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 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 a.Serum sodium: 163 mEq/L b.Serum creatinine: 1.6 mg/dL c.Presence of urine ketone bodies d.Serum osmolarity: 375 mOsm/kg ANS: D Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The client's serum osmolarity is high. The client's sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria. After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a."At my age, I should continue seeing the ophthalmologist as I usually do." b."I will see the eye doctor when I have a vision problem and yearly after age 40." c."My vision will change quickly. I should see the ophthalmologist twice 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 Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) 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 teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections? a."Wash your hands after completing each test." b."Do not share your monitoring equipment." c."Blot excess blood from the strip with a cotton ball." d."Use gloves when monitoring your blood glucose." ANS: B Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught to avoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her hands before testing. The client would not need to blot excess blood away from the strip or wear gloves. A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client's teaching? a."Change positions slowly when you get out of bed." b."Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." 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 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 glucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake. 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 a.Administer 1 mg of intramuscular glucagon. b.Encourage the client to drink orange juice. c.Insert a new intravenous access line. d.Administer 25 mL dextrose 50% (D50) IV push. ANS: A The client's blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the client's blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the client's blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter. 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 Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary 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 bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels. A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? a.Administration of oxygen via face mask b.Intravenous administration of 10% glucose c.Implementation of seizure precautions d.Administration of intravenous insulin ANS: D The rapid, deep respiratory efforts of Kussmaul respirations are the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the client glucose would be contraindicated. The client does not require seizure precautions. A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an 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." 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 take my cyclosporine exactly the way I was 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 c.Consult the provider to test for ketoacidosis. d.Perform meticulous pulmonary hygiene care. ANS: C The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a "fruity" odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this client's problem. A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take? a.Document the finding in the client's chart. b.Administer a bolus of regular insulin IV. c.Call the surgeon to cancel the procedure. d.Draw blood gases to assess the metabolic state. 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 assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next? a.Administer another half-cup of orange juice. b.Administer a half-ampule of dextrose 50% intravenously. c.Administer 10 units of regular insulin subcutaneously. d.Administer 1 mg of glucagon intramuscularly. 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.Glasgow Coma Scale score is unchanged. 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." 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."I can still develop complications even though I do not have to take insulin at this time." d."If I have surgery or get very ill, I may have to receive insulin injections for a short time. ANS: B Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in the future. When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How should the nurse respond? a."I can give your injections to you while you are here in the hospital." b."Everyone gets used to giving themselves injections. It really does not hurt." c."Your disease will not be managed properly if you refuse to administer the shots." d."Tell me what it is about the injections that are concerning you." ANS: D Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly 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 Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. 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: 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 • Fasting blood glucose: 75 mg/dL • 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 Because the client's glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance. A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: • Insulin glargine: 12 units daily at 1800 • Regular insulin: 6 units QID at 0600, 1200, 1800, 2400 Based on the client's medication administration record, which action should the nurse take? a.Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. b.Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin. c.First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together. d.First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix, and inject the two insulins together. 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 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 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 potassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurse 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 ANS: C The client's symptoms are related to hypoglycemia. Since the client has not been tolerating food, the nurse should administer dextrose intravenously. The client's oxygen level could be checked, but based on the information provided, this is not the priority. The client will not be reoriented until the glucose level rises. A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) 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 Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy 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 NS: A, B, D Which explanation best assists a client in differentiating type 1 diabetes from type 2 diabetes? a) Most clients with type 1 diabetes are born with it. b) People with type 1 diabetes are often obese. c) Those with type 2 diabetes make insulin, but in inadequate amounts. d) People with type 2 diabetes do not develop typical diabetic complications. Correct Answer: c People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for complications, especially cardiovascular complications. The nurse receives report on a 52-year-old client with 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 A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. 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." 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) "I should never go barefoot." 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) "I should begin exercising for at least an hour a day." b) "I should monitor my diet." c) "If I lose weight, I may not need to use the insulin anymore." d) "Weight loss can be a sign of diabetic ketoacidosis." Correct Answer: a For long-term maintenance of major weight loss, large amounts of exercise (7 hr/wk) or moderate or vigorous aerobic physical activity may be helpful, but the client must start slowly. Monitoring the diet is key to type 2 diabetes management. Weight loss can minimize the need for insulin and can also be a sign of diabetic ketoacidosis. The nurse is providing discharge teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet? a) "If I become hyperglycemic, it is a medical emergency." b) "If I become hypoglycemic, I could become unconscious." c) "Medical personnel may need confirmation of my insurance." d) "I may need to be admitted to the hospital suddenly." Correct Answer: b 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 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 can learn in one day may actually cause the client to become more nervous; an overload of information is 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. 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 is the best referral that the nurse can suggest to a client who has been newly diagnosed with diabetes? a) American Diabetes Association b) Centers for Disease Control and Prevention c) Health care provider office d) Pharmaceutical representative Correct Answer: a The American Diabetes Association can provide national and regional support and resources to clients with diabetes and their families. The Centers for Disease Control and Prevention does not focus on diabetes. The client's health care provider's office is not the best resource for diabetes information and support. A pharmaceutical representative is not an appropriate resource for diabetes information and support. 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 Performing bedside glucose monitoring is an activity that may be delegated because it does not require extensive clinical judgment to perform; the nurse will follow up with the results. Intravenous therapy and medication administration are not within the scope of practice for UAP. The client with blood glucose of 68 mg/dL will need further monitoring, assessment, and intervention not within the scope of practice for UAP. The client reporting palpitations and anxiety may have hypoglycemia, requiring further intervention; this client must be assessed by licensed nursing staff. The nurse has just taken change-of-shift report on a group of clients on the medical-surgical unit. Which client does the nurse assess first? a) Client taking repaglinide (Prandin) who has nausea and back pain b) Client taking glyburide (Diabeta) who is dizzy and sweaty c) Client taking metformin (Glucophage) who has abdominal cramps d) Client taking pioglitazone (Actos) who has bilateral ankle swelling Correct Answer: b The client taking glyburide (Diabeta) who is dizzy and sweaty has symptoms consistent with hypoglycemia and should be assessed first because this client displays the most serious adverse effect of antidiabetic medications. 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 A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action does the nurse plan to take next? a) Instruct the client to continue with the current diet and metformin use. b) Discuss the need to check blood glucose several times every day. c) Talk about the possibility of adding rapid-acting insulin to the regimen. d) Ask the client about current dietary intake and medication use. Correct Answer: d The nurse's first action should be to assess whether the client is adherent to the currently prescribed diet and medications. The client's current diet and medication use have not been successful in keeping glucose in the desired range. Checking blood glucose more frequently and/or using rapid-acting insulin may be appropriate, but this will depend on the assessment data. The HbA1C indicates that the client's average glucose level is not in the desired range, but discussing the need to check blood glucose several times every day assumes that the client is not compliant with the therapy and glucose monitoring. The nurse should not assume that adding 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 interpretation should the nurse make based on this result? 1. This result is below normal levels. 2. This result is within acceptable levels. 3. This result is above recommended levels. 4. This result is dangerously high. 1. The acceptable level for an A1c for a client with diabetes is between 6% and 7%, which corresponds to a 120- 140 mg/dL average blood glucose level. 2. This result is not within acceptable levels for the client with diabetes, which is 6% to 7%. **3. This result parallels a serum blood glucose level of approximately 180 to 200 mg/dL. An A1c is a 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 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 1. Crumbling toenails indicate tinea unguium, which is a fungus infection of the toenail. 2. Athlete's foot is a fungal infection that is not life threatening. **3. A necrotic big toe indicates "dead" tissue. The client does not feel pain in the lower extremity and does not realize there has been an injury and therefore does not seek treatment. Increased blood glucose levels decrease oxygen supply that is needed to heal the wound and increase the risk for developing an infection. 4. Big, thick toenails are fungal infections and would not require immediate intervention by the nurse; 50% of the adult population has this. TEST-TAKING HINT: The test taker should select the option that indicates to the nurse that this is possibly a life-altering complication or some type of assessment data that the health-care provider should be informed of immediately. Remember "warrants immediate intervention." The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with Type 2 diabetes that must be controlled with 70/30-combination insulin. Which intervention should be included in the plan of care? 1. Assess the client's ability to read small print. 2. Monitor the client's serum PT 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 4. Pancreatic enzymes are administered when the pancreas cannot produce amylase and lipase, not when the 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 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 enough glucose to pre- vent hypoglycemia when receiving insulin. 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 2. Have the client drink eight (8) ounces of orange juice. 3. Go to the client's room and assess the client for hypoglycemia. 4. Prepare to administer one amp 50% Dextrose intravenously. 1. The blood glucose level should be obtained, but it is not the first intervention. 2. If it is determined that the client is having a hypoglycemic reaction, orange juice would be appropriate. **3. Regular insulin peaks in 2-4 hours. There- fore, the nurse should think about the possibility that the client is having a hypo- glycemic reaction and should assess the client. The nurse should not delegate nursing tasks to an assistant if the client is unstable. 4. Dextrose 50% is only administered if the client is unconscious and the nurse suspects hypo- glycemia. TEST-TAKING HINT: When answering a question that requires the nurse to implement an intervention first, all four options will be interventions that are appropriate for the situation but only one answer should be implemented first. The test taker must apply the nursing process, which states assessment of the first intervention. The nurse at a freestanding health clinic is caring for a 56-year-old client who is home- less and is a Type 2 diabetic controlled with insulin. Which action is an example of client advocacy? 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 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 receiving regular insulin drips. 4. Arterial blood gases are not affected in HHS because there is no breakdown of fat resulting in ketones that cause metabolic acidosis. TEST-TAKING HINT: The test taker should elim- inate option "3" based on the word "daily." In the ICU with a client who is very ill, most checks would be more often than daily. Remember to look at adjectives; "intermedi- ate" in option "2" is the word that eliminates this as a possible correct answer. Which electrolyte replacement should the nurse anticipate being ordered by the health-care provider in the client diagnosed with DKA who has just been admitted to the ICD? 1. Glucose. 2. Potassium. 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. Administer 50% dextrose IVP. 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. 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: Responding to medical treatment is asking the test taker to determine which data indicate the client is getting better. The correct answer will be normal data and the other three (3) options will be signs/symp- toms of the disease process or condition. The nursing assistant on the medical floor tells the primary nurse that the client diag- nosed with DKA wants something else to eat for lunch. What action should the nurse implement? 1. Instruct the assistant to get the client additional food. 2. Notify the dietician about the client's request. 3. Ask the assistant to obtain a glucometer reading. 4. Tell the assistant that the client cannot have anything else. 1. The client is on a special diet and should not have any additional food. **2. The client will not be compliant with the diet if he or she is still hungry. Therefore, the nurse should request the dietician to talk to the client to try and adjust the meals so that the client will adhere to the diet. 3. There is no need for the assistant to check the client's glucose level. 4. The client is on a special diet. The nurse needs to help the client maintain compliance with the medical treatment and should refer the client to the dietician. 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. The American Diabetic Association is an excellent referral, but the nurse should discuss specific ways 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 CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers Which arterial blood gas would the nurse expect in the client diagnosed with diabetic ketoacidosis? 1. pH 7.34, PaO2 99, PaCO2 48, HCO3 24. 2. pH 7.38, PaO2 95, PaCO2 40, HCO3 22. 3. pH 7.46, PaO2 85, PaCO2 30, HCO3 26. 4. pH 7.30, PaO2 90, PaCO2 30, HCO3 18. 1. This ABG indicates respiratory acidosis, which would not be expected. 2. This ABG is normal, which would not be expected. 3. This ABG indicates respiratory alkalosis, which would not be expected. **4. This ABG indicates metabolic acidosis, which is what is expected in a client that is in diabetic ketoacidosis. TEST-TAKING HINT: The client must know normal ABGs to be able to correctly answer this question. Normal ABGs are pH 7.35-7.45; PaO2 80-100; PaCO2 35-45; HCO3 22-26. The client is admitted to the ICD diagnosed with DKA. Which interventions should the nurse implement? Select all that apply. CNA 101Diabetes Mellitus (exam 3) latest update (Q & As)upgraded/rated 100 % correct answers