Question Answered step-by-step Diabetes M.R.is a 72-year-oldalert,but confusedmale who isadmitted… Diabetes M.R. is a 72-year-old alert, but confused male who is admitted to the emergency department. He has a known history of type 1 diabetes mellitus. His wife accompanies him and informs the staff that she thinks he has the flu and has been unable to eat or drink very much for the past 2 days. The wife stated that he had not taken his insulin in the past 2 days because he had been experiencing nausea and vomiting and has been unable to eat. The patient’s vital signs are: temperature 101.8 F; pulse 120 beats/min, weak and irregular; respirations, 22 breaths/min, deep, and fruity odor; and blood pressure 80/42 mm Hg. Blood specimens and arterial blood gases are drawn and an IV infusion is begun.1. Based on the clients history and physical assessment data, what acute complication of diabetes is this client experiencing? 2. Based on this information, what laboratory data would the nurse expect to assess for this client? (Select all that apply)a. Presence of large amount of ketones in urine.b. ABGs: pH 7.47, CO2 28 mm Hg, HCO3 15 mm Hg.c. Serum BUN 37 mg/dL.d. Serum Creatinine 0.87 mg/dL. e. Serum Potassium 5.3 mEq/L.f. Serum Glucose 150 mg/dL. 3. What initial treatment would the nurse anticipate the provider to order to treat this client’s acute complication of diabetes? a. Sliding scale rapid-acting insulin subcutaneous before meals.b. Isotonic IV fluid bolus.c. Oral potassium replacement.d. Intermediate acting insulin intravenous.4. The client has the following laboratory values: fasting blood glucose level of 382 mg/dL and hemoglobin A1C level of 8.4%. What is the nurse’s interpretation of these results?a. The clients’ glucose control in the last 24 hours has been good and they have good overall control.b. The clients’ glucose control in the last 24 hours has been good, but they have poor overall control.c. The clients’ glucose control in the last 24 hours has been poor and they have poor overall control.d. The clients’ glucose control in the last 24 hours has been poor, but they have good overall control.5. At 4:00 p.m., the initial finger stick blood glucose (FSBG) result is 642 mg/dL. An insulin infusion is ordered and has 200units of regular insulin in 500 mL Normal Saline to be infused at 20 units/hr. How many mL/hr will the nurse set the infusion pump? Round to the nearest whole number if necessary.Show your work. 6. While the client is receiving the continuous insulin infusion, the cardiac monitor shows ventricular ectopy. What assessment is essential for the nurse to obtain?a. Urine output.b. 12 lead electrocardiogram (ECG).c. Serum potassium level.d. Rate of intravenous (IV) fluids. 7. Once the patients’ glucose normalizes on the insulin infusion, the healthcare provider prescribes 10 units aspart insulin in addition to sliding scale aspart insulin to be administered before meals. The client’s morning glucose level is 276 mg/dL. Usingthe sliding scale orders below, how much total insulin would the nurse draw up to administer per the physicians orders to the client before meals?Blood glucose 70-150 mg/dL Hold insulinBlood glucose 151-250 mg/dL Administer 5 units aspart insulinBlood glucose 251-350 mg/dL Administer 10 units aspartinsulinBlood glucose 350-400 mg/dL Administer 15 units aspartinsulinBlood glucose greater than 401 mg/dL Notify healthcare provider for further orders M.R. is going to be discharged on a mixed-dose regimen for insulin. He is to receive 10 units regular insulin (novolin R) and 18 units NPH insulin (humulin N) before breakfast and another 5 units regular insulin and 12 units NPH at dinner time.8. The nurse instructs the M.R. and his wife that the most likely time for a hypoglycemic reaction to occur after administration of NPH insulin (Humulin N) is:a. 1 to 2 hours.b. 4 to 12 hours.c. 16 to 24 hours.9. After teaching the client about regular insulin at home, which client statement(s) would indicate understanding of teaching? (Select all that apply)a. “I will need to eat within 30 minutes of taking this insulin.”b. “I don’t need to monitor my blood glucose as long as I’m feeling okay.” c. “I am most at risk for low blood sugar 3 hours after taking this medication.”d. “This medication will be taken orally to help control my glucose throughout the day.”e. “I will store this medication in the freezer when it is not being used.”10. Which client statement indicates a need for further teaching regarding administration of insulin? a. “I will rotate sites in my abdomen.”b. “I will inspect my insulin before drawing it up to ensure that the regular insulin is cloudy.” c. “I will clean my skin with an alcohol swab and inject the syringe at a 90 degree angle.”d. “I will discard the needle after each use in a container.” 11. Which signs/symptoms would the nurse teach the client and spouse to monitor for that would indicate hypoglycemia? (Select all the apply)a. Slurred speech and irritability.b. Headache.c. Palpitations.d. Cold, clammy skin.e. Changes in vision.f. Increase in urination.g. Tremors.12. What intervention would the nurse teach the spouse to do if the client develops hypoglycemia at home but is alert and able to talk? a. Give a cup of apple sauce with two packets of sugar.b. Give a glass of orange or other type of juice and recheck blood glucose within half an hour.c. Give a complex carbohydrate and monitor for symptoms of hyperglycemia.d. Administer 1 mg subcutaneous glucagon and call 911 immediately. 13. When teaching M.R. about dietary management, what would the nurse include in teaching? a. Alcoholic beverage consumption is unrestricted.b. Carbohydrate counting is emphasized when adjusting dietary intake of nutrients. c. Omega-3 Fatty Acids should be avoided because of the side effects.d. Both soluble and non-soluble fiber foods should be limited. 14. After teaching about dietary management, the nurse asks M.R.to fill out a menu for dinner. Which meal choice indicates a need for further instruction regarding diabetic diets? a. Fried chicken, mashed potatoes, gravy, corn on the cob, and whole milk.b. Spaghetti with marinara meat sauce, a side garden salad, and iced tea.c. Roasted turkey breast, baked potato, steamed carrots, and skim milk.d. Hamburger on a bun with lettuce and tomato, baked chips, and diet soda. 15. The nurse is providing M.R. tips on how to increase activity. Which suggestion(s) would the nurse include in teaching? (Select all that apply) a. Get a workout buddy.b. Take the stairs at work.c. Play card games at home.d. Limit computer time.e. Use a fitness tracker.f. Attend a musical performance. 16. What would the nurse include in discharge teaching about exercise?a. “You can exercise if your blood glucose is over 250 mg/dL, just make sure to take an extra dose of your short-acting insulin.”b. “Check your urine for ketones prior to exercise. Ketones in your urine indicate that you are at risk for hypoglycemia during exercise.”c. “Carry a simple sugar during periods of exercise if symptoms of hypoglycemia occur.”d. “Make sure to exercise while insulin is working at its best to avoid the risk of hyperglycemia while exercising.”17. The nurse is explaining to M.R about managing blood glucose levels when ill. What would the nurse include in teaching? (Select all that apply)a. “Hold your medications if you’re unable to eat your normal diet.”b. “Continue to drink fluids at regular intervals to prevent dehydration.”c. “Check your temperature and report fever (>101.5 degrees F) to provider.”d. “Check urine for ketones if blood glucose levels exceed 240 mg/dL.”e. “Check your blood glucose levels once a day and keep an ongoing log.” 18. What signs and symptoms would the nurse assess in a client who has developed microvascular complications of diabetes? (Select all that apply)a. Parathesia in fingers and toes.b. Elevated Serum BUN & Creatinine. c. Blurry or double vision. d. Warm, dry skin.e. Blood pressure 160/82 mm Hg. 19. What would the nurse include in teaching the diabetic client about foot care? a. Use rubbing alcohol to toughen the skin on the soles of the feet.b. Wear open toes shoes or sandals in warm weather to prevent perspiration.c. Apply moisturizing cream to the feet after bathing, but not between the toes.d. Use cold water for bathing the feet to prevent inadvertent thermal injury. Health Science Science Nursing NURSING MISC Share QuestionEmailCopy link Comments (0)
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