LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 20 Nursing Care of Patients with Diabetes Mellitus

1) A patient at risk for the development of type 2 diabetes mellitus asks why weight loss will reduce risk of developing the health problem. Which response by the nurse is most accurate?

1. "The amount of foods taken in require more insulin to adequately metabolize them, resulting in diabetes."

2. "Excess body weight impairs the body's release of insulin."

3. "Thin people are less likely to become diabetic."

4. "The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin."

Page Ref: 597

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

2) A patient recently diagnosed with type 1 diabetes mellitus does not understand why the disease developed because the patient is thin and eats all of the time. What is the most appropriate response by the nurse?

1. "Thin people can be diabetic, too."

2. "Your condition makes it impossible for you to gain weight."

3. "Diabetes makes it difficult for your body to obtain energy from the foods you eat."

4. "Your lab tests indicate the presence of diabetes."

Page Ref: 598

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

3) An older patient without polyuria, polydipsia, or polyphagia has a serum glucose level of 130 mg/dL. What should the nurse conclude about this patient?

1. The patient might have eaten a meal with high sugar content prior to the testing.

2. The laboratory results might be erroneous.

3. The patient has type 1 diabetes mellitus.

4. The patient will need to be assessed for other manifestations of diabetes.

Page Ref: 599

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Aging Process

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

4) The nurse notes that a patient who has not been diagnosed with diabetes has a hemoglobin A1C level of 6%. What should the nurse suspect is occurring with the patient?

1. Severe hyperglycemia

2. Consistent with diabetes

3. Normal results

4. High risk for developing diabetes

Page Ref: 609

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with diabetes mellitus.

5) A patient recently diagnosed with diabetes wants to check the urine for glucose instead of using capillary blood because of the cost. Which response should the nurse make to the patient?

1. "Urine testing is best when combined with serum testing."

2. "Urine testing is as reliable as finger stick testing."

3. "Yes, urine testing is cheaper than glucose test strips."

4. "Would you like to switch to this method of monitoring?"

Page Ref: 609

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with diabetes mellitus.

6) A patient with type 1 diabetes mellitus who had one episode of vomiting in the past 2 hours asks if the routine insulin injection should be taken. What action by the nurse is best at this time?

1. Contact the physician.

2. Explain the need to take the insulin.

3. Document the refusal and continue on with the planned care.

4. Check the patient's fasting serum glucose level.

Page Ref: 626

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.5 Design best practices of self-care management of DM related to diet planning, sick-day management, and exercise.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

7) A patient beginning insulin for type 2 diabetes is experiencing blurred vision and is concerned about becoming blind. What response by the nurse is most appropriate?

1. "I will make an appointment for you to see an ophthalmologist."

2. "I will call the physician to report your symptoms."

3. "Blurry vision is very common. Do not worry."

4. "This is a normal response when insulin therapy is initiated."

Page Ref: 613

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

8) A patient with diabetes is diaphoretic, has a heart rate of 112 beats per minute, and is feeling nervous and shaky. What action should the nurse take first?

1. Provide the patient with a snack of milk and crackers.

2. Administer insulin utilizing the prescribed sliding scale dosages.

3. Contact the laboratory and order a serum glucose level.

4. Obtain a capillary serum glucose level reading with a glucose meter.

Page Ref: 603-604

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.3 Differentiate the acute and chronic complications of DM and describe treatment plans for each.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with diabetes mellitus.

9) The nurse is preparing to administer insulin to an underweight patient. Which action should the nurse take when providing this injection? Select all that apply.

1. Ensure insulin is at room temperature.

2. Make sure no air bubbles are present in the syringe.

3. Massage the site of insertion.

4. Rotate injection sites.

5. Insert the needle at a 90-degree angle.

Page Ref: 614-616

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

10) While conducting an educational session for a group of patients regarding the incidence and prevalence of diabetes, the nurse explains that approximately 25.1 million people have been diagnosed with the disorder, but 7.2 million people have not. Statistically, what is the percentage of people who have undiagnosed diabetes? Calculate to the first decimal point.

Page Ref: 595

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.1 Describe the prevalence and incidence of diabetes mellitus (DM).

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

11) The nurse is conducting an educational session with a patient who is newly diagnosed with diabetes. Which statement indicates that additional teaching is required?

1. "6 million people have diabetes."

2. "23.1 million people have been diagnosed with diabetes."

3. "84.1 million people have prediabetes."

4. "7.2 million people have diabetes but have not been diagnosed."

Page Ref: 595

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 20.1 Describe the prevalence and incidence of diabetes mellitus (DM).

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

12) The nurse is teaching a patient with diabetes about the illness. Which patient statement about pancreatic cells indicates that teaching has been effective? Select all that apply.

1. Alpha cells produce glucagon.

2. Beta cells secrete insulin.

3. Cephalon cells produce creatine.

4. Delta cells produce somatostatin.

5. Epsilon cells produce erythropoietin.

Page Ref: 596

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 20.1 Describe the prevalence and incidence of diabetes mellitus (DM).

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

13) The nurse is instructing a 5-year-old patient with diabetes mellitus. In which way should the nurse explain the action of insulin?

1. Building blocks that help make protein into strong muscles

2. A wagon that carries sugar into the cells of the body

3. A mud pie that makes the blood vessels thick and sticky

4. Salty potato chips that make people feel very thirsty

Page Ref: 598

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

14) The nurse is caring for a healthy patient who has a serum glucose level of 60 mg/dL. Which counterregulatory serum hormonal changes should the nurse expect to occur in this patient? Select all that apply.

1. Increased epinephrine levels

2. Increased growth hormone levels

3. Increased insulin levels

4. Decreased thyroxine levels

5. Decreased glucocorticoid levels

Page Ref: 597

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.1 Describe the prevalence and incidence of diabetes mellitus (DM).

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

15) A patient with type 1 diabetes mellitus voided 4000 mL of urine in the past 24 hours. The patient's skin turgor is poor, and the patient is reporting polyphagia and polydipsia. Which blood glucose level should the nurse expect when assessing this patient?

1. 60 mg/dL

2. 110 mg/dL

3. 125 mg/dL

4. 180 mg/dL

Page Ref: 609

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with diabetes mellitus.

16) The nurse is concerned that a patient with type 1 diabetes mellitus is at risk for developing diabetic ketoacidosis. What did the nurse assess to come to this conclusion?

1. Reports of anxiety

2. Pale, cool skin

3. Serum glucose level of 325 mg/dL

4. Ulcer on plantar aspect of right foot

Page Ref: 601

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.3 Differentiate the acute and chronic complications of DM and describe treatment plans for each.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with diabetes mellitus.

17) The nurse is assessing a patient who has a family history of type 2 diabetes mellitus. Which finding would require follow-up by the nurse?

1. A new prescription for levothyroxine (Synthroid) for hypothyroidism

2. Decreased waist-to-hip ratio through dietary changes

3. Delivery of a baby that weighed 8 lbs. and 12 ounces

4. A fasting blood glucose level of 89 mg/dL

Page Ref: 297

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

18) The nurse is reviewing data collected from a patient with a predisposition to developing insulin resistance. Which medication should the nurse identify as potentially causing this patient to develop diabetes? Select all that apply.

1. Nicotinic acid (Niacor)

2. Acetaminophen (Tylenol)

3. Levothyroxine (Synthroid)

4. Furosemide (Lasix)

5. Phenytoin (Dilantin)

Page Ref: 597

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

19) The nurse is reviewing data collected for a patient's health history. Which factor should the nurse identify as increasing the patient's risk of developing type 2 diabetes mellitus?

1. Body mass index of 23 kg/m2

2. Blood pressure of 120/70 mmHg

3. Physical inactivity

4. Low waist-to-hip ratio

Page Ref: 599

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

20) The nurse is trying to determine if a patient is experiencing manifestations of type 1 or type 2 diabetes mellitus. Which question should the nurse ask the patient to help determine the type?

1. "Have you been urinating in greater amounts than in the past?"

2. "Have you been drinking more liquids than in the past?"

3. "Have you been losing weight despite eating regularly?"

4. "Have you noticed any changes in your vision?"

Page Ref: 599

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

21) The nurse teaches about the prevalence of type 2 diabetes in older adults. Which should the nurse include about the number of older adults with diabetes?

1. 10 out of 100 will have type 2 diabetes.

2. 17 out of 100 will have type 2 diabetes.

3. 21 out of 100 will have type 2 diabetes.

4. 33 out of 100 will have type 2 diabetes

Page Ref: 599

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.2 Distinguish the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

22) The nurse is planning care for a patient with type 1 diabetes mellitus. Which action should the nurse identify as being the most effective to reduce the development of complications?

1. Self-monitoring of blood glucose levels

2. Performance of effective foot care

3. The necessity of a yearly eye examination

4. Knowing symptoms of urinary tract infections

Page Ref: 609

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

23) A patient with type 2 diabetes mellitus is scheduled for laparoscopic adjustable gastric banding (LAGB) surgery. What should the nurse explain to the patient about this procedure and diabetes?

1. "Evidence indicates positive outcomes for many patients with diabetes who undergo surgical weight loss procedures."

2. "Surgical procedures can be dangerous for patients with diabetes."

3. "Do you feel that a surgical weight loss procedure will cure your obesity?"

4. "This procedure is more appropriate for a patient who has a diagnosis of type 1 diabetes mellitus."

Page Ref: 621

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with diabetes mellitus.

24) The nurse instructs a patient with type 2 diabetes mellitus on the use of a glucometer for self-monitoring. Which patient return demonstration and statement about glucometer performance indicate that teaching has been effective? Select all that apply.

1. Correctly apply the blood to the meter strip.

2. Follow manufacturer's recommendation regarding cleaning of meter.

3. A patient with sickle cell anemia may need another way to check blood glucose levels.

4. Grapefruit juice should not be ingested when using the glucometer.

5. A sufficient amount of blood must be applied to the strip.

Page Ref: 610-611

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

25) A patient with type 1 diabetes mellitus has a serum hematocrit level of 24%. What additional finding should the nurse report to the healthcare provider?

1. Capillary blood glucose of 60 mg/dL

2. Glycosylated hemoglobin of 7.0

3. The presence of albumin in urine

4. The presence of glucose in urine

Page Ref: 610

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with diabetes mellitus.

26) The nurse is teaching a patient with diabetes about self-management. What should the nurse include regarding medications to treat diabetes mellitus?

1. Patients with type 1 diabetes may achieve normal blood glucose levels with oral medications.

2. Patients with type 1 diabetes may progress to type 2 if blood glucose levels are not well controlled.

3. Patients with type 2 diabetes will always need an exogenous source of insulin.

4. Patients with type 2 diabetes may achieve normal blood glucose levels with a combination of oral medications and insulin.

Page Ref: 611

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

27) The nurse is identifying patients at risk for needing insulin. Which patient should the nurse identify as potentially needing insulin to maintain a normal blood glucose level? Select all that apply.

1. Patients who are fasting or malnourished

2. Patients with type 2 diabetes who are diagnosed with an infection

3. Patients with type 2 diabetes who are undergoing surgical procedures

4. Patients with gestational diabetes

5. Patients receiving total parenteral nutrition

Page Ref: 611

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with diabetes mellitus.

28) The nurse is caring for a patient with type 1 diabetes mellitus. Which patient statement requires immediate intervention by the nurse?

1. "I am allergic to eggs."

2. "I will take my lispro insulin 15 minutes before I eat breakfast."

3. "I won't mix my cloudy regular insulin with other insulins."

4. "I will not use insulin detemir in my insulin pump."

Page Ref: 611

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

29) The nurse is reviewing a teaching tool created for insulin therapy. Which statement on the tool should be corrected? Select all that apply.

1. Lispro is a rapid-acting insulin.

2. Regular insulin can be administered intravenously.

3. NPH insulin may be mixed with lispro insulin.

4. Insulin detemir is administered prior to each meal.

5. Insulin glargine may be used to treat gestational diabetes.

Page Ref: 611-612

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

30) A patient is prescribed 120 units of U-100 regular insulin to be administered at 0700 and 1600 hours. The prescription is written for an equivalent dose of U-500 insulin to be provided. How many units of U-500 insulin should be given? Record your answer rounding to the nearest whole number.

Page Ref: 612

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

31) A patient with diabetes mellitus has albuminuria, hypertension, and edema. What should the nurse expect to be prescribed for this patient?

1. Restrict activity.

2. Increase salt intake.

3. Review weight loss strategies.

4. Provide antibiotic therapy as prescribed.

Page Ref: 606

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 20.3 Differentiate the acute and chronic complications of DM and describe treatment plans for each.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with diabetes mellitus.

32) A patient with type 1 diabetes mellitus has difficulty swallowing and takes milk of magnesium every day for nausea and constipation. What should the nurse suspect is occurring with this patient?

1. Age-related changes

2. Visceral neuropathy

3. Peripheral neuropathy

4. Reaction to insulin injections

Page Ref: 607

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.3 Differentiate the acute and chronic complications of DM and describe treatment plans for each.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

33) An older patient with type 2 diabetes mellitus is upset because family members do not believe the patient has an illness and resist helping with diet and activity modifications. What should the nurse suggest to help this patient?

1. Limit discussions about the illness with family members.

2. Store health-related items away from common family areas in the home.

3. Invite family to participate in a support group.

4. Explain the risk for family also to develop the illness.

Page Ref: 625

Cognitive Level: Applying

Client Need & Sub: Psychosocial Integrity: Support Systems

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.5 Design best practices of self-care management of DM related to diet planning, sick-day management, and exercise.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

34) The nurse is assessing a patient with type 2 diabetes mellitus. What question should the nurse ask to determine the patient's risk for a lower extremity amputation? Select all that apply.

1. "Do you use insulin or oral hypoglycemic agents?"

2. "What were your glycosylated hemoglobin values over the past year?"

3. "Do you have any problems with your eyes related to diabetes?"

4. "Do you have any problems with your kidney related to diabetes?"

5. "When were you first diagnosed with diabetes mellitus?"

Page Ref: 608

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.3 Differentiate the acute and chronic complications of DM and describe treatment plans for each.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with diabetes mellitus.

35) A group of patients with type 1 or 2 diabetes mellitus are planning to participate in an athletic triathlon. On which potential complication from this event should the nurse focus when teaching these patients?

1. Diabetic ketoacidosis

2. Hypoglycemia

3. Hyperosmolar hyperglycemic state

4. Impaired glucose tolerance

Page Ref: 603

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.3 Differentiate the acute and chronic complications of DM and describe treatment plans for each.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

36) The nurse is teaching a patient with type 2 diabetes mellitus about glyburide (DiaBeta). Which medication should the nurse instruct the patient to monitor for dizziness, lightheadedness, and sweating if taken with the hypoglycemic agent? Select all that apply.

1. Ibuprofen

2. Ranitidine

3. Cetirizine

4. Metoprolol

5. Docusate sodium

Page Ref: 617

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

37) A patient with type 2 diabetes mellitus has been instructed on an eating plan where 65% of all daily calories are to be carbohydrates. The patient's daily caloric intake is to be 1600 calories. If each serving of carbohydrates is 15 grams and each gram is 4 kilocalories, how many servings of carbohydrates should the patient be instructed to consume each day? Record your answer rounding to the nearest whole number.

Page Ref: 620

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

38) The nurse is reviewing the actions that a patient with type 1 diabetes mellitus should take if mild hypoglycemia is experienced. What should the nurse include in this teaching? Select all that apply.

1. Test blood glucose 30 minutes after reaching a normal blood glucose level.

2. Ingest 4 ounces of fruit juice when mild hypoglycemia occurs.

3. Measure blood glucose 15 minutes after ingesting a carbohydrate source.

4. Add table sugar to 8 ounces of fruit juice when mild hypoglycemia occurs.

5. Ingest additional 15 grams of carbohydrate if blood glucose remains low after 15 minutes.

Page Ref: 604

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 20.3 Differentiate the acute and chronic complications of DM and describe treatment plans for each.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with diabetes mellitus.

39) The nurse is caring for a patient experiencing diabetic ketoacidosis. What action should the nurse take when preparing this patient's insulin infusion? Select all that apply.

1. Attach insulin infusion to an intravenous pump.

2. Have one ampule of Dextrose 10% at the bedside.

3. Flush the tubing with the insulin solution before connecting.

4. Prepare an infusion of Dextrose 5% and 0.45% normal saline.

5. Discontinue the infusion after first dose of subcutaneous insulin.

Page Ref: 603

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Practice-Know-How; Apply evidence to support decision making in situations characterized by ambiguity and uncertainty | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.3 Differentiate the acute and chronic complications of DM and describe treatment plans for each.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with diabetes mellitus.

40) The nurse notes that a patient with type 2 diabetes mellitus is not prescribed aspirin 81 mg as recommended for the prevention of cardiovascular complications. What information in the patient's health history should the nurse use to understand why this medication has not been prescribed for the patient? Select all that apply.

1. Patient receives a vitamin B12 injection every month.

2. Patient admitted for gastrointestinal bleeding 3 months ago.

3. Patient prescribed warfarin (Coumadin) 2.5 mg by mouth every day.

4. Patient treated for chronic alcoholism and liver cirrhosis the past year.

5. Patient develops a rash and urticaria when taking medications with sulfa.

Page Ref: 618

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.4 Outline the diagnostic tests used for screening, diagnosing, and monitoring DM and the use of insulin and oral hypoglycemic agents to treat patients with DM.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with diabetes mellitus.