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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.
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A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled?
- A. 5.50%
- B. 6.50%
- C. 8.80%
- D. 7.80%
Correct Answer: A
Rationale: A glycosylated hemoglobin level below 7% (e.g., 5.5%) indicates good blood glucose control over the past 2-3 months. Levels of 7.5% or higher (e.g., 7.8%, 8.8%) suggest suboptimal control, with 7% correlating to an average blood glucose of 150 mg/dL.
A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings?
- A. Finger
- B. Upper arm
- C. Thigh
- D. Forearm
Correct Answer: A
Rationale: The fingertip provides the most accurate blood glucose readings due to its rich blood supply and minimal lag in glucose levels compared to alternate sites like the arm or thigh, which are less reliable for tight glucose control.
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.
Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus?
- A. With diabetes, drinking more results in more urine production.
- B. Increased ketones in the urine promote the manufacturing of more urine.
- C. High sugar pulls fluid into the bloodstream, which results in more urine production.
- D. The body's requirement for fuel drives the production of urine.
Correct Answer: C
Rationale: High blood glucose levels increase blood osmolality, pulling fluid into the vascular system, which leads to increased urine production (polyuria) as the kidneys attempt to excrete excess glucose. This triggers thirst (polydipsia), not vice versa. Ketones and fuel requirements do not directly cause polyuria.
The nurse is teaching an older client how to self-administer insulin. Which of the following would be most helpful to the client who is having difficulty drawing up the correct dosage of insulin in the syringe?
- A. Syringe magnifier
- B. Insulin pen
- C. Jet injector
- D. Insulin pump
Correct Answer: A
Rationale: A syringe magnifier is a cost-effective and simple tool to help older clients with visual or dexterity issues accurately draw insulin doses. Insulin pens require precise dialing, which may be challenging, and jet injectors and insulin pumps are more complex and costly, potentially unsuitable for older clients.