Nokea
On initial nursing rounds, the diabetic client reports 'not feeling well.' Later, the nurse finds the client to be diaphoretic and in a stuporous state. Which is the immediate action taken by the nurse?
- A. Call the physician.
- B. Obtain a glucometer reading.
- C. Administer fruit juice.
- D. Start an IV of dextrose.
Correct Answer: B
Rationale: A glucometer reading is critical to differentiate between hypoglycemia and diabetic ketoacidosis in a stuporous diabetic client. Administering juice or IV dextrose without confirming hypoglycemia risks worsening hyperglycemia, and calling the physician is secondary to obtaining a glucose level.
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The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?
- A. Increases ability for glucose to get into the cell and lowers blood sugar
- B. Creates an overall feeling of well-being and lowers risk of depression
- C. Decreases need for pancreas to produce more cells
- D. Decreases risk of developing insulin resistance and hyperglycemia
Correct Answer: A
Rationale: Exercise enhances glucose uptake by increasing transmembrane glucose transporters in muscles, lowering blood sugar levels. While it may improve well-being and reduce insulin resistance, the primary benefit for diabetes management is improved glucose transport into cells.
The nurse is admitting a client with the diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) following steroid therapy. Which sign(s) and symptom(s) would the nurse likely note? Select all that apply.
- A. High blood pressure
- B. Extreme thirst
- C. Bradycardia
- D. Poor skin turgor
- E. Acidosis
- F. Hypoglycemia
Correct Answer: B,D
Rationale: HHNKS presents with extreme thirst and dehydration (poor skin turgor) due to severe hyperglycemia and fluid shifts. High blood pressure is unlikely (hypotension is more common), bradycardia is incorrect (tachycardia occurs), acidosis is not typical (unlike DKA), and hypoglycemia is not associated with HHNKS.
A client with type 2 diabetes who is physically active reports recurrent symptoms of weakness and nervousness. Which is the best response from the nurse?
- A. These symptoms are related to added stress.
- B. Maybe you should eat simple carbohydrates.
- C. Sounds like high blood sugar symptoms.
- D. Exercise and activity can lower glucose levels.
Correct Answer: D
Rationale: Weakness and nervousness suggest hypoglycemia, which can be triggered by exercise lowering blood glucose levels. These are not typical of hyperglycemia, stress alone, or a need for simple carbohydrates, which could exacerbate glucose fluctuations.
A client with type 2 diabetes is informed of being unable to have a pancreatic transplant and asks the nurse why this is. Which reason would the nurse provide to the client?
- A. Increased risk for urologic complications
- B. Need for exocrine enzymatic drainage
- C. Underlying problem of insulin resistance
- D. Need for lifelong immunosuppressive therapy
Correct Answer: C
Rationale: Clients with type 2 diabetes have insulin resistance, which a pancreas transplant does not address, as the issue lies in tissue response rather than insulin production. Urologic complications and exocrine drainage are not primary reasons, and while immunosuppressive therapy is required, it is not specific to type 2 diabetes.
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.