Med/Surg - Chapter 52: Nursing Management: Diabetes Mellitus

Med/Surg - Chapter 52: Nursing Management: Diabetes Mellitus ScienceMedicineNursing Pius_Kameka Save Chapter 48: Diabetes Mellitus Lewis:...Teacher 44 terms unitedwestand34 Preview Diabetes Mellitus NCLEX Style Ques...Teacher 36 terms ssandholmPreview

Chapter 52: Nursing Management- ...

39 terms jiae_choiPreview Lewis M 39 terms Piu 1. The nurse is caring for a client with newly diagnosed type 2 diabetes mellitus who asks the nurse what "type 2" means in relation to diabetes. Which of the following statements by the nurse about type 2 diabetes is correct?

• Insulin is not used to control blood glucose in clients with type 2 diabetes.
• Complications of type 2 diabetes are less serious than those of type 1 diabetes.
• Type 2 diabetes is usually diagnosed when the client is admitted with a

hyperglycemic coma.

• Changes in diet and exercise may be sufficient to control blood glucose levels in

type 2 diabetes.

ANS: D

For some clients, changes in lifestyle are sufficient for 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 client develops complications such as frequent yeast infections.

• The nurse is assessing a client for diabetes at a clinic who has a fasting plasma glucose

level of 6.7 mmol/L. Which of the following information should the nurse include in the plan of care?

• Self-monitoring of blood glucose.
• Use of low doses of regular insulin.
• Lifestyle changes to lower blood glucose.
• Effects of oral hypoglycemic medications.

ANS: C

The client's impaired fasting glucose indicates prediabetes and the client should be counselled about lifestyle changes to prevent the development of type 2 diabetes. The client with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

• Which of the following actions by a client with type 1 diabetes indicates that the nurse

should implement teaching about exercise and glucose control?

• The client always carries hard candies when engaging in exercise.
• The client goes for a vigorous walk when the glucose is 11.1 mmol/L.
• The client has a peanut butter sandwich before going for a bicycle ride.
• The client increases daily exercise when ketones are present in the urine.

ANS: D

When the client is ketotic, exercise may result in an increase in blood glucose level. Type

• diabetic clients should be taught to avoid exercise when ketosis is present. The other

statements are correct.

• The nurse is assessing a client who is experiencing the onset of symptoms of type 1

diabetes. Which of the following questions is best for the nurse to ask?

• "Have you lost any weight lately?"
• "How long have you felt anorexic?"
• "Is your urine unusually dark coloured?"
• "Do you crave fluids containing sugar?"

ANS: A

Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The client 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.

• To evaluate the effectiveness of treatment for a client with type 2 diabetes who is

scheduled for a follow-up visit in the clinic, which of the following tests will the nurse plan to schedule for the client?

• Urine dipstick for glucose
• Oral glucose tolerance test
• Fasting blood glucose level
• Glycosylated hemoglobin level

ANS: D

The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90-120 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.

• The nurse is caring for a client who has just been diagnosed with type 2 diabetes and has a

nursing diagnosis of imbalanced nutrition: more than body requirements. Which of the following client goals is most important?

• The client will have a glycosylated hemoglobin level of less than 7%.
• The client will have a diet and exercise plan that results in weight loss.
• The client will choose a diet that distributes calories throughout the day.
• The client 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 client outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.

• A client who has type 1 diabetes plans to take a swimming class daily at 1:00 P.M. Which

of the following instructions should the nurse teach to the client?

• Check glucose level before, during, and after swimming.
• Delay eating the noon meal until after the swimming class.
• Increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
• Time the morning insulin injection so that the peak occurs while swimming.

ANS: A

The change in exercise will affect blood glucose, and the client will need to monitor glucose carefully to determine the need for changes in diet and insulin administration.Because exercise tends to decrease blood glucose, clients 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.

• The nurse is caring for a client with newly diagnosed type 1 diabetes who has received diet

instruction. Which of the following client statements indicate a need for additional instruction?

• "I may have an occasional alcoholic drink if I include it in my meal plan."
• "I will need a bedtime snack because I take an evening dose of NPH insulin."
• "I may eat whatever I want, as long as I use enough insulin to cover the calories."
• "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia."

ANS: C

Most clients with type 1 diabetes need to plan diet choices very carefully. Clients 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 client statements are correct and indicate good understanding of the diet instruction.

• Which of the following actions is most important for the nurse to take in order to assist a

client with diabetes to engage in moderate daily exercise?

• Remind the client that exercise will improve self-esteem.
• Determine what type of exercise activities the client enjoys.
• Give the client a list of activities that are moderate in intensity.
• Teach the client about the effects of exercise on glucose level.

ANS: B

Since consistency with exercise is important, assessment for the types of exercise that the client 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.

• The nurse is teaching the client to administer a dose of 10 units of regular insulin and 28

units of NPH insulin. Which of the following statements by the client indicates a need for additional instruction?

• "I need to rotate injection sites among my arms, legs, and abdomen each day."
• "I will buy the 0.5 mL syringes because the line markings will be easier to see."
• "I should draw up the regular insulin first after injecting air into the NPH bottle."
• "I do not need to aspirate the plunger to check for blood before injecting insulin."

ANS: A

Rotating sites are no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other client statements are accurate and indicate that no additional instruction is needed.