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A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan?

check glucose before exercising


In the client with DKA, the nurse should expect to note

blood glucose levels between 350 and 1500 mg/dL (20 and 85.7 mmol/L),

ketonuria, serum pH less than 7.35, and

serum bicarbonate less than 15 mEq/L (15 mmol/L).


m #554 The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client

"I need to increase my fluid intake.

"I need to monitor my blood glucose every 3 to 4 hours."

"I need to call the primary health care provider (PHCP) because of these symptoms."


A clinic nurse is providing instructions to a client who is scheduled for a glucose tolerance test. Which instruction should the nurse provide to the client in preparation for the test?

Avoid alcohol, coffee, and tea for 36 hours before and during the test.


orticosteroid therapy can cause calcium and potassium depletion, sodium retention, and glucose intolerance. The client should be monitored for hyperglycemia. Also, an increase in potassium and a decrease in sodium intake are recommended to prevent potassium depletion and sodium retention while taking the corticosteroid. Although increased fluids are important for the client with emphysema to maintain thin respiratory secretions, this action is not specific to the use of corticosteroids.



The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels.



Humulin NPH is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 30 to 60 minutes, it peaks in 1 to 5 hours, and its duration is 6 to 10 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously. Regular insulin is always drawn up before NPH.



A client with diabetes mellitus reports to the clinic for determination of the glycosylated hemoglobin (HbA1c) level. Which value on this laboratory test indicates client co



Glyburide is a sulfonylurea that acts primarily by stimulating the release of insulin from pancreatic islets. It causes a dose-dependent reduction in blood glucose and can thereby cause hypoglycemia. Importantly, regardless of what the glucose level is–high, normal, or low–sulfonylureas will lead to a low blood glucose level. If the level is high, reducing it will be therapeutic. However, if the level is normal, reducing it will cause mild hypoglycemia



Uncontrolled hyperglycemia may lead to the production of ketones, thus leading to diabetic ketoacidosis (DKA), a life-threatening condition. The most common precipitating factor for development of DKA is infection.



Corticosteroids, thiazide diuretics, and lithium may decrease the effect of glyburide, thus causing hyperglycemia. The medications listed in the incorrect options increase the effect of glyburide, leading to hypoglycemia.



prothrombin time (PT) and international normalized ratio (INR) test

coagulation time


Renal calculi are a complication associated with reduced mobility as a result of bone demineralization. Pressure ulcers and deep vein thrombosis



Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment measure for DKA.



HHS is seen primarily in clients with type 2 diabetes mellitus, who experience a relative deficiency of insulin. The onset of signs and symptoms may be gradual. Manifestations may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness.



The Schilling test is used to determine the cause of vitamin B12 deficiency, which leads to pernicious anemia. This test involves the use of a small oral dose of radioactive B12, followed by a large nonradioactive intramuscular (IM) dose. The IM dose helps flush the oral dose into the urine if it was absorbed. A 24-hour urine collection is performed to measure the amount of radioactivity in the urine.



acidosis symptoms






rbc up



abdominal thrusts order

  1. Assess unconsciousness.
  2. Open the airway.
  3. look in the mouth and remove the object blocking the airway if seen
  4. Attempt ventilation.
  5. Perform abdominal thrusts.


sputum culture


A client with a hip fracture asks the nurse about Buck's (extension) traction that is being applied before surgery and what is involved. The nurse should provide which information to the client?

Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels


Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first.



An iodine-based dye may be used during intravenous pyelography and can cause allergic reactions such as itching, hives, rash, a tight feeling in the throat, shortness of breath, and bronchospasm. Assessing for allergies is the priority. Fluids