agents are effective in clients with type 2 diabetes after nutrition and exercise therapy have failed. Clients should exercise for 20 to 45 minutes at the desired heart rate at least three times a week. The general recommendation for the U.S. population is to decrease total dietary fat to 30% or less of total calories.

DIF: Evaluation REF: pp. 1072, 1073 OBJ: Evaluation

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

9. The nurse tells a client that the regular insulin the client has taken this morning will begin to act in

a.

a few minutes.

b.

30 minutes to 1 hour.

c.

2 to 4 hours.

d.

6 to 8 hours.

ANS: B

The onset of action of short-acting, regular insulin is 30 minutes to 1 hour.

DIF: Comprehension/Understanding REF: p. 1074 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

10. A client who is newly diagnosed with diabetes is in the hospital for initial management of the disease. The nurse is administering an injection of NPH insulin at 7 AM. While the nurse is in the room, the client asks if s/he can go to the cafeteria with family around 2 PM, when they visit. The best response by the nurse is

a.

No, Id rather you wait until after 5, then you can go.

b.

No, we need to monitor everything you eat for the next few days.

c.

Sure, just be certain you dont eat or drink anything while youre there.

d.

Thats fine; lets talk about what kind of snack you can get there.

ANS: A

The peak action for intermediate-acting NPH is 4 to 10 hours after administration. In a client newly diagnosed with diabetes, monitoring the client during insulin peak is critical to be able to promptly recognize hypoglycemia. If the client were off the floor when hypoglycemia occurred, he/she might be injured and treatment would be delayed.

DIF: Application/Applying REF: p. 1074 OBJ: Assessment

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

11. A nurse warns a newly-admitted diabetic client that to avoid injury related to a common diabetic complication, the client should

a.

always call for help before getting up.

b.

keep needed items within easy reach.

c.

only ambulate with assistance.

d.

wear house shoes while out of bed.

ANS: D

Neuropathy is the most common of the diabetic complications, affecting nearly 60% of diabetic clients. Polyneuropathy involves both sensory and autonomic nerves, with sensory nerve impairment being more common. Sensory polyneuropathy often affects the lower extremities, causing tingling, numbness, burning, and/or sensory loss. This complication is a major factor in injuries to the feet. Once a diabetic clients foot is injured, the client is at high risk of infection, poor wound healing, and often amputation. Wearing some sort of shoes while ambulating in the hospital (and at home) can help prevent foot injuries.

DIF: Analysis/Analyzing REF: p. 1104 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

12. A client frustrated with self-monitoring his blood glucose levels tells the nurse he wants an insulin pump. The nurses most helpful response would be

a.

Pumps dont monitor blood glucose levels. You will still need to do that yourself.

b.

The pump must be calibrated several times a day, but you will not need to monitor your blood glucose levels anymore.

c.

Pumps are still experimental, and there are many problems associated with them.

d.

If you are willing to make a commitment to good aseptic technique, you should like the pump.

ANS: A

Insulin pumps often improve blood glucose control by means of continuous subcutaneous insulin infusion. However, pumps do not have a built-in feedback mechanism for monitoring blood glucose levels.

DIF: Application REF: pp. 1074-1075 OBJ: Intervention

MSC: Physiological Integrity

13. The nurse caring for a client with a history of experiencing the Somogyi effect would monitor the clients blood sugar level between

a.

2 AM and 7 AM.

b.

10 AM and 3 PM.

c.

12 PM and 6 PM.

d.

5 PM and 12 AM.

ANS: A

Nocturnal rebound hyperglycemia (Somogyi phenomenon) should be investigated by monitoring blood glucose levels between 2 and 4 AM and again at 7 AM.

DIF: Comprehension/Understanding REF: p. 1098 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

14. The nurse counseling a client with diabetes about establishing an exercise program would encourage

a.

playing tennis.

b.

running.

c.

swimming.

d.

walking.

ANS: D

The client should be helped to choose an exercise regimen and to set reasonable goals, because any increase in activity level is beneficial. Walking is usually well tolerated.

DIF: Application/Applying REF: pp. 1078-1079

OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

15. A diabetic client had gallbladder surgery 2 days ago. The nurse changing the dressing should use which intervention specifically related to the clients diabetes?

a.

Dispose of the soiled dressings in an appropriate manner.

b.

Use strict aseptic technique to avoid infection.

c.

Record the amount, type, and characteristics of the drainage.

d.

Only use paper tape to avoid skin injury.

ANS: B

All options are good postoperative nursing care interventions. However, the diabetic client is more susceptible to infection than other clients and dressing changes should be done with strict technique. Diabetic clients have impaired polymorphonuclear leukocyte function and damaged vascular systems that cannot carry sufficient oxygen, WBCs, nutrients, and antibodies to the infected site.

DIF: Analysis/Analyzing REF: p. 1101 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Medical and Surgical Asepsis

16. The nurse caring for a client admitted for treatment of diabetic ketoacidosis (DKA) assesses Kussmauls respirations, which are

a.

fast and deep.

b.

irregular and gasping.

c.

rapid and short.

d.

slow and shallow.

ANS: A

Respirations increase in rate and depth (Kussmauls respirations) in clients with DKA, and the breath has a fruity or acetone odor.

DIF: Application/Applying REF: pp. 1088, 1091

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

17. The nurse must carefully monitor the client who is being aggressively treated for DKA for the common, immediate complication of

a.

dehydration.

b.

premature ventricular contractions.

c.

pulmonary infarction.

d.

respiratory tract infection.

ANS: A

Clients with DKA lose fluids from several sources. Severe dehydration resulting from these fluid losses may be followed by hypovolemic shock and lactic acidosis.

DIF: Application/Applying REF: pp. 1089-1090, 1091

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

18. The nurse is preparing to care for a client with DKA being admitted from the emergency department (ED). The nurse would anticipate using an intravenous (IV) solution of

a.

half-strength saline.

b.

isotonic saline.

c.

Ringers solution.

d.

serum albumin.

ANS: B

IV infusions of isotonic saline are started immediately. Usually the client receives 1000 ml of isotonic solution in the first hour, followed by 2000 to 8000 ml more over the next 24 hours.

DIF: Application/Applying REF: p. 1090 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Parenteral/Intravenous Therapies

19. A client admitted to the hospital 3 hours ago for treatment of acidosis has an order for parenteral potassium in his IV infusion. Before hanging the potassium, the nurse would assess for

a.

chest pain.

b.

elevation in blood glucose level.

c.

tachypnea.

d.

urine output.

ANS: D

The nurse should frequently assess and measure urine output. Potassium should not be administered to a client with low urine output because dangerous hyperkalemia may develop. The other three options are not assessments needed specifically to administer potassium.

DIF: Analysis/Analyzing REF: p. 1091 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

20. For a client with DKA receiving insulin to correct hyperglycemia, the nurse knows that the most appropriate route of administration would be

a.

intradermal.

b.

intramuscular.

c.

intravenous.

d.

subcutaneous.

ANS: C

Insulin should never be given subcutaneously to a client with DKA, because the subcutaneous tissues are dehydrated and poorly perfused with blood from dehydration and hypovolemic shock. Traditionally, the hyperglycemia associated with DKA is treated with an IV bolus of regular insulin, with an insulin drip then started.

DIF: Knowledge/Remembering REF: p. 1092 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

21. A client is being admitted to the nursing unit with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). The nurse understands that compared with the care of DKA clients, the care of HHNK clients differs in that

a.

assessments must be constant.

b.

insulin is usually administered at a lower rate.

c.

parenteral hyperalimentation will be needed.

d.

treatment for dehydration will not be needed.

ANS: B

In clients with HHNK, insulin is given by infusion pump but usually at lower dosages than used in DKA clients because the HHNK client is producing some insulin. In both conditions, assessments must be frequent because the client is critically ill. Hyperalimentation (TPN) is not part of the care for either complication. In HHNK, dehydration is actually worse than in DKA.

DIF: Comprehension/Understanding REF: p. 1094 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

22. A newly diagnosed diabetic client is crying and says I cant learn to live with this. Its overwhelming and people with diabetes get their feet cut off and just die! The best response by the nurse is

a.

I know you are upset, but try to think about learning to cope with this.

b.

Think of your children; they need you to learn to control your disease.

c.

When youre ready, I can teach you to make good decisions about diabetes.

d.

Would you like to have a social worker or chaplain come visit you?

ANS: C

In the empowerment approach to diabetic education, the nurse assumes the client will be capable of being responsible for making informed decisions about their diabetes care. This is a powerful coping mechanism. However, a newly diabetic client may wish to have the health care team make decisions until the client feels ready, after becoming more familiar with the disease and costs/benefits of different treatment options. Option c is the only answer that utilizes knowledge of the empowerment-based educational approach with the sensitive understanding that the client may not yet be ready for education.

DIF: Application/Applying REF: p. 1077 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

23. A client is having a second amputation on the same leg for a nonhealing wound. He is visibly upset and states With one leg, I am not a man anymore and wont be able to provide for my family. Which response by the nurse best demonstrates caring communication?

a.

Have you spoken to your wife about how you feel?

b.

I can call a social worker to talk to you about vocational rehabilitation.

c.

I am sorry this is happening to you. I can sit with you for a while.

d.

Many war veterans have amputations and still consider themselves men.

ANS: C

More than half of nontraumatic amputations are the direct result of peripheral vascular disease in diabetic clients, a macrovascular complication. Option c shows that the nurse understands the client is upset and needs to ventilate. Offering self gives the client the opportunity to discuss feelings and other issues related to the condition. Options a and d are dismissive and not therapeutic. Option b might be a good option later on, when the client is ready for a rehabilitation program and the clients functional status is known.

DIF: Application/Applying REF: p. 1101 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

24. A teenage diabetic client is admitted for a fourth episode of profound hypoglycemia in 6 months. Besides assessing the clients knowledge level, the nurse should also question the client about

a.

deliberate errors in insulin dosage.

b.

how often the client performs quality checks on the glucometer.

c.

where the client gets diabetic supplies.

d.

whether the client uses human- or animal-based insulin brands.

ANS: A

Inadvertent or deliberate errors in insulin dose are a frequent cause of hypoglycemia. Other causes include schedule changes; vigorous, unplanned exercise; vomiting; or oversleeping in the morning. Certainly the glucometer should be checked for accuracy, but with so many hypoglycemic episodes, the nurse should gently inquire about deliberate overdose.

DIF: Application/Applying REF: p. 1094 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Substance Abuse

25. The nurse would encourage the client who is attempting to lose weight to reduce the intake of

a.

broccoli.

b.

cheese.

c.

chicken.

d.

oranges.

ANS: B

Reduction of fat calories may be a good initial modification. Moderate calorie reduction of 250-500 calories per day may not be perceived as negatively as a stricter regimen and may promote compliance.

DIF: Application/Applying REF: p. 1080 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

26. The nurse teaching a diabetic client who has just started insulin therapy would include the instruction to

a.

draw up short-acting insulin before longer-acting insulin.

b.

inject at a 30-degree angle.

c.

routinely aspirate before injecting.

d.

shake short-acting insulin vigorously to mix it.

ANS: A

The client should shake insulin vials to resuspend all forms, except short-acting insulins. The prescribed amount of short-acting insulin is drawn up first. Routine aspiration is not necessary. Injection should be at a 90-degree angle, or a 45-degree angle if the client is thin or has loose skin.

DIF: Application/Applying REF: p. 1081 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

27. The nurse would instruct a client who is on a rowing team to avoid injecting insulin in his arms on rowing practice days because

a.

exercise increases the absorption rate of insulin.

b.

increased circulation in the arms will dilute the insulin.

c.

the arms have increased muscle mass.

d.

the arms will become painful.

ANS: A

The nurse should tell clients to avoid sites above muscles that will be exercised heavily that day, because exercise increases the rate of insulin absorption.

DIF: Analysis/Analyzing REF: p. 1084 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

28. The nurse assesses a diabetic client and finds a blood sugar level of 280 mg/dl, low blood pressure, nausea and vomiting, and erratic pulse. The nurse would suspect the electrolyte abnormality of

a.

hypermagnesemia.

b.

hypernatremia.

c.

hypocalcemia.

d.

hypokalemia.

ANS: D

Electrolyte imbalances such as hyponatremia and hyperkalemia or hypokalemia accompany acute hyperglycemia, with clinical manifestations of nausea and vomiting, diarrhea, ectopic beats, and hypotension.

DIF: Analysis/Analyzing REF: p. 1090 OBJ: Assessment

MSC: Physiological Integrity-Pathophysiology

29. In a client who needs fluid replacement therapy for DKA, the nurse would evaluate the best indicator of rehydration as

a.

a balance of intake and output.

b.

improving skin turgor.

c.

moistness of tongue and mucous membranes.

d.

urine output at least 0.5 ml/kg/hr.

ANS: D DIF: Analysis/Analyzing REF: p. 1090

OBJ: Assessment MSC: Physiological Integrity-Pathophysiology

30. The nurse explains that diabetic retinopathy, the leading cause of blindness in the United States, results when the retina

a.

detaches from the inner chamber wall.

b.

hemorrhages and loses it ability to function.

c.

is deprived of oxygen.

d.

is obstructed by protein plaque.

ANS: C

As the microangiography progresses into the chamber of the eyes, the vessels gradually occlude, depleting the retina of oxygen; the retina depends on oxygen to function.

DIF: Comprehension/Understanding REF: p. 1101 OBJ: Intervention

MSC: Physiological Integrity-Pathophysiology

31. The ED nurse who is giving insulin by continuous IV infusion to a client with DKA would plan to monitor the clients blood glucose level every

a.

10 minutes.

b.

30 minutes.

c.

1 hour.

d.

2 hours.

ANS: B

Blood glucose levels need to be monitored every 30 minutes initially, preferably with a blood glucose meter.

DIF: Comprehension/Understanding REF: p. 1092 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

32. The nurse would be most vigilant in assessing for hypoglycemia in a client taking the oral antidiabetic agent

a.

acarbose (Precose).

b.

chlorpropamide (Diabinese).

c.

metformin (Glucophage).

d.

repaglinide (Prandin).

ANS: B

Most recorded cases of hypoglycemia have been in clients receiving chlorpropamide (Diabinese), which has a duration of action of 24 to 72 hours.

DIF: Comprehension/Understanding REF: p. 1094 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

33. The nurse suspects hypoglycemia in a client with diabetes who is difficult to arouse. To reverse this condition, the nurse knows that the best therapy would be

a.

glucagon.

b.

graham crackers.

c.

orange juice.

d.

4 teaspoons of granulated sugar.

ANS: A

The nurse should never force an unconscious or semi-conscious client to drink liquids, because fluid may be aspirated into the lungs. Glucagon or IV glucose can be administered in the event of a serious hypoglycemic episode. Glucagon can be given either IM or subcutaneously in a 1-mg dose.

DIF: Application/Applying REF: p. 1095 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

34. The nurse would recognize that the trend in the lipid levels of a client with diabetes follows the pattern that accompanies macrovascular disease, which is

a.

decreased low-density lipoproteins.

b.

decreased very-low-density lipoproteins.

c.

increased high-density lipoproteins.

d.

increased triglyceride levels.

ANS: D

Typically, very-low-density and low-density lipoproteins are increased and high-density lipoproteins are decreased. The most characteristic lipid abnormality in diabetes is an elevated triglyceride level.

DIF: Comprehension/Understanding REF: p. 1100 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

35. The nurse would explain to a client diagnosed with diabetes and hypertension that the most likely prescribed medication will be a(n)

a.

angiotensin-converting enzyme (ACE) inhibitor.

b.

beta-adrenergic blocker.

c.

direct-acting vasodilator.

d.

diuretic.

ANS: A

ACE inhibitors and calcium channel blockers are the agents of choice for treatment of diabetic clients with hypertension. Beta-blockers and diuretics may increase glucose tolerance and lipid levels.

DIF: Comprehension/Understanding REF: p. 1101 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapy-Pharmacological Agents/Actions

36. The nurse would counsel a diabetic client who has developed nephropathy that the best dietary alteration to manage this complication is a

a.

high-calorie diet.

b.

high-fat diet.

c.

low-carbohydrate diet.

d.

low-protein diet.

ANS: D

Clients with nephropathy are taught to eat a low-protein diet and to avoid nephrotoxic drugs (e.g., gentamicin). The protein component of the diet should be less than 10%.

DIF: Application/Applying REF: p. 1104 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

37. A client with diabetes who has properly learned the principles of foot care would be most likely to say

a.

A mirror will be very helpful so I can look at all parts of my feet each day.

b.

I should limit walking barefoot to a half hour a day.

c.

I should wear nice, tight shoes for firm support.

d.

The best method of testing bath temperature is with the toes.

ANS: A

The feet should be inspected daily for any trauma (a mirror may be needed). The diabetic client should wear properly fitting, nonrestrictive shoes; avoid walking barefoot; and test water temperature with the elbow before bathing.

DIF: Application/Applying REF: p. 1103 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

38. For a client with diabetes mellitus scheduled for surgery at 8 AM, the nurse would plan to check the clients blood glucose level on the day of surgery between

a.

12 midnight and 2 AM.

b.

2 and 4 AM.

c.

4 and 6 AM.

d.

7 and 8 AM.

ANS: D

A blood glucose determination should be performed and reported to the physician within 1 hour before surgery to ensure that the client (who has been NPO since midnight) will not develop hypoglycemia during surgery.

DIF: Application/Applying REF: p. 1087 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential: Potential for Complications from Surgical Procedures/Health Alterations

39. In a teaching plan for clients newly diagnosed with diabetes, the nurse would include some basic facts relative to the pathophysiology of diabetes mellitus, such as

a.

insulin assists in metabolizing fats for energy.

b.

insulin must be present to convert glucose to glycogen.

c.

the liver is capable of producing adequate insulin levels.

d.

urine output increases to excrete by-products of fat metabolism.

ANS: B

Insulin is the key hormone that turns glucose into glycogen, which can be stored in the muscles.

DIF: Comprehension/Understanding REF: p. 1067 OBJ: Intervention

MSC: Physiological Integrity-Pathophysiology

40. The nurse counsels a client that in the beta-cell destruction process toward type 1 diabetes, the client may experience a honeymoon period, during which the pancreas

a.

becomes desensitized to high levels of blood glucose.

b.

compensates with adequate amounts of insulin for 3 to 12 months.

c.

produces proinsulin in greater quantities for about 3 months.

d.

regenerates and produces adequate amounts of insulin indefinitely.

ANS: B

Diabetes is an autoimmune process during which the beta cells of the pancreas are destroyed. An illness or other stressor may cause the client to become hyperglycemic, but once the illness or stress abates, the client then reverts to a state of compensation, in which the pancreas can produce an adequate amount of insulin for a while. This compensated state, which can last for 3-12 months, is referred to as the honeymoon period.

DIF: Comprehension/Understanding REF: pp. 1065-1066

OBJ: Intervention MSC: Physiological Integrity-Pathophysiology

41. For a diabetic client weighing 80 pounds, the nurse would anticipate that the starting dose of insulin will be

a.

72 units.

b.

54 units.

c.

36 units.

d.

18 units.

ANS: D

The rule is that initial insulin should be ordered at 0.5 unit/kg/day:

DIF: Comprehension/Understanding REF: p. 1074 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapy-Pharmacological Agents/Actions

42. The diabetic nurse educator would emphasize to a group class that quality of life in diabetes can be enhanced by

a.

becoming a full and active partner in control of diabetes.

b.

complying with the prescribed medical regimen.

c.

not having too many complications from the disease.

d.

taking as few medications to control the diabetes as possible.

ANS: A

No disease requires as much self-care ability as does diabetes. The client can be in control of the disease, which will enhance the clients quality of life.

DIF: Comprehension/Understanding REF: p. 1076 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Quality of Life

MULTIPLE RESPONSE

1. In planning teaching and ongoing care for a new diabetic client, the clinic nurse should base the plan around concepts such as (Select all that apply)

a.

continual assessment of client knowledge and skill level.

b.

empowering the client to become the expert in his/her care.

c.

liberal use of referrals depending on client need.

d.

the nurse being the expert in diabetes care.

e.

using a multidisciplinary approach.

ANS: A, B, C, E

Diabetes self-management is the responsibility of the client and family. The client must become empowered to accept self-management and to make sound decisions regarding care. A team approach is best for managing diabetic clients and should include a nurse, dietitian, and physician as core members. Other members may include a psychologist, social worker, pharmacist, exercise physiologist, and podiatrist.

DIF: Application/Applying REF: pp. 1076-1077

OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Collaboration with Interdisciplinary Team

2. The nurse teaches a client with type 1 diabetes that in order to prevent complications from exercising, before exercising the client should (Select all that apply)

a.

be adequately hydrated.

b.

carry a carbohydrate snack.

c.

eat a snack if blood glucose level is above 150 mg/dl.

d.

not drink water to avoid nausea.

ANS: A, B

Hypoglycemia can be a significant risk for diabetic clients who exercise. Adequate hydration before exercise is important. If the blood glucose level is under 100 mg/dl, the client should eat 15-30 grams of carbohydrate. If the blood glucose level is between 100 and 150 mg/dl, the client can eat later. The client should always carry a carbohydrate snack and diabetic identification.

DIF: Application/Applying REF: p. 1079 OBJ: Intervention

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Self Care

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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