NURS 309 Quiz 9 - Acute Type 2 Diabetes

407. A client with type 1 diabetes has an above the knee amputation because of severe lower extremity arterial disease. What is the nurse's primary responsibility 2 days after surgery when preparing the client to eat dinner? 1. checking the client's serum glucose level 2. assisting the client out of bed into a chair 3. placing the client in the high-fowler position 4. ensuring the client's residual limb is elevated

1 - because client has type 1 diabetes, it is essential that the blood glucose level be determined before meals to evaluate level of control of diabetes and possible need for insulin coverage

405. A nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. What interventions should the nurse include that will decrease the risk of complications? (select all) 1. examining the feet daily 2. wearing well-fitting shoes 3. performing regular exercise 4. powdering the feet after showering 5. visiting the health care provider weekly 6. testing bathwater with the toes before bathing

1,2,3

22. You are caring for an 81-year-old adult with type 2 diabetes, hypertension, and peripheral vascular disease. Which admission assessment findings increase the pt's risk for development of hyperglycemic-hyperosmolar syndrome (HHS)? (select all that apply) 1. hydrochlorothiazide (HCTZ) prescribed to control her diabetes 2. weight gain of 6 pounds over the past month 3. avoids consuming liquids in the evening 4. BP of 168/94 mmHg 5. urine output of 50-75 mL/hr

1,3

9. In care of a pt with type 2 diabetes, which actions can you delegate to the UAP? (select all that apply) 1. providing pt with extra packets of artificial sweetener for coffee 2. assessing how well the pt's shoes fit 3. recording the liquid intake from the pt's breakfast tray 4. teaching pt what to do if dizziness or lightheadedness occurs 5. checking and recording pt's BP

1,3,5

25. You are caring for a diabetic pt admitted with hypoglycemia that occurred at home. Which teaching points for treatment of hypoglycemia at home would you include in a teaching plan for the pt and family before discharge? (select all that apply) 1. signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL 2. treat hypoglycemia with 4-8 g of carbohydrate such as glucose tablets or 1/4 cup of fruit juice 3. retest blood glucose in 30 min 4. repeat the carbohydrate treatment if the symptoms do not resolve 5. eat a small snack of carbohydrate and protein if the next meal is more than an hour away

1,4,5

18. While you are performing an admission assessment on a pt with type 2 diabetes, he tells you that he routinely drinks 3 beers a day. What is your priority follow-up question at this time? 1. "Do you have any days when you do not drink?" 2. "When during the day do you drink your beers?" 3. "Do you drink any other forms of alcohol?" 4. "Have you ever had a lipid profile completed?"

2

370. A client tells the nurse during the admission history that an oral hypoglycemic agent is taken daily. For which condition does the nurse conclude that an oral hypoglycemic agent may be prescribed by the health care provider? 1. ketosis 2. obesity 3. type 1 diabetes 4. reduced insulin production

4 - oral hypoglycemics may be helpful when some functioning of the beta cells exists, as in type 2 diabetes

1. You are preparing to review a teaching plan for a pt with type 2 diabetes mellitus. To determine the pt's level of compliance with his prescribed diabetic regimen, which value would you be sure to review? 1. fasting glucose level 2. oral glucose tolerance test 3. glycosylated hemoglobin (HbgA1C) level 4. fingerstick glucose findings for 24 hours

3

14. A pt has a newly diagnosed type 2 diabetes. Which action should you assign to an LPN/LVN instead of a UAP? 1. measuring pt's vital signs every shift 2. checking pt's glucose level before each meal 3. administering subcutaneous insulin on a sliding scale as needed 4. assisting pt with morning care

3

368. Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1. Providing oxygen 2. encouraging carbohydrates 3. administering fluid replacement 4. teaching facts about dietary principles

3 - as a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated

344. 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. The nurse determines that the main difference between the newly diagnosed type 1 and type 2 diabetes is that the in type 1 diabetes: 1. The onset of the disease is slow 2. excessive weight is a contributing factor 3. complications are not present at the time of diagnosis 4. treatment involves diet, exercise, and oral medications

3 - type 1 has an acute onset which causes no time to develop long-term complications

2. A patient has newly-diagnosed type 2 diabetes. Which task should you delegate to the UAP? 1. arranging a consult with the dietitian 2. assessing the pt's insulin injection technique 3. teaching the pt to use a glucometer to monitor glucose at home 4. reminding the pt to check glucose level before each meal

4

7. A UAP tells you that, while assisting with the morning care of a postoperative pt with type 2 diabetes who has been given insulin, the pt asked if she will always need to take insulin now. What is your priority for teaching the pt? 1. explain to the pt that she is now considered to have type 1 diabetes 2. tell the pt to monitor fingerstick glucose level every 4 hours after discharge 3. teach the pt that a person with type 2 diabetes does not always need insulin 4. talk with the pt about the relationship between illness and increased glucose levels

4

397. A client with diabetes is given instructions about foot care. The nurse determines that the instructions are understood when the client states, "I will: 1. cut my toenails before bathing" 2. soak my feet daily for one hour" 3. examine my feet using a mirror at least once a week" 4. break in my new shoes over the course of several weeks"

4 - a slower, longer period of time to break in new, stiff shoes will help prevent blisters and skin breakdown

72. Which diabetic pt is at greatest risk for diabetic foot ulcer formation? a. 75 yr old african-american male with history of cardiovascular disease b. 53 yr old caucasian female with history of renal insufficiency c. 38 yr old american indian with history of gastric ulcers d. 28 yr old caucasian male with history of chronic kidney disease

a

11. Which complications of DM are considered emergencies? (select all that apply) a. DKA b. hypoglycemia c. diabetic retinopathy d. hyperglycemic-hyperosmolar state (HHS) e. diabetic neuropathy

a,b,d

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

a

26. Which class of antidiabetic medication should be taken with the first bite of a meal to be fully effective? a. alpha-glucosanide inhibitors, which include miglitol (Glyset) b. biguanides, which include metformin (glucophage) c. meglitinides, which include natelinide d. second-generation sulfonylureas, which include glipizide (glucotrol)

a

31. For which pt should the health care provider avoid prescribing rosiglitazone (avandia)? a. pt with symptomatic heart failure b. pt with new-onset asthma c. pt with kidney disease d. pt with hyperthyroidism

a

36. A pt asks the nurse how insulin injection site rotation should be accomplished. What is the nurse's best response? a. "rotation within one site is preferred to avoid changes in insulin absorption" b. "change rotation sites after a week or two to avoid lipohypertrophy" c. "rotation from site to site each day is best for the best insulin absorption" d. "always rotate insulin injection sites within 4-5 inches from the umbilicus"

a

56. What type of exercise does the nurse recommend for the pt with diabetic retinopathy? a. non-weight-bearing activities such as swimming b. weight-bearing activities such as jogging c. vigorous aerobic and resistance exercises d. weight training and heavy lifting

a

30. Which oral agent may cause lactic acidosis? a. nateglinide b. repaglinide c. metformin d. miglitol

c

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

a,b,d,e

49. Intensive therapy with good glucose control results in delays in which diabetic complications? (select all) a. macrovascular disease b. cardiovascular disease c. stroke d. retinopathy e. nephropathy f. neuropathy

a,b,d,e,f

78. The nurse is preparing to teach a diabetic pt how to select appropriate shoes. Which points must be included in the teaching plan? (select all) a. "it is best to have the shoes fitted by an experienced shoe fitter such as a podiatrist" b. "the shoes should be 1-1.5 inches longer than your longest toe" c. "the heels of the shoes should be less than 2 inches high d. "avoid tight-fitting shoes, which can cause tissue damage to your feet" e. "you should get at least two pairs of shoes so you can change them at midday and in the evening"

a,c,d,e

32. The pt with type 2 diabetes is prescribed sitagliptin (Januvia) for glucose regulation. Which key changes does the nurse teach a pt to report to the health care provider immediately? (select all) a. report any signs of jaundice b. report any signs of bleeding c. report any blue-grey discoloration of the abdomen d. report any cough or flu symptoms e. report any sudden onset of abdominal pain

a,c,e

27. Which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established? a. alpha-glucosanide inhibitors, which include miglitol (Glyset) b. biguanides, which include metformin (glucophage) c. meglitinides, which include natelinide d. second-generation sulfonylureas, which include glipizide (glucotrol)

b

33. Which statement about insulin is true? a. exogenous insulin is necessary for management of all cases of type 2 b. insulin's effectiveness depends on the individual pt's absorption of the drug c. insulin doses should be regulated according to self-monitoring urine glucose levels d. insulin administered in multiple doses per day decreases the flexibilitiy of a pt's lifestyle

b

35. A diabetic pt is on a mixed-dose insulin protocol of 8 units regular insulin and 12 units NPH insulin at 7am. At 10:30am, the pt reports feeling uneasy, shaky, and has a headache. Which is a probable explanation for this? a. the NPH insulin's action is peaking and there is an insufficient blood glucose level b. the regular insulin's action is peaking and there is an insufficient blood glucose level c. the pt consumed too many calories at breakfast and now has an elevated blood glucose level d. the symptoms are unrelated to the insulin administered in the early morning or food taken in at lunchtime

b

44. Which diabetic complication is associated with neuropathy? a. end-stage kidney disease b. muscle weakness c. permanent blindness d. eye hemorrhage

b

55. Along with exercise, what is the recommended calorie reduction for a pt with diabetes who must lose weight? a. 100-200 cal/day b. 250-500 cal/day c. 501-600 cal/day d. 601-750 cal/day

b

65. A pt with type 2 DM often has which laboratory value? a. elevated thyroid studies b. elevated triglycerides c. ketones in the urine d. low hemoglobin

b

73. A pt with DM has signs and symptoms of hypoglycemia. The pt is alert and oriented with a blood glucose of 56 mg/dL. What does the nurse do next? a. give a glass of orange juice with two packets of sugar and continue to monitor the pt b. give 8 oz of skim milk and then a carbohydrate and protein snack c. give a complex carbohydrate and continue to monitor the pt d. administer D50 IV push and give the pt something to eat

b

81. The critical care nurse is caring for an older pt admitted with HHS. What is the first priority in caring for this pt? a. slowly decreasing blood volume b. fluid replacement to increase blood volume c. potassium replacement to prevent hypokalemia d. diuretic therapy to maintain kidney function

b

68. The older adult with DM asks the nurse for advice about beginning an exercise program. What is the nurse's best response? (select all) a. begin with high-density activities b. start low-intensity activities in short sessions c. be sure to include a warm-up and cool-down periods d. start with periods of 20 min or less e. changes in activity should be gradual

b,c,e

34. Which statement about insulin administration is correct? a. insulin may be given orally, IV, or subcut. b. insulin injections should be spaced no closer than 1/2 inch apart c. rotating injection sites improves absorption and prevents lipohypertrophy d. shake the bottle of intermediate-acting insulin and then draw it into the syringe

c

38. A 47 yr old pt with a history of type 2 DM and emphysema who reports smoking three packs of cigarettes per day is admitted to the hospital with a diagnosis of acute pneumonia. The pt is placed on the regular oral antidiabetic agents, sliding-scale insulin, and antibiotic medications. On day 2 of hospitalization, the health care provider orders prednisone therapy. What does the nurse expect the blood glucose to do? a. decrease b. stay the same c. increase d. return to normal

c

50. The pt with diabetes has a foot that is warm, swollen, and painful. Walking causes the arch of the foot to collapse and gives the foot a "rocker bottom" shape. Which foot deformity does the nurse recognize? a. hallux valgus b. claw-toe deformity c. charcot foot d. diabetic foot ulcer

c

54. What is the recommended protocol for pts with type 2 DM who must lose weight? a. participate in aerobic program twice a week for 20 minutes each session b. slowly increase insulin dosage until mild hypoglycemia occurs c. reduce calorie intake moderately and increase exercise d. reduce daily calorie intake to 1000 calories and monitor urine for ketones

c

6. Which individual is at greatest risk for developing type 2 DM? a. 25 yr old african-american woman b. 36 yr old african-american man c. 56 yr old hispanic woman d. 40 yr old hispanic man

c

60. Which statement about sexual intercourse for pts with diabetes is true? a. the incidence of sexual dysfunction is lower in men than women b. retrograde ejaculation does not interfere with male fertility c. impotence is associated with DM in male pts d. sexual dysfunction in female pts includes the inability to achieve pregnancy

c

62. Which statement by a pt with DM indicates an understanding of the principles of self-care? a. "i dont like the idea of sticking myself so often to measure my sugar" b. "i plan to measure the sugar in my urine at least four times a day" c. "i plan to get my spouse to exercise with me to keep me company" d. "if i get a cold, i can take my regular cough medication until i feel better"

c

28. Which class of antidiabetic medication is most likely to cause a hypoglycemic episode because of the long duration of action? a. alpha-glucosanide inhibitors, which include miglitol (Glyset) b. biguanides, which include metformin (glucophage) c. meglitinides, which include natelinide d. second-generation sulfonylureas, which include glipizide (glucotrol)

d

42. A pt with type 2 DM, usually controlled with a second-generation sulfonylurea, develops a urinary tract infection, the pt must be treated with insulin. What additional information about this treatment does the nurse relay to the pt? a. the sulfonylurea must be discontinued and insulin taken until the infection clears b. insulin will now be necessary to control the pt's diabetes for life c. the sulfonylurea dose must be reduced until the infection clears d. the insulin is necessary to supplement the second-generation sulfonylurea until the infeciton clears.

d

74. A pt with diabetes has signs and symptoms of hypoglycemia. The pt has blood glucose of 56 mg/dL, is alert but responds to voice, and is confused and is unable to swallow fluids. What does the nurse do next? a. give a glass of orange juice with two packets of sugar and continue to monitor the pt b. give a glass of orange or other type of juice and continue to monitor the pt c. give a complex carbohydrate and continue to monitor the pt d. administer D50 IV push

d

22. Which are modifiable risk factors for type 2 DM? (select all ) a. age b. family history c. working in a low-stress environment d. maintaining ideal body weight e. maintaining adequate physical activity

d,e

377. A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? 1. fluid loss 2. glycosuria 3. kussmaul respirations 4. increased blood glucose level

3 - kussmaul resp occur in diabetic coma as the body attempts to correct a low pH caused by accumulation of ketones; HHNS affects people with type 2 diabetes who still have some insulin production; insulin prevents the breakdown of fats into ketones

376. Metformin (Glucophage) 2g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets should the nurse administer?

4 tablets

1. Which descriptors are typical of type 2 diabetes mellitus? (select all that apply) a. autoimmune response causes beta cell destruction b. cells have decreased ability to respond to insulin c. diagnosis is based on results of 100-g glucose tolerance test d. most pts diagnosed are obese adults e. usually has abrupt onset of thirst and weight loss

b,d

25. Which are considered the early signs of diabetic nephropathy? (select all) a. positive urine RBCs b. microalbuminuria c. positive urine glucose d. positive urine WBCs e. elevated serum uric acid

b,e

29. Which class of antidiabetic medication should be given 1-30 min before meals? a. alpha-glucosanide inhibitors, which include miglitol (Glyset) b. biguanides, which include metformin (glucophage) c. meglitinides, which include natelinide d. sulfonylrueas, which include chlorpromadine (diabinese)

c

48. Which statements about sensory alteration in pts with diabetes are accurate? (select all) a. healing of foot wounds is reduced because of impaired sensation b. very few patients with diabetic food ulcers have peripheral sensory neuropathy c. loss of pain, pressure, and temperature sensation in the foot increases the risk of injury d. sensory neuropathy causes loss of normal sweating and skin temperature regulation e. it can be delayed by keeping the blood glucose level as close to normal as possible

c,d,e

57. The nurse is teaching a pt with diabetes about proper foot care. Which instructions does the nurse include? (select all) a. use rubbing alcohol to toughen the skin on the soles of the feet b. wear open-toed shoes or sandals in warm weather to prevent perspiration c. apply moisturizing cream to feet after bathing but not between the toes d. use cold water for bathing the feet to prevent inadvertent thermal injury e. do not go barefoot f. inspect the feet daily

c,e,f