Metabolism - Diabetes, Liver, Pancreas

Which statement best indicates that a client understands how to administer his own insulin injections?

"I wrote down the steps in case I forget what to do."

A nurse reviews with the client the various types of medications used to treat diabetes. Which statement will the nurse use when teaching the client about liraglutide's mechanism of action?

"It causes delayed gastric emptying."

The nurse is teaching an adolescent with type 1 diabetes about signs and symptoms of hypoglycemia. Which of the following statements by the client help the nurse determine that the teaching has been effective?

-"If my blood sugar is low, I may feel sweaty and anxious." -"If my blood sugar is low, my heart rate will speed up." -"If my blood sugar is low, my blood pressure will increase."

A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching?

-"Insulin permits entry of glucose into the cells of the body." -"Insulin promotes synthesis of proteins in various body tissues." -"Insulin promotes the storage of fat in adipose tissue."

Which clients with diabetes mellitus would the nurse anticipate to have persistent elevation of blood glucose levels?

-A client with high anxiety -A client with COPD taking steroids -A client with a newly diagnosed leg fracture

A 12-year-old client who has had type 1 diabetes since infancy tests his glucose level before lunch and has a reading of 245 mg/dL (13.6 mmol/L). What will the nurse do next?

-Ask client to take the prescribed bolus dose plus additional aspart insulin per the sliding scale. -Ensure the client's lunch tray is present on the unit prior to giving insulin.

Which complications may be experienced by a client with diabetic neuropathies?

-Foot ulcers -Gastroparesis -Erectile dysfunction -Urinary retention

A child with type 1 diabetes is brought to the emergency department. The nurse suspects diabetic ketoacidosis (DKA) based on which assessment findings?

-Fruity breath odor -Decreased level of consciousness -Poor skin turgor

A newly admitted client in a skilled nursing facility has diabetes and is experiencing episodes of hypoglycemia. Place in the order the manner in which the nurse should provide evening care to the resident. All options must be used.

-Identify the client using two identifiers. -Assess the client's blood glucose level. -Provide an evening meal. -Assess percentage of the meal eaten. -Administer 20 units of insulin aspart. -Provide an evening snack.

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement.

-Increases lean muscle mass -Increases resting metabolic rate as muscle size increases -Decreases total cholesterol -Increases glucose uptake by body muscles

A client, who has been prescribed insulin, asks the nurse how the insulin will help get the glucose into the cells. What information will be the foundation for the nurse's response?

-Insulin reacts to specific receptor sites on the cell membrane -The reaction at the receptor site stimulate the nucleotide cyclic adenosine monophosphate (cyclic AMP) -The reaction that occurs changes the cell membrane's permeability to glucose -The reaction allows the insulin to produce the desired effect within seconds

The nurse knows that metabolic abnormalities that lead to type 2 diabetes include which physiologic problems?

-Insulin resistance -Beta cell failure -Hepatic glycogenolysis

Patient care dealing with nutrition and metabolism should include which factors?

-Knowledge about the value of the MyPlate diagram -Understanding food preferences of clients from the Jewish community -Information on the client's financial status related to meal provisions -Ability of the client to prepare food at home

A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis?

-Normal bedtime blood glucose -Increase in blood glucose from 3:00 AM until breakfast -Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM

A client admitted to the hospital with elevated blood glucose is diagnosed with type 2 diabetes mellitus. What characteristics commonly differentiate type 2 diabetes mellitus from type 1 diabetes mellitus?

-Onset after age 35 -Overweight

The nurse is teaching a client about insulin. What teaching will the nurse include? Select all that apply.

-Rapid-acting insulin and short-acting insulin are often combined with intermediate-acting insulin. -Humulin 50/50 contains equal amounts of intermediate-acting and short-acting insulin.

The nurse concludes that the participants of a community education class on prevention of osteoporosis are understanding the information when they identify which cause as a potential risk factor?

-Smoking -High-protein diet -Alcoholism -Excessive caffeine intake

A nurse is caring for a client receiving total parenteral nutrition (TPN). Which should the nurse educate the client about regarding TPN therapy?

-TPN has three primary components: proteins, carbohydrates, and fats. -TPN has a high glucose concentration. -TPN requires a PICC line or central venous access.

An obese client is being seen in the clinic for treatment of a weight problem. The client states that he or she has been on multiple dietary regimens without success. In which situation is treatment indicated?

-There is a body mass index (BMI) of 30 or higher -There is a large waist circumference with a BMI of 25-29 -There are two or more risk factors and BMI between 25-29

A nurse cares for older adults with obesity and understands that this particular population is impacted differently than the general population. What does the nurse understand is true regarding older adults with obesity?

-They are at greater risk for falls. -They are admitted to nursing homes more than other older adults. -They have lower SpO2 levels.

How does insulin participate in cellular metabolism?

-Transports glucose into skeletal muscle -Promotes triglyceride synthesis in the liver -Increases use of fatty acids as fuel

A client calls the office complaining of early morning glucose elevations. What should the nurse tell the client? A. Test at bedtime, 3 am, and early morning (7 am) and call results. B. Eliminate the bedtime snack C. Decrease carbohydrates by 15 grams each meal. D. Ensure strips are fully inserted into the meter when testing.

A

During a clinic appointment, the nurse notes erroneous capillary glucose results on the client's pad. What actions should the nurse take? A. Have the client demonstrate self-monitoring blood glucose (SMBG) technique B. Check the client's finger tips for scarring. C. Give the client some new strips. D. Order a new meter.

A

Which client should the nurse assess first? A. A client lying in bed, cool, clammy with slurred speech. B. A client with a blood glucose of 65 mg/dL talking on the phone. C. A client with a blood glucose of 259 mg/dL with negative urine ketones. D. A client admitted with a redden, inflamed great toe and temperature of 100.8 F.

A

A client diagnosed with T2 diabetes is admitted with a draining painful foot wound, BUN 42 mg/dL, Creatinine 3.0 mg/dL, WBC 18000. Which order should the nurse question? A. PICC line placement for long term antibiotics. B. Consult the wound nurse post debridement. C. Connect to EKG (telemetry) D. Capillary glucose and corrective dosing per protocol.

A - patients that have kidneys that kidney issues are not candidates for PICC lines because need this for dialysis at later time*****

A nurse is teaching a diabetic class about canaglifozin. Which instructions are correct? Select all that apply. A. _____ The drug may cause genital mycotic infections. B. _____ The drug reduces blood pressure. C. _____ Renal function should be assessed before initiation. D. _____The drug is contraindicated for GFR below 45 mg. E. _____ The drug reduces serum creatinine.

A,B,C,D

A nurse is teaching a diabetic class about pramlintide. Which instructions are correct ? Select all that apply. A. _____ Pramlintide is used for both T1 and T2 B. _____ The drug will slow gastric emptying. C. ____ The drug will stimulate the pancreas to secrete insulin. D. ____ The drug may cause a slight weight increase. E. _____ The medication is contraindicated with a history of pancreatitis.

A,B,C,E

A client prescribed pioglitazone asks the nurse several questions about the medication. What information is correct. Select all that apply A. _____ It increases the incidence of bone fractures. B. _____ The drug is contraindicated in clients' with heart problems. C. ____ The drug stimulates the pancreas to secrete insulin. D. _____ You should expect some weight gain. E. _____ Your chance of getting pregnant will be decreased.

A,B,D

A young lady with T 2 diabetes and a A1c of 7.9% expresses a desire to become pregnant. Which is an appropriate response by the nurse? Select all that apply. A. ____Use effective contraception at all times until good metabolic control is achieved. B. ____Discuss with your primary health care provider the need for initiation of insulin therapy. C. ____Try to achieve the lowest possible A1c without excessive hypoglycemia prior to conception. D. ____As long as you exercise daily, there is no restriction on becoming pregnant.

A,C

A diabetic client with a blood glucose of 143 mg/dL is NPO except medications for a procedure. Which medication(s) should be held? Select all that apply A. Lasix 20 mg po now B. Metoclopramide 20mg three times a day C. Lispro (Humalog) NPH 4 units SQ D. Plavix 75 mg po every morning E. Vitamin D one tablet daily

A,C,D

A client calls the clinic seeking a suggestion to avoid missing their evening glargine insulin dose because they are falling asleep prior to the injection. What is the most appropriate response by the nurse? A. "You need to set an alarm." B. "Have a family member call you ever evening to remind you." C. "Ask the primary healthcare provider to change the prescription." D. "Consider taking the injection at the same time in the morning."

ANS: D Covers 24 hours but must be given at the same time every day.

A client diagnosed with T2 diabetes, ask the nurse why their skin is so dry. Which explanation made by the nurse is appropriate? A. "Elevated glucose is associated with diuresis which causes loss of volume through the process of PID." B. 'The side effects associated with the use of insulin causes dryness." C. "The excretion of carbohydrate cause increased urination." D. "Beta cell production increase the risk of polyuria."

Answer: A - Elevated glucose is associated with diuresis which causes loss of volume through the process of PID."

A nurse is caring for a client diagnosed with Type 1 diabetes that wears an insulin pump and is scheduled for surgery. What should the nurse do? A. Remove the insulin pump until after surgery. B. Leave the pump in place insuring basal settings. C. Turn the pump off and check blood glucose after surgery. D. Suspend the pump delivery during surgery.

Answer: leave the pump in place insuring basal settings. Type 1 diabetics cannot live without insulin therefore the nurse should leave the pump on and ensure basal delivery.

The nurse is caring for a client diagnosed with diabetes admitted with an acute infection. Which clinical finding should be reported to the primary health care provider? A. Serum glucose of 170 mg/dL. B. pH 7.25, PCO2 45 mmHg, HCO3 17 mEq C. K+ 3.9 mEqL D. pH 7.39, PO2 96%, HCO23 mEq/L

B

The nurse is reviewing the health histories of newly admitted clients to an outpatient clinic. Which client would be most at risk for the development of type 2 diabetes? Select all that apply A. A middle- aged man who maintains a normal weight. B. A woman age 70 who is overweight and sedentary. C. A young adult who is a professional basketball player. D. A middle aged woman who is the sole caretaker of her parents. E. A woman with a family history of diabetes that is 2 months pregnant.

B,D,E

A client prescribed Metformin is scheduled for a CT scan with contrast. What is the priority intervention? A. Encourage the client to drink plenty of fluids after the test. B. Explain that the contrast will make them feel warm all over. C. Tell them they will have to hold their metformin 48 hours pre and post-test. D. Inform the client that an intravenous access will be required for the test.

C - most important

A client diagnosed with Type 2 is concern about removing a callus. What instructions should the nurse give? A. " Obtain an over the counter callus removable kit." B. "Use an emery board and sand the callus thin." C. "Soak the foot for 30 minutes, then attempt to peal the callus off." D. "Seek assistance from a certified foot nurse or podiatrists."

D

Which statement (s) is FALSE about metformin? Select all that apply. A___ Contraindicated in serum creatinine > 1.4. B. ___ Needs to be held during diagnostic tests using dye. C. ___ Not recommended with excessive alcohol intake. D. ___ Stimulates pancreas to secrete insulin. E. ____ Vitamin D deficiency is a potential side effect.

D,E (listen to zoom when they post)

A client who is post op from bariatric surgery experiences dumping syndrome. What is the nurse's understanding of the cause of this condition?

Hypertonic food releases metabolic peptides.

A client with diabetes mellitus has been admitted to the intensive care unit with a serum glucose reading of 400 mg/dL (22.20 mmol/L). Because the care for this client will involve multiple disciplines, which diagnostic statement would be most appropriate for the nurse to select?

PC: Hyperglycemia related to uncontrolled serum glucose