Evolve- Metabolism
While obtaining the client's health history, which factor does the nurse identify that predisposes the client to type 2 diabetes? Having diabetes insipidus Eating low-cholesterol foods Being 20 pounds (9 kilograms) overweight Drinking a daily alcoholic beverage
Being 20 pounds (9 kilograms) overweight Rationale Excessive body weight is a known predisposing factor to type 2 diabetes; the exact relationship is unknown. Diabetes insipidus is caused by too little antidiuretic hormone (ADH) and has no relationship to type 2 diabetes. High-cholesterol diets and atherosclerotic heart disease are associated with type 2 diabetes. Alcohol intake is not known to predispose a person to type 2 diabetes.
In her 36th week of gestation, a client with type 1 diabetes delivers a 9 lb 10 oz (4366 g) infant via cesarean birth. For which condition should the nurse monitor this infant of a diabetic mother? Meconium ileus Physiologic jaundice Respiratory distress syndrome Increased intracranial pressure
Respiratory distress syndrome Rationale A large-for-gestational-age infant born at 36 weeks' gestation to a mother with diabetes may have immature lung tissue, which predisposes the newborn to respiratory distress. Meconium ileus is suggestive of cystic fibrosis, which is unrelated to maternal diabetes. Physiologic jaundice manifests about 24 hours after birth, when fetal red blood cells begin to be subjected to hemolysis; this is unrelated to maternal diabetes. Increased intracranial pressure may be associated with birth injury or hydrocephalus; it is unrelated to maternal diabetes.
The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? (Select all that apply) Confusion Hyperactivity Excessive thirst Fruity-scented breath Decreased urinary output
Confusion Excessive thirst Fruity-scented breath Rationale Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased urination, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.
The nurse is caring for a client newly diagnosed with diabetes. When preparing the teaching plan about the importance of yearly eye examinations, the nurse should instruct the client on which eye problem most associated with diabetes? Cataracts Glaucoma Retinopathy Astigmatism
Retinopathy Rationale Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. Astigmatism is not associated with diabetes.
A nurse is caring for a client who has a 20-year history of type 2 diabetes. The nurse should assess for what physiologic changes associated with a long history of diabetes? Blurry, spotty, or hazy vision Arthritic changes in the hands Hyperactive knee and ankle jerk reflexes Dependent pallor of the feet and lower legs
Blurry, spotty, or hazy vision Rationale Blurry, spotty, or hazy vision; floaters or cobwebs in the visual field; and cataracts or complete blindness can occur as a result of diabetes. Diabetic retinopathy is characterized by abnormal growth of new blood vessels in the retina (neovascularization). More than 60% of clients with type 2 diabetes have some degree of retinopathy after 20 years. Arthritic changes of the hands are not a usual complication associated with diabetes mellitus. Clients who are diabetic have peripheral neuropathy, which is characterized by hypoactive, not hyperactive, reflexes. Peripheral vascular disease is indicated by dependent rubor with pallor on elevation, not dependent pallor.
A 6-year-old child is found to have type 1 diabetes. In light of the child's cognitive developmental level, which explanation of the illness is most appropriate? "Diabetes is caused by not having any insulin in your body." "You'll learn how to give yourself insulin now that you have diabetes." "Diabetes will require you to take insulin shots for the rest of your life." "Taking insulin for your diabetes is like getting new batteries for your superhero toys."
"Taking insulin for your diabetes is like getting new batteries for your superhero toys." Rationale The child is in Piaget's stage of preoperational thought, which is manifested by magical thinking; therefore teaching should also employ magical thinking. "Diabetes is caused by not having any insulin in your body" is too technical and does not take into account the child's preoperational stage of development. This statement is appropriate for an adolescent in the formal operational stage of cognitive development. "Diabetes will require you to take insulin shots for the rest of your life" is too direct and does not consider the child's cognitive developmental stage of preoperational thought. This statement is appropriate for an adolescent in the formal operational stage of cognitive development. Also, the use of the word "shots" may precipitate anxiety. "You will be taught how to give yourself insulin now that you have diabetes" is too direct and does not consider the child's cognitive developmental stage of preoperational thought. This statement is appropriate for an adolescent in the formal operational stage of cognitive development.
A client with severe diabetes insipidus is receiving desmopressin acetate, which is administered intranasally in a metered spray. During the follow-up visits, the client reports chest tightness to the primary healthcare provider. Which intervention would effectively reduce complications in the client? (Select all that apply) Administration of desmopressin acetate orally Administration of lithium carbonate intranasally Administration of antidiuretic hormone intravenously Administration of antidiuretic hormone intramuscularly Administration of desmopressin acetate subcutaneously
Administration of desmopressin acetate orally Administration of desmopressin acetate subcutaneously Rationale During the treatment of severe diabetes insipidus with nasal administration of desmopressin acetate, if the client reports any side effects, such as chest pain, then the mode of administration of the drug should be changed to oral or subcutaneous. It will help to reduce the complications in the client. Lithium carbonate should not be prescribed to a client with diabetic insipidus because it causes drug-related diabetes insipidus as it decreases the levels of antidiuretic hormone by interfering with the response of the kidneys. Administration of antidiuretic hormone does not relieve such symptoms as chest pain. It should be given to the clients during severe dehydration either intravenously or intramuscularly.
A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes, and the other client has type 2 diabetes. When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes what clinical presentation about type 1? Answer Options: Onset of the disease is slow. Excessive weight is a contributing factor. Complications are not present at the time of diagnosis. Treatment involves diet, exercise, and oral medications.
Complications are not present at the time of diagnosis. Rationale: Rationale Clinical presentation of type 1 diabetes is characterized by acute onset, and therefore there is no time to develop the long-term complications that are common with long-standing disease; 20% of newly diagnosed clients with type 2 diabetes demonstrate complications because the diabetes has gone undetected for an extended period of time. Clinical presentation of type 1 diabetes is rapid, not slow, as pancreatic beta cells are destroyed by an autoimmune process; in type 2 diabetes, the body is still producing some insulin, and therefore the onset of signs and symptoms is slow. In type 1 diabetes, clients are generally lean or have an ideal weight; 80% to 90% of clients with type 2 diabetes are overweight. Type 1 diabetes requires diet control, exercise, and subcutaneous administration of insulin, not oral medications; oral medications are used for type 2 diabetes because some insulin is still being produced.
The regulation of type 1 diabetes in an 8-year-old child is best attained with a combination of therapeutic modalities in addition to the administration of insulin. Which modalities should a nurse include in the teaching plan? Dietary control Regular exercise Urine testing for glucose Blood glucose monitoring Use of oral hypoglycemic agents
Dietary control Regular exercise Blood glucose monitoring Rationale Following a diet that balances protein, carbohydrates, and fats decreases the amount of exogenous insulin needed to regulate type 1 diabetes. Exercise uses glucose for energy, which decreases the amount of exogenous insulin needed to regulate type 1 diabetes. Blood glucose monitoring is used to adjust the amount of exogenous insulin needed. Urine is no longer tested routinely for glucose; occasionally it may be used to detect ketonuria when hyperglycemia is suspected. Oral hypoglycemics are used by individuals with type 2, not type 1, diabetes. Individuals with type 1 diabetes have little or no endogenous insulin and do not respond to stimulation with oral hypoglycemic agents.
A nurse is assessing a client with diabetes insipidus. Which signs indicative of diabetes insipidus should the nurse identify when assessing the client? (select all that apply) Excessive thirst Increased blood glucose Dry mucous membranes Increased blood pressure Decreased serum osmolarity Decreased urine specific gravity
Excessive thirst Dry mucous membranes Decreased urine specific gravity Rationale As excessive fluid is lost through urination, dehydration triggers the thirst response. As excessive fluid is lost through urination, dehydration occurs, resulting in dry mucous membranes and poor skin turgor. Because water is not being reabsorbed, urine is dilute, resulting in a low specific gravity (less than 1.005). Diabetes insipidus is not a disorder of glucose metabolism; blood glucose levels are not affected. Diabetes mellitus affects glucose metabolism. Loss of fluid may decrease the blood pressure because fluid is lost from the intravascular compartment. As fluid is lost from the intravascular compartment, serum osmolarity increases, not decreases.
The nurse is performing a physical assessment of a pregnant woman. Which factor in the client's history increases the risk for abruptio placentae? Hydramnios Hypertension Cardiac disease Diabetes mellitus
Hypertension Rationale Abruptio placentae occurs in about 1% of all pregnancies. The problem is more common in women with hypertension; however the causative factors are not clear. Hydramnios occurs about 10 times more often in pregnancies involving clients with type 1 diabetes. Spontaneous abortion, preterm labor and birth, and intrauterine fetal growth retardation are more common in pregnant clients with heart disease than in those without it. There is not a higher incidence of abruptio placentae in clients with diabetes mellitus; clients with diabetes are more likely to experience preeclampsia or to go into preterm labor if they have diabetes before becoming pregnant, especially if pathologic changes related to diabetes are present.
A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? Decreased serum glucose levels Decreased serum calcium levels Increased blood urea nitrogen levels Increased serum bicarbonate levels
Increased blood urea nitrogen levels Rationale With diabetic ketoacidosis blood urea nitrogen level generally is increased because of dehydration. With diabetic ketoacidosis, the serum glucose levels are generally above 300 mg/dL (16.7 mmol/L). The calcium level is unrelated to diabetic ketoacidosis. Serum bicarbonate levels are below 15 mEq/L (15 mmol/L).
A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? Increased serum lipids Decreased hematocrit level Increased serum calcium levels Decreased blood urea nitrogen level
Increased serum lipids Rationale With diabetic ketoacidosis, serum lipid levels are high because of the increased breakdown of fat. Serum lipid levels can go so high that the serum appears opalescent and creamy. With diabetic ketoacidosis the hematocrit level generally is increased because of dehydration. The calcium level is unrelated to diabetic ketoacidosis. With diabetic ketoacidosis the blood urea nitrogen level generally is increased because of dehydration.
A nurse is caring for a client who had a pancreaticoduodenectomy for cancer of the pancreas. The nurse provides education about hypoinsulinism, a long-term complication related to this type of surgery. The nurse evaluates that the teaching is understood when the client states that he will seek medical supervision if he experiences which symptom? Oliguria Anorexia Weight gain Increased thirst
Increased thirst Rationale Polydipsia is characteristic of hypoinsulinism (diabetes mellitus) because excessive urine is excreted related to glycosuria. Polyuria, not oliguria, is characteristic of diabetes mellitus because the kidneys excrete excess fluid with the glucose. Increased appetite is characteristic of diabetes mellitus because of impaired metabolism. Weight loss characterizes diabetes mellitus because of the use of body mass as a source of energy.
An adolescent is found to have type 1 diabetes. The nurse plans to teach the adolescent that dietary control and exercise can help regulate the disorder. What additional information should the nurse include in the teaching plan?(Select all that apply) Insulin therapy Prophylactic antibiotics Blood glucose monitoring Oral hypoglycemic agents Adherence to the treatment regimen
Insulin therapy Blood glucose monitoring Adherence to the treatment regimen Rationale Because clients with type 1 diabetes have little or no endogenous insulin, they must take insulin. Blood glucose monitoring is an important aspect of therapy because it aids evaluation of the effectiveness of diabetic control. Dietary control and exercise reduce the amount of exogenous insulin needed. Although adhering to the diabetic regimen is difficult, especially for adolescents who need to identify with their peers, its importance in promoting euglycemia should be discussed. Although infection increases insulin requirements, prophylactic antibiotics are not needed. Oral hypoglycemics are ineffective in stimulating insulin secretion in clients with type 1 diabetes.
A 15-year-old adolescent is found to have type 1 diabetes. What should the nurse include when teaching the adolescent about type 1 diabetes? Answer Options It does not always require insulin. It involves early vascular changes. It occurs more often in obese adolescents. It has a more rapid onset than does type 2 diabetes.
It has a more rapid onset than does type 2 diabetes. Rationale A characteristic difference between type 1 and type 2 diabetes is the rapid onset of type 1 diabetes. Type 1 diabetes often is first diagnosed during an episode of acute ketoacidosis. Children, adolescents, and adults with type 1 diabetes are insulin dependent. Vascular changes are complications associated with long-standing diabetes. Maturity-onset diabetes of the young (MODY), similar to type 2 diabetes, is more often seen in obese teenagers. Adolescents with type 1 diabetes tend to be at or below the expected weight for their height and bone structure.
A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, "I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What common complications of diabetes might the nurse expect to identify when assessing this client? (Select all that apply) Leg ulcers Loss of visual acuity Thick, yellow toenails Increased growth of body hair Decreased sensation in the feet
Leg ulcers Loss of visual acuity Thick, yellow toenails Decreased sensation in the feet Rationale:Leg ulcers are a common response to the microvascular and macrovascular changes associated with diabetes. Retinopathy, damage to the microvascular system of the retina (e.g., edema, exudate, and local hemorrhage), occurs as a result of the occlusion of the small vessels in the eyes, causing microaneurysms in the capillary walls. Thick, yellow toenails result from prolonged inadequate arterial circulation to the feet. Pedal pulses diminish, which can result in gangrene, necessitating amputation. Diabetic neuropathies affect 60% to 70% of people with diabetes. It is theorized that consistent hyperglycemia causes a buildup of sorbitol and fructose in the nerves that results in impairment via an unknown process. Inadequate arterial circulation to hair follicles results in a lack of hair on the feet and ankles. The skin becomes dry and cracks, predisposing it to leg ulcers and infection.
The nurse is caring for an older client admitted to the hospital with type 2 diabetes. What is important for the nurse to remember about older adults and type 2 diabetes? Older adults seldom develop ketoacidosis. Older adults secrete no endogenous insulin. Older adults have a lower risk of complications. Older adults develop a sudden onset of symptoms.
Older adults seldom develop ketoacidosis. Rationale Lipolysis is not a common response to meeting the metabolic needs of those with type 2 diabetes; therefore, ketones are not present in large enough amounts to cause ketoacidosis. Adults with type 2 diabetes do secrete endogenous insulin, but secretion is slow and in smaller than adequate amounts. The incidence of chronic complications depends on the level of glucose control, not developmental level. The onset of type 2 diabetes is usually gradual, whereas in type 1 diabetes, it is sudden and dramatic.
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? Somogyi effect Dawn phenomenon Diabetic ketoacidosis Hyperosmolar nonketotic syndrome
Somogyi effect Rationale The Somogyi effect is a response to hypoglycemia induced by too much insulin; the body responds to the hypoglycemia by counterregulatory hormones stimulating lipolysis, gluconeogenesis, and glycogenolysis, resulting in rebound hyperglycemia. The Dawn phenomenon is hyperglycemia that is present on awakening in the morning because of the release of counterregulatory hormones in the predawn hours; it is thought that growth hormone or cortisol is related to this phenomenon. Diabetic ketoacidosis (diabetic coma) is a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration. Hyperosmolar nonketotic syndrome occurs in clients with type 2 diabetes. It is a condition in which the client produces enough insulin to prevent diabetic ketoacidosis but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.
Which intervention does the nurse anticipate will be provided for the newborn of a mother with a long history of diabetes? Fast-acting insulin Special high-risk care Routine newborn care Limited glucose intake
Special high-risk care Rationale The infant of a diabetic mother is a newborn at risk because of the interaction between the maternal disease and the developing fetus. The newborn of a mother with type 1 diabetes generally is hypoglycemic because of oversecretion of insulin by the newborn's hypertrophied pancreas. The newborn of a mother with type 1 diabetes is at high risk and requires intensive care. The newborn of a mother with type 1 diabetes is prone to hypoglycemia and will probably need increased glucose.
A 12-year-old child with type 2 diabetes is scheduled for abdominal surgery. Which factors are most important for the nurse to consider during the postoperative period?(Select all that apply) Infection will likely occur at the surgical site. Ketoacidosis frequently occurs later in the postoperative period. The blood glucose level will increase because of the stress of surgery. Urine test results are the most useful gauge of diabetic control after surgery. Diabetic control is usually maintained with insulin after surgery.
The blood glucose level will increase because of the stress of surgery. Diabetic control is usually maintained with insulin after surgery. Rationale The stress of surgery causes the release of epinephrine and glucocorticoids, which increase the blood glucose level. Most individuals with type 2 diabetes who control their diabetes through diet and exercise require insulin during the recovery period. Although the child with diabetes is at risk for infection, surgical aseptic technique should prevent infection. Ketoacidosis is associated with type 1, not type 2, diabetes. Urine test results are affected by many variables and therefore are not reliable indicators of the blood glucose level.
The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. What should the nurse include in the teaching plan? (Select all that apply) The client should obtain a finger stick blood sugar reading before each meal. The client does not need to follow a specific diet until insulin is required. The teaching plan should include signs and symptoms of hypoglycemia. The teaching plan does not need to include signs and symptoms of hypoglycemia, as the client is not on insulin. The teaching plan should include sick day rules.
The client should obtain a finger stick blood sugar reading before each meal. The teaching plan should include signs and symptoms of hypoglycemia. The teaching plan should include sick day rules. Rationale All diabetic clients, regardless of type, should check finger stick blood sugars before each meal and snack. Antidiabetic medications can cause hypoglycemia; therefore the client needs to be instructed on the symptoms of hypoglycemia. All diabetic clients need to be educated on sick day rules. All diabetic clients need to follow the American Diabetes Association diet (Canada: Canadian Diabetes Association diet).
Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes? Ketones in the blood but not in the urine Glucose in the urine but not hyperglycemia Urine negative for ketones and hyperglycemia Blood and urine positive for both glucose and ketones
Urine negative for ketones and hyperglycemia Rationale In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia. Ketones in the blood but not in the urine does not occur with either type. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia and diabetes mellitus. Glucose in the urine but not hyperglycemia is impossible; if glycosuria is present, the level of glucose in blood first must exceed the renal threshold of 160 to 180 mg/dL (8.9 to 10 mmol/L). Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes.
Two clients with polydipsia and polyuria arrived at the hospital. Both were having similar symptoms but were diagnosed with different types of diabetes insipidus. Which assessment finding helped to differentiate the diagnosis? Urine output Specific gravity Urine osmolarity Serum osmolarity
Urine osmolarity Rationale Polydipsia and polyuria are signs of diabetes insipidus. When a water deprivation test is performed, urine osmolarity is increased dramatically from 100 to 600 mOsm (mmol)/kg in clients with central diabetes insipidus. But in nephrogenic diabetes insipidus, the urine osmolarity may not be greater than 300 mOsm (mmol)/kg. The urine output is 2 L to 20 L/day in all types of diabetes insipidus. The specific gravity is less than 1.005 in all types of diabetes insipidus and the serum osmolarity is also greater than 295 mOsm (mmol)/kg in all types of diabetes insipidus.
The nurse is caring for a client who is prescribed desmopressin acetate. What is the expected outcome in the client? Sodium: 136mEq/L Specific gravity: 1.005 Urine output: 3 L/day Osmolarity: 100 mOsm/kg
Urine output: 3 L/day Rationale Desmopressin acetate is used for the treatment of diabetes insipidus, a disease associated with urine output of more than 4 L/day. The amount of urine output should decrease when the client is treated with desmopressin acetate. Sodium levels may not be altered in a client taking medication for diabetes insipidus. The specific gravity in a client under medication for diabetes insipidus should be more than 1.005. Osmolarity between 50 to 200 mOsm/kg indicates that the client has diabetes insipidus and is not an outcome of desmopressin acetate treatment.
