Ch. 33 Pathophysiology
A client's primary care provider has ordered an oral glucose tolerance test (OGTT) as a screening measure for diabetes. Which of the following instructions should the client be given? A) "The lab tech will give you a sugar solution and then measure your blood sugar levels at specified intervals." B) "You'll have to refrain from eating after midnight and then go to the lab to have your blood taken first thing in the morning." C) "They'll take a blood sample and see how much sugar is attached to your red blood cells." D) "You can go to the lab at any time; just tell the technician when you last ate before they draw a blood sample."
A) "The lab tech will give you a sugar solution and then measure your blood sugar levels at specified intervals."
Which of the following clients would be considered to be exhibiting manifestations of "prediabetes"? A) A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL. B) A school-aged child who had a blood glucose level of 115 following lunch. C) A retired female registered nurse with a fasting plasma glucose level of 92 mg/dL. D) An elderly client who got "light-headed" when he skipped his lunch. Blood glucose level was 60 mg/dL at this time.
A) A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL.
6. The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which of the following pathophysiologic processes underlies the client's new diagnosis? A) Beta cell exhaustion due to long-standing insulin resistance B) Destruction of beta cells that is not attributable to autoimmunity C) T-lymphocyte-mediated hypersensitivity reactions D) Actions of insulin autoantibodies (IAAs) and islet cell autoantibodies (ICAs)
A) Beta cell exhaustion due to long-standing insulin resistance
Which of the following comorbidities represent the greatest risk for the development of foot ulcers in a diabetic client? Select all that apply. A) Bilateral distal loss of pain sensation B) Previous incidents of diabetic ketoacidosis with blood glucose levels of 400 mg/dL C) Diabetic renal problems with severely decreased GFR D) Motor neuropathy related to improperly fitted shoes E) Smoking history averaging 2 packs/day
A) Bilateral distal loss of pain sensation D) Motor neuropathy related to improperly fitted shoes E) Smoking history averaging 2 packs/day
A diabetic client presents to the clinic. He is concerned his lower legs are "feeling funny." Which of the following assessment findings lead the health care provider to suspect the client may have developed somatic neuropathy? Select all that apply. A) Both legs appear to be the same as far as numbness is involved. B) Bilateral cool ankles and feet. C) Right foot has a diminished perception of vibration; left foot is normal. D) With eyes closed, the client cannot identify where the HCP is touching his feet. E) One leg has a reddened area in the calf and has a positive Homan sign.
A) Both legs appear to be the same as far as numbness is involved. B) Bilateral cool ankles and feet. D) With eyes closed, the client cannot identify where the HCP is touching his feet.
A newly diagnosed type 2 diabetic client has been prescribed metformin. When explaining the actions of this medication, the nurse should include which statement? This medication: A) Inhibits hepatic glucose production and increases the sensitivity of peripheral tissues to the actions of insulin B) Blocks the action of intestinal brush border enzymes that break down complex carbohydrates C) Increases insulin sensitivity in the insulin-responsive tissues—liver, skeletal muscle, and fat—allowing the tissues to respond to endogenous insulin more efficiently D) Acts like a hormone released into the circulation by the gastrointestinal tract after a meal, especially one high in carbohydrates, which amplify the glucose-induced release of insulin
A) Inhibits hepatic glucose production and increases the sensitivity of peripheral tissues to the actions of insulin
A diabetic client was visiting the endocrinologist for annual checkup. The client's blood work reveals an increased level of which lab result that reveals early signs of diabetic nephropathy? A) Microalbuminuria B) Oliguria C) Hypokalemia D) Hyperlipidemia
A) Microalbuminuria
A client with type 2 diabetes has routine lab work, which reveals elevated free fatty acids (FFA). The client asks, "Why is this significant?" The most accurate response would be: Select all that apply. A) This may increase the amount of triglyceride (a form of fat) stored in your liver or around your heart. B) Your pancreas is affected by increased fat (lipotoxicity), which causes beta cell dysfunction, leading to the need for insulin. C) Excess fat in the liver causes a decrease in hepatic glucose production leading to severe hypoglycemia. D) Nonalcoholic fatty liver disease may lead to needing a liver transplant. E) Excess fatty acids may interfere with the way your body responds to an infection.
A) This may increase the amount of triglyceride (a form of fat) stored in your liver or around your heart. B) Your pancreas is affected by increased fat (lipotoxicity), which causes beta cell dysfunction, leading to the need for insulin.
A client is admitted in the ICU with diagnosis of hyperglycemic hyperosmolar state (HHS). The nurse caring for the client knows that the client's elevated serum osmolality has pulled water out of this brain cells based on which of the following assessment findings? Select all that apply. A) Weakness one side of the body B) After the sole of the foot has been firmly stroked, the toes flex and flare out C) Increase in urine output in proportion to the increase in blood glucose D) Unable to respond verbally to questions E) Uncontrollable twitching of a muscle group
A) Weakness one side of the body B) After the sole of the foot has been firmly stroked, the toes flex and flare out D) Unable to respond verbally to questions E) Uncontrollable twitching of a muscle group
A hospital client has been complaining of increasing fatigue for several hours, and his nurse has entered his room to find him unarousable. The nurse immediately checked the client's blood glucose level (and reverified with a second blood glucose meter), which is 22 mg/dL (1.2 mmol/L). The nurse should prepare to administer which of the following? A) A snack that combines simple sugars, protein, and complex carbohydrates B) A 50% glucose solution intravenously C) Infusion of rapid-acting insulin D) An oral solution containing glucagon and simple sugars
B) A 50% glucose solution intravenously
A client with a history of diabetes presents to the emergency department following several days of polyuria and polydipsia with nausea/vomiting. On admission, the client labs show a blood glucose level of 480 mg/dL and bicarbonate level of 7.8 mEq/dL. The nurse suspects the client has diabetic ketoacidosis (DKA). The priority intervention should include: A) Limit fluid intake to only 250 mL/4 hours. B) Begin a loading dose of IV regular insulin followed by a continuous insulin infusion. C) Give at least 50 units of regular insulin IV stat and recheck blood glucose in 2 hours. D) Push a stat dose of bicarbonate followed by a double-dose (loading) of metformin.
B) Begin a loading dose of IV regular insulin followed by a continuous insulin infusion.
Diabetic retinopathy, the leading cause of acquired blindness in the United States, is characterized by retinal: A) Glaucoma B) Hemorrhages C) Dehydration D) Infections
B) Hemorrhages
While working on the med-surg floor, the nurse has a client who is experiencing an insulin reaction. The client is conscious and can follow directions. The most appropriate intervention would be: A) Call the physician and wait for him or her to respond to give you orders of what he or she prefers you do for this client. B) Immediately administer 15 g of glucose (preferably via oral route if the client is alert enough to swallow) and wait for 15 minutes. Then repeat this if necessary. C) Start pushing 50% glucose solution slowly and do not stop pushing until the client's repeat blood glucose level is above 100 mg/dL. D) Skip the oral glucose tablets and go directly to giving intramuscular glucagon. Repeat the glucagon in 15 minutes if the blood glucose level is not within a normal range.
B) Immediately administer 15 g of glucose (preferably via oral route if the client is alert enough to swallow) and wait for 15 minutes. Then repeat this if necessary.
Which of the following insulin administration regimens is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes? A) One large dose of long-acting insulin each day before breakfast B) Intermediate-acting insulin at 8:00 AM and 8:00 PM with rapid-acting insulin before each meal C) Six to eight small doses of rapid-acting insulin each day, with capillary monitoring before each D) Long-acting insulin twice daily (breakfast and bedtime), with intermediate-acting insulin in the afternoon
B) Intermediate-acting insulin at 8:00 AM and 8:00 PM with rapid-acting insulin before each meal
from the action of insulin? A) Promotion of fat breakdown B) Promotion of glucose uptake by target cells C) Promotion of gluconeogenesis D) Initiation of glycogenolysis
B) Promotion of glucose uptake by target cells
Which of the following assessment findings of a male client constitutes a criterion for a diagnosis of metabolic syndrome? The client: A) States that he does less than 30 minutes of strenuous physical activity each week B) Has a resting heart rate between 85 and 95 beats/minute C) Has blood pressure that is consistently in the range of 150/92 mm Hg D) Has a fasting triglyceride level of 100 mg/dL
C) Has blood pressure that is consistently in the range of 150/92 mm Hg
While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which of the following accurate information? A) The destruction of beta cells and absolute lack of insulin in people with type 2 diabetes means that they are particularly prone to the development of diabetic complication. B) Because of the loss of insulin response, all people with type 2 diabetes require exogenous insulin replacement to control blood glucose levels. C) In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance. D) They have increased predisposition to other autoimmune disorders such as Graves disease, rheumatoid arthritis, and Addison disease.
C) In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.
A client with long-standing type 2 diabetes is surprised at his high blood sugar readings while recovering from an emergency surgery. Which of the following factors may have contributed to the client's inordinately elevated blood glucose levels? A) The tissue trauma of surgery resulted in gluconeogenesis. B) Illness inhibited the release and uptake of glucagon. C) The stress of the event caused the release of cortisol. D) Sleep disruption in the hospital precipitated the dawn effect.
C) The stress of the event caused the release of cortisol.
A diabetic client presents to a clinic for routine visit. Blood work reveals a HbA1C of 11.0% (high)? Which response by the patient may account for this abnormal lab result? A) "I've had more periods of hypoglycemia than usual over the past few months." B) "I've been doing great. I haven't needed much insulin coverage before meals." C) "To tell you the truth, my blood glucose levels have been pretty normal for me." D) "My meter broke so I have not been checking my blood glucose levels for a while."
D) "My meter broke so I have not been checking my blood glucose levels for a while."
A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be: A) "Probably not since genetically your other children have a different cellular makeup, they just might not become diabetic." B) "If you put all your children on a low-carbohydrate diet, maybe they won't get diabetes." C) "We don't know what causes diabetes, so we will just have to wait and see." D) "This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."
D) "This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."
A client with type 1 diabetes has started a new exercise routine. Knowing there may be some increase risks associated with exercise, the health care provider should encourage the client to: A) Watch for too rapid weight loss B) Monitor for respiratory disorders C) Be careful that you're not experiencing a rebound hyperglycemia D) Carry a snack with carbs to prevent profound hypoglycemia
D) Carry a snack with carbs to prevent profound hypoglycemia
Impaired and delayed healing in a person with diabetes is caused by long-term complications that include: A) Ketoacidosis B) Somogyi effect C) Fluid imbalances D) Chronic neuropathies
D) Chronic neuropathies
A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing: A) Possible stress-related hypoglycemia B) Somogyi effect C) Hyperglycemic hyperosmolar state (HHS) D) Dawn phenomenon
D) Dawn phenomenon
A diabetic client's most recent blood work indicated a decreased glomerular filtration rate and urine testing revealed + microalbuminuria. Which priority self-care measures should the client's care team prescribe for this client? A) Use of over-the-counter herbal products for natural diuretic properties B) Increased fluid intake to at least 2000 mL/day C) Decreased oral sugar intake to less than 5 tsp/day D) Diet, exercise, and prescriptions to lower blood pressure below 140/80 mm Hg
D) Diet, exercise, and prescriptions to lower blood pressure below 140/80 mm Hg
Which of the following pregnant women likely faces the greatest risk of developing gestational diabetes? A client who: A) Was diagnosed with placenta previa early in her pregnancy B) Is gravida five (in her fifth pregnancy) C) Has BP of 130/85 mm Hg and pulse rate of 90 beats/minute D) Is morbidly obese defined as greater than 100 pounds over ideal weight
D) Is morbidly obese defined as greater than 100 pounds over ideal weight