ch 37 diabetes

A long-term diabetic patient reports that he has been diagnosed with early cardiovascular disease. How does diabetes predispose the patient to cardiovascular complications? a. Hyperglycemic periods cause thickening of the basement membrane in vessels, which causes atherosclerosis. b. Hypoglycemic periods increase cortisol release, which causes hypertension. c. Insulin constricts the cardiovascular vessels, which causes congestive heart failure. d. Diabetes decrease in the body's ability to digest fats by the pancreas, which leads to increased coronary artery blockage.

A

The nurse is reviewing the patient's prescribed insulin regimen. The nurse notes that the physician has ordered a long-lasting insulin. Which medication best meets this criteria? a. Lantus b. NovoLog c. Humalog d. Regular

A

Which factor(s) may cause diabetes mellitus (DM)? (select all that apply.) a. Genetic b. Microbiologic c. Metabolic d. Allogenic e. Immunologic

A B C E

The nurse is caring for a patient suspected of having ketoacidosis. Which manifestation(s) is/are characteristic with early ketoacidosis? (select all that apply.) a. Fruity breath b. Polyuria c. Nausea d. Thirst e. Sunken eyes

A B D

Which statement(s) explain(s) a reason for weight loss in type 1 diabetics? (select all that apply.) a. Loss of body fluid b. Insulin intolerance c. Metabolization of body fats d. Stress of disease e. Altered diet

A C

When discussing exercise programs with the diabetic, which instruction(s) is/are important for the nurse to include? (select all that apply.) a. Delay exercise until glucose controlled. b. Check glucose immediately after exercising. c. Keep a quick source of glucose readily available while exercising. d. Begin slowly and build up to 30 to 45 minutes. e. Only use the abdominal injection site for insulin.

A C D E

Which genetic factor(s) increase(s) the risk of a person developing diabetes mellitus (DM)? (select all that apply.) a. Number of relatives with DM b. Body mass index (BMI) c. Sedentary lifestyle d. Genetic closeness of relatives with DM e. Race

A D E

The nurse is counseling an overweight, noncompliant, 30-year-old female with type 2 diabetes. Which change is most important for the nurse to suggest? a. Begin an exercise program and lose weight. b. Obtain annual eye examinations. c. Keep a food diary. d. Inspect feet daily.

ANS: A All of these changes are important, but exercise and weight loss are priority changes. In the type 2 diabetic, weight reduction and increased physical activity can restore blood glucose to normal levels and maintained it—hence the importance of diet and exercise in the management of type 2 diabetes. Annual eye examinations are important to detect onset of diabetic retinopathy. A food diary can help the patient to visualize food intake that may be subconscious otherwise. Diabetics are prone to foot problems and wounds and should inspect their feet daily.

Which goal is the primary objective of a diabetic diet? a. Adequate nutrition with weight control b. Exclusion of all sweets c. Increased fat intake for greater energy d. Elimination of all fast foods

ANS: A Currently, the diabetic diet is much less stringent than diets of years past. The primary goal of the current diabetic diet includes adequate nutrition with weight and cholesterol control. The newer diets allow for some sweets and some fast foods. Fats are not adequate sources of energy. Fat intake should be limited to reduce complications related to weight gain and cardiovascular concerns.

Which laboratory values are consistent with a patient in ketoacidosis? a. Blood urea nitrogen (BUN) of 35 mg/dL b. Carbon dioxide (CO2) of 40 mEq/L c. pH of 7.54 d. Blood glucose of 70 mg/dL

ANS: A Diabetic ketoacidosis results when the body attempts to metabolize protein and fats, which results in high BUN readings. The CO2 should be normal or low depending on the effectiveness of Kussmaul respirations. The arterial pH will be low, and there will be high glucose, which the diabetic patient cannot use.

The nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%. What can the nurse infer from these findings? a. The patient's blood glucose control has improved over the last several months. b. The patient has been less compliant with the prescribed treatment regimen. c. The patient is experiencing a reduction in insulin sensitivity. d. The patient has less need for insulin.

ANS: A HbA1c is a diagnostic assessment used to review blood glucose levels retrospectively. A reduction in the value indicates improved glucose control by the patient. There is no evidence of insulin sensitivity. The need for insulin is not decreased in this patient.

The nurse is educating a 50-year-old patient about diabetes monitoring. Which statement reinforces the American Diabetes Association's (ADA's) recommendation? a. Obtain regularly scheduled fasting blood glucose levels. b. Strictly adhere to weight reduction diets. c. Exercise regularly in intervals lasting a minimum of 30 minutes. d. Use stress reduction techniques.

ANS: A The ADA recommends screening with a fasting blood glucose. Adherence to a weight loss plan, regular exercise, and stress reduction techniques help control diabetes but do not monitor it.

The nurse is educating the patient about the significance of islet cell antibodies. Which statement accurately describes islet cell antibodies? a. Islet cell antibodies cause beta cells to quit producing insulin and lead to type 1 diabetes mellitus (DM). b. Islet cell antibodies protect beta cells from viral attack. c. Islet cell antibodies increase production of insulin from beta cells. d. Islet cell antibodies decrease the size of the pancreas.

ANS: A The antibodies cause beta cells to quit production of insulin.

The patient comes to the emergency room complaining of abdominal pain. The nurse assesses dry, hot skin, fruity breath, and deep respirations. To which problem should the nurse attribute these findings? a. An insulin reaction b. Ketoacidosis c. Rebound hyperglycemia d. Hypoglycemia

ANS: B Abdominal pain with dry, hot skin, fruity breath, and deep respirations is characteristic of ketoacidosis. Manifestations of an insulin reaction, or hypoglycemia, include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Rebound hyperglycemia, or the Somogyi effect, follows a period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects of low blood sugar. The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose, it worsens the problem.

The nurse is caring for a patient with ketosis. Which statement indicates that the patient correctly understands the phenomenon? a. "I took too much insulin to decrease my body's glucose levels." b. "The condition resulted when my body tried to break down and use my stores of fats." c. "My blood glucose went over 150 mg/dL and caused this condition." d. "I exercised too much reduced my blood glucose level too dramatically."

ANS: B People with type 1 diabetes are more prone to a serious complication, ketosis, associated with an excess production of ketone bodies, leading to ketoacidosis (metabolic acidosis). When the glucose level gets too high, the body attempts to metabolize fats for energy, and the result is a buildup of ketone bodies.

A patient recently diagnosed with type 1 diabetes mellitus (DM) asks why she is experiencing increased thirst. Which explanation is most appropriate? a. Diabetes results in a lack of protein absorption that decreases amino acids and causes increased thirst. b. High glucose levels in the blood pull cellular water into circulating volume and increase thirst. c. Thirst results from the body's increased loss of fluids from frequent urination. d. Diabetes causes large amount of fluid to shut to the pancreas, which dehydrates the body.

ANS: B Polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling intracellular fluid into the circulating volume.

A patient asks the nurse if stress can be a potential cause of type 2 diabetes. Which response is most appropriate for the nurse to make? a. "Stress decreases the number of alpha cells in the pancreas, and increases the workload on the beta cells." b. "Periods of stress cause increases in glycogen production by the adrenal cortex." c. "Stress is directly associated with decreased insulin tolerance." d. "The inhibition of beta cells to glucose is increased in periods of stress."

ANS: B Stress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia.

Which reason best explains why diabetics are prone to infection? a. High glucose levels provide an environment conducive to bacterial growth. b. Atherosclerotic vascular changes decrease blood supply to tissues. c. Diabetics display abnormal phagocyte function. d. Diabetics display decreased leukocyte function.

ANS: B The primary reason for increased risk of infection in diabetic patients is the hyperglycemic environment. Lesser risk factors include atherosclerotic vascular changes, abnormal phagocyte function, and decreased leukocyte function.

The patient takes his NovoLog 70/30 at 0700. When should the nurse suggest that the patient schedule exercise? a. 0730. b. 1000. c. 1300. d. Scheduling exercise is unnecessary.

ANS: C Exercise should occur after peak action time to prevent hypoglycemia. NovoLog is a rapid-acting insulin that peaks 1 to 3 hours after administration. Since the insulin is administered at 70/30, scheduling exercise for 1300 would mean that it occurs after the peak insulin action.

The nurse is educating a patient with gestational diabetes. Which statement indicates that the patient needs additional teaching? a. "Gestational diabetes happens because of the hormonal changes of pregnancy." b. "I should exercise regularly and lose weight to reduce my risk of becoming a diabetic." c. "This problem goes away completely once I give birth." d. "The baby will have to be monitored for hypoglycemia during my pregnancy."

ANS: C Giving birth does not automatically resolve gestational diabetes. Of the women who have gestational diabetes, 5% to 10% go on to develop type 2 diabetes. The patient correctly understands that gestational diabetes occurs because of hormonal changes in pregnancy, proper diet and regular exercise may help decrease the likelihood of developing type 2 diabetes, and the baby will require monitoring for hypoglycemia throughout the patient's pregnancy.

The nurse is caring for an older adult patient who is diabetic. The nurse cautions against the technique of "tight control" of hyperglycemia. Which statement explains why this management method is not recommended? a. Older adults may not accurately test and administer sliding-scale insulin. b. Older adults possess lower risk for hyperglycemia. c. Older adults may experience cardiovascular problems from hypoglycemia. d. Older adults possess an unstable metabolic rate.

ANS: C One complication of the "tight control" method includes hypoglycemia. Older adults experience hypoglycemia more quickly than do younger people, and older adults are more prone to hypoglycemic episodes. The older adult may progress to dangerously low levels of blood glucose before signs and symptoms are obvious. Severe hypoglycemia in the older adult can precipitate myocardial infarction, angina, stroke, or seizures. For this reason, "tight control" may not be the best thing for the older adult. Older adults can accurately test and administer insulin, possess a higher risk for hypoglycemia, and do not possess an unstable metabolic rate.

The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy. The patient complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next? a. Administer insulin as scheduled. b. Notify the charge nurse. c. Give 6 ounces of orange juice. d. Document the findings.

ANS: C These findings are consistent with hypoglycemia; manifestations of hypoglycemia include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Management includes providing a source of quick-acting carbohydrate/glucose such as orange juice. The nurse should withhold the patient's scheduled insulin at this time. The nurse should document the findings and then notify the charge nurse.

The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin? a. A pituitary disorder inhibits beta cells. b. An allergic response alters beta cell responses to hyperglycemia. c. Alpha cells proliferated in the islets of Langerhans. d. The body's immune system destroyed beta cells.

ANS: D In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction.

Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes? a. 70% b. 75% c. 80% d. 95%

ANS: D Type 2 diabetics comprise 90% to 95% of all known cases.

The nurse is discussing insulin administration with an assigned patient. The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites. What response by the nurse is most appropriate? a. "Rotating injection sites helps reduce your risk of infection." b. "Rotating injection sites helps enhance insulin absorption." c. "Unsightly fatty tumors can develop when you do not adequately rotate injection sites." d. "Rotating injection sites decreases your risk of an insulin reaction."

B

Which requirement(s) is/are part of the criteria for "tight control" of hyperglycemia? (select all that apply.) a. Perform glucose testing twice daily. b. Administer insulin injections three times a day based on glucometer readings. c. Maintain fasting glucose within normal limits. d. Maintain normal weight for height and age. e. Maintain cholesterol within normal limits.

B C D E

The nurse watches a patient perform an insulin injection. Which observation(s) indicate(s) that the patient needs additional instruction? (select all that apply.) a. The patient uses a 90-degree angle to administer the injection. b. The patient cleans the injection site with alcohol before the injection. c. The patient rubs the injection site after administration of the insulin injection. d. The patient draws up the cloudy insulin and then the clear insulin. e. The patient shakes the insulin bottle before administration.

C D E

A patient with type 1 diabetes mellitus (DM) is preparing for a moderate 30-minute exercise period. Which action best indicates that the patient understands condition management? a. The patient reduces insulin use during days when exercise periods are planned. b. The patient administers insulin after exercise rather than before exercise. c. The patient eats a high-carbohydrate snack before the exercise period. d. The patient consumes a simple carbohydrate snack after 30 minutes of activity.

D