Nurse 2 Test 9 Diabetes PrepU Study Guide

c. Inhibit the production of glucose by the liver.

10. A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to: a. Stimulate the beta cells of the pancreas to secrete insulin. b. Decrease the body's sensitivity to insulin. c. Inhibit the production of glucose by the liver. d. Increase the absorption of carbohydrates in the intestines.

a. Increases lean muscle mass b. Increases resting metabolic rate as muscle size increases d. Decreases total cholesterol e. Increases glucose uptake by body muscles

11. Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply. a. Increases lean muscle mass b. Increases resting metabolic rate as muscle size increases c. Decreases the levels of high-density lipoproteins d. Decreases total cholesterol e. Increases glucose uptake by body muscles

c. wash and inspect the feet daily.

1. A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: a. use commercial preparations to remove corns. b. cut the toenails by rounding edges. c. wash and inspect the feet daily. d. walk barefoot at least once each day.

a. Change the needle every 3 days.

21. A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site? a. Change the needle every 3 days. b. Wear sterile gloves when inserting the needle. c. Take the ordered antibiotics before initiating treatment. d. Use clean technique when changing the needle.

c. Infuse 0.9% normal saline solution 1 L/hr for 2 hours.

22. A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first? a. Start an infusion of regular insulin at 50 U/hr. b. Administer sodium bicarbonate 50 mEq IV push. c. Infuse 0.9% normal saline solution 1 L/hr for 2 hours. d. Administer regular insulin 30 U IV push.

c. Encourage midday snack.

23. Which is the primary dietary consideration for a client receiving insulin isophane suspension (NPH) at breakfast? a. Make sure breakfast is not delayed. b. Provide fewest amount of carbohydrates at lunch meal. c. Encourage midday snack. d. Delay dinner meal.

c. 70% NPH insulin and 30% regular insulin

25. Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? a. 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin b. 70 units of regular insulin and 30 units of NPH insulin c. 70% NPH insulin and 30% regular insulin d. 70% regular insulin and 30% NPH insulin

d. Below-normal serum potassium level

26. A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? a. Elevated serum acetone level b. Serum ketone bodies c. Serum alkalosis d. Below-normal serum potassium level

c. Peripheral neuropathy

3. An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? a. A faulty heater b. Autonomic neuropathy c. Peripheral neuropathy d. Sudomotor neuropathy

b. Avoid drinking beer, wine, or liquor. c. Use artificial sweeteners instead of sugar in tea and coffee. d. Read food labels carefully to look for hidden sources of sugar.

39. The nurse is providing discharge instructions to a client who has just been diagnosed with type 1 diabetes. What instructions are most important for the client to follow related to diet? (Select all that apply.) a. Lose 10-15 pounds. b. Avoid drinking beer, wine, or liquor. c. Use artificial sweeteners instead of sugar in tea and coffee. d. Read food labels carefully to look for hidden sources of sugar. e. If you skip a meal, increase your next insulin dosage.

b. Decreased renal function

4. Which age-related change may affect diabetes and its management? a. Hypotension b. Decreased renal function c. Increased bowel motility d. Increased thirst

b. False

41. Pramlintide is administered orally. a. True b. False

c. Headache d. Confusion e. Diaphoresis

45. During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hypoglycemia that include which symptoms? (Select all that apply.) a. Increased thirst b. Increased urination c. Headache d. Confusion e. Diaphoresis

a. "Diet, exercise, and weight loss can eliminate the need for medication."

9. A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate? a. "Diet, exercise, and weight loss can eliminate the need for medication." b. "You will be placed on a strict low-sugar diet for better control." c. "Some doctors do not treat blood sugar elevation until symptoms appear." d. "You misunderstood the doctor. Let's ask for clarification."

a. Blurred or deteriorating vision b. Fatigue and irritability c.Polyuria and polydipsia e. Wounds that heal slowly or respond poorly to treatment

13. A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. a. Blurred or deteriorating vision b. Fatigue and irritability c. Polyuria and polydipsia d. Sudden weight loss and anorexia e. Wounds that heal slowly or respond poorly to treatment

a. Rosiglitazone (Avandia) c. Pioglitazone (Actos)

56. Which produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity? (Select all that apply.) a. Rosiglitazone (Avandia) b. Metformin (Glucophage) c. Pioglitazone (Actos) d. Miglitol (Glyset) e. Acarbose (Precose)

b. Bloating and diarrhea

57. The nurse is educating a client who is beginning therapy with acarbose and tells the client to take the medication with the first bite of each main meal to help prevent what adverse effect? a. Dizziness b. Bloating and diarrhea c. Nausea and vomiting d. Chest pain

a. "I'm thirsty all the time. I just can't get enough to drink."

6. A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? a. "I'm thirsty all the time. I just can't get enough to drink." b. "It seems like I have no appetite. I have to make myself eat." c. "I have a cough and cold that just won't go away." d. "I notice pain when I urinate."

b. Rosiglitazone

51. Which agent would a nurse expect to administer as a single oral dose in the morning? a. Repaglinide b. Rosiglitazone c. Exenatide d. Miglitol

a. 3 to 4 hours

52. A patient is taking chlorpropamide. The nurse warns the patient about the possibility of hypoglycemia within approximately which time frame after taking the drug? a. 3 to 4 hours b. 1 to 2 hours c. 2 to 3 hours d. 4 to 5 hours

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

12. 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? Select all that apply. a. Normal bedtime blood glucose b. Rise in blood glucose about 3:00 AM c. Increase in blood glucose from 3:00 AM until breakfast d. Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM e. Elevated blood glucose at bedtime

c. Slow, bounding pulse

14. Which of the following would lead a nurse to suspect that a client is experiencing hypoglycemia? a. Flushed hot skin b. Air hunger c. Slow, bounding pulse d. Thirst

d. Change the second IV solution to dextrose 5% in water.

15. A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question? a. Infuse 500 ml of normal saline solution over 1 hour. b. Hold insulin infusion for 30 minutes. c. Add 40 mEq potassium chloride to an infusion of half normal saline solution and infuse at a rate of 10 mEq/hour. d. Change the second IV solution to dextrose 5% in water.

a. Hypokalemia

16. A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? a. Hypokalemia b. Hyperkalemia c. Hyperglycemia d. Hyponatremia

a. Diet soda

17. Which of the following would be considered a "free" item from the exchange list? a. Diet soda b. Green salad c. Medium apple d. 1 tsp olive oil

b. Switch the client to a different oral antidiabetic agent.

18. After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do? a. Initiate insulin therapy. b. Switch the client to a different oral antidiabetic agent. c. Order an additional oral antidiabetic agent. d. Restrict carbohydrate intake to less than 30% of the total caloric intake.

d. Carbohydrates 50%, fat 25%, and protein 20%

19. The nurse practitioner worked with a registered dietitian to customize a 1,800-calorie diabetic diet for a 53-year-old man with special dietary needs. Which of the following percent distribution of calories should be provided? a. Carbohydrates 35%, fat 10%, and protein 5% b. Carbohydrates 40%, fat 15%, and protein 10% c. Carbohydrates 45%, fat 20%, and protein 15% d. Carbohydrates 50%, fat 25%, and protein 20%

a. Exenatide

53. The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the client's breakfast. Which agent would the nurse most likely be administering? The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the client's breakfast. Which agent would the nurse most likely be administering? a. Exenatide b. Rosiglitazone c. Repaglinide d. Miglitol

a. An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.

2. Which would be included in the teaching plan for a client diagnosed with diabetes mellitus? a. An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. b. Sugar is found only in dessert foods. c. The only diet change needed in the treatment of diabetes is to stop eating sugar. d. Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued.

a. glycosylated hemoglobin

20. A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance? a. glycosylated hemoglobin b. hematocrit A1c c. postprandial glucose d All options are correct.

a. Patient's eating and sleeping habits

24. Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? a. Patient's eating and sleeping habits b. Patient's ability to self-administer insulin c. Cognitive problems d. Patient's history

c. 50% to 60%

27. The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively? a. 10% to 20% b. 25% to 40% c. 50% to 60% d. 85% to 90%

b. Helps tissues use insulin more efficiently

28. A type 2 diabetic is ordered metformin (Glucophage) as part of the management regime. Which is the best nursing explanation for the action of this drug in controlling glucose levels? a. Delays digestion of carbohydrates b. Helps tissues use insulin more efficiently c. Stimulates insulin release d. Reduces the production of glucose by the liver

d. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

29. A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADA's recommendations include? a. 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein b. 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein c. 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein d. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

a. Fasting plasma glucose greater than or equal to 126 mg/dL

30. A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? a. Fasting plasma glucose greater than or equal to 126 mg/dL b. Random plasma glucose greater than 150 mg/dL c. Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions d. Random plasma glucose greater than 126 mg/dL

a. Abdominal obesity b. Elevated blood glucose levels d. Hypertension

31. A client has gained 55 lb in the last 3 years and is concerned about developing type 2 diabetes mellitus. Additionally, the client's healthcare provider has diagnosed metabolic syndrome. What are the conditions contributing to the development of metabolic syndrome? Select all that apply. a. Abdominal obesity b. Elevated blood glucose levels c. Elevated high-density lipoproteins (HDL) d. Hypertension e. Decreased low-density lipoproteins (LDL)

b. Blood pH of 6.9

32. The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find? a. Blood glucose level of 250 mg/dL b. Blood pH of 6.9 c. Serum bicarbonate of 19 mEq/L d. PaCO2 of 40 mm Hg

a. Initiate fluid replacement therapy.

33. A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first? a. Initiate fluid replacement therapy. b. Administer insulin. c. Correct diabetic ketoacidosis. d. Determine the cause of diabetic ketoacidosis.

c. Obesity and inadequate exercise

34. The school nurse identifies more children with type 2 diabetes each year and recognizes that this trend is mainly attributed to what issue? a. Working parents b. Economics c. Obesity and inadequate exercise d. Lack of after-school programs due to budget constraints

d. All the above

35. A nurse diabetes educator is planning an initial visit to a home care client who was recently diagnosed with diabetes mellitus. Which skills would the nurse help the client learn? a. Planning an appropriate and consistent diet b. Self-administration of medication c. Self-monitoring of glucose levels d. All the above

c. Insulin glargine (Lantus) d. Insulin detemir (Levemir)

36. A nurse must recognize the duration of insulin as to not cause harm to the client with administration of the improper type of insulin. Which insulins are long-acting insulin? (Select all that apply.) a. Insulin apart (NovoLog) b. Insulin lispro (Humalog) c. Insulin glargine (Lantus) d. Insulin detemir (Levemir) e. Insulin glulisine (Apidra)

d. Widespread changes in the blood vessels

37. A patient with type 1 diabetes has come to the clinic for a routine follow-up appointment. While assessing the patient's skin, the nurse observes brown spots on his lower legs. What might these spots indicate? a. Infection b. Impaired glucose tolerance c. Poor insulin injection technique d. Widespread changes in the blood vessels

d. Take an oral dose of some form of glucose as soon as possible.

38. A nurse is working with a newly diagnosed diabetic client on understanding hypoglycemia and insulin reactions. Which action would be most important for the client to understand when planning the response to an insulin reaction? a. Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. b. Stay calm and still until the reaction subsides. c. Notify your health care provider immediately. d. Take an oral dose of some form of glucose as soon as possible.

a. Binding to potassium channels on pancreatic beta cells

54. A client is receiving glipizide as treatment for his type 2 diabetes. The nurse understands that this drug acts by: a. Binding to potassium channels on pancreatic beta cells b. Inhibiting alpha-glucosidase to delay glucose absorption c. Increasing the uptake of glucose d. Decreasing insulin resistance

c. increased risk of lactic acidosis

55. A client is receiving metformin therapy at a health care facility. The client is also prescribed glucocorticoids. The nurse would be alert for which adverse reaction due to the interaction of these two drugs? a. increased hypoglycemic effect b. increased risk for bleeding c. increased risk of lactic acidosis d. delay in gastric emptying

b. Blurred vision

40. A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for? a. Dry skin b. Blurred vision c. Fruity breath d. Flushing of the face

a. "Give it by subcutaneous injection immediately before your major meals."

42. The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate? a. "Give it by subcutaneous injection immediately before your major meals." b. "Take the drug orally once a day, preferably in the morning." c. "Give yourself an injection 1 hour before you eat breakfast and dinner." d. "Take the drug orally with the first bite of each meal."

c. Perform a blood sugar analysis.

43. A female client is diagnosed with type 1 diabetes. She suddenly reports feeling weak, shaky, and dizzy. What should the nurse's first response be? a. Administer 1 amp of 50% dextrose IV. b. Administer 10 units of regular insulin subcutaneously. c. Perform a blood sugar analysis. d. Have the client drink a glass of orange juice.

a. Glimepiride b. Glyburide

44. After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea? Select all that apply. a. Glimepiride b. Glyburide c. Tolazamide d. Pramlintide e. Repaglinide

c. Place glucose gel between the gums and cheek.

46. The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client? a. Administer regular insulin subcutaneously. b. Give 8 oz orange juice. c. Place glucose gel between the gums and cheek. d. Raise the head of the bed.

a. Inhibits an enzyme to delay glucose absorption

47. A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug? a. Inhibits an enzyme to delay glucose absorption b. Decreases insulin resistance c. Binds to potassium channels on pancreatic beta cells d. Increases the uptake of glucose

a. a client who received 12 units of Humulin R 45 minutes ago

48. The nurse is providing care for several clients who have diabetes. Which client should the nurse monitor most closely for signs and symptoms of hypoglycemia? a. a client who received 12 units of Humulin R 45 minutes ago b. a client who received 12 units of metformin minutes ago c. a client whose most recent blood glucose level was 150 mg/dL d. a client whose type 2 diabetes was diagnosed one week ago

a. Irritability c. Impaired mental functioning e. Lethargy

49. The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.) a. Irritability b. Anorexia c. Impaired mental functioning d. Hallucinations e. Lethargy

c. Abdomen

5. A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse would administer the insulin at which site as the preferred site? a. Arms b. Thighs c. Abdomen d. Upper buttock

a. It slows gastric emptying.

50. A client with a diagnosis of diabetes is prescribed pramlintide. How will this drug assist in controlling the client's blood sugar? a. It slows gastric emptying. b. It blocks the absorption of food. c. It absorbs with the insulin. d. It increases the release of insulin.

b. To restore liver glycogen and prevent secondary hypoglycemia

7. A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? a. To decrease the possibility of nausea and vomiting b. To restore liver glycogen and prevent secondary hypoglycemia c. To stimulate her appetite d. To decrease the amount of glycogen in her system

d. Weight reduction through diet and exercise

8. A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? a. Maintenance of blood glucose levels between 180 and 200 mg/dl b. Smoking reduction but not complete cessation c. An eye examination every 2 years until age 50 d. Weight reduction through diet and exercise