CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answe, Exams of Nursing

Download CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answe and more Exams Nursing in PDF only on Docsity! CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How should the nurse respond? a. "Glucose is the only fuel used by the body to produce the energy that it needs." b. "Your brain needs a constant supply of glucose because it cannot store it." c. "Without a minimum level of glucose, your body does not make red blood cells." d. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis." ANS: B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation. A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria? CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers ANS: C Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the client's chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed. A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How should the nurse respond? a. "Your risk of diabetes is higher than the general population, but it may not occur." b. "No genetic risk is associated with the development of type 1 diabetes mellitus." c. "The risk for becoming a diabetic is 50% because of how it is inherited." d. "Female children do not inherit diabetes mellitus, but male children will." ANS: A Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate. A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? a."Maintain tight glycemic control and prevent hyperglycemia." b."Restrict your fluid intake to no more than 2 liters a day." c."Prevent hypoglycemia by eating a bedtime snack." d."Limit your intake of protein to prevent ketoacidosis." ANS: A Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as important as maintaining daily glycemic control. A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers a.A 29-year-old Caucasian b.A 32-year-old African-American c.A 44-year-old Asian d.A 48-year-old American Indian ANS: D Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-aged places this client at highest risk. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? a.Assess for pain or burning with urination. b.Review the client's liver function study results. c.Instruct the client to increase water intake. d.Test a sample of urine for occult blood. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers ANS: B Thiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at the start of therapy and at regular intervals while the client continues to take these drugs. Dark urine is one indicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurse should check the client's most recent liver function studies. The nurse does not need to assess for pain or burning with urination and does not need to check the urine for occult blood. The client does not need to be told to increase water intake. A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How should the nurse respond? a. "You need to start with multiple injections until you become more proficient at self-injection." b. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." c. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." d. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock." ANS: B Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Additional injections are not required to allow the client practice with injections, nor will one dose increase the client's risk of insulin shock. After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "The lower abdomen is the best location because it is closest to the pancreas." b. "I can reach my thigh the best, so I will use the different areas of my thighs." c. "By rotating the sites in one area, my chance of having a reaction is decreased." d."Changing injection sites from the thigh to the arm will change absorption rates." ANS: A The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration. A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first? CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers c. "Store the insulin in the freezer until you need it." d. "Change the needle every 3 days." ANS: D Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk for infection in or through the delivery system. Having an insulin pump does not require the client to test for ketones in the urine. Insulin should not be frozen. Insulin is not buffered. After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I have so many complications; exercising is not recommended." b. "I will exercise more frequently because I have so many complications." c. "I used to run for exercise; I will start training for a marathon." d. "I should look into swimming or water aerobics to get my exercise." ANS: D Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously. An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition? a.Increased rate and depth of respiration b.Extremity tremors followed by seizure activity c.Oral temperature of 102° F (38.9° C) d.Severe orthostatic hypotension ANS: A CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis. A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client? a.pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg b.pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg c.pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg d.pH 7.32, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg ANS: B When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this client's teaching to decrease the client's insulin needs? a. "Limit your fluid intake to 2 liters a day." b. "Animal organ meat is high in insulin." c. "Limit your carbohydrate intake to 80 grams a day." d. "Walk at a moderate pace for 1 mile daily." ANS: D Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day. A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, "I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." How should the nurse respond? CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers a. "Following the drug regimen more closely would have prevented this." b. "One acute rejection episode does not mean that you will lose the new organs." c."Dialysis is a viable treatment option for you and may save your life." d."Since you are on the national registry, you can receive a second transplantation." ANS: B An episode of acute rejection does not automatically mean that the client will lose the transplant. Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allow the graft to be maintained. The other statements either belittle the client or downplay his or her concerns. The client may not be a candidate for additional organ transplantation. After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional education? a. "If I develop an infection, I should stop taking my corticosteroid." b. "If I have pain over the transplant site, I will call the surgeon immediately." c. "I should avoid people who are ill or who have an infection." d. "I should take my cyclosporine exactly the way I was CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers taught." ANS: A Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Anti-rejection drugs cause immunosuppression, and the client should avoid crowds and people who are ill. Changing the routine of anti- rejection medications may cause them to not work optimally. A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a "fruity" odor. Which action should the nurse take? a.Encourage the client to use an incentive spirometer. b.Increase the client's intravenous fluid flow rate. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury. A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, "My cousin has depression and is taking this drug. Do you think I'm depressed?" How should the nurse respond? a. "Many people with long-term diabetes become depressed after a while." b. "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?" c. "This antidepressant also has anti-inflammatory properties for diabetic pain." d. "No. Many medications can be used for several different disorders." CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers ANS: B Damage along nerves causes peripheral neuropathy and leads to burning pain along the nerves. Many drugs, including duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The nurse should assess the client for this condition and then should provide an explanation of why this drug is being used. This medication, although it is used for depression, is not being used for that reason in this case. Duloxetine does not have anti- inflammatory properties. Telling the client that many medications are used for different disorders does not provide the client with enough information to be useful. A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a.Urine specific gravity of 1.033 b.Presence of protein in the urine c.Elevated capillary blood glucose level d.Presence of ketone bodies in the urine CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function. A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet should the nurse decrease? a.Carbohydrates b.Proteins c.Fats d.Total calories ANS: B Restriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients with microalbuminuria to delay progression to renal failure. The client's diet does not need to be decreased in carbohydrates, fats, or total calories. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching? a. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." b. "Monitor your blood glucose levels at least every 4 hours while sick." c. "If vomiting, do not use insulin or take your oral antidiabetic agent." d. "Try to continue your prescribed exercise regimen even if you are sick." ANS: B When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick. A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted? a.Serum potassium level has increased. b.Blood osmolarity has decreased. c.Glasgow Coma Scale score is unchanged. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers d.Urine remains negative for ketone bodies. ANS: C A slow but steady improvement in central nervous system functioning is the best indicator of therapy effectiveness for HHS. Lack of improvement in the level of consciousness may indicate inadequate rates of fluid replacement. The Glasgow Coma Scale assesses the client's state of consciousness against criteria of a scale including best eye, verbal, and motor responses. An increase in serum potassium, decreased blood osmolality, and urine negative for ketone bodies do not indicate adequacy of treatment. nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers NPH insulin? a.0800 b.1600 c.2000 d.2300 ANS: B Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the client at 2000 and 2300 would be too late. The nurse should check the client at 1600. After teaching a client with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I need to have an annual appointment even if my glucose levels are in good control." b. "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick." c. "I can still develop complications even though I do not have to take insulin at this time." CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers ANS: D client's tissue has been damaged from continuous use of the same site. The client should be educated to rotate sites. The damaged tissue is not caused by cellulitis or any type infection, and applying ice may cause more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be appropriate or practical to change the administration route. A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? a.Pioglitazone (Actos) b.Glimepiride (Amaryl) c.Glipizide (Glucotrol) d.Metformin (Glucophage) ANS: D Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast. After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I should increase my intake of vegetables with higher amounts of dietary fiber." b. "My intake of saturated fats should be no more than 10% of my total calorie intake." c. "I should decrease my intake of protein and eliminate carbohydrates from my diet." d. "My intake of water is not restricted by my treatment plan or medication regimen." ANS: C The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present. A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: • Fasting blood glucose: 75 mg/dL CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers • Postprandial blood glucose: 200 mg/dL • Hemoglobin A1c level: 5.5% How should the nurse interpret these laboratory findings? a.Increased risk for developing ketoacidosis b.Good control of blood glucose c.Increased risk for developing hyperglycemia d.Signs of insulin resistance ANS: B The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers d. 2, 3, 1, 8, 7, 5, 4, 6 ANS: B After washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubber stoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. It is important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoid mixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first. A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis: Vital Signs and Assessment Laboratory Results CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Medications Blood pressure: 90/62 mm Hg Pulse: 120 beats/min Respiratory rate: 28 breaths/min Urine output: 20 mL/hr via catheter Serum potassium: 2.6 mEq/L Potassium chloride 40 mEq IV bolus STAT Increase IV fluid to 100 mL/hr Which action should the nurse take? a.Administer the potassium and then consult with the provider about the fluid order. b.Increase the intravenous rate and then consult with the provider about the potassium prescription. c.Administer the potassium first before increasing the infusion flow rate. d.Increase the intravenous flow rate before administering the potassium. ANS: B The client is acutely ill and is severely dehydrated and hypokalemic. The client requires more IV fluids and potassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurse CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers should first increase the IV rate and then consult with the provider about the potassium. At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominal hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews the assessment data provided in the chart below: Capillary Blood Glucose Testing (AC/HS) Dietary Intake At 0630: 95 At 1130: 70 At 1630: 47 Breakfast: 10% eaten - client states she is not hungry Lunch: 5% eaten - client is nauseous; vomits once After reviewing the client's assessment data, which action is appropriate at this time? a.Assess the client's oxygen saturation level and administer oxygen. b.Reorient the client and apply a cool washcloth to the client's forehead. c.Administer dextrose 50% intravenously and reassess the client. d.Provide a glass of orange juice and encourage the client to eat dinner. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers d.Dependent pulmonary crackles e.Orthostatic hypotension ANS: A, C, E DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur. A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Do not walk around barefoot." b. "Soak your feet in a tub each evening." c. "Trim toenails straight across with a nail clipper." d. "Treat any blisters or sores with Epsom salts." e. "Wash your feet every other day." ANS: A, C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds. A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.) a.Stroke b.Kidney failure c.Blindness CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers d.Respiratory failure e.Cirrhosis ANS: A, B, C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus. A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.) a.Registered dietitian b.Clinical pharmacist c.Occupational therapist d.Health care provider e.Speech-language pathologist CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers must be reported to avoid potential gangrene and amputation. Although one glucose reading is elevated, the hemoglobin A1c indicates successful glucose control over the past 3 months. After the age of 40, reading glasses may be needed due to difficulty in accommodating to close objects. Lungs are clear and no evidence of distress is noted. A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client should be monitored for hypoglycemia at which time? a) 7:30 a.m. b) 11:00 a.m. c) 2:00 p.m. d) 7:30 p.m. Correct Answer: b Onset of regular insulin is ½ to 1 hour; peak is 2 to 4 hours. Therefore, 11:00 a.m. is the anticipated peak time for regular insulin received at 7:00 a.m. For regular insulin received at 7:00 a.m., 7:30 a.m., 2:00 p.m., and 7:30 p.m. are not the anticipated peak times. A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Which information is the priority for the nurse to teach the client and the client's family? a) Causes and treatment of hyperglycemia b) Causes and treatment of hypoglycemia c) Dietary control d) Insulin administration Correct Answer: b The causes and treatment of hypoglycemia must be understood by the client and family to manage the client's diabetes effectively. The causes and treatment of hyperglycemia is a topic for secondary teaching and is not the priority for the client with diabetes. Dietary control and insulin administration are important, but are not the priority in this situation. The nurse is providing discharge teaching to a client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching? a) "I can break in my shoes by wearing them all day." b) "I need to monitor my feet daily for blisters or skin breaks." c) "I should never go barefoot." CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers d) "I should quit smoking." Correct Answer: a Shoes should be properly fitted and worn for a few hours a day to break them in, with frequent inspection for irritation or blistering. People with diabetes have decreased peripheral circulation, so even small injuries to the feet must be managed early. Going barefoot is contraindicated. Tobacco use further decreases peripheral circulation in a client with diabetes. The nurse is teaching a client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers a) Current lifestyle b) Educational and literacy level c) Sexual orientation d) Current energy level CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Correct Answer: b A large amount of information must be synthesized; typically written instructions are given. The client's educational and literacy level is essential information. Although lifestyle should be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the client to provide self-care. Although energy level will influence the ability to exercise, it is not essential. A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response? a) "It is overwhelming, isn't it?" b) "Let's see how much you can learn today, so you are less nervous." c) "Let's tackle it piece by piece. What is most scary to you?" d) "Other people do it just fine." Correct Answer: c Suggesting the client tackle it piece by piece and asking what is most scary to him or her is the best response; this approach will allow the client to have a sense of mastery with acceptance. Referring to the illness as overwhelming is supportive, but is not therapeutic or helpful to the client. Trying to see how much the client can learn in one day may actually cause the client to become more nervous; an overload of information is CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers overwhelming. Suggesting that other people handle the illness just fine is belittling and dismisses the client's concerns. A client recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the client the proper use of the machine? a) Day of discharge b) On admission c) When the client states readiness d) While performing the test in the hospital Correct Answer: d Teaching the client about the operation of the machine while performing the test in the hospital is the best way for the client to learn. The teaching can be reinforced before discharge. Instructing the client on the day of admission or the day of discharge would be overwhelming to the client because of all of the other activities taking place on those days. The client may never feel ready to learn this daunting task; the nurse must be more proactive. Which is the best referral that the nurse can suggest to a client who has been newly diagnosed with diabetes? CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers a) "I should go barefoot in my house so that my feet are exposed to air." b) "I must inspect my shoes for foreign objects before putting them on." c) "I will soak my feet in warm water to soften calluses before trying to remove them." d) "I must wear canvas shoes as much as possible to decrease pressure on my feet." Correct Answer: b To avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on. Diabetic clients should not go barefoot because foot injuries can occur. To avoid injury or trauma, a callus should be removed by a podiatrist, not by the client. The diabetic client must wear firm support shoes to prevent injury. An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make? a) Urine output b) 12-lead electrocardiogram (ECG) c) Potassium level d) Rate of IV fluids CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Correct Answer: c With insulin therapy, serum potassium levels fall rapidly as potassium shifts into the cells. Detecting and treating the underlying cause is essential. Insulin treats symptoms of diabetes by putting glucose into the cell as well as potassium; ectopy, indicative of cardiac irritability, is not associated with changes in urine output. A 12- lead ECG can verify the ectopy, but the priority is to detect and fix the underlying cause. Increased fluids treat the symptoms of dehydration secondary to DKA, but do not treat the cause. In reviewing the health care provider admission requests for a client admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis? a) 20 mEq KCl for each liter of IV fluid b) IV regular insulin at 2 units/hr CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers c) IV normal saline at 100 mL/hr d) 1 ampule NaHCO3 IV now Correct Answer: d NaHCO3 is given for the acid-base imbalance of diabetic ketoacidosis, not the hyperglycemic-hyperosmolar state, which presents with hyperglycemia and absence of ketosis/acidosis. KCl 20 mEq for each liter of IV fluid will correct hypokalemia from diuresis. IV regular insulin at 2 units/hr will correct hyperglycemia. IV normal saline at 100 mL/hr will correct dehydration. The nurse caring for four diabetic clients has all of these activities to perform. Which is appropriate to delegate to unlicensed assistive personnel (UAP)? a) Perform hourly bedside blood glucose checks for a client with hyperglycemia. b) Verify the infusion rate on a continuous infusion insulin pump. c) Monitor a client with blood glucose of 68 mg/dL for tremors and irritability. d) Check on a client who is reporting palpitations and anxiety. Correct Answer: a CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers assistive personnel while assessing the client whose insulin pump is beeping. Although a blood glucose reading of 150 mg/dL is mildly elevated, this is not an emergency. Mild hypertension is also not an emergency. Which nursing action can the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes? a) Assist the client's spouse in choosing appropriate dietary items. b) Evaluate the client's use of a home blood glucose monitor. c) Inspect the extremities for evidence of poor circulation. d) Assist the client with washing the feet and applying moisturizing lotion. Correct Answer: d Assisting with personal hygiene is included in the role of home health aides. Assisting with dietary choices, evaluating the effectiveness of teaching, and performing assessments are complex actions that should be implemented by licensed nurses. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Which of these clients with diabetes does the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit? a) A 58-year-old with sensory neuropathy who needs teaching about foot care b) A 68-year-old with diabetic ketoacidosis who has an IV running at 250 mL/hr c) A 70-year-old who needs blood glucose monitoring and insulin before each meal d) A 76-year-old who was admitted with fatigue and shortness of breath Correct Answer: c A nurse from the labor/delivery unit would be familiar with blood glucose monitoring and insulin administration because clients with type 1 and gestational diabetes are frequently cared for in the labor/delivery unit. The 58-year-old with sensory neuropathy, the 68-year-old with diabetic ketoacidosis, and the 76-year-old with fatigue and shortness of breath all have specific teaching or assessment needs that are better handled by nurses more familiar with caring for older adults with diabetes. A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The client's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Hg, and O2 saturation 99% on room air. Which action does the nurse take first? a) Check the blood glucose. b) Administer oxygen. c) Offer reassurance. d) Attach a cardiac monitor. Correct Answer: a The client's clinical presentation is consistent with diabetic ketoacidosis, so the nurse should initially check the client's glucose level. Based on the oxygen saturation, oxygen administration is not necessary. The nurse provides support, but it is early in the course of assessment and intervention to offer reassurance without more information. Cardiac monitoring may be implemented, but the first action should be to obtain the glucose level. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Which action is correct when drawing up a single dose of insulin? a) Wash hands thoroughly and don sterile gloves. b) Shake the bottle of insulin vigorously to mix the insulin. c) Pull back plunger to draw air into the syringe equal to the insulin dose. d) Recap the needle and save the syringe for the next dose of insulin. Correct Answer: c The plunger is pulled back to draw an amount of air into the syringe that is equal to the insulin dose. The air is then injected into the insulin bottle before withdrawing the insulin dose. Although handwashing is important before any medication administration, sterile gloves are not required. The bottle of insulin should be rolled gently in the palms of the hands to mix the insulin, not shaken. Insulin syringes are never recapped or reused; the syringe and needle should be disposed of (without recapping) in a puncture-proof container. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Exam 2: Diabetes Mellitus The client, an 18-year-old female, 54 tall, weighing 113 kg, comes to the clinic for a wound on her lower leg that has not healed for the last two (2) weeks. Which disease process would the nurse suspect that the client has developed? 1. Type 1 diabetes. 2. Type 2 diabetes. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers 3. Gestational diabetes. 4. Acanthosis nigricans. 1. Type 1 diabetes usually occurs in young clients who are underweight. In this disease, there is no production of insulin from the beta cells in the pancreas. People with Type 1 diabetes are insulin-dependent with a rapid onset of symp- toms, including polyuria, polydipsia, and polyphagia. **2. Type 2 diabetes is a disorder that usually occurs around the age of 40, but it is now being detected in children and young adults as a result of obesity and sedentary life- styles. Wounds that do not heal are a hall- mark sign of Type 2 diabetes. This client weighs 248.6 pounds and is short. 3. Gestational diabetes is diabetes that occurs during pregnancy. 4. Acanthosis nigricans (AN), dark pigmentation and skin creases in the neck, is a sign of hyper- insulinemia. The pancreas is secreting excess amounts of insulin as a result of excessive caloric intake. It is identified in young children and is a precursor to the development of Type 2 diabetes. TEST-TAKING HINT: The test taker must be aware of kilogram and pounds; the stem is asking about a disease process and acantho- sis nigricans is a clinical manifestation of a disease, not a disease itself. Therefore, the test taker should not select this as a correct answer. The client diagnosed with Type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers 2. The food intake at lunch will not affect the client's blood glucose level at midnight. 3. The client's glucometer reading should be done around 2100 to assess the effectiveness of insulin at 1600. 4. Humulin N is an intermediate-acting insulin that has an onset in 2-4 hours but does not peak until 6-8 hours. TEST-TAKING HINT: Remember to look at the adjective or descriptor. Intermediate-acting insulin gives the reader a clue that anything intermediate, instead of longer-acting, action would be incorrect. The client diagnosed with Type 1 diabetes is receiving Humalog, a rapid-acting insulin, by sliding scale. The order reads blood glucose level: 150, 0 units; 151-200, 3 units; 201-250, 6 units; 251, contact health-care provider. The unlicensed nursing assistant reports to the nurse that the client's glucometer reading is 189. How much insulin should the nurse administer to the client? Three (3) units. The client's result is 189, which is between 151 and 200, so the nurse should administer 3 units of Humalog insulin subcutaneously. TEST-TAKING HINT: The test taker must be aware of the way the HCPs write medication orders. HCPs order insulin in a sliding scale according to a range of blood glucose levels. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers The nurse is discussing the importance of exercising to a client diagnosed with Type 2 diabetes whose diabetes is well controlled with diet and exercise. Which information should the nurse include in the teaching about diabetes? 1. Eat a simple carbohydrate snack before exercising. 2. Carry peanut butter crackers when exercising. 3. Encourage the client to walk 20 minutes three (3) times a week. 4. Perform warmup and cooldown exercises. 1. The client diagnosed with Type 2 diabetes who is not taking insulin or oral agents does not need extra food before exercise. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers 2. The client with diabetes who is at risk for hypoglycemia when exercising should carry a simple carbohydrate, but this client is not at risk for hypoglycemia. 3. Clients with diabetes that is controlled by diet and exercise must exercise daily at the same time and in the same amount to control the glucose level. **4. All clients who exercise should perform warmup and cooldown exercises to help prevent muscle strain and injury. TEST-TAKING HINT: The "1" and "2" options apply directly to clients diagnosed with dia- betes and "3" and "4" options do not directly address clients diagnosed with diabetes. The reader could narrow the choices by either eliminating or including the two similar options. The nurse is caring for a client with long-term Type 2 diabetes and is assessing the feet. Which assessment data would warrant immediate intervention by the nurse? 1. The client has crumbling toenails. 2. The client has athlete's feet. 3. The client has a necrotic big toe. 4. The client has thickened toenails. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers TEST-TAKING HINT: Always notice the age of a client if it is given because this is often impor- tant when determining the correct answer for the question. Be sure to read the adjectives such as "weekly," instead of "daily." The client with Type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a computed tomography (CT) with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement? 1. Provide a high-fat diet 24 hours prior to test. 2. Hold the biguanide medication for 48 hours prior to test. 3. Obtain an informed consent form for the test. 4. Administer pancreatic enzymes prior to the test. 1. High-fat diets are not recommended for clients diagnosed with diabetes, and food does not have an effect on a CT scan with contrast. **2. Biguanide medication must be held for a test with contrast medium because it in- creases the risk of lactic acidosis, which leads to renal problems. 3. Informed consent is not required for a CT scan. The admission consent covers routine diagnostic procedures. 4. Pancreatic enzymes are administered when the pancreas cannot produce amylase and lipase, not when the CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers beta cells cannot produce insulin. TEST-TAKING HINT: The test taker could elimi- nate option "1" because high-fat diets are not recommended for any client. Because the stem specifically refers to the biguanide medication and CT contrast, a good choice would address both of these. Option "2" discusses both the medication and the test. The diabetic educator is teaching a class on diabetes Type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion? Select all that apply. 1. Take diabetic medication even if unable to eat the client's normal diabetic diet. 2. If unable to eat, drink liquids that are equal to the client's normal caloric intake. 3. It is not necessary to notify the health-care provider if ketones are in the urine. 4. Test blood glucose levels and test urine ketones once a day and keep a record. 5. Call the health-care provider if glucose levels are higher than 180 mg/dL. **1. The most important issue to teach clients is to take insulin even if they are unable to eat. Glucose levels are increased with ill- ness and stress. **2. The client should drink liquids such as regular cola, orange juice, or regular gela- tin, which provide enough glucose to pre- vent hypoglycemia when receiving insulin. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers 3. Ketones indicate a breakdown of fat and must be reported to the HCP because they can lead to metabolic acidosis. 4. Blood glucose levels and ketones must be checked every three (3) to four (4) hours, not daily. **5. The HCP should be notified if the blood glucose level is this high. Regular insulin may need to be prescribed to keep the blood glucose level within acceptable range. TEST-TAKING HINT: This is an alternate-type question that may have more than one correct answer. The test taker should read all options and determine if it is an intervention that is appropriate. The client received 10 units of Humulin R, a fast acting insulin, at 0700. At 1030 the unlicensed nursing assistant tells the nurse the client has a headache and is really acting "funny." Which action should the nurse implement first? 1. Instruct the assistant to obtain blood glucose level. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers would be an appropriate short-term goal for the client? 1. The client will have a blood glucose level between 90 and 140 mg/dL. 2. The client will demonstrate appropriate insulin injection technique. 3. The nurse will monitor the client's blood glucose levels four times a day. 4. The client will maintain normal kidney function with 30 mL/hr urine output. **1. The short-term goal must address the response part of the nursing diagnosis, which is "high risk for hyperglycemia," and this blood glucose level is within acceptable ranges for a client who is noncompliant. 2. This is an appropriate goal for a knowledge- deficit nursing diagnosis. Noncompliance is not always the result of knowledge deficit. 3. Note that this is the nurse implementing an intervention and the question asks for a goal, which addresses the problem of "high risk for hyperglycemia." 4. The question asks for a short-term goal and this is an example of a long-term goal. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers TEST-TAKING HINT: Remember the nursing diagnosis consists of a problem related to an etiology. The goals must address the problem and the interventions must address the etiol- ogy. Always remember a short-term goal is usually a goal that can be met during the hospitalization, and the long-term goal may take weeks, months, or even years. The client diagnosed with Type 2 diabetes is admitted to the intensive care department with hyperosmolar hyperglycemic nonketonic state coma (HHS). Which assessment data would the nurse expect the client to exhibit? 1. Kussmaul's respirations. 2. Diarrhea and epigastric pain. 3. Dry mucous membranes. 4. Ketone breath odor. 1. This occurs with diabetic ketoacidosis (DKA) as a result of the breakdown of fat, resulting in ketones. 2. Diarrhea and epigastric pain are not associated with HHS. **3. Dry mucous membranes are a result of the hyperglycemia and occur with both HHS and DKA. 4. This occurs with DKA as a result of the break- down of fat, resulting in ketones. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers TEST-TAKING HINT: The test taker must be able to differentiate between HHS (Type 2) and DKA (Type 1), which primarily is the result of the breakdown of fat and results in an increase in ketones that causes a decrease in pH, result- ing in metabolic acidosis. The elderly client is admitted to the intensive care department diagnosed with severe HHS. Which collaborative intervention should the nurse include in the plan of care? 1. Infuse 0.9% normal saline intravenously. 2. Administer intermediate-acting insulin. 3. Perform blood glucometer checks daily. 4. Monitor arterial blood gas results. **1. The initial fluid replacement is O.9% normal saline (an isotonic solution) intra- venously, followed by 0.45% saline. The rate depends on the client's fluid volume status and physical health, especially that of the heart. 2. Regular insulin, not intermediate, is the insulin of choice because of its quick onset and peak in two (2) to four (4) hours. 3. Blood glucometer checks are done every one (1) hour or more often in clients with HHS who are receiving regular insulin drips. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers 3. Provide the client with a therapeutic diabetic meal. 4. Notify the HCP to obtain an order to decrease insulin therapy. 1. The regular intravenous insulin is continued because ketosis is not present, as with DKA. 2. The client diagnosed with Type 2 diabetes does not excrete ketones in HHS because there is enough insulin to prevent fat breakdown but not enough to lower blood glucose. 3. The client may or may not feel like eating,but it is not the appropriate intervention when the blood glucose level is reduced to 300 mg/dL. **4. When the glucose level is decreased to around 300 mg/dL, the regular insulin infu- sion therapy is decreased. Subcutaneous insulin will be administered per sliding scale. TEST-TAKING HINT: When two (2) options are the opposite of each other, they can either be eliminated or they can help eliminate the other two options as incorrect answers. Options "2" and "3" do not have insulin in the answer; therefore they should be eliminated as possible answers. The client diagnosed with Type 1 diabetes is found lying unconscious on the floor of the bathroom. Which intervention should the nurse implement first? 1. Administer 50% dextrose IVP. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers 2. Notify the health-care provider. 3. Move the client to the ICD. 4. Check the serum glucose level. **1. The nurse should assume the client is hypoglycemic and administer IVP dextrose, which will rouse the client immediately. If the collapse is the result of hyperglycemia, this additional dextrose will not further injure the client. 2. The health-care provider may or may not need to be notified, but this would not be the first intervention. 3. The client should be left in the client's room, and 50% dextrose should be administered first. 4. The serum glucose level requires a venipuncture, which will take too long. A blood glucometer reading may be obtained, but the nurse should first treat the client, not the machine. The glucometer only reads "low" after a certain point, and a serum level would be needed to confirm exact glucose level. TEST-TAKING HINT: The question is requesting the test taker to select which intervention should be CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers implemented first. All four options could be possible interventions, but only one is first. The test taker should select the intervention that will directly treat the client; do not select a diagnostic test. Which assessment data indicate that the client diagnosed with diabetic ketoacidosis is responding to the medical treatment? 1. The client has tented skin turgor and dry mucous membranes. 2. The client is alert and oriented to date, time, and place. 3. The client's ABGs results are pH 7.29, PaCO2 44, HCO3 15. 4. The client's serum potassium level is 3.3 mEq/L. 1. This indicates the client is dehydrated, which does not indicate that the client is getting better. **2. The client's level of consciousness can be altered because of dehydration and acido- sis. If the client's sensorium is intact, the client is getting better and responding to the medical treatment. 3. These ABGs indicate metabolic acidosis; there- fore the client is not responding to treatment. 4. This potassium level is low and indicates hypokalemia, which shows the client is not responding to medical treatment. TEST-TAKING HINT: Responding to medical treatment is asking the test taker to determine which data CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers 1. A client with Type 2 diabetes usually is prescribed oral hypoglycemic medications, not insulin. 2. The client could not eat enough food to cause a 680 mg/dL blood glucose level; therefore this question does not need to be asked. **3. The most common precipitating factor is infection. The manifestations may be slow to appear, with onset ranging from 24 hours to 2 weeks. 4. This would not help determine the cause of this client's HHS. TEST-TAKING HINT: If the test taker does not know the answer to this question, the test taker could possibly relate acute complication and realize that a medical problem might cause this and select infection, option "3." The nurse is discussing ways to prevent diabetic ketoacidosis with the client diagnosed with Type 1 diabetes. Which instruction would be most important to discuss with the client? 1. Refer the client to the American Diabetes Association. 2. Do not take any over-the-counter medications. 3. Take the prescribed insulin even when unable to eat because of illness. 4. Be sure to get your annual flu and pneumonia vaccines. 1. The American Diabetic Association is an excellent referral, but the nurse should discuss specific ways CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers to prevent DKA. 2. The client should be careful with OTC medications, but this intervention would not help prevent the development of DKA. **3. Illness increases blood glucose levels; therefore the client must take insulin and drink high-carbohydrate fluids such as regular Jell-O, regular popsicles, and orange juice. 4. Vaccines are important to help prevent illness, but regardless of whether the client gets these vaccines, the client can still develop diabetic ketoacidosis. TEST-TAKING HINT: The words "most impor- tant" in the stem of the question indicate that one or more option may be appropriate instructions but only one is the priority inter- vention. The charge nurse is making client assignments in the intensive care department. Which client should be assigned to the most experienced nurse? 1. The client with Type 2 diabetes who has a blood glucose level of 348 mg/dL. 2. The client diagnosed with Type 1 diabetes who is experiencing hypoglycemia. 3. The client with DKA who has multifocal premature ventricular contractions. 4. The client with HHS who has a plasma osmolarity of 290 mOsm/L. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers 1. This blood glucose level is elevated, but not life threatening, in the client diagnosed with Type 2 diabetes. Therefore, a less experienced nurse could care for this client. 2. Hypoglycemia is an acute complication of Type 1 diabetes, but it can be managed by frequent monitoring, so a less experienced nurse could care for this client. **3. Multifocal PVCs, which are secondary to hypokalemia and which can occur in clients with DKA, are an emergency and can be life threatening. This client needs an expe- rienced nurse. 4. A plasma osmolarity of 280-300 mOsm/L is within normal limits; therefore, a less experi- enced nurse could care for this client. TEST-TAKING HINT: The test taker must select the client that has an abnormal, unexpected, or life-threatening sign/symptom for the disease process and assign this client to the most experienced nurse. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers