HESI Case Study: Diabetes Mellitus Correct and Verified Answers Graded A

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HESI Case Study: Diabetes Mellitus

Correct and Verified Answers Graded A

• The client starts to cry and says that the nurse has no idea how awful this is and

asks to be left alone. What is the best response by the nurse?

• I'll leave you alone for now, but I will stop back by in 30 minutes.
• I'll notify the diabetes counselor that you need a visit right away.
• You shouldn't be by yourself right now. I'll stay here with you.
• You need to express your feelings. Tell me more about what you are feeling.

Correct Answer: A. I'll leave you alone for now, but I will stop back by in 30 minutes.Rationale: This response respects the client's request to be left alone, but the nurse is offering support and physical presence.

• Ethical-Legal Issues: Client Information. The client's blood glucose level stabilizes,

and they begin taking oral fluids. IV solutions are switched to dextrose 5% in sodium chloride 0.45% at a keep-open rate, and the insulin infusion is discontinued. While hospitalized, family members and many of the client's college friends call the nursing unit to check on the client's condition. The nurse's decision about what to tell these callers should be based on what primary consideration?

• The instructions of the nursing unit supervisor.
• The nature of the caller's relationship to the client.
• The seriousness of the client's condition at the time of the call.
• The client's right to privacy regarding her health information.

Correct Answer: D. The client's right to privacy regarding her health information.Rationale: The Health Information Privacy Protection Act (HIPAA) stipulates that a client has the right to privacy regarding health information and must give permission for the release of that information.

• What is the mechanism that results in Kussmaul respirations?
• To compensate for metabolic acidosis, the respirations are deep and rapid.

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• To overcome respiratory acidosis, the respirations are fast and shallow.
• Injury to the brain's respiratory center results in periods of apnea.
• Hypoxemia causes labored, gasping, and irregular respirations.

+1 Correct Answer: A. To compensate for metabolic acidosis, the respirations are deep and rapid.Rationale: To compensate for the ketoacidosis (metabolic acidosis), the lungs attempt to remove CO2 through a pattern of deep, rapid respirations referred to as Kussmaul respirations.

• The client tells the nurse that they know that diabetes is a chronic condition and

realizes that they probably had it for a while. The client asks why didn't they experience any symptoms before now. How should the nurse respond?

• The symptoms were so minor that you just didn't notice them until you got the flu.
• The type of diabetes you have is the acute form of diabetes, rather than the chronic form.
• The onset of symptoms is so gradual that your body adjusts to the changes.
• The symptoms have an abrupt onset that is often brought on by a viral illness, like the flu.

Correct Answer: D. The symptoms have an abrupt onset that is often brought on by a viral illness, like the flu.Rationale: Since Type 1 diabetes seems to involve an interaction of genetic predisposition with an environmental trigger, the onset of symptoms is often abrupt, following an illness such as the flu.

• To restore the client's blood glucose to a normal level, what should the nurse

prepare to administer?

• An IV infusion containing regular insulin.
• Humulin-N insulin SC before meals.
• 50?xtrose IV push.
• Glucagon subcutaneously PRN per sliding scale.

Correct Answer: A. An IV infusion containing regular insulin.

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Rationale: Continuous IV infusions containing regular insulin are used to reduce the client's blood glucose level. The client's IV solution will be changed to one that contains glucose when her blood glucose level reaches 250 mg/dl.

• A student nurse is assigned to work with the charge nurse in caring for the client

during their acute illness. The student tells the nurse that they plan to present information about the client to fellow students during a post-clinical conference, and asks the charge nurse for permission to copy the client's lab data to take to the conference. Which response is best for the charge nurse to provide?

• Information about the client cannot be removed from the nursing unit.
• The lab values can be copied as long as there is no identifying client data.
• Since this is for educational purposes, you can remove any information you need.
• Your instructor should tell you what information you are allowed to copy.

Correct Answer: B. The lab values can be copied as long as there is no identifying client data.Rationale: Information used for educational purposes may be shared, as long as the data does not permit identification of the client.

• To achieve the goal of restoring the client's fluid volume, the nurse would expect to

implement which intervention?

• Insert a saline lock for PRN diuretic administration.
• Administer an albumin/furosemide continuous infusion.
• Maintain an infusion of normal saline solution.
• Obtain a type and crossmatch for 2 units of packed RBCs.

Correct Answer: C. Maintain an infusion of normal saline solution.

Rationale: The treatment of hyperglycemia includes fluid replacement to correct

dehydration caused by the increased concentration of glucose in the blood. Isotonic fluids, such as normal saline, are used initially to treat the dehydration.

• Therapeutic Communication: The client states that they wish they hadn't gotten the

flu so that the diabetes wouldn't have been discovered, and they could keep having a normal life. What is the best initial response by the nurse?

• What do you mean when you say a normal life?

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• It's better to find out now before complications develop.
• Perhaps you would like to speak to someone who has diabetes.
• It must be quite a shock to learn that you have diabetes.

Correct Answer: D. It must be quite a shock to learn that you have diabetes.

Rationale: This statement acknowledges the client's feelings, and is open-ended, allowing the client to continue to verbalize their feelings if they wish.

• In addition to monitoring the client's blood glucose level, what additional lab values

should the nurse monitor carefully? (Select all that apply.)

• Uric acid.
• Hemoglobin.
• Calcium.
• Potassium.
• Blood Urea Nitrogen (BUN).

Correct Answer: B, C, D, E.

Rationale: Though blood glucose and potassium are the most critical lab values to assess, hemoglobin levels may be altered related to the state of hydration and should be monitored. Treatment with an IV insulin infusion will cause the potassium to return to the cells and may result in hypokalemia. Lara should be closely monitored for symptoms of hypokalemia. Supplemental potassium may be added to the IV infusion to prevent or correct this. Dehydration that occurs with DKA can lead to an increased BUN and should be monitored for signs of renal insufficiency.+1

• Manifestations: Once the acute ketoacidosis is controlled, the client is told that

they have Type 1 diabetes mellitus. The nurse obtains the client's history. The client states that prior to the flu, they had been healthy. However, the client had noticed that they had been eating more than normal, but had not been gaining any weight. The client also states that they had been drinking a lot of diet colas and that got up at night frequently to go to the bathroom. The nurse identifies that the client has experienced

classic symptoms of diabetes, which are:

• Dysuria, dyspepsia, and dysphagia.