Saunders NCLEX Diabetes Questions

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NCLEX questions: Perioperative Nur...

12 terms christal9Preview NCLEX 31 terms hey The nurse is developing a plan of care for an older client diagnosed with type 1 diabetes mellitus who is also experiencing acute gastroenteritis.To maintain food and fluid intake in order to prevent dehydration, which action should the nurse plan to include?

• Offering only water until the client is able to tolerate solid foods
• Withholding all fluids until vomiting has ceased entirely for at least 4 hours
• Encouraging the client to take 8 to 12 ounces of fluid every hour while awake
• Maintaining a clear liquid diet for at least 5 days before advancing to solid foods
• Encouraging the client to take 8 to 12 ounces of fluid every hour while awake

Dehydration needs to be prevented in the client with type 1 diabetes mellitus because of the risk of diabetic ketoacidosis (DKA). Small amounts of fluid may be tolerated, even when vomiting is present. The client should be offered liquids containing both glucose and electrolytes. The diet should be advanced as tolerated and include a minimum of 100 to 150 g of carbohydrates daily. Offering water only and maintaining liquids for 5 days will not prevent dehydration but may promote it in this client

The nurse provides discharge instructions to a client beginning oral hypoglycemic therapy. Which statements if made by the client indicate a need for further teaching? Select all that apply.

• "If I am ill, I should skip my daily dose."
• "If I overeat, I will double my dosage of medication."
• "Oral agents are effective in managing type 2 diabetes."
• "If I become pregnant, I will discontinue my medication."
• "Oral hypoglycemic medications will cause my urine to turn orange."
• "My medications are used to manage my diabetes along with diet and exercise."

A, B, D, E

Clients are instructed that oral agents are used in addition to diet and exercise as therapy for diabetes mellitus. During illness or periods of intense stress, the client should be instructed to monitor her or his blood glucose level frequently and should contact the primary health care provider if the blood glucose is elevated because insulin may be needed to prevent symptoms of acute hyperglycemia. The medication should not be skipped or the dosage should not be doubled. Taking extra medication should be avoided unless specifically prescribed by the primary health care provider. Medication should never be discontinued unless instructed to do so by the primary health care provider. However, the diabetic who becomes pregnant will need to contact her primary health care provider because the oral diabetic medication may have to be changed to insulin therapy because some oral hypoglycemics can be harmful to the fetus. These medications do not change the color of the urine.The clinic nurse instructs a client diagnosed with diabetes mellitus about preventing diabetic ketoacidosis on days when the client is feeling ill.Which statement by the client indicates the need for further teaching?

• "I need to stop my insulin if I am vomiting."
• "I need to call my doctor if I am ill for more than 24 hours."
• "I need to eat 10 to 15 g of carbohydrates every 1 to 2 hours."
• "I need to drink small quantities of fluid every 15 to 30 minutes."
• "I need to stop my insulin if I am vomiting."

Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes mellitus that develops when a severe insulin deficiency occurs. The client needs to be instructed to take insulin, even if he or she is vomiting and unable to eat. It is important to self-monitor blood glucose more frequently during illness (every 2 to 4 hours). If the premeal blood glucose is more than 250 mg/dL, the client should test for urine ketones and contact the primary health care provider. All the remaining options are accurate interventions

The nurse is instructing a client with diabetes mellitus regarding hypoglycemia. Which statement by the client indicates the need for further teaching?

• "Hypoglycemia can occur at any time of the day or night."
• "I should drink 6 to 8 ounces of milk if hypoglycemia occurs."
• "If I feel sweaty or shaky, I might be experiencing hypoglycemia."
• "If hypoglycemia occurs, I need to take my regular insulin as prescribed."
• "If hypoglycemia occurs, I need to take my regular insulin as prescribed."

Hypoglycemia can occur when the blood glucose level falls below 70 mg/dL (4mmol/L). Insulin is not taken as a treatment for hypoglycemia because the insulin will lower the blood glucose level. Hypoglycemic reactions can occur at any time of the day or night. If a hypoglycemic reaction occurs, the client will need to consume 10 to 15 g of carbohydrate; 6 to 8 ounces of milk, for example, contain this amount of carbohydrate. Tremors and diaphoresis are signs of mild hypoglycemia.A client diagnosed with type 2 diabetes mellitus is being discharged from the hospital after an occurrence of hyperglycemic hyperosmolar state (HHS). The nurse creates a discharge teaching plan for the client and identifies which intervention as a priority?

• Exercise routines
• Controlling dietary intake
• Keeping follow-up appointments
• Monitoring for signs/symptoms of dehydration
• Monitoring for signs/symptoms of dehydration

Clients at risk for HHS should report signs and symptoms of dehydration to primary health care providers. Dehydration can be severe, and it may progress rapidly. Although exercising, dietary modifications, and follow-up appointments are components of the teaching plan, for the client diagnosed with HHS, dehydration is the priority.The nurse creates a plan of care for an older client diagnosed with diabetes mellitus. It is important that the nurse plans to complete which action first?

• Structure menus for adherence to diet.
• Teach with videotapes showing insulin administration to ensure competence.
• Encourage dependence on others to prepare the client for the chronicity of the disease.
• Assess the client's ability to read label markings on syringes and blood glucose monitoring equipment.
• Assess the client's ability to read label markings on syringes and blood glucose monitoring equipment.

The nurse first assesses the client's ability for self-care. Structuring menus for the client promotes dependence. Allowing the client to have hands-on experience rather than teaching with videos is more effective. Independence should be encouraged.

The nurse is teaching a client who had been newly diagnosed with diabetes mellitus about blood glucose monitoring. The nurse should teach the client to report glucose levels that consistently exceed which level?

• 150 mg/dL (8.57 mmol/L)
• 200 mg/dL (11.42 mmol/L)
• 250 mg/dL (14.28 mmol/L)
• 350 mg/dL (20.0 mmol/L)
• 250 mg/dL (14.28 mmol/L)

The normal blood glucose level ranges from 70 to 110 mg/dL (4 to 6 mmol/L), or as designated and preferred by the primary health care provider. The client with diabetes mellitus should be taught to report blood glucose levels that exceed 250 mg/dL (14.28 mmol/L), unless otherwise instructed by the primary health care provider. Options 1 and 2 are high levels but do not require primary health care provider notification. Option 4 is a high value; the client should report an elevated level before it reaches this point The nurse is reviewing home care instructions with a client who has been diagnosed with type 1 diabetes mellitus and has a history of diabetic ketoacidosis (DKA). The client's spouse is present when the instructions are given. Which statement by the spouse indicates that further teaching is necessary?

• "If he is vomiting, I shouldn't give him any insulin."
• "I should bring him to the doctor if he develops a fever."
• "If our grandchildren are sick, they probably shouldn't come to visit."
• "I should call the doctor if he has nausea or abdominal pain lasting for more than 1 or 2 days."
• "If he is vomiting, I shouldn't give him any insulin."

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus that develops when a severe insulin deficiency occurs.Infection and the stopping of insulin are precipitating factors for DKA. Nausea and abdominal pain that last more than 1 or 2 days need to be reported to the primary health care provider because these signs/symptoms may be indicative of DKA A client diagnosed with diabetes mellitus has been controlled with daily NPH insulin. The client has been prescribed atenolol to control angina pectoris. Because of the effects of the atenolol, the nurse determines that which finding is the most reliable indicator of hypoglycemia?

• Sweating
• Tachycardia
• Feelings of anxiety
• Low capillary glucose level
• low capillary glucose level

Beta-adrenergic blocking agents, such as atenolol, mask the signs and symptoms (such as tachycardia, sweating, and feelings of anxiety) of acute hypoglycemia. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully