Diabetes Mellitus

When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan? a. achieving a normal weight b. performing daily aerobic exercise c. eliminating red meat from the diet d. monitoring the blood glucose periodically

The answer is A. Metabolic syndrome is a cluster of abnormalities that include elevated glucose levels, abdominal obesity, elevated BP, high levels of triglycerides, and low levels of HDLs. Overweight individuals with metabolic syndrome can prevent or delay the onset of diabetes through a program of weight loss. Regular physical activity is also important, but normal weight is more important.

Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. decrease glucose production b. stimulate glucose output by the liver c. increase glucose transport into the cells d. independently regulate glucose levels in the blood

The answer is B. The counter regulatory hormones have the opposite effect of insulin by stimulating glucose production and output by the liver and by decreasing glucose transport into the cells. The counter regulatory hormones and insulin together regulate the blood glucose levels.

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to best explain how this medication works? a. Increases insulin production from the pancreas b. Slows the absorption of carbohydrate in the small intestine c. Reduces glucose production by the liver and enhances insulin sensitivity d. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying

The answer is C. Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

A patient taking the medication Precose asks when it is the best time to take this medication. Your response is:* A. 1 hour prior to eating B. 1 hour after eating C. With the first bite of food D. At bedtime

The answer is C. Precose is an alpha-glucoside inhibitor that works by lowering the blood sugar by slowly breaking down starchy foods in the GI system which helps slowly rise the blood sugar. Therefore, it should be taken with the first bite of food.

The nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as the priority by the nurse? a. bilateral numbness of both hands b. stage II pressure ulcer on the right heel c. rapid respirations with deep inspiration d. areas of lumps and dents on the abdomen

The answer is C. Rapid deep respirations are symptoms of DKA, so this is the priority of care.

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? a. 8:40 PM to 9:00 PM b. 9:00 PM to 11:30 PM c. 10:30 PM to 1:30 AM d. 12:30 AM to 8:30 AM

The answer is C. Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 and 30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.

The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included? Select all that apply a. maintain a healthy weight b. exercise for 60 minutes each day c. have blood pressure checked regularly d. assess for visual changes on a monthly bases e. monitor for polyuria, polydipsia, and polyphagia

The answers are: A and E. To reduce the risk of developing diabetes, the patient with prediabetes should maintain a healthy weight, learn to monitor for symptoms of diabetes, have blood glucose and glycosylated hemoglobin rested regularly, exercise regularly, and eat a healthy diet.

What characterizes type 2 diabetes? Select all that apply a. beta cell exhaustion b. insulin resistance c. genetic predisposition d. altered production of adipokines e. inherited defect in insulin receptors f. inappropriate glucose production by the liver

The answers are: A, B, C, D, E, and F. Type 2 diabetes is characterized by beta cell exhaustion, insulin resistance, genetic predisposition, altered production of adipokines, inherited defect in insulin receptors, and inappropriate glucose production by the liver.

The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level? Select all that apply a. headache b. unsteady gait c. abdominal cramps d. emotional changes e. increase in urination f. weakness and fatigue

The answers are: A, C, E, and F. Manifestations of hyperglycemia include abdominal cramps, polyuria, weakness, fatigue, and headache.

The patient with type 2 diabetes is being put on acarbose (Precose) and wants to know about taking it. What should the nurse include in this patient's teaching? Select all that apply a. take it with the first bite of each meal b. it is not used in patients with heart failure c. endogenous glucose production is decreased d. effectiveness is measured by 2 hour postprandial glucose e. it delays glucose absorption from the gastrointestinal tract

The answers are: A, D, and E. Acarbose (Precose) is an alpha-glucosidase inhibitor that is taken with the first bite of each meal. The effectiveness is measured with 2 hour postprandial blood glucose testing, as it delays glucose absorption from the GI tract.

What disorders and diseases are related to macrovascular complications of diabetes? Select all that apply a. chronic kidney disease b. coronary artery disease c. microaneurysms and destruction of retinal vessels d. ulceration and amputation of the lower extremities e. capillary and arteriole membrane thickening specific to diabetes

The answers are: B and D. Macrovascular disease causes coronary artery disease and ulceration and results in amputation of the lower extremities. However, neuropathy may also contribute to not feeling ulcerations.

The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient? Select all that apply a. painless foot ulcers b. erectile dysfunction c. burning foot pain at night d. loss of fine motor control e. vomiting undigested food f. painless myocardial infarction

The answers are: B, E, and F. Autonomic neuropathy affects most body systems. Manifestations of autonomic neuropathy include erectile dysfunction in men and decreased libido, gastroparesis (nausea, vomiting, gastroesophageal reflux and feeling full), painless myocardial infarction, postural hypotension, and resting tachycardia.

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, the patient is totally dependent on an outside source of insulin." c. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." d. "With type 2 diabetes, the body produces auto antibodies that destroy β-cells in the pancreas."

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

You administered 5 units of Humalog at 0800. What is the ONSET and DURATION of this medication?* A. Onset: 15 minutes, Duration: 3 hours B. Onset: 2 hours, Duration: 16 hours C. Onset: 30 minutes, Duration: 1 hour D. Onset: 2 hours, Duration: 24 hours

The answer is A. Humalog is a rapid-acting insulin. It has an onset: 15 minutes and duration: 3 hours Watch the YouTube video to learn the mnemonics on how to remember these times...very helpful.

The nurse is reviewing laboratory results 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)

The answer is 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.

Neuropathy prevention

control blood sugar

Hypoglycemia

blood glucose < 60 mg/dL sweating, clammy, confused, light-headed, dizzy, double vision *Need SIMPLE carbs or if unconscious IV D50

Neuropathy screening

foot checks; infections put people at risk for amputations

Insulin

helps with high blood sugar levels hormone: regulates amount of glucose in body secreted by beta cells of pancreas (islets of Langerhans)

Glucagon

helps with low blood sugar levels...causes the liver to turn glycogen into glucose...secreted by pancreas

Biguanides MOA

increases insulin sensitivity and reduce glucose production by the liver; improves glucose transport into cells

Glucose

sugar body needs to survive...fuels cells in the body but it can not enter the cell without the help of insulin

Biguanides examples

Metformin

Treatment DM Type 2

diet and exercise...then oral meds if not working...may need insulin during stress, surgery, or infection

Causes of Diabetes Mellitus Type 2

cells quit responding to insulin..."insulin resistant" glucose hangs in body...pancreas thinks you need insulin...over secretion of insulin "Hyperinsulinemia" = metabolic syndrome *related to lifestyle, obese, sedentary, poor diet, genetic

True or False: The Somogyi effect causes the patient to experience an increase in their blood glucose during the hours of 2-3 am.* True False

The answer is FALSE. The Somogyi effect causes the patient to experience a DECREASE in their blood glucose during the hours of 2-3 am.

SGLT2 inhibitors MOA

Sugar Diuretic....Prevent reabsorption of renal glucose, increases glucose excretion (pee it out): increased risk of UTI/vaginal yeast infections, weight loss!

Which laboratory results would indicate that the patient has prediabetes? a. glucose tolerance result of 132 mg/dL b. glucose tolerance result of 240 mg/dL c. fasting blood glucose result of 80 mg/dL d. fasting blood glucose result of 120 mg/dL

The answer is D. Prediabetes is defined as impaired glucose tolerance and impaired fasting glucose or both. Fasting blood glucose results t between 100 mg/dL and 125 mg/dL indicate prediabetes.

DPP-4 inhibitors MOA

Enhance activity of incretins. Stimulate release of insulin from pancreatic beta cells Decrease hepatic glucose production

Causes of Diabetes Mellitus Type 1

beta cells in islet of Langerhans don't work...destroyed...there is no more insulin = must use insulin treatment *genetic *autoimmune (virus)

Retinopathy prevention

blood pressure control and glucose control

DPP-4 inhibitors examples

Januvia and Tradjenta

Glycogen

Storage form of glucose in the liver

Simple carbs to give to hypoglycemic patients

*orange juice, hard candies, graham crackers, honey

Angiopathy preventions

control cholesterol levels with a statin; control blood sugar; and control blood pressure

Nephropathy Prevention

control glucose and blood pressure

A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia?* A. 1900 B. 1300 C. 1130 D. 1500

The answer is A. Humulin N is an intermediate-acting insulin. The peak of this medication is 8 hours. Watch the YouTube video to learn the mnemonics on how to remember these times...very helpful.

Type 1 diabetics typically have the following clinical characteristics:* A. Thin, young with ketones present in the urine B. Overweight, young with no ketones present in the urine C. Thin, older adult with glycosuria D. Overweight, adult-aged with ketones present in the urine

The answer is A. Thin, young with ketones present in the urine

A Type 2 diabetic may have all the following signs or symptoms EXCEPT:* A. Blurry vision B. Ketones present in the urine C. Glycosuria D. Poor wound healing

The answer is B. Ketones present in the urine.

Which tissues require insulin to enable movement of glucose into the tissue cells? Select all that apply a. liver b. brain c. adipose d. blood cells e. skeletal muscle

The answer is C and E. Adipose tissue and skeletal muscle require insulin to allow the transport of glucose into the cells.

Neuropathy: what are you looking for on their feet?

paresthesias; ulcers; wounds; calluses; these put the patient at risk for amputations due to infection

Diagnostic Studies

*fasting glucose: normal 70-99 *oral glucose tolerance: normal <200 at 30, 60, 90 minutes and <140 at 120 minutes *capillary glucose monitoring *glycosylated hemoglobin (HgbA1c): normal <6% for a diabetic their goal is 7% *urine ketones

Type 2 Diabetes Mellitus

*insufficient insulin production *resistant to insulin *keto acidosis not common *adults after 40 most often *was adult onset diabetes *familial *may need insulin

Type 1 Diabetes Mellitus

*no insulin produced *was juvenile diabetes *autoimmune disorder *familial and lifelong

GLP-1 receptor agonists MOA

-Increase insulin secretion in response to oral glucose -Decreased glucagon secretion -Reduces apoptosis of islet cells -Reduces hunger (due to CNS effect and delayed gastric emptying)

Organ problems in diabetics

atherosclerotic (CAD)...glucose sticks to proteins of vessels...become hard and form plaques...heart disease, HTN, neuropathy, decreased wound healing, eye trouble (retinopathy), infections, and strokes

Signs and Symptoms of Hypoglycemia

"TIRED" Tachycardia Irritability Restless Excessive Hunger Diaphoresis/Depression

Biguanides contraindications

- Low renal function - increases risk of lactic acidosis - recent iodinated contrast media - Cimetidine

A patient with newly diagnosed type 2 diabetes has been given a prescription to start oral hypoglycemic medication. The patient tells the nurse she would rather control her blood sugar with herbal therapy. Which action should the nurse take? a. teach the patient that herbal therapy is not safe and should not be used b. advise the patient to discuss using herbal therapy with her HCP before using it c. encourage the patient to give the prescriptive medication time to work before using herbal therapy d. teach the patient that if she takes herbal therapy, she will have to monitor her blood sugar more often

The answer is B. Advise the patient to seek the guidance of the HCP regarding the safety, efficacy, and specifics of using herbal therapy rather than or with the medication prescribed.

The following interventions are planned for a patient with diabetes. which intervention can the nurse delegate to unlicensed assistive personnel? a. discuss complications of diabetes b. check that the bath water is not too hot c. check the patient's technique for drawing up insulin d. teach the patient to use a meter for self-monitoring of blood glucose

The answer is B. Checking the temperature of the bath water is part of assisting with ADLs and within the scope of care for CNAs.

The nurse is teaching a patient with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? a. "Smokeless tobacco products decrease the risk of kidney damage." b. "I can help control my blood pressure by avoiding foods high in salt." c. "I should have yearly dilated eye examinations by an ophthalmologist." d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

The answer is B. Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.

A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins?* A. These insulins cannot be mixed, therefore, should be drawn up in different syringes. B. Draw-up the Humulin R insulin first and then the NPH insulin. C. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D. Draw-up the NPH insulin first and then the Humulin R insulin.

The answer is B. Remember when drawing up regular and intermediate insulins...you draw-up clear (regular insulins) to cloudy (NPH intermediate). Remember the mnemonic R.N.

A nurse is working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for a minority populations every year b. FPG for all individuals at age 45 and then every 3 years c. testing people under the age of 21 for islet cell antibodies d. testing for type 2 diabetes in all overweight or obese individuals

The answer is B. The American Diabetes Association recommends that testing for type 2 diabetes with a FPG, A1C, or 2 hour OGTT should be considered for all individuals at the age of 45 and above and , if normal, repeated every 3 years.

decreased blood sugar

pancreas releases glucagon = causes liver to release glycogen which turns into glucose to increase blood sugar

increased blood sugar

pancreas releases insulin = causing glucose to enter cells for usage or saved as glycogen in liver for later

Liver

sensitive to insulin levels increased blood sugar/increased insulin in body absorbs the extra and stores it as Glycogen decreased blood sugar/decreased insulin releases glycogen which turns into glucose to increase blood sugar

GLP-1 receptor agonists considerations

take fast acting oral meds 1 hour before injecting

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 the finger to obtain a drop of blood d. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes

The answer is 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.

Which of the following patient statements about the diabetic diet regime is correct?* A. "I'll try to consume about 20% carbs and 40% fats on a daily basis." B. "Foods that are high in mono and poly fats are avocados, olives, and nuts." C. "Meats increase the glycemic index; therefore, I should only consume 5% of them on a daily basis." D. "I should completely avoid starchy vegetables like potatoes and corn."

The answer is B. "Foods that are high in mono and poly fats are avocados, olives, and nuts."

Which class of oral glucose lowering agents is most commonly used for people with type 2 diabetes because is reduces hepatic glucose production and enhances tissue uptake of glucose? a. insulin b. biguanide c. meglitinide d. sulfonylurea

The answer is B. Biguanides ( like metformin (Glucophage)) are most commonly used with type 2 diabetes. They reduce glucose production by the liver and increase insulin sensitivity at the tissue level that improves glucose transport into the cells.

SGLT2 inhibitors examples

Invokana and Jardiance

Which of the following insulins can be administered intravenously? A. NPH B. Lantus C. Humulin R D. Novolog

The answer is C. Humulin R.

When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. tight glycemic control can be maintained b. errors in insulin dosing are less likely to occur c. complications of insulin therapy are prevented d. frequent blood glucose monitoring is unnecessary

The answer is A. Insulin pumps provide tight glycemic control by continuous subcutaneous insulin infusion based on the patient's basal profile, with bolus doses at mealtime at the patient's discretion and related to blood glucose monitoring.

The nurse teaches a patient recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? a. "I will discard any insulin bottle that is cloudy in appearance." b. "The best injection site for insulin administration is in my abdomen." c. "I can wash the site with soap and water before insulin administration." d. "I may keep my insulin at room temperature (75oF) for up to 1 month."

The answer is A. Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86°F (30°C) or below freezing

Which of the following insulins has no peak but a duration of 24 hours?* A. NPH B. Novolog C. Lantus D. Humulin N

The answer is C. Lantus is the only option here that is a LONG-ACTING insulin which has NO peak and a 24 hour duration.

A patient has a blood glucose of 400. Which of the following medications could be the cause of this?* A. Glyburide B. Atenolol C. Bactrim D. Prednisone

The answer is D. Prednisone

GLP-1 receptor agonists examples

Byetta, Trulicity, Victoza

What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. ideal body weight b. normal serum glucose and lipid levels c. a special diabetic diet using dietetic foods d. five smalls meals per day with a bedtime snack

The answer is B. The specific goals of nutrition therapy for people with diabetes include maintaining near-normal blood glucose levels and achievement of optimal serum lipid levels and BP.

Which of the following symptoms do NOT present in hyperglycemia?* A. Extreme thirst B. Hunger C. Blood glucose <60 mg/dL D. Glycosuria

The answer is C.

Nephropathy Screening

- Annual urine test to quantitate urine albumin excretion is recommended. (if we have albuminuria we have some degree of nephropathy) - Either an ACE inhibitor (Lisinopril) or ARB (Losartan) should be started in diabetes patients with urinary albumin excretion of >=30 mg/24 hours. - Type 1 diabetes > Annual testing starting 5 years after diagnosis in patients >= 10 years old -Type 2 diabetes > Annual testing starting at the time of diagnosis

A patient is admitted with diabetes mellitus, malnutrition cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply.)? a. The level may be increased as a result of dehydration that accompanies hyperglycemia. b. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. c. The level is consistent with renal insufficiency that can develop with renal nephropathy. d. The patient may be excreting extra sodium and retaining potassium because of malnutrition. e. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.

The answer is A, B, C. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. The kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus, it is not a contributing factor to this patient's potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.

The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient correlates with the diagnosis? a. Excessive thirst b. Gradual weight gain c. Overwhelming fatigue d. Recurrent blurred vision

The answer is A.

Which of the following statements are INCORRECT about exercise management for the diabetic patient?* A. "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising." B. "I plan on exercising for an extended period. So I will check my blood glucose prior, during, and after exercising." C. "My blood glucose is 268 and I have ketones in my urine. Therefore, I will avoid exercising today." D. All of the options are correct statements.

The answer is A. "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising."

Two days following a self-managed hypoglycemic episode at home, the patient tells the nsure that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse? a. that is good range for your glucose levels b. you should call your healthcare provider because you need to have your insulin increased. c. that level is too low in view of your recent hypoglycemia and you should increase your food intake. d. you should take only half your insulin dosage for the next few days to get your glucose level back to normal.

The answer is A. Blood glucose levels of 80 to 90 mg/dL are within the normal range and are desired in the patient with diabetes, even following a recent hypoglycemic episode. Hypoglycemia is often caused by a single event, such as skipping a meal, taking too much insulin, or vigorous exercise.

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

The answer is 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 reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? a. A 48-yr-old woman with a hemoglobin A1C of 8.4% b. A 58-yr-old man with a fasting blood glucose of 111 mg/dL c. A 68-yr-old woman with a random plasma glucose of 190 mg/dL d. A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

The answer is A. Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C of 6.5% or greater, fasting plasma glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of 200 mg/dL or greater.

A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially?* A. Diet and exercise regime B. Metformin BID by mouth C. Regular insulin subcutaneous D. None, monitoring at this time is sufficient enough

The answer is A. Diet and exercise regime

A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. administer the usual insulin dosage b. hold fluid intake until the nausea subsides c. come to the clinic immediately for evaluation and treatment d. monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL

The answer is A. During minor illnesses, the patient with diabetes should continue drug therapy and fluid and food intake. Insulin is important because counter regulatory hormones may increase blood glucose during the stress of illness. Food or a carbohydrate liquid substitution is important because during illness the body requires extra energy to deal with the stress of the illness.

During the summer many children are more physically active. What changes in the management of the child with diabetes would the camp nurse expect as a result of more exercise? a. Increased food intake b. Decreased food intake c. Increased risk of hyperglycemia d. Decreased risk of insulin shock

The answer is A. Food intake should be increased in the summer when the child is more active. Exercise lowers blood glucose, and hypoglycemia needs to be prevented. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugar must be monitored closely to avoid too much insulin being administered during times of reduced need.

The nurse is assigned to the care of a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention? a. Assess patient's perception of what it means to have diabetes. b. Ask the patient to write down current knowledge about diabetes. c. Set goals for the patient to actively participate in managing his diabetes. d. Assume responsibility for all of the patient's care to decrease stress level.

The answer is A. For teaching to be effective, the first step is to assess the patient. Teaching can be individualized after the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.

A 72 year old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? a. it is more difficult to achieve strict glucose control than in younger patients b. treatment is not warranted unless the patient develops severe hyperglycemia c. it does not include treatment with insulin because of limited dexterity and vision d. it usually requires that a younger family member be responsible for care of the patient

The answer is A. Older adults have more conditions that may be treated with medications that impair insulin action. Hypoglycemic unawareness is more common, so these patients are more likely to suffer adverse consequences from blood glucose lowering therapy. Clinical manifestations of long term complications of diabetes take 10 to 20 years to develop, so the goals for glycemic control are not as rigid as in the younger population. Treatment is indicated and insulin may be used if the patient does not respond to oral agents.

Individualized nutrition therapy for patient using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times b. restrict calories to promote moderate weight loss c. eliminate sucrose and other simple sugars from the diet d. limit saturated fat intake to 30% of dietary calorie intake

The answer is A. The body requires food at regularly spaced intervals throughout the day, and omission or delay of meals can result in hypoglycemia, especially for the patient using conventional insulin therapy or oral agents.

A patient newly diagnosed with diabetes is about to be discharged home. You are watching the patient administer insulin. Which of the following actions causes you to re-educate them?* A. They massaged the site after administering the insulin. B. They injected into the fat of their thighs. C. They used an opposite side for injection compared to the last insulin injection. D. They engaged the safety after administering the medication.

The answer is A. They massaged the site after administering the insulin.

A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be to:* A. Administer Dextrose 50% IV per protocol B. Continue to monitor the glucose C. Give the patient 4 oz of fruit juice D. None, this is a normal blood glucose reading

The answer is A. This question requires critical thinking because the patient is NPO for surgery and can NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However, the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50% IV per protocol to help increase the blood glucose and recheck the glucose level.

To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? a. plan activity and food intake related to blood glucose levels b. when blood glucose is greater than 250 mg/dL and ketones are present c. when glucose monitoring reveals that the blood glucose is in the normal range d. when blood glucose levels are high, because exercise always has a hypoglycemic effect

The answer is A. To plan for exercise, a person with diabetes must monitor blood glucose and make adjustments to insulin dose (if taken) and food intake to prevent exercise induced hypoglycemia. Exercise is delayed if blood glucose is >250 mg/dL with ketones. Before exercise if blood glucose is <100 mg/dL a 15 g carbohydrate snack is eaten. Blood glucose levels should be monitored before, during, and after exercise to determine the effect of exercise on the levels.

The nurse is explaining about the destruction of pancreatic beta cells, which produce insulin, to a parent whose child is running high glucose levels. Which metabolic problem is the nurse explaining about? a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Impaired glucose tolerance

The answer is A. Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes. Gestational diabetes occurs during pregnancy.

A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. withdraws the NPH dose into the syringe first b. injects air equal to the NPH dose into the NPH vial first c. removes any air bubbles after withdrawing the first insulin d. adds air equal to the insulin dose into the regular vial and withdraws the dose

The answer is A. When mixing regular and intermediate acting insulin, regular insulin should always be drawn into the syringe first to prevent contamination of the regular insulin vial with intermediate acting insulin additives. Air is added to the NPH vial first. Then air is added to the regular vial and the regular insulin is withdrawn, bubbles are removed, and then the dose of NPH is withdrawn.

A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? a. Avoid sick people and wash hands. b. Obtain comprehensive dental care. c. Maintain hemoglobin A1C below 7%. d. Coughing and deep breathing with splinting

The answer is B. A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep breathing with splinting would be important for any type of surgery but are not the priority for this patient with mitral valve replacement.

A patient with type 1 diabetes uses 20 U of Novolin 70/30 (NPH/regular) in the morning and at 6:00 pm. When teaching the patient about this regimen, what should the nurse emphasize? a. hypoglycemia is most likely to occur before the noon meal. b. a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. c. flexibility in food intake is possible because insulin is available 24 hours a day. d. premeal glucose checks are required to determine needed changes in daily dosing.

The answer is B. A split mixed dose of insulin requires that the patient adhere to a set meal pattern to provide glucose for the peak action of the insulin, and a bedtime snack is usually required when patient take an intermediate-acting insulin late in the day to prevent nocturnal hypoglycemia. Hypoglycemia is most likely to occur with this dose late in the afternoon and during the night. When premixed formulas are used, flexible dosing based on glucose levels are not recommended.

The nurse instructs a patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? a. "I plan to lose 25 lb this year by following a high-protein diet." b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." c. "I should include more fiber in my diet than a person who does not have diabetes." d. "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."

The answer is B. Eating carbohydrates when drinking alcohol reduces the risk for alcohol-induced hypoglycemia. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes mellitus. High-protein diets are not recommended for weight loss.

A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important?* A. Recheck the glucose level B. Give the patient ½ cup (4 oz) of fruit juice C. Call the doctor D. Keep the patient nothing by mouth

The answer is B. Give the patient ½ cup (4 oz) of fruit juice

A patient with Type 2 Diabetes is started on the medication Glyburide. Which of the following statements by the patient causes concern?* A. "I will monitor my blood glucose regularly because I know this medication can cause a low blood sugar." B. "I will consume no more than 8 oz. of alcohol per week." C. "I will continue monitoring my diet and participating in exercise while taking this medication." D. "This medication works by stimulating the beta cells in the pancreas to make insulin."

The answer is B. Glyburide is a sulfonylureas diabetic medication and a patient should NEVER consume alcohol while taking this medication because it can cause severe hypoglycemia.

Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness? a. A 58-yr-old patient with diabetic retinopathy b. A 73-yr-old patient who takes propranolol (Inderal) c. A 19-yr-old patient who is on the school track team d. A 24-yr-old patient with a hemoglobin A1C of 8.9%

The answer is B. Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

Which of the following statements are true regarding Type 2 diabetes treatment?* A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes. B. Insulin may be needed during times of surgery or illness. C. Insulin is never taken by the Type 2 diabetic. D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.

The answer is B. Insulin may be needed during times of surgery or illness.

A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct?* A. Administer the medication as ordered. B. Hold the dose and notify the doctor for further orders. C. Administer the medication as ordered but hold the next day's dose. D. Check the patient's blood glucose prior to administering the medication.

The answer is B. Metformin (Glucophage) is held 48 hours prior to surgery (however a doctor's order is needed for this). Therefore, you should hold the dose and call the doctor for further orders.

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? a. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. c. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. d. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes

The answer is B. Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.

The nurse has taught a patient admitted with diabetes 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."

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

When is a patient most susceptible to hypoglycemic symptoms after the administration of insulin?* A. Onset B. Peak C. Duration D. Duration & Peak

The answer is B. Peak

In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. fatigue b. polydipsia c. polyphagia d. recurrent infections

The answer is B. Polydipsia is caused by fluid loss from polyuria when high glucose levels cause osmotic diuresis. Cellular starvation from lack of glucose and the use of body fat and protein for energy contribute to fatigue, weight loss, and polyphagia in type 1 diabetes.

Which of the following patients is at most risk for Type 2 diabetes?* A. A 6 year old girl recovering from a viral infection with a family history of diabetes. B. A 28 year old male with a BMI of 49. C. A 76 year old female with a history of cardiac disease. D. None of the options provided.

The answer is B. Remember Type 2 diabetes risk factors are related to lifestyle....being obese is a risk factor (BMI >30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for Type 2.

Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. it can be prevented by tight glucose control b. it occurs with a higher frequency and earlier onset than in the nondiabetic population c. it is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes d. it cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake.

The answer is B. The development of atherosclerotic vessel disease seems to be promoted by the altered lipid metabolism common in diabetes. Although tight glucose control may help to delay the process, it does not prevent it completely. Atherosclerosis in patients with diabetes does respond somewhat to a reduction in general risk factors, as it does in non diabetics, and reduction in fat intake, control of hypertension, abstention from smoking, maintenance of normal weight, and regular exercise should be carried out by all patients.

A patient with diabetes is experiencing a blood glucose of 275 when waking. What is a typical treatment for this phenomenon?* A. None, this is a normal blood glucose reading. B. The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia. C. A bedtime snack may prevent this phenomenon. D. This is known as the Somogyi effect and requires decreasing the bedtime dose of insulin.

The answer is B. This is known as the DAWN PHENOMENON and is best treated with a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia.

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

The answer is B. Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. pull back on the plunger after inserting the needle to check for blood b. consistently use the same size of insulin syringe to avoid dosing errors. c. clean the skin at the injection site with an alcohol swab before each injection. d. rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.

The answer is B. U100 insulin must be used with a U100 syringe but for those using low doses of insulin, syringes that have increments of 1 unit instead of 2 units are available. Errors can be made in dosing if patients switch back and forth between different sizes of syringes.

A patient with diabetes asks you about what type of exercise they should perform throughout the week. The best response is:* A. Lifting weights B. Sprinting C. Swimming D. Jumping

The answer is C. Aerobic exercise is the best and swimming is the only option that is an aerobic exercise.

The nurse is talking with the parents of a child experiencing precocious puberty. What information should the nurse share with the parents? a. The child is not yet fertile. b. Heterosexual interest is usually advanced. c. Dress and activities should be appropriate to chronologic age. d. Appearance of secondary sexual characteristics does not proceed in the usual order.

The answer is C. Because of the early sexual maturation of the child, both family and child require extensive teaching. Included in this is the information that the child should be engaged in activities according to chronologic age. The secondary sexual characteristics proceed in the usual order. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age.

The nurse assess the technique of the patient with diabetes for self-monitoring of blood glucose 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. doing the SMBG before and after exercising b. puncturing the finger on the side of the finger pad c. cleaning the puncture site with alcohol before the puncture d. holding the hand down for a few minutes before the puncture

The answer is C. Cleaning the puncture site with alcohol is not necessary and may interfere with test results and lead to drying and splitting of the fingertips. Washing the hands with warm water is adequate cleaning and promotes blood flow to the fingers.

A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak?* A. 1300 B. 0930 C. 1100 D. 1700

The answer is C. Humulin-R is a SHORT-ACTING insulin which has a PEAK time of 2 hours. If you gave the medication at 0900...it would peak at 1100.

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

The answer is 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 nonlabored. 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.

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. What is the most appropriate response by the nurse? a. "The pills work with an adult pancreas only." b. "The drugs affect fat and protein metabolism, not sugar." c. "Your child needs insulin replaced, and the oral hypoglycemics stimulate the pancreas to release the existing supply of insulin." d. "Perhaps when your child is older, the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

The answer is C. In type 1 diabetes the beta cells have been destroyed. It is necessary to supply the insulin that is no longer produced by the beta cells. Without a pancreas beta cell transplant, it is unlikely that insulin would be produced. The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes.

A 17-year-old boy with diabetes mellitus tells the school nurse that he has recently started drinking alcohol with his friends on weekends. What is the most appropriate action by the nurse? a. Tell him not to do this. b. Ask him why he is drinking alcohol. c. Teach him about the effects of alcohol on diabetes. d. Recommend that he attend counseling.

The answer is C. The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the correct management of his illness. A recommendation for counseling can be included in the teaching plan, but if this is the nurse's first response, the adolescent's trust could be lost. Admonishing him will not help the adolescent if he chooses to continue drinking and will damage the nurse's therapeutic relationship with him. Asking him why will provide information to the nurse but will not address the information that the adolescent needs to have about managing his disease. This response is judgmental and non-therapeutic. "Why" questions should not be asked, because they put anyone answering on the defensive.

A patient taking insulin has recorded fasting glucose levels above 200 mg/dL on awakening for the last five mornings. What should the nurse advise the patient to do first? a. increase the evening insulin dose to prevent the dawn phenomenon b. use a single dose insulin regimen with an intermediate acting insulin c. monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising d. decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect

The answer is C. The patient's elevated glucose on arising may be the result of either dawn phenomenon or Somogyi effect. The best way to determine whether the patient needs more or less insulin is by monitoring the glucose at bedtime, between 2:00 am and 4:00 am, and on arising. If the 2:00 am to 4:00 blood glucose levels are below 60 mg/dL, the insulin dose should be reduced to prevent Somogyi effect; if it is high, the insulin should be increased to prevent dawn phenomenon.

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? a. Routine insulin therapy and exercise b. Administer a different antibiotic for the UTI. c. Cardiac monitoring to detect potassium changes d. Administer IV fluids rapidly to correct dehydration.

The answer is 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.

Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. an obese 40 year old Hispanic woman b. a child whose father has type 1 diabetes c. a 34 year old woman whose parents both have type 2 diabetes d. a 12 year old boy whose father has maturity onset diabetes of the young

The answer is C. Type 2 diabetes has a strong genetic influence and offspring of parents who both have type diabetes have an increased chance of developing it.

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise her to take? a. Eat a piece of pizza. b. Drink some diet pop. c. Eat 15 g of simple carbohydrates. d. Take an extra dose of rapid-acting insulin.

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

The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? a. Prealbumin level b. Urine ketone level c. Fasting glucose level d. Glycosylated hemoglobin level

The answer is D. A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.

The _____ ______ secrete insulin which are located in the _______.* A. Alpha cells, liver B. Alpha cells, pancreas C. Beta cells, liver D. Beta cells, pancreas

The answer is D. Beta cells, pancreas

Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? a. i should wash my feet daily with soap and warm water. b. I should always wear shoes to protect my feet from injury. c. if my feet are cold, i should wear socks instead of using a heating pad. d. i'll know if I have sores or lesions on my feet because they will be painful.

The answer is D. Complete or partial loss of protective sensation of the feet is common with peripheral neuropathy of diabetes, and patients with diabetes may suffer foot injury and ulceration without ever having pain. Feet must be inspected during daily care for any cuts, blisters, swelling, or reddened areas.

During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL. At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results? Select all that apply a. A1C of 7.5% b. glycosuria of 3+ c. FPG > or equal to 127 mg/dL d. random blood glucose of 126 mg/dL e. a 2 hour oral glucose tolerance test (OGTT) of 190 mg/dL

The answers are: A and C The patient has one prior test result of fasting plasma glucose greater than or equal to 126 mg/dL that meets criteria for a diagnosis of diabetes, and the result is confirmed on this follow up visit. The A1C is 7.5% and greater than diagnostic criteria of 6.5% or higher.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse, "Can I still swim and play soccer and baseball?" What should the nurse's response be? a. "No, exercise is contraindicated until you are well maintained on a regimen." b. "Soccer and baseball are too strenuous, but swimming is acceptable." c. "The level of activity depends on the type of insulin required." d. "Exercise is not restricted unless indicated by other health conditions."

The answer is D. Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having appropriate snacks available. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be taught to monitor responses to the exercises. The level of activity is not dependent on the type of insulin used. Long-acting and short-acting insulin both may be used to compensate for the effects of training and sporting events.

A patient with diabetes is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. have the patient drink some orange juice b. administer 10 U of regular insulin subcutaneously c. call for an ambulance to transport the patient to a medical facility d. administer glucagon 1 mg intramuscularly (IM) or subcutaneously

The answer is D. If a patient with diabetes is unconscious, immediate treatment for hypoglycemia must be given to prevent brain damage, and IM or subcutaneous administration of 1 mg of glucagon should be done.

The nurse determines that a patient with a 2 hour OGTT of 152 mg/dL has a. diabetes b. elevated A1C c. impaired fasting glucose d. impaired glucose tolerance

The answer is D. Impaired glucose tolerance exists when a 2 hour OGTT level is higher than normal but lower than the level diagnostic for diabetes (>200 mg/dL).

The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration b. storing syringes prefilled with NPH and regular insulin needle up in the refrigerator c. placing the insulin bottle currently in use in a small container on the bathroom counterop d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration

The answer is D. Insulin glargine (Lantus), a long acting insulin that is continuously released with no peak of action, cannot be diluted or mixed with any other insulin or solution. Mixed insulins should be stored needle-up in the refrigerator and warmed before administration.

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. enhances the breakdown of adipose tissue for energy b. stimulates hepatic glycogenolysis and gluconeogenesis c. prevents the transport of triglycerides into adipose tissue d. increases amino acid transport into cells and protein synthesis

The answer is D. Insulin is an anabolic hormone that is responsible for growth, repair, and storage. It facilitates movement of amino acids into cells, synthesis of protein, storage of glucose as glycogen, and deposition of triglycerides and lipids as fat into adipose tissue. Fat is used as energy when glucose levels are depleted. Glucagon is responsible for hepatic glycogenolysis and gluconeogenesis.

Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. at mealtime or within 15 minutes of meals

The answer is D. Lispro is a rapid-acting insulin that has an onset of action of approximately 15 minutes and should be injected at the time of the meal to within 15 minutes of eating. Regular insulin is short acting with an onset of action in 30 to 60 minutes following administration and should be given 30 to 45 minutes before meals.

A patient has a blood glucose of 58 and is sweating, cold, and clammy. The patient is conscious. What is your next nursing intervention?* A. Recheck the blood glucose in 5 minutes. B. Give the patient 15 grams of a complex carbohydrate. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 15 grams of a simple carbohydrate.

The answer is D. Simple carbohydrates work faster than complex. Example of a simple carbohydrate would be 4 oz of fruit juice or soda, glucose tablet or gel, etc.

The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? a. "I want to go fishing for 30 minutes each day; I will drink fluids and wear sunscreen." b. "I will go running each day when my blood sugar is too high to bring it back to normal." c. "I will plan to keep my job as a teacher because I get a lot of exercise every school day." d. "I will take a brisk 30-minute walk 5 days per week and do resistance training three times a week."

The answer is D. The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days per week and resistance training three times a week. Brisk walking is moderate activity. Fishing and teaching are light activity, and running is considered vigorous activity.

The patient with type 2 diabetes has had trouble controlling his blood glucose with several oral agents but wants to avoid the risks of insulin. The HCP told him a medication will be prescribed that will increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying. The nurse knows this is which medication that will have to injected? a. dopamine receptor agonist, bromocriptine (Cycloset) b. dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin (Januvia) c. sodium-glucose co-transporter 2 (SGLT2) inhibitor, canagliflozin (Invokana) d. glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)

The answer is D. This glucagon-like peptide-1 (GLP-1) receptor agonist stimulates GLP-1 to increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, slow gastric emptying, and must be injected subcutaneously once every 7 days.

What statement or statements are INCORRECT regarding Diabetic Ketoacidosis?* A. DKA occurs mainly in Type 1 diabetics. B. Ketones are present in the urine in DKA. C. Cheyne-stokes breathing will always present in DKA. D. Severe hypoglycemia is a hallmark sign in DKA. E. Options C & D

The answer is E.

The patient with diabetes is brought to the emergency department by his family members, who say that he has had an infection, is not acting like himself, and he is more tired than usual. Number the nursing actions in the order of priority for this patient. a. establish IV access b. check blood glucose c. ensure patent airway d. begin continuous regular insulin drip e. administer 0.9% NaCl solution at 1 L/hr f. establish time of last food and medications

The order is C: ensure patent airway, B: check blood glucose, A: establish IV access, E: administer 0.9% NaCl solution at 1 L/hr, D: begin continuous regular insulin drip, F: establish time of last food and medications.