48 -- DIABETES MELLITUS

The nurse is assigned to care for a patient with type 2 diabetes. To encourage the patient to become an active participant in his or her care, what action should the nurse take? a) Assess the patient's understanding of the disease b) Make a list of food restrictions for proper diabetes management c) Refer the patient to a nutritionist d) Set long-term goals to decrease the risk of complications

A For teaching to be effective, the first step is assessing the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. Food restrictions, nutritionist referral, and setting long-term goals can occur once the nurse is confident the patient understands what it means to have diabetes.

Which complication of diabetes can be treated with hyperbaric oxygen? a) Diabetic foot ulcers b) Diabetic nephropathy c) Neuropathic arthropathy d) Peripheral vascular disease

A Hyperbaric oxygen is used for wound healing in diabetic foot ulcers. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used in the treatment of diabetic nephropathy. Neuropathic arthropathy results in ankle and foot changes and increases the chances of developing foot ulcers. Peripheral vascular disease is one of the macrovascular complications of diabetes. Management includes smoking cessation and control of hypertension.

What are the symptoms of peripheral arterial disease? Select all that apply. a) Cold feet b) Loss of hair c) Dependent rubor d) Urinary retention e) Bowel incontinence

A - B - C Peripheral arterial disease causes decreased blood flow to the lower extremities. Cold feet, loss of hair, and dependent rubor are the signs of peripheral arterial disease. Urinary retention and bowel incontinence are symptoms of autonomic neuropathy.

The nurse, reviewing hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) and diabetic ketoacidosis recalls that with HHNKS, which condition occurs? a) Hyperglycemia b) Absence of ketones c) High serum osmolarity d) Decreased in serum potassium

B Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) is different from diabetic ketoacidosis (DKA) because of the absence of ketone production. HHNKS is seen in type 2 non-insulin-dependent diabetics. Ketones are not released because there is some insulin available to transport glucose across cell membranes. Therefore, fat is not catabolized for energy. In DKA there is no insulin available, so fats are broken down for energy, releasing ketones as a by-product. Hyperglycemia, issues with serum potassium, and issues with serous osmolarity are seen in both HHNKS and DKA.

Which population experiences the most disparity related to the amount of complications from diabetes? a) White Americans b) Native Americans c) African Americans d) Hispanic Americans

B Native Americans have a six times higher rate of end-stage renal disease and a four times higher rate of amputation than other ethnicities with diabetes, including white Americans, African Americans, and Hispanic Americans.

The patient received regular insulin eight units subcutaneously (SQ) at 0900. The nurse plans to monitor this patient for signs of hypoglycemia during which time? a) 1000 and 1100 b) 1100 and 1400 c) 1200 and 1300 d) 1300 and 1500

B Regular insulin exerts peak action in two to five hours, placing the patient at greatest risk for hypoglycemia between 1100 and 1400. At this time, the nurse should offer the patient a snack. 1000 and 1100, 1200 and 1300, and 1300 and 1500 are not consistent with peak action of insulin administered at 0900.

Diabetic ketoacidosis (DKA) is caused by a profound deficiency of insulin and is characterized by: Select all that apply. a) Hypoglycemia b) Dehydration c) Hyperglycemia d) Absence of Ketones e) Ketosis

B-C-E Characteristics of DKA include profound dehydration, severe hyperglycemia, and presence of ketones. Hypoglycemia and absence of ketones are not signs of DKA.

The nurse would encourage a patient with diabetes mellitus and coronary artery disease to limit intake of which of the following foods to help reduce the percentage of saturated fat in the diet? a) Chicken and turkey b) Frozen and canned vegetables c) Enriched flour products d) Dairy products

D Cheese and dairy products are higher in fat and calories than vegetables, fruit, enriched flour products, or poultry and should be limited.

Who can serve as a health care proxy? a) A blood relative b) A family member c) A domestic partner d) Anyone the patient chooses

D The patient may choose anyone to serve as a health care proxy. Proxies do not have to be a domestic partner, family member, or blood relative.

A patient with diabetes experiences hypoglycemia. What does the nurse educate the patient that a cause of this condition may be? a) Mild illness with fever b) Insufficient injection of insulin c) Overeating at a family holiday dinner d) Exercise without a carbohydrate-based snack

D Exercise without a carbohydrate-based snack could result in hypoglycemia. Mild illness, insufficient insulin dosage, and overeating are situations that would cause hyperglycemia, or an increased blood glucose level.

Patients with metabolic syndrome have a higher risk of developing type 2 diabetes. Which of these components may result in metabolic syndrome? Select all that apply. a) Low body weight b) Low glucose levels c) Low levels of triglycerides d) Elevated blood pressure (BP) e) Decreased levels of high-density lipoproteins (HDL)

D - E If an individual has elevated blood pressure (BP), he or she is at a greater risk of developing type 2 diabetes as a result of having metabolic syndrome. A decreased level of high-density lipoproteins (HDL) is also a risk factor for metabolic syndrome, which may lead to type 2 diabetes mellitus. Low body weight, low glucose levels, and low levels of triglycerides are not associated with the development of metabolic syndrome; therefore, these are not risk factors for the onset of type 2 diabetes.

The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? a) Chooses a puncture site in the center of the finger pad b) Washes hands with soap and water to cleanse the site to be used c) Warms the finger before puncturing it to obtain a drop of blood d) Tells the nurse that the result of 110 mg/dL indicates good control of diabetes

A The patient should select a site on the sides of the fingertips, not on the center of the finger pad, because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8 AM. The nurse instructs the patient to fast for what period of time? a) At least eight hours b) 4 AM on the day of the test c) After dinner the evening before the test d) 7 AM on the day of the test

A Typically, a patient is prescribed to be nothing by mouth (NPO) for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8 AM should not have any food or beverages containing any calories after midnight. It is not necessary to fast longer than eight hours; 4 AM and 7 AM would not allow for sufficient time to fast for morning laboratory testing.

Which complication can be monitored by annual screening using a monofilament? a) Diabetic neuropathy b) Diabetic retinopathy c) Diabetic dermopathy d) Diabetic nephropathy

A Sensory neuropathy is a type of diabetic neuropathy in which loss of protective sensation (LOPS) is common. LOPS may lead to lower extremity amputation. Therefore, annual screening using a monofilament is important in monitoring the patient for diabetic neuropathy. Diabetic retinopathy is monitored by annual fundoscopic examination. Examining the skin changes is important in diabetic patients to monitor for diabetic dermopathy. Serum creatinine and urinalysis for microalbuminuria help to monitor for diabetic nephropathy.

The nurse provides education to a patient with newly diagnosed type 1 diabetes mellitus. Which statement made by the patient indicates a need for further instruction? a) "If I skip breakfast, I can hold my insulin until noon." b) "I'll have some options when it comes to food choices." c) "If I feel sweaty, shaky, or dizzy, my blood sugar might be low." d) "If I have to urinate a lot, feel thirsty all of the time, or have blurred vision, my blood sugar might be high."

A A diabetic patient should adhere to an American Diabetes Association diet and insulin regimen. These patients should not self-regulate insulin unless directed to do so by their primary health care provider. The statements in the other answer options are all correct in regard to self-management of diabetes at home.

Which complication of diabetes can cause hypoglycemic unawareness? a) Diabetic neuropathy b) Diabetic dermopathy c) Diabetic ketoacidosis d) Diabetic nephropathy

A Autonomic neuropathy is a type of diabetic neuropathy. Autonomic neuropathy can affect all the systems in the body leading to hypoglycemic unawareness. Diabetic dermopathy may cause acanthosis nigricans and necrobiosis lipoidica diabeticorum. Diabetic ketoacidosis may cause dehydration, metabolic acidosis, and electrolyte disturbance. Diabetic nephropathy leads to reduction in the glomerular filtration rate of the kidneys.

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? a) Cheese b) Broccoli c) Chicken d) Oranges

A Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

The nurse is evaluating the patient who has developed diabetes as a result of another medical condition. The nurse knows that which condition can be linked to diabetes? a) Cushing syndrome b) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) c) Hypothyroidism d) Celiac disease

A Cushing syndrome is treated with corticosteroids, which can then cause diabetes. SIADH and hypothyroidism will not. Celiac disease is another autoimmune disease that a patient with diabetes is at a greater risk of developing.

The nurse has taught a patient who was admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse determines that additional teaching is necessary when the patient makes which statement? a) "Taking a hot bath every day will help with my circulation." b) "I should avoid walking barefoot at all times." c) "I should look at the condition of my feet every day." d) "I need a podiatrist to treat my ingrown toenails."

A Hot water may injure tissue related to decreased sensation and should be avoided. Patients with diabetes mellitus should inspect the feet daily for broken areas that are at risk for delayed wound healing, avoid walking barefoot, and have a podiatrist for foot care.

A patient diagnosed with type 1 diabetes has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse should be performed initially? a) Check the patient's blood sugar at 3 AM. b) Provide the patient with an evening snack. c) Rotate insulin injection sites between the abdomen, thigh, and arm. d) Contact the health care provider to increase the evening insulin dose.

A Hyperglycemia in the morning may be caused by the Somogyi effect. If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 and 4:00 AM for hypoglycemia will help determine if the cause is the Somogyi effect. Diabetics should be given evening snacks to prevent hypoglycemia during the night, but glucose assessment is a priority to rule out the Somogyi effect. Injection sites are rotated to prevent lipodystrophy. An increased dose of evening insulin may cause further decrease in early morning glucose and increased rebound hyperglycemia.

While caring for a patient showing signs of dawn phenomenon, the student nurse teaches the patient ways to avoid an increased level of blood glucose in the morning. Which instruction strongly suggests a need for further learning? a) "Decrease your insulin intake." b) "Take a sufficient amount of insulin before going to bed." c) "Check your blood glucose level in the morning regularly." d) "Notify the primary health care provider for dosage adjustments."

A In dawn phenomenon, there is a rise in the blood glucose level in the night, which causes hyperglycemia in the morning. Therefore, the treatment for dawn phenomenon is increasing the insulin intake. If insulin is taken before sleeping at night, then it will help to normalize the blood glucose level in the morning. A regular check on the blood glucose level in the morning will help to know the medication time, amount, and diet plan for maintaining an appropriate glucose level in the blood.

Laboratory results have been obtained for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? a) Increased triglyceride levels b) Increased high-density lipoproteins (HDL) c) Decreased low-density lipoproteins (LDL) d) Decreased very-low-density lipoproteins (VLDL)

A Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

What is a risk factor associated with macrovascular complications of diabetes mellitus? a) Obesity b) Seizures c) Hypovolemia d) Adrenal insufficiency

A Obesity increases the risk for blood vessel and cardiovascular disease. Hypoglycemia, if untreated, results in seizures and coma. Hypovolemia, due to excessive dehydration, may lead to shock. Patients with adrenal insufficiency may have minimal glycogen stores and may not respond to glucagon therapy.

The nurse observes a return demonstration by a patient who is learning how to mix regular insulin and NPH insulin in the same syringe. Which action by the patient indicates the need for further teaching? a) Withdrawing the NPH insulin first b) Injecting air into the NPH insulin bottle first c) Removing air bubbles after drawing up the first insulin d) Injecting an amount of air equal to the desired dose of insulin

A Regular insulin is always withdrawn first so it will not become contaminated with the NPH insulin. Injecting air into the NPH bottle first, removing air bubbles after drawing up the regular insulin, and injecting air equal to the desired dose of insulin are correct actions in regard to the mixture of regular and NPH insulin.

The patient has a prescription for repaglinide. The nurse instructs the patient to take the medication at which time? a) Immediately before meals b) When blood sugar levels are greater than 250 mg/dL c) Two hours after meals d) At bedtime

A Repaglinide is an oral antidiabetic agent that should be given any time from 30 minutes to just before meals. It is given on a fixed schedule rather than only when blood sugars are elevated. The medication will not be effective if administered after meals or at bedtime.

A patient with diabetes mellitus has a neurogenic bladder leading to urinary retention. How is the Credé maneuver performed to help the patient completely empty the bladder? a) By performing mild massage downward over the lower abdomen and bladder b) By performing mild massage downward over the upper abdomen and bladder c) By performing moderate massage downward over the lower abdomen and bladder d) By performing moderate massage downward over the upper abdomen and bladder

A The Credé maneuver involves mild massage downward over the lower abdomen and bladder with low pressure. This massage helps in relaxing the lower abdominal muscles, which may in turn help in complete bladder emptying. The upper abdomen is not involved in the Credé maneuver. Moderate massage on the lower or upper abdomen involves applying high pressure, so reflux of urine may occur and result in renal infection.

The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? a) Excessive thirst b) Gradual weight gain c) Overwhelming fatigue d) Recurrent blurred vision

A The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

The nurse provides dietary instructions to a patient with type 1 diabetes mellitus. Which statement made by the patient indicates a need for further teaching? a) "If I go over my calories, I can just increase my insulin." b) "I'll need a bedtime snack, because I take an evening dose of NPH insulin." c) "I can have an occasional low-calorie dessert as long as I include it in my meal plan." d) "I should eat meals at the scheduled times, even if I'm not hungry, to prevent hypoglycemia."

A The goal of dietary therapy for the patient with diabetes mellitus is to attain and maintain an ideal body weight and a stable blood glucose level. Each patient should be prescribed a specific caloric intake and insulin regimen to help him or her achieve this goal. Insulin dosage should not be increased to account for an increased caloric intake. A bedtime snack for people taking evening NPH insulin, planning for an occasional low-calorie dessert, and eating at scheduled times are all part of correct diabetes management.

Which drug does the nurse expect to be beneficial in a patient with type 2 diabetes who has the presence of albumin in the urine? a) Lisinopril b) Duloxetine c) Pregabalin d) Bethanechol

A The presence of albumin in the urine indicates nephropathy in patients with diabetes. Angiotensin converting enzyme inhibitors such as lisinopril may delay the progression of nephropathy in diabetic patients. Duloxetine is a selective serotonin reuptake inhibitor that is used for symptomatic treatment of sensory neuropathy. Pregabalin is an antiseizure medication used for neuropathic pain in diabetic patients. Bethanechol is a cholinergic agonist that is indicated for the treatment of neurogenic bladder.

The nurse is caring for a patient in an outpatient diabetes clinic. Which statement by the patient indicates an understanding of the teaching? a) "I will be sure to measure my finger stick blood glucose level four times a day, and more frequently when I am ill." b) "When I am ill, I will eliminate my Lantus insulin and only cover my finger stick blood glucose if it is over 250." c) "When I am ill, I will continue to take my Lantus insulin only." d) "When I am ill I will only take my rapid-acting insulin."

A When a patient with diabetes is ill, it is recommended he or she continues checking blood sugar every four hours and more frequently to prevent hyperglycemia and hypoglycemia during illness. The diabetic patient should adhere to the sick day rules, which indicate to continue with your basal dosing of insulin and continue to correct a finger stick blood sugar greater than 200. The patient also should be checking urine ketones for two blood sugars over 250 in a row.

A patient with type 2 diabetes wants to stop taking metformin (Glucophage) and manage the diabetes with diet and exercise. The patient states that cutting out carbohydrates was featured on television recently as a treatment for diabetes and is considering the paleo diet. Which responses by the nurse are most appropriate? Select all that apply. a) "Weight loss for overweight patients is recommended as a management strategy for type 2 diabetes." b) "You should maintain a healthy balance of nutrients to maintain blood glucose and overall health." c) "There is no ideal number of carbohydrates to consume, so you should individualize your meal plan." d) "Carbohydrates are only found in grain-based products, so any diet that eliminates these foods is best recommended." e) "Patients with diabetes only need to be concerned with their blood sugars, not with their lipid levels or blood pressure goals."

A , B , C Weight loss is recommended for overweight patients with type 2 diabetes. Dietary goals for patients with type 2 diabetes include maintaining a healthy balance of nutrients to maintain blood glucose levels without spikes. The American Diabetes Association recognizes that there is no ideal number of carbohydrates for every patient and recommends that patients customize their diets with their health care providers to maintain dietary control of diabetes. Patients with diabetes need to be concerned with blood sugars, lipid levels, weight, and maintaining blood pressure goals to lower cardiovascular risks. Carbohydrates are found in grains, fruits, vegetables, and low-fat dairy products.

A nurse is caring for a 24-year-old woman with no available medical history. The patient states that she has been vomiting for two days and feels weak. She states that she cannot seem to drink enough water at home and urinates more than usual throughout the day. The laboratory results reveal an arterial blood pH of 7.28, sodium level of 155 mEq/L, potassium level of 3.5 mEq/L, serum glucose level of 550 mg/dL, sodium bicarbonate level of 10 mEq/L, and a high level of ketones in the urine. What will the nurse include in this patient's plan of care? Select all that apply. a) Potassium replacement b) Assessment of mental status c) Administration of long-acting insulin d) Assessment of blood glucose levels e) Administration of intravenous (IV) fluids

A - B - D -E The patient is experiencing diabetic ketoacidosis (DKA), which is defined by a serum glucose level over 250 mg/dL, an arterial blood pH lower than 7.30, a serum bicarbonate level less than 16 mEq/L, and a moderate to high level of ketones in the urine or serum. Treatment for a patient with DKA includes electrolyte replacement (in this case potassium), administration of IV fluids for dehydration, assessment of mental status, and assessment of blood glucose levels. The treatment for DKA is administration of short-acting insulin, not long-acting insulin.

To demonstrate an understanding of Somogyi effect, the nurse correctly identifies which defining characteristics? Select all that apply. a) Documented morning hyperglycemia b) Caused by not rotating insulin injection sites c) May be avoided by consuming a bedtime snack d) Treatment is a lower dose of insulin in the evening e) Documented hypoglycemia between 2:00 AM and 4:00 AM f) Requires an adjustment of administration time of evening insulin

A - C - D - E Hyperglycemia in the morning can be caused by the Somogyi effect, which can be stimulated by too much insulin in the evening. During the night, typically between 2:00 AM and 4:00 AM, hypoglycemia occurs, which stimulates a release in counterregulatory hormones in an attempt to raise the blood sugar. What results is rebound hyperglycemia resulting in higher blood sugar readings upon awakening. The Somogyi effect must be differentiated from dawn phenomenon, which also results in higher morning blood sugar readings. The treatment for Somogyi effect includes consuming a bedtime snack or reducing the evening insulin dose, whereas the treatment for dawn phenomenon is an increase in the evening insulin dose or an adjustment in the timing of the evening insulin dose. Not rotating insulin injection sites does not result in either the Somogyi effect or dawn phenomenon. In fact, current recommendations are to use the same anatomical injection site (e.g., the abdomen) for one week before moving to another anatomical injection site.

A patient with an oral glucose test value of 160 mg/dL has a high risk of developing type 2 diabetes. What would the nurse recommend to help delay the development of type 2 diabetes? Select all that apply. a) Maintain a healthy weight. b) Include 50 g/day of fiber in diet. c) Consume a high-protein diet for weight loss. d) Monitor for polyuria, polyphagia, and polydipsia. e) Regularly monitor blood glucose and glycosylated hemoglobin levels.

A - D - E The nurse should inform the patient with a risk for developing type 2 diabetes to maintain a healthy weight, monitor for symptoms of diabetes, such as polyuria (excessive urination), polyphagia (excessive hunger), and polydipsia (excessive thirst). It is important for the nurse to educate patients at risk for developing diabetes to take action to prevent or delay the development of type 2 diabetes by regularly monitoring blood glucose and glycosylated hemoglobin levels. A dietary intake of 25 to 30 g/day of fiber is a general recommendation. There is no evidence that increased fiber in the diet will delay the risk of diabetes. High-protein diets are not recommended as a weight loss method for people with diabetes or people at risk for diabetes.

What are the possible client-specific reasons for giving 1 mg of glucagon by the intramuscular or subcutaneous route to treat hypoglycemia? Select all that apply. a) Intravenous access is not available. b) Client is unconscious or unable to swallow. c) Deltoid muscle injection gives a faster response. d) Client prefers intramuscular glucagon administration. e) Intramuscular doses are smaller than intravenous doses.

A B C The best reasons to administer 1 mg of glucagon by intramuscular (IM) or subcutaneous injection are when the client has no intravenous (IV) access or is unable to swallow oral glucose. Also, a deltoid muscle IM injection does produce a faster treatment response, which is desirable during an acute hypoglycemic emergency. This is because glucagon stimulates rapid glycogenolysis in the liver, making glucose readily available. If the client is able to swallow and tell the nurse their preferred medication administration route, oral glucose is the best route and not an IM injection. Although it is true that the IM injection is smaller (1 mg/1 mL) compared to the IV injection (50% dextrose in 20 mL to 50 mL), the IV injection is only better in an acute care setting for a client with patent IV access and not due to any dose size considerations.

Which other symptoms should be assessed in a hospitalized patient whose blood and urine tests indicate diabetic ketoacidosis (DKA)? Select all that apply. a) Tachycardia b) Kussmaul respirations c) Orthostatic hypotension d) Hypovolemic shock state e) Reduced bowel movements f) Manifestations that mimic alcohol intoxication state

A-B- C- D DKA is caused by profound deficiency of insulin, characterized by hyperglycemia, ketosis, acidosis, and dehydration. Tachycardia in DKA results from inadequate blood supply to the tissues. A hypovolemic shock state is a result of acid accumulation. Kussmaul respirations, which involve rapid, deep breathing with dyspnea, are one of the characteristic symptoms of DKA. Orthostatic hypotension may occur because the body is unable to maintain an even distribution of fluids in its various compartments. Reduced bowel movements are not associated with DKA. Symptoms that mimic an alcohol intoxication state are present in a hypoglycemic condition.

Which assessment findings are associated with type 1 diabetes mellitus? Select all that apply. a) Fatigue b) Excessive thirst c) Frequent urination d) Recurrent infections e) Unexplained weight loss

A-B-C-E Excessive thirst, frequent urination, fatigue, and unexplained weight loss are clinical symptoms of both type 1 and type 2 diabetes mellitus (DM). Recurrent infections are a clinical manifestation of type 2 DM and not of type 1 DM.

The nurse is providing education on managing type 2 diabetes with lifestyle modification to a group of patients. Which topics should the nurse include in the education session? Select all that apply. a) Proper nutrition b) Regular physical activity c) Drug therapy with insulin d) Maintenance of recommended body weight e) Drug therapy with oral agents

A-B-D In newly diagnosed type 2 diabetics, proper nutrition, regular physical activity, and maintenance of recommended body weight or promoting weight loss are the focus to try and control the disease. Medications are not considered topics for lifestyle change.

Which key factors could be linked with diabetes mellitus type 1? Select all that apply. a) Endogenous insulin is not present in diabetes mellitus. b) Islet cell antibodies are absent in diabetes mellitus type 1. c) Diabetes mellitus type 1 is more common with people of young age. d) Resistance of ketosis is found except in conditions of infection or stress. e) Diabetes mellitus type 1 is diagnosed in 5 to 10 percent of the total diabetes cases. f) Requirement of insulin is mandatory in all the cases of diabetes mellitus type 1.

A-C-E-F Endogenous insulin is absent in patients with diabetes mellitus. Diabetes mellitus type 1 is more common in young people but can occur at any age, with 5 to 10 percent of the total diabetes diagnoses being type 1 diabetes. Insulin is required for all patients with type 1 diabetes. Islet cell antibodies are often present in diabetes mellitus type 1 patients; absence of these islet cells is associated with diabetes mellitus type 2. The development of type 1 ketosis occurs at onset or during insulin deficiency. Ketosis resistance, except during infections or stress, is associated with diabetes mellitus type 2.

Which treatment strategy would be most effective for an obese patient who has had type 2 diabetes for more than four years who has a body mass index (BMI) of 40 kg/m 2 and 8% A1C? a) Insulin therapy b) Bariatric surgery c) Nutritional therapy d) Pancreas transplantation

B Bariatric surgery is a stomach and/or intestinal operation that decreases the BMI level, helps to maintain blood glucose levels, and helps in recovering from type 2 diabetes in obese patients. Insulin therapy helps in maintaining the glucose level in the body; however, it will not be very effective in decreasing the BMI level. Nutritional therapy only will not be effective in completely curing type 2 diabetes. Pancreas transplantation is effective for type 1 diabetes only.

Which manifestation might the nurse suspect in a patient with diabetes whose serum osmolality is increased and blood glucose level is 610 mg/dL? a) Acidosis b) Seizures c) Hyperkalemia d) Cerebral edema

B Blood glucose level more than 600 mg/dL indicates hyperosmolar hyperglycemic syndrome, which increases the serum osmolality and produces severe neurologic manifestations such as seizures. Acidosis is mainly associated with diabetic ketoacidosis. Fluid losses may cause mild deficits in potassium leading to hypokalemia but not hyperkalemia. Cerebral edema is a complication associated with rapid administration of intravenous fluids.

Which statement from the patient with diabetes mellitus indicates effective learning? a) "I will have lots of fruit juices." b) "I will carry extra insulin during travel." c) "I will skip doses of insulin when I am sick." d) "I will not exercise because it increases my blood glucose level."

B Carrying extra insulin during travel is important in case an insulin vial is lost or broken. Having lots of fruit juices would not help in diabetes management because juice contains sugars that are easily absorbed. Skipping insulin doses when the patient is sick worsens the condition. Exercising might help in lowering blood glucose levels, and may help in keeping the patient healthy.

What is the effect of counter-regulatory hormones on insulin? a) They inhibit glucose production in the body. b) They maintain the blood glucose level in the body. c) They help insulin in decreasing the level of glucose in the body. d) They increase the movement of glucose into the cells of the body.

B Counterregulatory hormones are antagonist to insulin. They help in maintaining the blood glucose level by increasing the blood glucose level and decreasing the movement of glucose into the cells. Counterregulatory hormones key up the glucose production. Their function is contradictory to insulin, because they increase the level of glucose in the body. They decrease the movement of glucose in the cells of the body.

A patient with type 2 diabetes who takes metformin daily to manage blood sugar is scheduled for an intravenous pyelogram (IVP). Which question by the nurse is most important to ask the patient when preparing for the procedure? a) "Have you ever skipped a dose of metformin?" b) "When was the last time you took your metformin?" c) "How many times a day do you take your metformin?" d) "How long have you been taking metformin for diabetes?

B During an IVP, contrast dye is injected so that the urinary system can be visualized. To reduce risk of kidney injury, metformin should be discontinued a day or two before the procedure and for 48 hours following the procedure. Medication administration adherence, dosage, and history are important to assess, but will not affect the interaction.

Despite repeated instructions from a nutritionist, a diabetic patient failed to adhere to the recommended dietary allowance (RDA) for carbohydrates. This resulted in low levels of glucose in the blood. Which advice given by the nutritionist would be most appropriate for the patient? a) "Consume low glycemic index (GI) foods and beverages." b) "Evaluate blood glucose levels using carbohydrate counting." c) "Avoid whole grains, vegetables, fruits, and low-fat milk in your diet." d) "Keep the recommended dietary allowance (RDA) for carbohydrates to a maximum of 130 g/day."

B Evaluation of blood glucose levels using carbohydrate counting will help keep glucose levels within the target range. Consumption of foods and beverages with low GI will further lower blood glucose levels. Avoiding whole grains, vegetables, fruits, and low-fat milk will lower glucose levels. The minimum recommendation for carbohydrate intake is 130 g/day.

Which complication of diabetes mellitus can be monitored by fundus photography? a) Neuropathy b) Retinopathy c) Nephropathy d) Dermatopathy

B Fundus photography helps to examine the interior surface of the eye (fundus). Therefore, fundus photography helps to detect the microvascular damage caused by chronic hyperglycemia to the retina, known as retinopathy. Neuropathy can be monitored by a comprehensive foot examination. Diabetic nephropathy can be monitored by checking for microalbuminuria and serum creatinine. Dermatopathy can be monitored by frequent skin examinations.

Which statement by a patient shows ineffective learning about diabetes management? a) "I will exercise daily." b) "I will drink fruit juices daily." c) "I will walk wearing shoes daily." d) "I will have yearly influenza vaccination."

B Having fruit juices daily does not help in diabetes management, because it contains sugars that are easily absorbed. Exercising daily helps to maintain good health. Wearing shoes daily will avoid injuries to feet, which is important, because wound healing is delayed in diabetic patients. Diabetic patients have weakened immune systems and are more prone to flu. Therefore, annual vaccination against influenza is required.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? a) "With type 2 diabetes, the body of the pancreas becomes inflamed." b) "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." c) "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." d) "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

B In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. In type 1 diabetes mellitus, the patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas.

A patient who had been diagnosed with pre-diabetes six months ago is following up in the outpatient diabetes clinic. The nurse is reviewing the assessment data and understands the best reflection of good management of this condition is what? a) A 20-pound weight loss b) Hemoglobin A1C of 5.5 percent c) Reduction of total cholesterol to 200 mg/dL d) Decrease in polyuria, polydipsia, and polyphagia

B Individuals with pre-diabetes are at increased risk for development of type-2 diabetes mellitus. Prediabetes is an intermediate stage between normal glucose homeostasis and elevated blood glucose levels (diabetes). The best indicator of control of this condition is a hemoglobin A1C within normal limits for the nondiabetic patient. Hemoglobin A1C measures the amount of glucose that binds with the component of hemoglobin (A1C), which gives an indication of average glucose levels in the blood over a 90-day period. Although a reduction of risk factors through weight reduction, dietary management, and exercise is important, weight loss and cholesterol within normal limits does not reflect prevention of diabetes. Because the patient does not have true diabetes, the patient would not be experiencing the classic symptomology of the disease: polyuria, polydipsia, and polyphagia.

The nurse is conducting a teaching session about nephropathy as a complication of diabetes. Which information would be appropriate for the nurse to include in the session? a) Vessels may begin to bleed, resulting in permanent blindness. b) Controlling blood sugar and blood pressure will reduce the risk of kidney injury. c) Organ damage resulting from changes in large and medium-sized blood vessels can be prevented by careful glucose control. d) This will not occur if one does not require insulin to control diabetes.

B Microangiopathy occurs in diabetes mellitus. When the kidneys are affected, the patient has nephropathy. Maintaining control of blood sugar and blood pressure will decrease microvascular organ damage and help to preserve kidney function. Blindness occurs as a result of microvascular damage, not bleeding. Organ damage is caused from small vessel damage. Regardless of the treatment type, nephropathy can occur if blood sugars are not controlled properly.

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? a) "I should only walk barefoot in nice dry weather." b) "I should look at the condition of my feet every day." c) "I am lucky my shoes fit so nice and tight because they give me firm support." d) "When I am allowed up out of bed, I should check the shower water with my toes."

B Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. The patient should not walk barefoot. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.

A patient's blood glucose level before breakfast is 324 mg/dL. The nurse reviews the electronic medical record and notes that the patient receives a high dose of insulin each evening at bedtime. The nurse recognizes that the patient's hyperglycemia is most likely due to which problem with insulin therapy? a) Lipodystrophy b) Somogyi effect c) Allergic reaction d) Dawn phenomenon

B The Somogyi effect occurs when a patient receives a high dose of evening/bedtime insulin that produces a decline in blood glucose levels during the night. As a result, counter regulatory hormones are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia. Lipodystrophy is atrophy or hypertrophy of the subcutaneous tissue. Allergic reactions related to insulin occur as local inflammatory reactions and do not produce hyperglycemia. The dawn phenomenon also is characterized by hyperglycemia that is present on awakening; however, it is caused by growth hormone and cortisol excretion during the early morning hours and is unrelated to the amount of insulin given at nighttime.

A nurse is caring for a patient with diabetes mellitus who is in an inpatient unit. The primary health care provider has ordered regular insulin. The nurse is preparing the medication for subcutaneous injection. What is the most effective site for subcutaneous injection of insulin? a) Thigh b) Abdomen c) Upper arm d) Right buttock

B The abdomen is the preferred injection site; it provides the fastest subcutaneous absorption. The thigh, upper arm, and buttock are other sites that may be used for subcutaneous injection, but the abdomen is the best site.

When should the nurse instruct the patient to monitor the blood sugar if dawn phenomenon is suspected? a) 1 AM b) 3 AM c) 5 AM d) Upon arising

B The blood sugar should be checked between 2 AM and 4 AM. This is the time when the patient's blood sugar will be at its lowest. The counter-regulatory hormones will now be released and the rising blood sugar will show hyperglycemia if the patient has dawn phenomenon. Checking the blood glucose levels at 1 AM, 5 AM, and upon rising would likely not show the hyperglycemia the nurse is suspecting.

What may be the fasting blood glucose value of a patient with prediabetes? a) 70 to 130 mg/dL b) 100 to 125 mg/dL c) Less than 70 mg/dL d) Greater than 200 mg/dL

B The fasting blood glucose level of a patient with prediabetes may range from 100 to 125 mg/dL. The normal blood glucose level ranges from 70 to 130 mg/dL. A blood glucose level less than 70 mg/dL indicates hypoglycemia. A blood glucose level greater than 200 mg/dL indicates hyperglycemia.

A patient calls the health care provider's office at 8:00 AM and states, "I just experienced an episode of low blood sugar, which responded to oral glucose tablets." To help identify the cause of the low blood sugar, an appropriate question the nurse should ask is: a) "Did you check your urine for ketones?" b) "Were you more active than usual yesterday?" c) "Did you take a lower than normal dose of insulin today?" d) "Have you been running a fever or do you have any illness symptoms?"

B The glucose-lowering effects of exercise can last up to 48 hours, so it is possible for hypoglycemia to occur after activity, particularly if exercise is at a greater intensity or time than normal. Asking the patient about activity level would be the most appropriate question for the nurse to ask. Ketones can be found in the urine with elevated blood glucose levels and may indicate the presence of diabetic ketoacidosis. Ketones would not be of concern with hypoglycemia. Taking a lower dose of insulin would result in higher blood glucose. Fever and illness can lead to hyperglycemia as well.

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? a) 6:00 PM on the evening before the test b) Midnight before the test c) 4:00 AM on the day of the test d) 7:00 AM on the day of the test

B Typically, a patient is prescribed to be nothing by mouth (NPO) for eight hours before a fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

Which drug may result in weight gain as a side effect? a) Biguanides b) Meglitinides c) Dopamine agonist d) Dipeptidyl peptidase-4 inhibitors

B Weight gain is a common side effect seen with meglitinides. Biguanides, dopamine agonists, and dipeptidyl peptidase-4 inhibitors may not result in weight gain.

Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis? a) Electrolytes b) Insulin therapy c) Sodium bicarbonate d) Intravenous (IV) fluids

B When the body cannot utilize glucose for energy, it burns fat for energy, resulting in the production of ketones. Insulin therapy is useful for reducing the serum ketone levels. Electrolytes are given to correct the electrolyte imbalance. Sodium bicarbonate is given to treat metabolic acidosis. IV fluids are indicated for correction of dehydration.

The laboratory test reports of a hospitalized average adult patient reveal the estimated insulin level to be more than 0.6 U/kg body weight. Which complications does the nurse suspect? Select all that apply. a) Enhanced gluconeogenesis b) Increased protein synthesis c) Stored protein from muscle releases d) Enhanced glycogen storage in muscle e) Enhanced fat deposition in adipose tissue f) Decreased release of stored glucose from liver

B - D - E - F The average amount of insulin secreted daily by an adult is approximately 40 to 50 U or 0.6 U/kg body weight. Insulin facilitates a normal blood glucose range by promoting glucose transport to cell cytoplasm across cell membrane. A high level of glucose may result in increased protein synthesis, enhanced glycogen storage in muscle, enhanced fat deposition in adipose tissue, and decreased release of stored glucose from the liver. A decrease in the insulin level may cause other activities in the body, such as enhanced protein synthesis and enhanced fat deposition in adipose tissue.

Which medications does the nurse expect to be beneficial in a patient with diabetes mellitus who complains of numbness and a tingling sensation in the lower extremities? Select all that apply. a) Losartan b) Duloxetine c) Gabapentin d) Bethanechol e) Amitriptyline

B-C-E Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor that is used for treatment of sensory neuropathy in patients with diabetes. Gabapentin is an antiseizure medication that decreases the release of neurotransmitters that transmit pain in patients with neuropathy. Amitriptyline is a tricyclic antidepressant used in the treatment of sensory neuropathy. Losartan is an angiotensin receptor blocker used to delay the progression of kidney damage in patients with diabetes. Bethanechol is used for the treatment of neurogenic bladder, which is caused by autonomous neuropathy.

What are the clinical manifestations of diabetes mellitus type 2? Select all that apply. a) Ketoacidosis b) Candidal infection c) Recurrent infections d) Abdominal cramping e) Recurrent vaginal yeast f) Prolonged wound healing

B-C-E-F Candidal infection, recurrent infections, recurrent vaginal yeast, and prolonged wound healing are clinical manifestations of diabetes mellitus type 2. Recurrent infection involves the symptomatic reactivation of the latent infection. Wound healing is prolonged for patients with diabetes mellitus due to an impaired immune system. Ketoacidosis and abdominal cramping are key symptoms of diabetes mellitus type 1.

A patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? a) Routine insulin therapy and exercise b) Administer a different antibiotic for the UTI c) Cardiac monitoring to detect potassium changes d) Administer intravenous (IV) fluids rapidly to correct dehydration

C This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.

A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? a) Central apnea b) Hypoventilation c) Kussmaul respirations d) Cheyne-Stokes respirations

C In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and unlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis? a) Polyuria b) Hypokalemia c) Cerebral edema d) Metabolic acidosis

C Incorrect fluid replacement especially with hypotonic fluids may cause a sudden drop in serum sodium resulting in cerebral edema. Polyuria is a manifestation of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Hypokalemia may be seen with severe dehydration. Metabolic acidosis is observed with diabetic ketoacidosis due to fluid losses.

LAB TEST FINDING Blood Glucose --> 26- mg/dL Arterial Blood pH --> 6.8 Serum Bicarbonate --> 12 mEq/L Ketone Bodies --> Moderate to Large Ketones >> A nurse is reviewing the laboratory findings of a diabetic patient. What condition does the nurse suspect? a) Diabetic retinopathy b) Diabetic neuropathy c) Diabetic ketoacidosis d) Diabetic nephropathy

C Laboratory findings of blood glucose level greater than 250 mEq/L, arterial blood pH less than 7.30, serum bicarbonate level less than 16 mEq/L, and the presence of moderate to large ketone bodies in the urine or serum indicate diabetic ketoacidosis. Diabetic retinopathy is microvascular damage to the retina; it may not be associated with these manifestations. Diabetic neuropathy is nerve damage due to diabetes mellitus. Diabetic nephropathy is damage to nephrons due to hyperglycemia.

The nurse is teaching the caregiver about the manifestations of hypoglycemia in the diabetic patient. What should the caregiver identify as a manifestation of hypoglycemia? a) Increase in urination b) Abdominal cramps c) Nervousness and tremors d) Nausea and vomiting

C Nervousness and tremors; cold, clammy skin; and numbness of the fingers and toes are some of the manifestations of hypoglycemia which the caregiver should watch for out in the patient. An increase in urination, abdominal cramps, and nausea and vomiting are manifestations of hyperglycemia.

Which drug is used for treating neurogenic bladder? a) Valsartan b) Gabapentin c) Bethanechol d) Amitriptyline

C Neurogenic bladder may develop as a sensation in the inner bladder wall, causing urinary retention. A cholinergic agonist drug such as bethanechol is used for treating this condition. Valsartan is an angiotensin receptor blocker that is used in patients with diabetes and microalbuminuria. Gabapentin is an antiseizure medication used for treating neuropathic pain. Amitriptyline is a tricyclic antidepressant used in the treatment of neuropathic pain.

What is the cause of microaneurysms in nonproliferative retinopathy? a) Retinal edema b) Neurovascularization c) Partial blood vessels occlusion d) Intraretinal hemorrhages

C Partial occlusion of small blood vessels in the retina causes microaneurysms in the capillary walls. Retinal edema is caused by leakage of the capillary fluids from the walls of microaneurysms. Occlusion of retinal capillaries leads to neurovascularization, which is the formation of new blood vessels to supply the retina with blood. Intraretinal hemorrhages may occur due to leakage of the capillary fluids from microaneurysms.

A patient diagnosed with diabetes mellitus is suspected of having insulin resistance. The nurse identifies that which medication would be most beneficial for the patient? a) Glipizide b) Acarbose c) Pioglitazone d) Repaglinide

C Pioglitazone, a thiazolidinedione, is used to improve insulin sensitivity in patients having insulin resistance. Glipizide, a sulfonylurea, is prescribed to stimulate insulin production. Acarbose, an α-glucosidase inhibitor, is used to lower postprandial blood glucose. Repaglinide, a meglitinide, stimulates insulin production in the pancreas.

Which is an insulin-dependent tissue? a) Brain b) Kidney c) Skeletal muscle d) Red blood cells

C Skeletal muscles have specific receptors that are activated by insulin that permit the transportation of glucose into the cells. The brain, kidney, and red blood cells do not have receptors; instead they require only a specific amount of glucose for normal functioning.

A nurse is providing discharge teaching to a patient with a new diagnosis of type I diabetes mellitus who will need to give self-injections of insulin at home. What statement by the patient indicates to the nurse that the discharge teaching was effective? a) "I can use my lower forearm for insulin injections." b) "If my intermediate-acting insulin looks cloudy, I should discard the bottle." c) "I need to rotate sites of injection to allow for better absorption of the insulin." d) "I should push the plunger all the way down and then remove the needle as soon as possible."

C Teaching the patient to rotate the injection within and between sites is important to allow for better insulin absorption. The lower forearm is not an injection site for subcutaneous insulin administration. The abdomen, arm, thigh, and buttock are the preferred sites. Intermediate-acting insulin is normally cloudy, and the patient should gently roll the bottle between the palms of hands to mix the insulin. The patient should push the plunger all the way down and leave the needle in place for 5 seconds to ensure that all of the insulin has been injected before removing the needle.

The nurse is instructing a diabetic patient who has infrequent voiding, difficulty voiding, and a weak stream of urine. Which action indicates the need for additional teaching? a) Emptying the bladder for every three hours b) Emptying the bladder in a sitting position c) Loosening the abdominal muscles during voiding d) Massaging downwards over the lower abdomen and bladder

C The abdominal muscles should be tightened for complete voiding of the urine and to prevent urine stasis. Difficulty in voiding the urine in patients with diabetes is due to autonomic neuropathy. Emptying the bladder every three hours helps to prevent stasis and subsequent infections. Emptying the bladder in a sitting position helps to void the urine completely. Massaging downwards over the lower abdomen and bladder may promote complete bladder emptying.

Which complication of diabetes can be diagnosed by the ankle-brachial index? a) Diabetic neuropathy b) Diabetic nephropathy c) Peripheral arterial disease d) Hyperosmolar hyperglycemic syndrome

C The ankle-brachial index is used to diagnose peripheral arterial disease. Diabetic neuropathy is diagnosed based on the symptoms and by examining the patient's lower extremities. Increased serum creatinine, decreased glomerular filtration rate, and albuminuria is indicative of diabetic nephropathy. Hyperosmolar hyperglycemic syndrome is suspected if the blood glucose levels are more than 600 mg/dL, with a marked increase in serum osmolality.

Which intervention may help prevent further complications in an unconscious patient with a history of diabetes whose blood sugar level is found to be 65 mg/dL? a) Administering 100 mL of whole milk orally b) Administering 15 g of fast-acting carbohydrate orally c) Administering 25 to 50 mL of 50 percent glucose intravenously d) Administering 20 to 40 U of 30/70 insulin subcutaneously

C The patient should be immediately administered 25 to 50 mL of 50 percent glucose intravenously, which would rapidly raise the glucose concentration in the blood stream. An oral route of administration of fast-acting carbohydrate is not appropriate in an unconscious patient. Treatment with carbohydrate that contains fats, such as whole milk, should be avoided, because the fat will decrease the absorption of glucose and delay the response. Insulin is to be administered in patients with hyperglycemia.

After a teaching session with the registered nurse, the newly diagnosed patient with type 1 diabetes mellitus is correct when he or she makes which statement? a) "If I lose weight, I will be able to stop taking insulin." b) "My pancreas will produce more insulin as I recover." c) "I will need to be medicated with insulin for the rest of my life." d) "I will be able to take insulin pills once my blood sugar is stabilized.

C Type 1 diabetes is caused by destruction of pancreatic β-cells, which causes permanent insulin insufficiency and eventual absence. Weight loss and recovery will not affect insulin production. Exogenous insulin is not absorbed in the GI system and therefore must be given parenterally.

To determine how well a patient's diabetes mellitus has been controlled over the past two to three months, what assessment parameter should the nurse review? a) Fasting blood glucose b) Oral glucose tolerance c) Glycosylated hemoglobin d) Random fingerstick blood glucose

C When the glucose level is increased, glucose molecules attach to hemoglobin in the red blood cells (RBCs). This attachment lasts for the life of the RBC, two to three months. Monitoring the numbers of these attachments makes it possible to assess the average blood glucose for the previous two to three months. Fasting blood glucose, oral glucose tolerance, and random fingerstick blood glucose tests are used to measure the current blood glucose level, which is different from the glycosylated hemoglobin level.

Which factor may lead to coexistence of hyperinsulinemia and hyperglycemia? a) The β-cells of the pancreas are damaged. b) More insulin is produced than is required. c) The insulin receptors do not respond to the insulin and the production of insulin increases. d) The insulin receptors do not respond to the insulin but production of insulin is occurring at a normal rate.

C When the insulin receptors do not respond to insulin, it delays the transportation of glucose into the cell. Therefore, the pancreas produces high levels of insulin in response to an increased blood glucose level. This results in hyperinsulinemia and hyperglycemia at the same time. If the β-cells of the pancreas are damaged, there will be no or less production of insulin, which will not result in hyperinsulinemia. When both the conditions coexist, the blood glucose level increases, thereby increasing the insulin production. During insulin resistance, β-cells produce more insulin than normal in response to the increased blood glucose level.

A college student is newly diagnosed with type 1 diabetes. The patient now has a headache, changes in vision, and is anxious, but does not have the portable blood glucose monitor with him or her. Which action should the campus nurse advise the patient to take? a) Eat a piece of pizza b) Drink some diet soft drink c) Eat 15 g of simple carbohydrates d) Take an extra dose of rapid-acting insulin

C When the patient with type 1 diabetes is unsure about the meaning of the symptoms he or she is experiencing, the patient should treat him- or herself for hypoglycemia to prevent seizures and coma from occurring. The patient also should be advised to check the blood glucose as soon as possible. The fat in the pizza and the diet soft drink would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.

Which statement of the diabetic patient suggests the need for additional learning about foot care? a) "I will wear only padded socks." b) "I will wash my feet daily with gentle soap." c) "I will check my feet for swelling and cuts every day." d) "I will give a hot water bottle treatment to my feet daily."

D A patient suffering from severe diabetes may have sensory neuropathy. Hot water is not recommended, because the patient will not be able to sense the degree of warmth of the water and may get burns. Using padded socks will protect the patient from cuts. Washing the feet daily with gentle soap will reduce the risk of infection. By checking for swelling and cuts every day, the patient can get timely treatment if needed.

Which diagnostic test is the most appropriate to assess the risk of diabetes in a patient who reports polyuria and a family history of diabetes? a) Hematocrit test b) Serum creatinine test c) Postprandial blood test d) Glycosylated hemoglobin test

D Glycosylated hemoglobin is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods. As the average amount of plasma glucose increases, the fraction of glycosylated hemoglobin increases in a predictable way. This serves as a marker for the average blood glucose level over a period of three months. Hematocrit is the erythrocyte volume in the blood. A serum creatinine test is an indicator of renal function. A postprandial blood test determines the amount of glucose in the blood after a meal.

Which is a symptom of autonomic neuropathy? a) Aphasia b) Glaucoma c) Paresthesias d) Gastroparesis

D Gastroparesis is delayed gastric emptying, which is one of the complications of autonomic neuropathy. Aphasia is one of the severe neurologic manifestations of hyperosmolar hyperglycemic syndrome. Glaucoma may occur due to diabetic retinopathy. Paresthesias is seen in sensory neuropathy.

A patient is admitted with diabetic ketoacidosis. Which signs/symptoms would the nurse expect to find upon physical examination? a) Blood sugar 200 mg/dL and bradypnea b) Hypotension and blood sugar 68 mg/dL c) Diaphoresis and extreme hunger d) Dry skin and ketonuria

D In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. The patient also will present with dry, loose skin. Blood pressure will not be low and respiratory rate will be increased, not decreased.

Which is an insulin-dependent diabetes? a) Prediabetes b) Gestational diabetes c) Adult-onset diabetes d) Juvenile-onset diabetes

D Juvenile-onset diabetes is also known as type 1 diabetes. Type 1 diabetes is an insulin-dependent diabetes, because there is lack of insulin due to breakdown of islet cells. Prediabetes is a condition in which the blood glucose levels are above normal, but not enough to be diagnosed as diabetes. Gestational diabetes is seen during pregnancy; it may be insulin-dependent or non-insulin-dependent diabetes. Adult-onset diabetes is also known as type 2 diabetes. Type 2 diabetes is non-insulin-dependent diabetes, because some insulin is produced by the pancreas, but it is either insufficient for the needs of the body, poorly used by the tissues, or both.

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.8 mEq/L. The nurse understands that a possible cause of hyperkalemia would be: a) Retention of potassium related to inadequate nutrition b) The body's attempt to fight off the infection caused by cellulitis c) Excess insulin administration causing potassium to leak out of the cells d) Decreased secretion of potassium through the kidneys secondary to nephropathy

D Nephropathy, a complication of diabetes, results in elevated potassium levels. Malnutrition does not cause sodium excretion accompanied by potassium retention; therefore, it is not a contributing factor in this patient's potassium level. Potassium is not affected by the body's immune system. Insulin causes a decrease in potassium by pushing it into the cells.

The nurse is reviewing diabetic self-care management with a patient newly diagnosed with diabetes. The patient is in need of further education when stating to the nurse: a) "I am going to check my feet for pressure areas every morning before I take a bath." b) "I need to be careful on how I cut my toenails. I should not cut down the corners of the nail." c) "I have scheduled an eye examination with an ophthalmologist for next week. I will need to have an annual eye exam." d) "To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath."

D Patients with diabetes are at great risk for skin breakdown because of peripheral vascular problems and peripheral neuropathy. Patients should avoid using rubbing alcohol on skin to prevent tissue damage. The best way to prevent foot ulcers is prevention and early detection. Inspecting the feet every day for cuts, abrasions, pressure areas, or sores is a good practice. Toenails should be cut with the rounded contour of the nail and not cut down the corners of the nail. Another complication of diabetes is retinopathy. Patients with a history of diabetes should have an eye examination annually by an ophthalmologist.

A nurse is evaluating an overweight patient in the adult ambulatory clinic for a yearly physical. The patient has a family history of type 2 diabetes and is afraid of developing this disease. How should the nurse respond? a) "There is only a genetic link in type 1 diabetes." b) "Weight plays no role in the development of type 2 diabetes." c) "In type 2 diabetes, the pancreas is unable to produce insulin, so symptoms would already be noticeable." d) "Metabolic abnormalities such as insulin resistance and being overweight play a role in developing type 2 diabetes."

D Patients with metabolic abnormalities such as being overweight increase the risk of insulin resistance and inappropriate insulin secretion, which can lead to type 2 diabetes. There is a genetic link associated with type 2 diabetes, although the link is not fully understood at this time. People with first-degree relatives suffering from this disease are 10 times more likely to be diagnosed as well. Overweight patients have increased adipocytes, which secrete hormones (adipokines) that play a role in glucose and fat metabolism and likely contribute to the development of this disease. Type 1 diabetes is characterized by the autoimmune destruction of insulin-producing beta cells in the pancreas, which causes the downstream effects of the disease.

What will be the drug of choice for a patient who has insulin resistance? a) Acarbose b) Glimepiride c) Nateglinide d) Pioglitazone

D Pioglitazone is an insulin sensitizer that is very effective when the receptors on the insulin-dependent tissue do not respond to the insulin, resulting in insulin resistance. Therefore, it is given to patients with insulin resistance. Acarbose is an α-glucose inhibitor and is unassociated with insulin resistance. It reduces absorption of carbohydrate in the intestine. Glimepiride is incapable of treating insulin resistance because it helps boost insulin production and causes hypoglycemia. Nateglinide is not effective for insulin resistance because it enhances insulin production without causing hypoglycemia.

While reviewing the laboratory reports of a patient with type 2 diabetes mellitus, the nurse concludes that the patient has high risk for macrovascular complications. Which finding supports the nurse's conclusion? a) The patient has triglycerides of 137 mg/dL b) The patient has blood pressure of 130/80 mm Hg c) The patient has high-density lipoprotein (HDL) of 45 mg/dL d) The patient has low-density lipoprotein (LDL) of 120 mg/dL

D The recommended LDL cholesterol level for patients with diabetes is less than 100 mg/dL. A higher LDL cholesterol may increase the risk of macrovascular complications such as cerebrovascular, cardiovascular, or peripheral vascular disease in patients with diabetes. The recommended target value of triglycerides less than 150 mg/dL is indicated in patients with diabetes. A target blood pressure of 130/80 mm Hg is recommended for diabetic patients to decrease the incidence of macrovascular complications. A patient with diabetes should have HDL cholesterol greater than 40 mg/dL in order to decrease the risk of macrovascular complications.

A patient with type 2 diabetes takes oral hypoglycemics and is admitted to the hospital with a urinary tract infection (UTI). The patient asks why insulin injections have been prescribed. What explanation should the nurse provide? a) Insulin acts synergistically with the antibiotic that was prescribed. b) Insulin should have been prescribed for the patient to take at home. c) Oral hypoglycemic medications are contraindicated in patients with UTIs. d) The infection increases the glucose level, resulting in a need for more insulin.

D When the body is under stress, as in an acute illness, the need for insulin is more than oral hypoglycemics can provide. Insulin injections are usually required until the illness resolves. Insulin does not act synergistically with antibiotics, the patient did not need insulin at home, and oral hypoglycemics are not contraindicated in patients with UTIs.