Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection?
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Solution
More insulin
During periods of infection or illness, diabetics may need even more insulin to compensate for increased blood glucose levels.
A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?
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Solution
Kussmaul’s respirations and a fruity odor on the breath
Coma and severe acidosis are ushered in with Kussmaul’s respirations (very deep but not labored respirations) and a fruity odor on the breath (academia).
Which of the following causes of HHNS is most common?
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Solution
Undiagnosed, untreated diabetes mellitus
Undiagnosed, untreated DM is one of the most common causes of HHNS.
Insulin forces which of the following electrolytes out of the plasma and into the cells?
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Solution
Potassium
Insulin forces potassium out of the plasma, back into the cells, causing hypokalemia. Potassium is needed to help transport glucose and insulin into the cells. Calcium, magnesium, and phosphorus aren’t affected by insulin.
Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?
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Solution
IV bolus, followed by continuous infusion.
An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose. After the client is stabilized, subcutaneous insulin is given. Insulin is never given intramuscularly.
Rotating injection sites when administering insulin prevents which of the following complications?
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Solution
Insulin lipodystrophy
Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites.
Which of the following chronic complications is associated with diabetes?
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Solution
Retinopathy, neuropathy, and coronary artery disease
These are all chronic complications of diabetes. Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism. Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia.
Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?
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Solution
Monitor blood glucose closely, and look for signs of hypoglycemia.
When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemia. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Giving insulin would also lower the glucose levels, causing hypoglycemic. The client wouldn’t have hyperglycemia if the glyburide was absorbed.
A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse’s primary responsibility to:
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Solution
Check the client’s serum glucose level
Because the client has diabetes, it is essential that the blood glucose level be determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage.
A client with DM states, “I cannot eat big meals; I prefer to snack throughout the day.” The nurse should carefully explain that the:
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Solution
Regulated food intake is basic to control
An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two between meals snacks needs to be tailored to the client’s specific needs, with due regard for activity, diet, and therapy.