Diabetes Mellitus (DM)

After administering glucagon to an unconscious patient, the nurse would place the patient in which position? A. Supine B. Side-lying C. High-Fowler's D. Semi-Fowler's

B Rationale - Nausea is a common reaction after glucagon injection. The patient should be placed in the side-lying position to prevent aspiration should the patient vomit. The supine, high-Fowler's, and semi-Fowler's positions are not advisable because of the risk of aspiration of vomitus.

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

B Rationale - The Somogyi effect occurs when a patient receives a high dose of evening/bedtime insulin that produces a decline in blood glucose levels during the night. As a result, counter regulatory hormones are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia.

Which statement is characteristic of metformin? A. It causes weight gain. B. It decreases hepatic glucose production. C. It should not be given with sulfonylureas. D. It is inappropriate for initial management of type 2 diabetes.

B Rationale - The primary action of metformin is to reduce glucose production by the liver. - Metformin often causes weight loss instead of weight gain. - Metformin can be administered in conjunction with sulfonylureas. - Metformin is preferred for the initial management of type 2 diabetes.

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."

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

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.

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.

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

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 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.

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.

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

C

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

C

Which drug is used for treating neurogenic bladder? A. Valsartan B. Gabapentin C. Bethanechol D. Amitriptyline

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

Which instruction, in relation to mealtimes, would the nurse give to a patient who is prescribed lispro? A. Take on an empty stomach between meals. B. Take it simultaneously with a meal. C. Take it within 15 minutes of mealtime. D. Take it 30 to 45 minutes before a meal.

C Rationale - Rapid-acting synthetic insulin analogs, which include lispro (Humalog), aspart (NovoLog), and glulisine (Apidra), have an onset of action of approximately 15 minutes and should be injected within 15 minutes of mealtime. - The rapid-acting analogs most closely mimic natural insulin secretion in response to a meal. - Lispro is not administered on an empty stomach or simultaneously with a meal. - "15 minutes feels like an hour during 3 rapid responses"

During which timeframe would the nurse monitor the patient for hypoglycemia after administering 10 units regular insulin subcutaneously at 8:30 p.m.? A. 8.40 pm - 9pm B. 9pm - 11.30 pm C. 10.30pm - 1.30 pm D. 12.30am - 8.30 am

C Rationale - Regular insulin exerts peak action in two to five hours, making the patient most at risk for hypoglycemia between 10:30 p.m. and 1:30 a.m. - "Short staffed nurse went from 30 patients 2 (to) 8 patients"

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

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

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

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

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

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

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

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.

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.

D

A patient with type 2 diabetes who takes oral hypoglycemics at home is admitted to the hospital with an infection and asks why insulin injections have been prescribed. Which explanation would the nurse provide? A. Insulin acts synergistically with the antibiotic that was prescribed. B. Insulin should have been prescribed for the patient to take at home. C. Oral hypoglycemic medications are contraindicated in patients with infections. D. The infection increases the glucose level, resulting in a need for more insulin.

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

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

D - Prednisone is a steroid drug, which can increase the glucose level

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

E

What is the goal in treating patients with DKA or HHS?

Establish IV access and begin F&E replacement

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

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

What is the respiration in patient with DKA? 1. Cheyne-Stokes respiration 2. Kussmaul 3. Bradypnea 4. Tachypnea

2

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

A

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.

A

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

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.

A

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

A

A patient diagnosed with type 1 diabetes has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse would be performed initially? A. Check the patient's blood sugar at 3:00 AM. B. Provide the patient with an evening snack. C. Rotate insulin injection sites between the abdomen, thigh, and arm. D. Contact the health care provider to increase the evening insulin dose.

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

The nurse would instruct the patient with diabetes to fast for which period of time when scheduled for a fasting blood glucose level at 8:00 a.m.? A. At least 8 hours B. 4am on the day of the test C. After dinner the evening before the test D. 7am on the day of the test

A Rationale - Typically, a patient is prescribed to be NPO for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 a.m. should not have any food or beverages containing any calories after midnight. It is not necessary to fast longer than eight hours; 4:00 a.m. and 7:00 a.m. would not allow for sufficient time to fast for morning laboratory testing.

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

A - Humulin N is an intermediate-acting insulin. The peak of this medication is 8 hours.

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

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.

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

B

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.

B