Diabetes - Saunders NCLEX-PN Review (Chapter 44)
A nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?
A. Soak the feet in hot water.
B. Avoid using soap to wash the feet.
C. Apply a moisturizing lotion to dry feet, but not between the toes.
D. Always have a podiatrist cut your toenails; never cut them yourself.
C. Apply a moisturizing lotion to dry feet, but not between the toes.
Test-taking Strategy:
Use the process of elimination. Eliminate option D first because of the word “always,” and eliminate option A because of the word “hot”. From the remaining options, recalling the concern related to skin infection will assist you with eliminating option B.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- A nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement, if made by the client, indicates the need for further teaching?
A. “I’ll eat a balanced meal plan.”
B. “I need to drink diet soft drinks.”
C. “I need to buy special dietetic foods.”
D. “I need to snack on fruit instead of cake.”
C. “I need to buy special dietetic foods.”
Test-Taking Strategy:
Note the strategic words “indicates the need for further teaching.” These words indicate a negative event query and ask you to select an option that is an incorrect statement. Basic principles related to the diabetic diet will direct you to option B.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?
A. Keep insulin vials refrigerated at all times.
B. Rotate the insulin injection sites systematically.
C. Increase the amount of insulin before unusual exercise.
D. Monitor the urine acetone level to determine the insulin dosage.
B. Rotate the insulin injection sites systematically.
Test-Taking Strategy:
Use the process of elimination. Eliminate option A first because of the words “at all times.” Knowledge regarding insulin administration and the significance of acetone in the urine will assist you with eliminating options C and D.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- A nurse reinforces reaching with a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which of the symptoms develops?
A. Polyuria
B. Shakiness
C. Blurred vision
D. Fruity break odor
B. Shakiness
Test-Taking Strategy:
Remember that shakiness is a sign of hypoglycemia. The rest are symptoms of hyperglycemia.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- When the nurse is reinforcing teaching a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective?
A. “I will stop taking my insulin dose during times of illness.”
B. “I will decrease my insulin dose during times of illness.”
C. “I will adjust my insulin dose according to the level of glucose in my urine.”
D. “I will notify my physician if my blood glucose level is greater than 250 mg/dL.”
D. “I will notify my physician if my blood glucose level is greater than 250 mg/dL.”
Test-Taking Strategy:
Use the process of elimination. Note options A, B, and C all relate to the adjustment of insulin doses; therefore, eliminate these options.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- A nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for sign of complications. Which of the following, if exhibited by the client, would indicate hyperglycemia and thus warrant physician notification?
A. Polyruia
B. Bradycardia
C. Diaphoresis
D. Hypertension
A. Polyruia
Test-Taking Strategy:
The classic symptoms of hyperglycemia include the three Ps (polydipsia, polyuria, and polyphagia). Options B, C, D are not signs of hyperglycemia.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- A nurse is reinforcing instructions with a client with diabetes mellitus who is recovering from diabetic ketaoscidosis (DKA) regarding measures to prevent a recurrence. Which instruction is important for the nurse to emphasize?
A. Eat six small meals daily.
B. Test the urine ketone levels
C. Monitor blood glucose levels frequently.
D. Receive appropriate follow-up health care.
C. Monitor blood glucose levels frequently.
Test-Taking Strategy:
Focus on the subject of preventing DKA. Recall that the treatment of DKA focuses on the maintenance of an appropriate blood glucose level. Option A is not an accurate component of diabetic care. Option D will not prevent DKA. Option B does not prevent DKA but rather confirms the diagnosis.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of NPH insulin and exercise?
A. “I should not exercise after lunch.”
B. “I should not exercise after breakfast.”
C. “I should not exercise in the late evening.”
D. “I should not exercise in the late afternoon.”
D. “I should not exercise in the late afternoon.”
Test-Taking Strategy:
Use the process of elimination, and note the strategic words “a correct understanding.” Recalling peak time of insulin will direct you to option D.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- When a nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs, what information should the nurse obtain from the client?
A. Plan of injection rotation
B. Consistency of aspiration
C. Preparation of the injection site
D. Angle at which the medication is administered.
A. Plan of injection rotation
Test-Taking Strategy:
Recalling the definition of lipodystrophy will direct you to the correct option. Remember that lipodystrophy is the hypertrophy of subcutaneous tissue at the injection site.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- Which client complain would alert the nurse to a possible hypoglycemic reaction?
A. Tremors
B. Anorexia
C. Hot, dry skin
D. Muscle cramps
A. Tremors
Test-Taking Strategy:
Focus on the subject of a hypoglycemic reaction. Recalling the signs associated with this reaction will direct you to option A.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which symptoms is indicative of this disorder?
A. Diarrhea
B. Polydipsia
C. Weight gain
D. Blurred vision
B. Polydipsia
Test-taking Strategy:
Use the process of elimination and your knowledge of the manifestations of diabetes insipidus. Remember that polydipsia and polyuria are classic symptoms.
Diabetes - Saunders NCLEX-PN Review (Chapter 44)
- A hospitalized client with type 1 diabetes mellitus received NPH and regular insulin 2 hours ago 7:30 AM. The client calls the nurse and reports that he is feeling hungry, shaky, and weak. The client ate breakfast at 8:00 and is due to eat lunch at noon. List, in order priority, the actions that the nurse would take . (Number 1 is the first action.)
__ Take the client’s vital signs.
__ Retest the client’s blood glucose level.
__ Check the client’s blood glucose level.
__ Give the client half a cup of fruit juice to drink.
__ Give the client a small snack of carbohydrate and protein.
__ Document the client’s complaints, the actions taken, and the outcome.
3 Take the client’s vital signs.
4 Retest the client’s blood glucose level.
1 Check the client’s blood glucose level.
2 Give the client half a cup of fruit juice to drink.
5 Give the client a small snack of carbohydrate and protein.
6 Document the client’s complaints, the actions taken, and the outcome.
Diabetes - Burke Textbook (Chapter 36)
A client with diabetes mellitus experiences hypoglycemia during the night followed by episodes of hyperglycemia when the blood glucose is assessed in the morning. The nurse recognizes these symptoms as:
A. Somogyi effect.
B. Diabetic Ketoaciosis.
C. Dawn phenomenon.
D. Hyperosomlar hyperglycemic state.
A. Somogyi effect.
Rationale:
Clients experiencing Somogyi effect should be taught the symptoms of nighttime hypoglycemia, including tremors, night sweats, and restlessness. A bedtime snack or decreasing the evening dose of intermediate insulin may reduce the risk of developing the effect.
Diabetes - Burke Textbook (Chapter 36)
A female client with a history of diabetes mellitus visits her physician because of flu-like symptoms. Which of the following indicates a need for further teaching when she discusses her sick-day care?
A. “I will check my blood glucose every four hours.”
B. “I will check my urine ketones if my blood glucose is above 250 mg/dL.”
C. “I will hold my daily insulin dose until I stop vomiting.”
D. “I will consume 10 to 15 g of carbohydrates every 1 to 2 hours.”
B. “I will check my urine ketones if my blood glucose is above 250 mg/dL.”
Rationale:
During periods of illness, blood glucose levels increase in response to physiologic stress and the body’s need for glucose. It is important to continue taking insulin in order to prevent DKA or HHS.
Diabetes - Burke Textbook (Chapter 36)
Which one of the following clients has the highest risk factors for developing type 2 diabetes mellitus?
A. 16-year-old Native American who plays basketball in high school.
B. 30-year-old Caucasian with a family history of diabetes mellitus.
C. 52-year-African American with a history of thyroid disease.
D. 68-year-old Hispanic female who is overweight.
C. 52-year-African American with a history of thyroid disease.
Rationale:
Risks for type 2 DM include adults over 65, obesity, sedentary lifestyle, and Hispanic or African American women, and Native Americans. The 16-year-old has lower risk due to physical activity. Heredity plays a more important role in the development of type 1 DM. Thyroid disease does not increase risk for DM.
Diabetes - Burke Textbook (Chapter 36)
A 16-year-old girl diagnosed with type 1 diabetes mellitus. Which of the following statements made by the client indicates a need for further instruction?
A. “When my blood sugar is stable, I will use pills for my diabetes.”
B. “I will rotate my insulin injection sites.”
C. “My blood glucose should be maintained between 70 and 110 mg/dL.”
D. “I will perform foot care and inspect my feet daily.”
A. “When my blood sugar is stable, I will use pills for my diabetes.”
Rationale:
Type 1 diabetes is caused by lack of insulin production. These individuals are insulin dependent and cannot be managed with oral antidiabetic medications.
Diabetes - Burke Textbook (Chapter 36)
A client with diabetes mellitus received lispro (Humalog) 20 units at 7:30 am. The most likely times that the nurse would expect the client to experience the client to experience hypoglycemia is:
A. Between 8:30 am and 9:30 am.
B. Between 10:30 am and 2:00 pm.
C. Between 12:30 pm and 2:30 pm.
D. Between 1:30 pm and 3:30 pm.
A. Between 8:30 am and 9:30 am.
Rationale:
The most likely time for a client to experience hypoglycemia as a result of receiving lispro insulin is 3 to 6 1/2 hours after administration.
Diabetes - Burke Textbook (Chapter 36)
A client is admitted to the medical unit with a diagnosis of diabetic ketoacidosis. Which of the following clinical manifestations should the nurse expect to find?
A. Cool, clammy skin.
B. Acetone breath odor.
C. Slurred speech.
D. Radial pulse 70, bounding
B. Acetone breath odor.
Rationale:
Diabetic ketaoacidosis is characterized by hyperglycemia and spillage of ketones in the urine, which causes the classic acetone breath. The skin is very warm and dry as a result of dehydration. Slurred speech occurs with hypoglycemia. The pulse is usually rapid and weak.
Diabetes - Burke Textbook (Chapter 36)
The nurse instructs a client to mix Humulin N and Humulin R insulin. List the action in the sequence in which the client should perform them.
__ Inject air into the Humulin N vial first.
__ Gently rotate Humulin N vial.
__ Withdraw Humulin R insulin first.
__ Wipe off top of both vials iwth alcohol pad.
__ Inspect Humulin R for clarity.
4 Inject air into the Humulin N vial first.
2 Gently rotate Humulin N vial.
5 Withdraw Humulin R insulin first.
3 Wipe off top of both vials iwth alcohol pad.
1 Inspect Humulin R for clarity.
Diabetes - Burke Textbook (Chapter 36)
A conscious client arrives in the emergency department with a blood glucose of 50 mg/dL. What nursing intervention should the nurse anticipate doing for this client?
A. Give lispro (Humalog) injection.
B. Give crackers and cheese.
C. Give glucagon injection.
D. Give a half cup of regular soda.
D. Give a half cup of regular soda.
Rationale:
Regular soda, a rapid-acting glucose source, is given immediately to a conscious client with hypoglycemia. Giving insulin would decrease glucose levels further. Glucagon is only used with an unconscious client. Crackers and cheese are given after glucose levels have returned to normal because they take longer to act.
Diabetes - Burke Textbook (Chapter 36)
The nurse instructs a diabetic client on foot care. Appropriate instruction should include which of the following points? (Select all that apply.)
A. Cut the toenails straight across with a clipper.
B. Have a family member check a heating pad before applying to feet.
C. Apply lotion or oil generously between the toes.
D. Wear closed-toe shoes made of soft leather.
E. If buying a new pair shoes, shop in early morning.
F. Use a mirror to check your soles every day.
A. Cut the toenails straight across with a clipper.
D. Wear closed-toe shoes made of soft leather.
F. Use a mirror to check your soles every day.
Diabetes - Burke Workbook (Chapter 36)
The nurse understands that the diabetic client must be cautious when exercising because:
A. blood sugar levels may drop rapidly.
B. Hyperglycemia may develop.
C. insulin dosages need to be increased.
D. exercise produces fatigue and weakness.
A. blood sugar levels may drop rapidly.
Diabetes - Burke Workbook (Chapter 36)
The nurse is explaining oral antidiabetic agent. The best statement that reflects the nurse’s understanding is:
A. the medication increases the production of natural insulin.
B. beta cells are stimulated to release more insulin in response to hyperglycemia.
C. oral agents provide long-acting release of previously injected pork insulin.
D. antidiabetic agents slow insulin production by the pancreas.
B. beta cells are stimulated to release more insulin in response to hyperglycemia.
Diabetes - Burke Workbook (Chapter 36)
Jacob is being evaluated for possible diabetes mellitus. When collecting the initial data, the nurse should ask:
A. “Do you eat a lot of sweets?”
B. “How long have you been overweight?”
C. “Do you have to urinate frequently?”
D. “Have you had this type of blood work done before?”
C. “Do you have to urinate frequently?”
