Nokea
A client reports taking oral medication for control of sugar problems. Which is the best nursing interpretation of this verbal accounting?
- A. Lack of knowledge of disease process
- B. Client has type 2 diabetes mellitus.
- C. Client has prediabetes mellitus.
- D. Lack of knowledge on medication regime
Correct Answer: B
Rationale: Oral antidiabetic medications are typically prescribed for type 2 diabetes, indicating the client likely has this condition. Prediabetes is not treated with medication, and there is insufficient information to assume a lack of knowledge about the disease or medication.
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Which assessment finding is most important in determining nursing care for a client with diabetes mellitus?
- A. Respirations of 12 breaths/minute
- B. Cloudy urine
- C. Blood sugar 170 mg/dL
- D. Fruity breath
Correct Answer: D
Rationale: Fruity breath indicates rising ketones and potential diabetic ketoacidosis, a life-threatening condition requiring immediate intervention to prevent complications like acidosis or renal shutdown. A blood sugar of 170 mg/dL is elevated but less critical, cloudy urine may suggest a UTI, and normal respirations are not a priority.
The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order?
- A. Provides best information on the body's ability to maintain normal blood functioning
- B. Best indicator for the nutritional state of the client.
- C. Is less costly than performing daily blood sugar test
- D. Reflects the amount of glucose stored in hemoglobin over past several months
Correct Answer: D
Rationale: Glycosylated hemoglobin (HbA1c) measures glucose bound to hemoglobin over its 120-day lifespan, reflecting long-term glucose control. It does not assess overall blood functioning, nutritional status, or cost relative to daily testing, which is still necessary for insulin-dependent clients.
The client asks the nurse if dipstick of urine can be used for monitoring glucose levels. Which is the best response by the nurse?
- A. Yes, it is a cheaper method of monitoring glucose and ketones in the urine.
- B. This test can detect ketones but not glucose levels.
- C. The most accurate way to monitor glucose levels is by blood testing.
- D. Dipstick of urine will only indicate lower levels of glucose and ketones.
Correct Answer: C
Rationale: Blood testing via glucometer is the most accurate method for monitoring glucose levels, as urine dipsticks only detect glucose above the renal threshold, which is less precise. Urine dipsticks can detect both glucose and ketones but are not the preferred method for ongoing management.
A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA?
- A. Give prescribed antiemetics.
- B. Begin fluid replacements.
- C. Administer prescribed dose of insulin.
- D. Administer bicarbonate to correct acidosis.
Correct Answer: B
Rationale: In DKA, correcting dehydration and electrolyte imbalances with fluid replacement is the first priority to stabilize the patient before addressing hyperglycemia with insulin. Antiemetics and bicarbonate are secondary, and insulin requires a physician's order.
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?
- A. Glargine
- B. Regular
- C. NPH
- D. Lente
Correct Answer: B
Rationale: Regular insulin is used intravenously for DKA due to its rapid onset and ability to be infused continuously. Glargine, NPH, and Lente are long- or intermediate-acting insulins administered subcutaneously, unsuitable for acute DKA management.