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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.
- D. Urine remains negative for ketone bodies.
Correct Answer: C
Rationale: An unchanged Glasgow Coma Scale score indicates no improvement in consciousness, suggesting inadequate fluid replacement in HHS. Increased potassium, decreased osmolarity, and negative ketones are expected or not indicative of treatment failure.
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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 diabetic is 50% because of how it is inherited.
- D. Female children do not inherit diabetes mellitus, but male children will.
Correct Answer: A
Rationale: Risk for type 1 diabetes is influenced by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Having a parent with type 1 diabetes increases the risk, but environmental factors also play a role, so not everyone with these genes develops diabetes. The other statements are inaccurate.
A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, 'Can I ask my niece to prefill my syringes and then store them for later use when I need them?' How should the nurse respond?
- A. Yes, prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up.
- B. Yes, syringes can be filled with insulin and stored for a month in a location that is protected from light.
- C. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes.
- D. No, insulin syringes cannot be prefilled and stored for any length of time outside of the container.
Correct Answer: A
Rationale: Insulin in prefilled plastic syringes is stable for up to 3 weeks when refrigerated, stored vertically with the needle up to prevent clogging. The other options are incorrect regarding storage duration, material, or stability.
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. Wipe excess blood from the strip with a cotton ball.
- D. Use gloves when monitoring your blood glucose.
Correct Answer: B
Rationale: Sharing monitoring equipment can transmit bloodborne infections like hepatitis B, which can survive in dried blood. Not sharing equipment is critical. Washing hands before testing, not after, is recommended. Wiping blood with a cotton ball or using gloves is not standard practice for preventing infections.
A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take?
- A. Apply ice to the site to reduce inflammation.
- B. Consult the provider for a new administration route.
- C. Assess the client for other signs of cellulitis.
- D. Instruct the client to rotate sites for insulin injection.
Correct Answer: D
Rationale: The spongy, swollen area suggests lipohypertrophy from repeated injections at the same site. Rotating injection sites prevents this complication. Ice, a new route, or assessing for cellulitis are not appropriate for lipohypertrophy.
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%.
- C. Administer 10 units of regular insulin subcutaneously.
- D. Administer 1 mg of glucagon intramuscularly.
Correct Answer: A
Rationale: The client has mild hypoglycemia, and since the initial orange juice did not resolve symptoms, repeating the oral glucose treatment is appropriate. Intravenous dextrose, insulin, or glucagon are not indicated for mild, unresolved symptoms in an alert client.