Diabetes Mellitus 1

When glucagon is administered, what does it do? a. Competes for insulin at the receptor sites b. Frees glucose from hepatic stores of glycogen c. Supplies glycogen directly to the vital tissues d. Provides a glucose substitute for rapid replacement

b. Frees glucose from hepatic stores of glycogen

Which insulins are considered to have a rapid onset of action? (Select all that apply) a. Novolin 70/30 b. Glulisine c. Humulin N d. Aspart e. Lispro

b. Glulisine d. Aspart e. Lispro

Which are considered the early signs of diabetic nephropathy? (Select all that apply) a. Positive urine red blood cells b. Microalbuminuria c. Positive urine glucose d. Positive urine white blood cells e. Elevated serum uric acid

b. Microalbuminuria e. Elevated serum uric acid

Which statement is true about insulin? a. It is secreted by alpha cells in the Islet of Langerhans b. It is a catabolic hormone that builds up glucagon reserves. c. It is necessary for glucose transport across cell membranes. d. It is stored in muscles and converted to fat for storage.

c. It is necessary for glucose transport across cell membranes.

In a patient with hyperglycemia, the respiratory is triggered in an attempt to excrete more carbon dioxide and acid, thus causing a rapid and deep respiratory pattern. What is the term for this respiratory pattern? a. Tachypnea b. Cheyne-strokes respiration c. Kussmaul respiration d. Biot respiration

c. Kussmaul respiration

Which lab value indicates that Lara is working to reduce her risk for cardiovascular disease? a. Fasting blood glucose of 120 mg/dL b. Glycosylated hemoglobin at 9% c. Low-density lipoprotein (LDL) cholesterol of 80 mg/dL d. High-density lipoprotein (HDL) cholesterol of 30 mg/dL

c. Low-density lipoprotein (LDL) cholesterol of 80 mg/dL

To achieve the goal of restoring Lara's fluid volume, the nurse would expect to implement which intervention? a. Insert a saline lock for PRN diuretic administration b. Administer an Albumin/Lasix continuous infusion c. Maintain an infusion of normal saline solution d. Obtaina type and crossmatch for 2 units of packed RBCs

c. Maintain an infusion of normal saline solution

Which class of antidiabetic medication should be given 1-30 minutes before meals? a. Alpha-glucosidase inhibitors, which include miglitol (Glyset) b. Biguanides, which include metformin (Glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Sulfonylureas, which include chlorpromadine (Diabinese)

c. Meglitinides, which include nateglinide (Starlix)

Which oral agent may cause lactic acidosis? a. Nateglinide b. Repaglinide c. Metformin d. Miglitol

c. Metformin

Which electrolyte is most affected by hyperglycemia? a. Sodium b. Chloride c. Potassium d. Magnesium

c. Potassium

What type of insulin is used in the emergency treatment of DKA and hyperglycemic-hyperosmolar nonketoic syndrome (HHNS)? a. NPH b. Lente c. Regular d. Protamine zinc

c. Regular

Glucagon is used primarily to treat the patient with which disorder? a. DKA b. Idiosyncratic reaction to insulin c. Severe hypoglycemia d. HHNS

c. Severe hypoglycemia

Untreated hyperglycemia results in which condition? a. Respiratory acidosis b. Metabolic alkalosis c. Respiratory alkalosis d. Metabolic acidosis

d. Metabolic acidosis

A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a fingerstick. What is the nurse's best response to this question? 1. "There is no difference between readings" 2. These types of monitors are meant for children" 3. "Readings are on a different scale for each monitor" 4. "Faster readings can be obtained from a fingerstick"

1. "There is no difference between readings"

A nurse is caring for a client with diabetes who is scheduled for a radiographic study requiring contrast. Which should the nurse expect the health care provider to prescribe? 1. Acetylcysteine (Acetadote) before the test 2. Renal friendly contrast medium for the test 3. Forced diuresis with mannitol (Osmitrol) after the test 4. Hydration with dextrose and water throughout the test

1. Acetylcysteine (Acetadote) before the test

You are caring for a diabetic patient who is developing diabetic ketoacidosis (DKA). Which task delegation is most appropriate. 1. Ask the unit clerk to page the physician to come to the unit 2. Ask the LPN/LVN to administer IV push insulin according to the sliding scale 3. Ask the UAP to hang a new bag of normal saline 4. Ask the UAP to get the patient a cup of orange juice

1. Ask the unit clerk to page the physician to come to the unit

A nurse is planning to teach facts about hyperglycemia to a client with the diagnose of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis? 1. Breakdown of fat stores for energy 2. Ingestion of too many highly acidic food 3. Excessive secretion of endogenous insulin 4. Increased amounts of cholesterol in the extracellular compartment

1. Breakdown of fat stores for energy

A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? Select all that apply 1. Dry skin 2. Abdominal pain 3. Kussmaul respirations 4. Absence of ketones in the urine 5. Blood glucose level of less than 100 mg/dL

1. Dry skin 2. Abdominal pain 3. Kussmaul respirations

A health care provider prescribes 36 units of NPH insulin (Novolin N) and 12 units of regular insulin (Novolin R). The nurse plans to administer these drugs in one syringe. Identify the steps in this procedure by listing the numbers by each picture next to the step below in priority order. (Start with the number of the picture that represents the first step and end with the number by the picture that represents the last step

1, 3, 2, 4

The UAP reports to you that a patient with type 1 diabetes has a questions about exercise. What important points would you be sure to teach this patient? Select all that apply 1. Exercise guidelines are based on blood glucose and urine ketone levels 2. Be sure to test your blood glucose only after exercising 3. You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL 4. Exercise will help resolve the presence of ketones in your urine 5. A 5 to 10 minute warm up and cool down period should be included in your exercise

1. Exercise guidelines are based on blood glucose and urine ketone levels 3. You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL 5. A 5 to 10 minute warm up and cool down period should be included in your exercise

A client is learning alternate site testing (AST) for glucose monitoring. Which client statement indicates to the nurse that additiona teaching is necessary? 1. "I need to rub for forearm vigorously until warm before testing at this site" 2. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected" 3. "Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels" 4. "I have to make sure that my current glucose monitor can be used at an alternative site"

2. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected"

A nurse is monitoring a client's fasting plasma glucose (FPG) level. At which FPG level should the nurse identify that the client has prediabetes? 1. 70 mg/dL 2. 100 mg/dL 3. 130 mg/dL 4. 160 mg/dL

2. 100 mg/dL

A patient with diabetes has hot, dry skin; rapid and deep respirations; and a fruity odor to his breath. As charge nurse, you observe a newly-graduated RN performing all the following patient tasks. Which one requires that you intervene immediately? 1. Checking the patient's fingerstick glucose level 2. Encouraging the patient to drink orange juice 3. Checking the patient's order for sliding-scale insulin dosing 4. Assessing the patient's vital signs every 15 minutes

2. Encouraging the patient to drink orange juice

A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition? 1. Sodium bicarbonate, causing alkalosis 2. Ketones as a result of rapid fat breakdown, causing acidosis 3. Nitrogen from protein catabolism, causing ammonia intoxication 4. Glucose from rapid carbohydrate metabolism, causing drowsiness

2. Ketones as a result of rapid fat breakdown, causing acidosis

A nurse is assessing a client with a diagnosis of hypoglycemia, What clinical manifestations support this diagnosis? (Select all that apply) 1. Thirst 2. Palpitations 3. Diaphoresis 4. Slurred speech 5. Hyperventilation

2. Palpitations 3. Diaphoresis 4. Slurred speech

A nurse is caring for a postoperative client who has diabetes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider for this client? 1. Emotional stress 2. Presence of infection 3. Increased insulin dose 4. Inadequate food intake

2. Presence of infection

Which action should you delegate to a UAP for the client with diabetic ketoacidosis? Select all that apply 1. Checking fingerstick glucose results every hour 2. Recording intake and output every hour 3. Measuring vital signs every 15 minutes 4. Assessing for indicators of fluid balance 5. Notifying the provider of changes in glucose level

2. Recording intake and output every hour 3. Measuring vital signs every 15 minutes

A nurse working in the diabetes clinic is evaluating a client's success with managing the medical regimen. Which is he best indication that a client with type 1 diabetes is successfully managing the disease? 1. Reduction in excess body weight 2. Stabilization of the serum glucose 3. Demonstrated knowledge of the disease 4. Adherence to the prescription for insulin

2. Stabilization of the serum glucose

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply 1. Sweating 2. Retinopathy 3. Acetone breath 4. Increased arterial bicarbonate level 5. Decreased arterial carbon dioxide level

3. Acetone breath 5. Decreased arterial carbon dioxide level

A client with type 1 diabetes mellitus has a fingerstick glucose level of 258 mg/dL at bedtime. A prescription for sliding scale regular insulin (Novolin R) exists. What should the nurse do? 1. Call the health care provider 2. Encourage the intake of fluids 3. Administer the insulin as prescribed 4. Give the client a half cup of orange juice

3. Administer the insulin as prescribed

A nurse is collecting information about a client who has type 1 diabetes and who is being admitted because of diabetic ketoacidotic coma. What factors can predispose a client to this condition? Select all that apply 1. Taking too much insulin 2. Getting too much exercise 3. Excessive emotional stress 4. Running a fever with the flu 5. Eating fewer calories than prescribed

3. Excessive emotional stress 4. Running a fever with the flu

A client has a glycosylated hemoglobin measurement of 6%. What should the nurse conclude about this client when planning a teaching plan based on the results of this laboratory test? 1. Is experiencing a rebound hyperglycemia 2. Needs the insulin changed to a different type 3. Has followed the treatment plan as prescribed 4. Requires further teaching regarding nutritional guidelines

3. Has followed the treatment plan as prescribed

A nurse is caring for a client newly diagnosed with type 1 diabetes. When the health care provider tries to regulate this client's insulin regimen, the client experiences episodes of hypoglycemia and hyperglycemia and 15 g of a simple sugar is prescribed. What is the reason this is administered when a client experiences hypoglycemia? 1. Inhibits glycogenesis 2. Stimulates release of insulin 3. Increases blood glucose levels 4. Provides more storage of glucose

3. Increases blood glucose levels

A nurse is caring for a client with type 1 diabetes, and the health care provider prescribes one tube of glucose gel. What is the primary reason for the administration of glucose gel to this client? 1. Diabetic acidosis 2. Hyperinsulin secretion 3. Insulin induced hypoglycemia 4. Idiosyncratic reactions to insulin

3. Insulin induced hypoglycemia

A urine specimen is need to test for the presence of ketones in a client who is diabetic. What should the nurse do when collecting this specimen from a urinary retention catheter? 1. Disconnect the catheter and drain the urine into a clean container 2. Clean the drainage valve and remove the urine from the catheter bag 3. Wipe the catheter with alcohol and drain the urine into a sterile test tube 4. Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine

4. Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine

A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse expect to identify when monitoring this client's labratory values? 1. Increased pH 2. Decreased PO2 3. Increased PCO2 4. Decreased HCO3

4. Decreased HCO3

Which labratory test is the best indicator of a patient's average blood glucose level and/or compliance with the DM regimen over the last 3 months? a. Postprandial blood glucose test b. Oral glucose tolerance test (OGTT) c. Casual blood glucose test d. Glycosylated hemoglobin (HbA1c)

d. Glycosylated hemoglobin (HbA1c)

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

a. "I'll leave you alone for now, but I will stop back by in 30 minutes"

From which injection site is insulin absorbed most rapidly? a. Buttocks b. Abdomen c. Deltoid d. Thigh

b. Abdomen

Which statement by Lara reflects understanding of glycosylated Hgb? a. "The results of the test are probably high, because I was not fasting before my blood was drawn this morning" b. "The results of my test are probably high, because I went to a party last night and did not follow my diet" c. "I know that I need to check my glycosolated Hbg before each meal and at bedtime, but I don't always have time" d. "At least I won't have this done again for 3 months, I will really work at following my diet between now and then"

d. "At least I won't have this done again for 3 months, I will really work at following my diet between now and then"

A nurse diagnosis for a patient with newly-diagnosed diabetes is Risk for Injury related to sensory alterations. Which key points should you include in the teaching plan for this patient? Select all that apply 1. "Clean and inspect your feet every day" 2. "Be sure that your shoes fit properly" 3. "Nylon socks are best to prevent friction on your toes from shoes" 4. "Only a podiatrist should trim your toenail" 5. "Report ant nonhealing skin breaks to your health care provider"

1. "Clean and inspect your feet every day" 2. "Be sure that your shoes fit properly" 5. "Report ant nonhealing skin breaks to your health care provider"

A client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis . An increase in which component in the blood is a direct cause of this type of acidosis? 1. Ketones 2. Glucose 3. Lactic acid 4. Glutamic acid

1. Ketones

The patient's urinalysis shows proteinuria. Which pathophysiology does the nurse suspect? a. Nephropathy b. Neuropathy c. Retinopathy d. Gastroparesis

a. Nephropathy

A client is admitted to the hospital witha diagnoses of diabetic ketoacidosis. What is the initial intervention that the nurse should expect the health care provider to prescribe for this client. 1. IV fluids 2. Potassium 3. NPH insulin (Novolin N) 4. Sodium polystyrene sulfonate (Kayexalate)

1. IV fluids

A nurse is caring for several clients with type 1 diabetes, and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action? 1. Insulin lispro (Humalog) 2. Insulin glargine (Lantus) 3. NPH insulin (Novolin N) 4. Regular insulin (Novolin R)

1. Insulin lispro (Humalog)

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? (Select all that apply) 1. Irritability 2. Glycosuria 3. Dry, hot skin 4. Heart palpitations 5. Fruity odor of breath

1. Irritability 4. Heart palpitations

which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? 1. Monitoring for signs of hypoglycemia as a result of treatment 2. Withholding glucose in any form until the situation is corrected 3. Giving fruit juices, broth, and milk as soon as the client is able to take juices orally 4. Regulating insulin dosage according to the amount of ketones found in the client's urine.

1. Monitoring for signs of hypoglycemia as a result of treatment

A client has a hypoglycemic reaction to insulin. Which client responses should the nurse document as clinical manifestations of hypoglycemia ? Select all that apply 1. Pallor 2. Tremors 3. Glycosuria 4. Acetonuria 5. Diaphoresis

1. Pallor 2. Tremors 5. Diaphoresis

A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiologic finding should be the nurse's focus when collecting additional data about this client? 1. Starvation 2. Alcoholism 3. Bone healing 4. Positive nitrogen balance

1. Starvation

A client with diabetes is being taught to self-administer a subcutaneous injection of insulin. Identify the preferred site for the self administration of this drug (Picture listed on pg. 291) 1. A 2. B 3. C 4. D

3. C

After a 2-hour glucose challenge, which result demonstrates impaired glucose tolerance a. Less than 100 mg/dL b. Less than 140 mg/dL c. Greater than 140 mg/dL d. Greater than 250 mg/dL

c. Greater than 140 mg/dL

A patient with type 1 DM is taking a mixture of NPH and regular insulin at home. The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patient's morning dose of insulin? a. Administer the dose that is routinely prescribed at home because the patient has type 1 DM and needs the insulin. b. Administer half the dose because the patient is NPO c. Hold the insulin with all the other medications because the patient is NPO and there is no need for insulin d. Contact the health care provider for an order regarding the insulin.

d. Contact the health care provider for an order regarding the insulin.

What action should the nurse implement? a. Advise Lara to remove the needle and reinsert it at a 45-degree angle b. Instruct Lara to pull the plunger back slightly before injecting the insulin c. Tell Lara to remove the needle, and draw up a new dose of insulin d. Encourage Lara to inject the insulin with the needle in place, as inserted

d. Encourage Lara to inject the insulin with the needle in place, as inserted

The nurse's decision about what to tell these callers should be based on what primary consideration? a. The instructions of the nursing unit supervisor b. The nature of the caller's relationship to Lara c. The seriousness of Lara's condition at the time of the call d. Lara's right to privacy regarding her health performance

d. Lara's right to privacy regarding her health performance

Which are modifiable risk factors for type 2 DM? (Select all that apply) a. Age b. Family history c. Working in a low-stress environment d. Maintaining ideal body weight e. Maintaining adequate physical activity

d. Maintaining ideal body weight e. Maintaining adequate physical activity

What technique should the nurse use to assess for this occurrence? a. Obtain preprandial and postprandial blood glucose measurements b. Compare a baseline glycosylated Hgb to a current measurement c. Compare venous blood glucose levels to capillary blood glucose levels d. Monitor blood glucose levels during the night and before breakfast

d. Monitor blood glucose levels during the night and before breakfast

Early treatment of DKA and HHNS includes IV administration of which fluid? a. Glucagon b. Potassium c. Bicarbonate d. Normal saline

d. Normal saline

Which class of antidiabetic medication is most likely to cause a hypoglycemic episode because of the long duration of action? a. Alpha-glucosidase inhibitors, which include miglitol (Glyset) b. Biguanides, which include metformin (Glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)

d. Second-generation sulfonylureas, which include glipizide (Glucotrol)

A patient will be using an external insulin pump. What does the nurse tell the patient about the pump? a. SMBG levels can be done only twice a day b. The insulin supply must be replaced every 2 to 4 weeks c. The pump's battery should be checked on a regular weekly schedule d. The needle must be changed every two to three days

d. The needle must be changed every two to three days

A client's problem with ineffective control of type 1 diabetes is identified when a sudden decrease in blood glucose level is followed by rebound hyperglycemia. What should the nurse do when this event occurs? 1. Give the client a glass of orange juice 2. Seek an order to increase the insulin dose at bedtime 3. Encourage the client to eat smaller, more frequent meals 4. Collaborate with the health care provider to alter the insulin prescription

4. Collaborate with the health care provider to alter the insulin prescription

Which statements about type 1 DM are accurate? (Select all that apply.) a. It is an autoimmune disorder b. Most people with type 1 DM are obese. c. Age of onset is typically younger than 30 d. Etiology can be attributed to viral infections e. It can be treated with oral antidiabetic medications and insulin

a. It is an autoimmune disorder c. Age of onset is typically younger than 30 d. Etiology can be attributed to viral infections

Which statements about type 2 DM are accurate? (Select all that apply) a. It peaks at about the age of 50 b. Most people with type 2 DM are obese. c. It typically has an abrupt onset. d. People with type 2 DM have insulin resistance. e. It can be treated with oral antidiabetic medications and insulin.

a. It peaks at about the age of 50 b. Most people with type 2 DM are obese. d. People with type 2 DM have insulin resistance. e. It can be treated with oral antidiabetic medications and insulin.

What glucose level range does the American Association of Clinical Endocrinologists recommend for a critically ill patient a. Between 100 and 130 mg/dL b. Between 140 and 180 mg/dL c. Between 180 and 200 mg/dL d. Between 200 and 240 mg/dL

b. Between 140 and 180 mg/dL

What is the best response? a. "Women with gestational diabetes only experience diabetes during the time they are pregnant" b. "She probably had pregnancy-induced glucose intolerance, rather than true gestational diabetes" c. "Women with gestational diabetes are at high risk for developing diabetes after pregnancy, but not all will get the disease" d. "She will eventually develop diabetes. All women who experience gestational diabetes eventually get the disease"

c. "Women with gestational diabetes are at high risk for developing diabetes after pregnancy, but not all will get the disease"

A patient has been receiving insulin in the badomen for 3 days. On day 4, where does the nurse give the insulin injection? a. Deltoid b. Thigh c. Abdomen, but in an area different from the previous day's injection d. Abdomen, in the same area as the previous day's injection

c. Abdomen, but in an area different from the previous day's injection

Which action should the nurse take first? a. Return to Lara's room to supervise the scheduled insulin injection b. Administer a dose of IV antibiotics to a diabetic with an infected foot ulcer c. Administer IV dextrose to a diabetic client with a blood glucose level of 25 mg/dL d. Hang a new bag of normal saline on a diabetic with a blood glucose level of 275 mg/dL

c. Administer IV dextrose to a diabetic client with a blood glucose level of 25 mg/dL

What is the best response by the nurse? a. Remind Lara that she should also carry a simple carbohydrate snack with her b. Acknowledge Lara's understanding of correct pre-exercise measures c. Advise Lara that extra insulin should not generally be taken before exercise d. Teach Lara that the extra insulin will give her more energy

c. Advise Lara that extra insulin should not generally be taken before exercise

How should the nurse respond? a. HHNS is the result of excess insulin, rather than hyperglycemia and ketosis b. HHNS is primarily caused by excess ketone bodies, although hyperglycemia occurs c. HHNS is caused by persistent hyperglycemia, but ketosis does not occur d. HHNS is the result of fluid and electrolyte imbalance, not blood glucose

c. HHNS is caused by persistent hyperglycemia, but ketosis does not occur

The diabetic patient experiences early morning hyperglycemia (Somogyi effect) as a result of the counterregulatory response to hyperglycemia. What treatment does the nurse expect for this condition? (Select all that apply) a. Administer a 10 PM dose of intermediate acting insulin b. Provide an evening snack to ensure adequate dietary intake c. Evaluate insulin dosage and exercise program d. Add an oral antidiabetic drug to patient's regimen e. Increase blood glucose checks to every 2 hours around the clock

b. Provide an evening snack to ensure adequate dietary intake c. Evaluate insulin dosage and exercise program

What intervention should the nurse implement? a. Explain to Lara that HHNS is not as serious as DKA, since ketosis does not occur b. Tell Lara that HHNS is less likely to occur in Type 1 diabetes than in Type 2 diabetes c. Suggest that Lara may be misinformed because it is unlikely the blood glucose level was that high d. Advise Lara to share her concerns about this syndrome with her grandmother

b. Tell Lara that HHNS is less likely to occur in Type 1 diabetes than in Type 2 diabetes

An LPN/LVN is to administer rapid-acting insulin (Lispro) to a patient with type 1 diabetes. What essential information would you be sure to tell the LPN/LVN? 1. Give this insulin after the aptient's food tray has been delivered and the patient is ready to eat 2. Only give this insulin if the patient's fingerstick glucose reading is above 200 mg/dL 3. This insulin mimics the basal glucose control of the pancreas 4. Rapid-acting insulin is the only insulin that can be given subcutaneously or IV

1. Give this insulin after the aptient's food tray has been delivered and the patient is ready to eat

A nurse identifies that the client is experiencing a hypoglycemic reaction. Which nursing intervention should the nurse implement to relieve the symptoms associated with this reaction? 1. Giving 4 oz of fruit juice 2. Administering 5% dextrose solution IV 3. Withholding a subsequent dose of insulin 4. Providing a snack of cheese and dry crackers

1. Giving 4 oz of fruit juice

A nurse administers the prescribed regula rinsulin (Novolin R) to a client in a diabetic ketoacidosis. In addition, the nurse anticipates that the IV solution prescribed will contain potassium to replenish potassium ions in the extracellular fluid that are being: 1. Rapidly lost from the body by copious diaphoresis present during coma 2. Carried with glucose to the kidneys to be excreted in the urine in increased amounts 3. Quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose 4. Moved into the intracellular fluid compartment because of the generalized anabolism induced by insulin and glucose

4. Moved into the intracellular fluid compartment because of the generalized anabolism induced by insulin and glucose

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? 1. Insulin lispro (Humalog) 2. Insulin glargine (Lantus) 3. NPH insulin (Novolin N) 4. Regular insulin (Novolin R)

4. Regular insulin (Novolin R)

A patient with type 1 diabetes reports feeling dizzy. what should the nurse do first? 1. Check the patient's blood pressure 2. Give the patient some orange juice 3. Give the patient's morning dose of insulin 4. Use a glucometer to check the patient's glucose level

4. Use a glucometer to check the patient's glucose level

How should the nurse respond? a. "She needs a second test performed before a diagnosis is made" b. "Since her value is high, it sounds like both of you have diabetes" c. "Her value is low and indicates that she does not have diabetes" d. "She is too young to develop Type 1 diabetes. She may have Type 2"

a. "She needs a second test performed before a diagnosis is made"

The nurse is caring for a patient with DM. The patient's urine is positive for ketones. What does the nurse instruct the patient with regard to exercise? a. "When urine ketones are present, you should not exercise." b. "You may exercise as long as serum ketones are negative" c. "If you exercise now, be sure to perform aerobic exercises" d. "Exercise is always a good option because it helps with glucose utilization"

a. "When urine ketones are present, you should not exercise."

What response should the nurse make? a. "You're absolutely right, and your health care team will be there to help you" b. "It is most important to keep your spirits up to avoid long-term complications" c. "Diet and exercise are the most important parts of maintaining daily control" d. "Taking your insulin every day is the most important thing you can do"

a. "You're absolutely right, and your health care team will be there to help you"

A patient with diabetic ketoacidosis is on an insulin drip of 50 units of regula rinsulin in 250 mL of normal saline. The current blood glucose level is 549 mg/dL. According to insulin protocol, the insulin drip needs to be changed to 8 units per hour. At what rate does the nurse set the pump? a. 40 mL/hr b. 50 mL/hr c. 60 mL/hr 75 mL/hr

a. 40 mL/hr

In which situations does the nurse teach a patient to perform urine ketone testing? (Select all that apply) a. Acute illness or stress b. When blood glucose levels are above 240 mg/dL c. When symptoms of DKA are present d. To evaluate the effectiveness of DKA treatment. e. When a diabetic patient is in a weight loss program

a. Acute illness or stress c. When symptoms of DKA are present e. When a diabetic patient is in

Which class of antidiabetic medication should be taken with the first bite of a meal to be fully effective? a. Alpha-glucosidase ingibitors, which include miglitol (Glyset) b. Biguanides, which include metformin (Glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)

a. Alpha-glucosidase ingibitors, which include miglitol (Glyset)

Which infection control measures must the nurse teach a patient who will be performing SMBG? (Select all that apply) a. Always wash hands before monitoring glucose b. Regular cleaning of the meter is critical c. Do not reuse lancets d. Do not share blood glucose monitoring equipment e. Sterilize blood glucose monitor before each use

a. Always wash hands before monitoring glucose b. Regular cleaning of the meter is critical c. Do not reuse lancets d. Do not share blood glucose monitoring equipment

To restore Lara's blood glucose to a normal level, what should the nurse prepare to administer? a. An IV infusion containing regular insulin b. Humulin-N insulin SC before meals c. 50% dextrose IV push d. Glucagon subcutaneous PRN per sliding scale

a. An IV infusion containing regular insulin

What action should the nurse take first? a. Ask the unit clerk to find out when the trays will be available b. Distribute orange juice to all clients who have received insulin c. Notify the dietary supervisor that client safety is being compromised d. Observe Lara to ensure that she gives herself the insulin injection correctly

a. Ask the unit clerk to find out when the trays will be available

Which finding(s) indicate that Lara is experiencing complication of diabetes? (SATA) a. Burning sensation in her toes b. Visual acuity of 60/20 c. Protein in her urine d. Blood pressure of 110/60 e. A sore on her foot is having trouble healing

a. Burning sensation in her toes c. Protein in her urine e. A sore on her foot is having trouble healing

The nurse is caring for a diabetic patient in the ED. The patient's lab values include serum glucose 353 mg/dL, positive serum ketones, and positive urine ketones. What complications does the nurse suspect? a. DKA b. HHS c. Hyperglycemia d. Hypoglycemia

a. DKA

A diabetic patient is scheduled to have a blood glucose test the next morning. What does the nurse tell the patient to do before coming in for the test? a. Eat the usual diet but have nothing after midnight b. Take the usual oral hypoglycemic tablet in the morning c. Eat a clear liquid breakfast in the morning d. Follow the usual diet and medication regimen

a. Eat the usual diet but have nothing after midnight

Once Lara is more alert, what instructions should the nurse provide the roommate? a. Give Lara some crackers and milk while waiting for the emergency transport b. Help Lara to her bed and allow her to sleep as long as necessary c. Encourage Lara to drink a regular cola and eat a candy bar to keep her blood glucose level up d. Drive Lara to the hospital, keeping her NPO so she does not vomit

a. Give Lara some crackers and milk while waiting for the emergency transport

Which are signs and symptoms of mild hypoglycemia? (Select all that apply) a. Headache b. Weakness c. Cold, clammy skin d. Irritability e. Pallor f. Tachycardia

a. Headache b. Weakness d. Irritability

A patient is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dL. Which complication is the patient most at risk for developing? a. Hypoglycemia b. Pulmonary embolus c. Renal shutdown d. Pulmonary edema

a. Hypoglycemia

Which factors differentiate DKA from HHS? (Select all that apply) a. Levels of hyperglycemia b. Amount of ketones produced c. Serum bicarbonate levels d. Amount of volume depletion e. Dosage of insulin needed

a. Levels of hyperglycemia b. Amount of ketones

Which cultures tend to have higher incidence of DM? (Select all that apply) a. Mexican American b. African American c. Caucasian d. American Indian e. Eastern European

a. Mexican American b. African American d. American Indian

SMBG levels is most important in which patients? (Select all that apply) a. Patients taking multiple daily insulin injections b. Patients with mild type 2 diabetes c. Patients with hypoglycemic unawareness d. Patients using a portable infusion device for insulin administration e. Patients with acute illnesses f. Pregnant patients

a. Patients taking multiple daily insulin injections c. Patients with hypoglycemic unawareness d. Patients using a portable infusion device for insulin administration e. Patients with acute illnesses f. Pregnant patients

A patient will be using an external insulin pump. What does the nurse tell the patient about the pump? a. SMBG levels should be done three or more times a day b. The insulin supply must be replaced every 2 to 4 weeks c. The pump battery should be checked on a regular weekly schedule d. Theneedle site must be changed every day

a. SMBG levels should be done three or more times a day

A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing? a. Somogyi effect b. Dawn phenomenon c. Diabetic ketoacidosis d. Hyperosmolar nonketotoc syndrome

a. Somogyi effect

What is the mechanism that results in Kussmaul respirations? a. To compensate for metabolic acidosis, the respirations are deep and rapid b. To overcome respiratory acidosis, the respirations are fast and shallow c. Injury to the brain's respiratory center results in periods of apnea d. Hypoxemia causes labored, gasping, and irregular respirations

a. To compensate for metabolic acidosis, the respirations are deep and rapid

Which statement by Lara indicates that she correctly understands self-administration of insulin? a. "My daily dose of 70/30 insulin is based on how much I ate the day before" b. "The amount of short-acting insulin I take every day is base on my blood sugar readings" c. "I should store my insulin in the refrigerator and remove it 30 minutes before I need it" d. "I will alternate my injection sites from leg to abdomen each day to avoid overuse"

b. "The amount of short-acting insulin I take every day is base on my blood sugar readings"

Which response is best for the charge nurse to provide? a. "Information about the client cannot be removed from the nursing unit" b. "The lab values can be copied as long as there is no identifying client data" c. "Since this is for educational purposes, you can remove any information you need" d. "Your instructor should tell you what information you are allowed to copy"

b. "The lab values can be copied as long as there is no identifying client data"

How should the nurse respond? a. "Your mother's diabetes during pregnancy increased your risk for diabetes" b. "There is no direct correlation, but family history is important in diabetes" c. "You most likely inherited your tendency for diabetes from your grandmother" d. "Diabetes is an autoimmune disorder, with little likelihood of family inheritance"

b. "There is no direct correlation, but family history is important in diabetes"

What is the best response by the nurse? a. "Drinking alcohol is prohibited on a diabetic diet, because you cannot predict how your blood glucose will react" b. Alcohol does contain a lot of empty calories, but it is also likely to cause your blood glucose to decrease" c. "Plan to take extra insulin when your drink beer, because drinking will increase your blood glucose" d. "A can of beer equals one carbohydrate exchange, so adjust your calories and food intake accordingly"

b. Alcohol does contain a lot of empty calories, but it is also likely to cause your blood glucose to decrease"

A patient has been diagnosed with DM, Which aspects does the nurse consider in formulating the teaching plan for this patient? (Select all that apply) a. Covering all needed information in one teaching session. b. Assessing visual impairment regarding insulin labels and markings on syringes c. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe. d. Assessing patient motivation to learn and comprehend instructions e. Assessing the patient's ability to read printed material

b. Assessing visual impairment regarding insulin labels and markings on syringes c. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe. d. Assessing patient motivation to learn and comprehend instructions e. Assessing the patient's ability to read printed material

Which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established? a. Alpha-glucosidase inhibitors, which include miglitol (Glyset) b. Biguanides, which include metformin (Glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)

b. Biguanides, which include metformin (Glucophage)

A patient with type 1 DM is planning to travel by air and asks the nurse about preparations for the trip. What does the nurse tell the patient to do? a. Pack insulin and syringes in a labeled, crushproof kit in the checked luggage. b. Carry all necessary diabetes supplies in a clearly identified pack aboard the plane c. Ask the flight attendant to put the insulin in the galley refrigerator once on the place d. Take only minimal supplies and get the prescription filled at his or her destination.

b. Carry all necessary diabetes supplies in a clearly identified pack aboard the plane

What is the priority nursing action? a. Obtain Lara's vital signs b. Check Lara's blood glucose c. Assure Lara that she will be able to give herself the injections d. Offer to bring Lara an orange so she can practice giving injections

b. Check Lara's blood glucose

In addition to monitoring Lara's blood glucose level, what additional lab values should the nurse monitor carefully? (SATA) a. Uric acid b. Hemoglobin c. Calcium d. Potassium e. Blood urea nitrogen (BUN)

b. Hemoglobin c. Calcium d. Potassium e. Blood urea nitrogen (BUN)

In determining if a patient is hypoglycemic, the nurse looks for which characteristics in addition to checking the patient's blood glucose? (Select all that apply) a. Nausea b. Hunger c. Irritability d. Palpitations e. Profuse perspiration f. Rapid, deep respirations

b. Hunger c. Irritability d. Palpitations e. Profuse perspiration

Why is glucose vital to the body's cells? a. It is used to build cell membranes b. It is used by cells to produce energy c. It affects the process or protein metabolism d. It provides nutrients for genetic material

b. It is used by cells to produce energy

A patient with diabetes presents to the emergency department (ED) with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate "all the time." How does the nurse document this subjective finding? a. Polydipsia and polyphagia b. Polydipsia and polyuria c. Polycoria and polyuria d. Polyphagia and polyesthesia

b. Polydipsia and polyuria

The nurse identifies that Lara has experienced classic symptoms of diabetes, which are a. Dysuria, dyspepsia, and dysphagia b. Polyuria, polyphagia, and polydipsia c. Abnormal diet, drink, and distention d. Increased metabolism, increaseed fluid volume, and increased urgency

b. Polyuria, polyphagia, and polydipsia

The nurse is providing discharge teaching to a patient about self-monitoring of blood glucose (SMBG). What information does th enurse include? (Select all that apply) a. Only perform SMBG before breakfast b. Wash hands before using the meter c. Do a retest if the results seem unusual d. It is okay to reuse lancets in the home setting e. Do not share the meter

b. Wash hands before using the meter c. Do a retest if the results seem unusual e. Do not share the meter

Which are characteristics of regular insulin (Select all that apply) a. This insulin does not have a peak time b. When mixing types of insulin, this insulin is always drawn up first c. This insulin is given once daily for basal insulin coverage d. This insulin should be given 30 minutes before meals e. This insulin should not be diluted or mixed with any other insulins

b. When mixing types of insulin, this insulin is always drawn up first d. This insulin should be given 30 minutes before meals

How should the nurse respond? a. "You are right. You should not take your insulin if you are feeling sick" b. "Take only sliding-scale insulin, not your regular dose, if your are feeling sick" c. "Being sick increases your blood sugar. Take your usual insulin dose is important" d. "When you are sick, you should test your urine and only take insulin if ketones are present"

c. "Being sick increases your blood sugar. Take your usual insulin dose is important"

What is the best nursing action? a. Advise the roommate to stay with Lara, remain calm, and check Lara's pulse, respirations, and skin color b. Tell the roommate to immediately find the dorm supervisor while she calls an ambulance c. Ask the roommate if Lara has emergency supplies such as Glucagon or cake icing available d. Instruct the roommate to hold Lara's head up and put small sips of juice in the side of her mouth

c. Ask the roommate if Lara has emergency supplies such as Glucagon or cake icing available

What is the best initial response by the nurse? a. "What do you mean when you say a normal life?" b. "It's better to find out now before complications develop" c. "Perhaps you would like to speak to someone who has diabetes" d. "It must be quite a shock to learn that you have diabetes"

d. "It must be quite a shock to learn that you have diabetes"

A 25-year-old female patient with type 1 DM tells the nurse, "I have two kidneys and I'm still young. I expect to be around for a long time, so why should I worry about my blood sugar?" What is the nurse's best response? a. "You have little to worry about as long as your kidneys keep making urine." b. "You should discuss this with your physician because you are being unrealistic." c. "You would be right if your diabetes was managed with insulin." d. "Keeping your blood sugar under control now can help to prevent damage to both kidneys."

d. "Keeping your blood sugar under control now can help to prevent damage to both kidneys."

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

d. "The symptoms have an abrupt onset that is often brought on by a viral illness, like the flu"

According to the American Diabetes Association (ADA), which laboratory finding is most indicative of DM? a. Fasting blood glucose = 80 mg/dL b. 2-hour postprandial blood glucose = 110 c. 1- hour glucose tolerance blood glucose = 110 mg/dL d. 2- hour glucose tolerance blood glucose = 210 mg/dL

d. 2- hour glucose tolerance blood glucose = 210 mg/dL