Patho Chp 37 Diabetes Mellitus and Its Complications
Which patient is at the greatest risk of developing type 2 diabetes mellitus (T2DM)? ANSWER CORRECT Unselected A college student whose twin was recently diagnosed with type 1 diabetes mellitus (T1DM) Unselected A high-profile lawyer who jogs 5 miles every morning Unselected A construction worker with central obesity, working hard to lose weight Correct YOU WERE UNSURE AND CORRECT An office worker with central obesity recently diagnosed with osteoporosis
A Westernized lifestyle includes a high-calorie diet and decreased physical activity, which leads to obesity. Central obesity, or increased weight around the trunk, is a prominent risk factor for type 2 diabetes mellitus (T2DM). Central obesity is a marker for glucose intolerance, hyperinsulinemia, and hypertriglyceridemia. Metabolic syndrome is also a strong risk factor for T2DM.
Which information should the nurse include when teaching a patient about the risk factors for type 2 diabetes mellitus (T2DM)? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Decreasing caloric intake and increasing physical exercise may decrease the risk of T2DM. Unselected Familial disposition is the greatest risk factor for T2DM. Unselected Because changes in urbanization and lifestyle are the greatest risk factors for T2DM, an individual cannot prevent or slow its occurrence. Unselected Individuals in the lowest socioeconomic brackets have the greatest risk of T2DM, making socioeconomic status the greatest risk factor for development of T2DM.
A Westernized lifestyle includes a high-calorie diet and decreased physical activity, which leads to obesity. Central obesity, or increased weight around the trunk, is a prominent risk factor for type 2 diabetes mellitus (T2DM). Central obesity is a marker for glucose intolerance, hyperinsulinemia, and hypertriglyceridemia. Metabolic syndrome is also a strong risk factor for T2DM. The development of T2DM can be prevented or slowed through lifestyle modifications. Lifestyle is the greatest risk factor for T2DM, not socioeconomic status or familial disposition.
The nurse is aware of a group of clinic patients who have a family member with type 1 diabetes mellitus (T1DM). Which patient should the nurse identify as the one with the greatest risk for developing the disorder? ANSWER I DON'T KNOW YET Unselected The patient's aunt diagnosed with type 1 diabetes mellitus (T1DM). Unselected The patient's mother-in-law diagnosed with type 2 diabetes mellitus (T2DM). Unselected The patient's sister diagnosed with type 2 diabetes mellitus (T2DM). Correct THE CORRECT ANSWER The patient's identical twin diagnosed with type 1 diabetes mellitus (T1DM)
A patient with a monozygotic twin diagnosed with type 1 diabetes mellitus (T1DM) has a 50% risk of developing T1DM. There is no correlation between a sibling with type 2 diabetes mellitus (T2DM) and a patient's risk of developing T1DM. There is no correlation between a mother-in-law with T2DM and a patient's risk of developing T1DM. An aunt is not a first-degree relative, so there is no correlation between an aunt with T1DM and the patient's risk of developing T1DM.
The nurse is caring for a patient experiencing polyuria and unexplained weight loss. Which diagnostic test result indicates to the nurse that the patient has diabetes mellitus (DM)? ANSWER I DON'T KNOW YET Unselected Fasting plasma glucose of 112 mg/dL Correct THE CORRECT ANSWER Glycosylated hemoglobin (A1C) of 7.2% Unselected Casual plasma glucose of 150 mg/dL Unselected Two-hour plasma glucose of 100 mg/dL after oral glucose tolerance test
An A1C level of 6.5% or higher indicates diabetes mellitus (DM). A casual plasma glucose level greater than 200 mg/dL along with symptoms of polyuria, polydipsia, and unexplained weight loss indicate diabetes mellitus. A fasting plasma glucose level greater than 126 mg/dL indicates diabetes mellitus. A 2-hour plasma glucose level of greater than 200 mg/dL during an oral glucose tolerance test indicates diabetes mellitus.
The nurse reviews the pathophysiology of diabetes mellitus before assessing a patient with the disorder. Which cells are destroyed and unable to produce insulin in a patient with type 1 diabetes mellitus (T1DM)? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Beta Unselected Alpha Unselected Delta Unselected Gamma
Beta cells secrete the hormone insulin. These cells are destroyed and are no longer able to produce insulin in a patient with type 1 diabetes mellitus (T1DM). The alpha, delta, and gamma cells are not destroyed and continue to function in a patient with type 1 diabetes mellitus. Alpha cells produce the hormone glucagon. Delta cells produce somatostatin. Gamma cells secrete pancreatic polypeptide.
A client missed the midday meal and is now diaphoretic and confused. Because the nurse knows that the ratio of glucagon to insulin has increased in an effort to provide glucose to the brain and nervous tissue, which metabolic state is the client most likely in? A. Absorptive B. Malabsorptive C. Postabsorptive D. Starvation
C. Postabsorptive Rationale: During the postabsorptive state, glucose levels fall. The focus is on providing glucose to fuel the brain and nervous tissue. The ratio of glucagon to insulin increases, and free fatty acids are released from adipose tissue to be broken down for energy.
Which clinical manifestation should the nurse expect to assess in a patient diagnosed with hyperglycemic hyperosmolar syndrome (HHS)? ANSWER I DON'T KNOW YET Unselected Metabolic acidosis Unselected Ketonuria Correct THE CORRECT ANSWER Electrolyte imbalances Unselected Fluid volume overload
Clinical manifestations of hyperglycemic hyperosmolar syndrome include fluid volume deficit and electrolyte imbalances. However, clinical signs of metabolic acidosis and ketosis are not present. Metabolic acidosis and ketosis are not clinical manifestation of HHS. Fluid volume deficit, not fluid volume overload, is a clinical manifestation of HHS.
The nurse is presenting information on the incidence of diabetes mellitus (DM) at a community health education program. Which statement should the nurse recognize as being incorrect about diabetes mellitus (DM)? ANSWER I DON'T KNOW YET Unselected Approximately 1 in 400 children and adolescents has diabetes mellitus. Unselected Type 2 diabetes mellitus is more common in Hispanics and non-Hispanic African Americans than in other ethnic groups. Correct THE CORRECT ANSWER Type 2 diabetes mellitus is more common in Asian Americans and non-Hispanic Caucasian Americans than in other ethnic groups. Unselected Prediabetes affects 79 million people.
Diabetes disproportionately affects minority populations; 7.6% of non-Hispanic Caucasian Americans, 9.0% of Asian Americans, 12.8% of Hispanics/Latinos, 13.2% of non-Hispanic African Americans, and 15.9% of American Indians/Alaskan Natives have diagnosed DM. In the general population, the risk of developing T2DM is approximately 3%.
A patient with diabetes mellitus who is recovering from bronchitis experiences nausea, vomiting, and abdominal pain. Which action should be the primary nursing intervention? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Placing telemetry leads for cardiac monitoring Unselected Collecting a urine specimen for a urinalysis Unselected Drawing blood for a complete blood count (CBC) Unselected Drawing blood for hemoglobin and hematocrit
Diabetic ketoacidosis (DKA) causes potassium loss. Cardiac dysrhythmias are the result of hypokalemia. Hemoglobin and hematocrit, urinalysis, and CBC are not priorities at this time.
The nurse is teaching a patient with diabetes mellitus (DM). Which statement should the nurse include in this teaching? ANSWER I DON'T KNOW YET Unselected "Hyperglycemia will not impact your blood pressure." Correct THE CORRECT ANSWER "Numbness and tingling in the legs or arms should be reported immediately." Unselected "It is not necessary to have regular eye exams." Unselected "Your lower legs and feet will be assessed only if you have unhealing wounds."
Diabetic neuropathy is nerve damage due to diabetes mellitus (DM). Clinical manifestations of diabetic neuropathy include numbness and tingling in the arms and legs. Regular eye exams are necessary to detect retinopathy. Lower legs and feet should be routinely assessed. Hyperglycemia will impact blood pressure.
The nurse is caring for a patient with diabetes mellitus (DM). Which assessment indicates to the nurse the patient may have developed diabetic neuropathy? ANSWER I DON'T KNOW YET Unselected Microalbumuria 45 mg albumin/24 hr Unselected Hypertension Correct THE CORRECT ANSWER Numbness and tingling in the lower legs Unselected Macular edem
Diabetic neuropathy is nerve damage due to diabetes mellitus (DM). Numbness and tingling in the lower legs is a clinical manifestation of neuropathy. Microalbuminuria of 45 mg albumin/24 hr, macular edema, and hypertension are not clinical manifestations of diabetic neuropathy.
in which state is the primary focus of metabolism on fueling the brain and nervous system with glucose? ANSWER I DON'T KNOW YET Unselected Puberty Correct THE CORRECT ANSWER Postabsorptive Unselected Starvation Unselected Absorptive YOUR ANSWER I DON'T KNOW YET
During the postabsorptive state the ratio of glucagon to insulin increases. During the absorptive state insulin increases. Puberty is not a metabolic state. During starvation, insulin levels remain low. The primary source of glucose is gluconeogenesis in the liver. Skeletal muscle uses free fatty acids for fuel, but also ketone bodies produced by the liver. The brain may begin to rely on ketone bodies for fuel.
Which reason explains polydipsia in the development of diabetes? ANSWER I DON'T KNOW YET Unselected Compensatory mechanism in response to hyperkalemia Correct THE CORRECT ANSWER Compensatory mechanism in response to dehydration and fluid volume depletion Unselected Compensatory mechanism in response to the alkaline state of the blood Unselected Compensatory mechanism in response to hypoglycemia
Hyperglycemia increases serum osmolarity. Extreme thirst is a compensatory mechanism for the high serum osmolarity and resulting fluid loss. Polydipsia does not occur due to hyperkalemia, hypoglycemia, or the alkaline state of the blood.
A patient with diabetic ketoacidosis (DKA) is concerned about being thirsty. Which explanation should the nurse provide to this patient? ANSWER I DON'T KNOW YET Unselected "The excess blood sugar makes the kidneys slow down in urine production. This leads to excess thirst." Unselected "Deep rapid respirations called Kussmaul respirations are common with DKA. These tend to dry your mouth out and make you more thirsty." Unselected "As the blood sugar returns to normal, the osmolarity of the blood goes up. The result is dehydration and thirst." Correct THE CORRECT ANSWER "The excess blood sugar raises the osmolarity of the blood, so more fluid is lost through the urine. This leads to dehydration. Thirst is your body's way of telling you that you are dehydrated and need more fluids."
Hyperglycemia increases serum osmolarity. Extreme thirst is a compensatory mechanism for the high serum osmolarity and resulting fluid loss. The kidneys will speed up, increasing urine output. Kussmaul respirations may occur, but are not the cause of thirst. Blood glucose returning to normal is not the cause of thirst.
The nurse is assessing patients with diabetes mellitus (DM) in the clinic. Which patient should the nurse see first? ANSWER I DON'T KNOW YET Unselected The patient who ate lunch 4 hours ago and is complaining of hunger Correct THE CORRECT ANSWER The patient who is sweaty, difficult to arouse, and disoriented to location Unselected The patient whose blood sugar was 75 mg/dL when it was checked 1 hour ago Unselected The patient who is asking for assistance to the bathroom
Hypoglycemia has two major categories of symptoms. The autonomic nervous system symptoms are caused by decreased glucose to the brain. The neuroglycopenic symptoms are caused by decreased glucose to the central nervous system. Sweating, drowsiness, and disorientation are physiological responses to hypoglycemia. Hunger and urination are not physiological responses to hypoglycemia. There is no information to indicate that a patient whose blood glucose was 75 mg/dL 1 hour ago is displaying signs of hypoglycemia.
A patient is being evaluated for diabetes mellitus (DM). Which finding should the nurse expect to assess in this patient? ANSWER I DON'T KNOW YET Unselected 5 lb weight gain in the last 3 weeks Unselected Anorexia over the last 2 months Unselected Blood pressure 180/94 mmHg; respirations 16 breaths/min and shallow; bounding pulses bilaterally Correct THE CORRECT ANSWER Blood pressure 82/58 mmHg and heart rate 124 beats/min
Hypotension and tachycardia indicate DM. Weight loss is more common with new onset of diabetes mellitus. Polyphagia is a sign of diabetes, not anorexia. Hypotension, not hypertension, is expected with new onset diabetes mellitus.
Which statement is accurate for the pathophysiological changes that occur in the development of diabetic ketoacidosis (DKA)? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Ketone bodies are produced through the breakdown of lipids into energy. Ketones in the bloodstream cause metabolic acidosis and electrolyte imbalances. Unselected Ketone bodies cause osmotic diuresis and loss of potassium. Unselected Ketone bodies are produced from the excess glucose in the bloodstream and cause metabolic acidosis and electrolyte imbalances. Unselected Ketone bodies result from the breakdown of fats into energy. Ketone bodies help transport glucose into the cells.
Ketone bodies are produced when fat is broken down. Ketones in the bloodstream cause metabolic acidosis. Ketones in the urine cause a loss of sodium.
The nurse is teaching a pregnant patient with gestational diabetes about the need for glucose control. Which statement made by the patient indicates that the teaching has been effective? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER "Excellent glucose control will reduce the risk of complications both for myself and my baby." Unselected "I should increase my carbohydrate intake to ensure my baby has a higher birth weight." Unselected "I should monitor my blood sugar once daily in the morning." Unselected "Because I have gestational diabetes, my baby is at high risk for low birth weight."
Low birth weight has been associated with insulin resistance. Infants born to mothers with diabetes typically have a high birth weight and also are at risk for developing diabetes. The best way to reduce complications and risks for mother and baby is to tightly control blood glucose during pregnancy. Gestational diabetes puts the baby at risk for high birth weight. Carbohydrate intake should be carefully monitored to prevent high blood glucose levels in the mother, which creates hyperinsulinemia in the baby. Hyperinsulinemia can lead to severe hypoglycemia in the baby shortly after birth. Blood glucose should be monitored more often than once a day.
Which clinical manifestation is the first sign of diabetic nephropathy?
Microalbuminuria
The nurse is caring for a patient with a new onset of diabetic nephropathy. Which clinical manifestation should the nurse expect the patient to exhibit? ANSWER I DON'T KNOW YET Unselected Glucosuria Unselected Esophageal disturbances Correct THE CORRECT ANSWER Microalbuminuria Unselected Gastroparesis
Microalbuminuria is the first sign of diabetic nephropathy. The goal of treatment of hypertension is to preserve renal function. Glucosuria, gastroparesis, and esophageal disturbances are not clinical manifestations of diabetic nephropathy.
The nurse teaches a patient with diabetes mellitus (DM) about ongoing care needs. Which patient statement requires follow-up by the nurse? ANSWER I DON'T KNOW YET Unselected "Routine screening will detect changes that could lead to kidney disease." Unselected "I should follow up with my healthcare provider regularly for a foot check." Correct THE CORRECT ANSWER "I should have my eyes checked every 5 years." Unselected "If I get sick, I should check my blood glucose more often."
Routine eye exams are part of the standard of care for patients with diabetes because retinopathy can be treated to prevent blindness, as long as it is caught prior to the onset of symptoms. It is appropriate for a patient to check blood glucose more often when sick. It is appropriate for the patient to follow up with the healthcare provider routinely for a foot check. Routine screening can detect changes that indicate kidney disease.
Which clinical manifestation should the nurse expect in a patient with stage 3 type 2 diabetes mellitus (T2DM)? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Fasting and postprandial hyperglycemia Unselected Hyperinsulinemia and normal blood glucose levels Unselected Hypoglycemia during menses Unselected Postprandial hyperglycemia and normal fasting blood glucose levels
Stage 3 type 2 diabetes mellitus (T2DM) occurs as insulin resistance continues to increase so patients exhibit hyperglycemia even when fasting and after lunch and dinner (postprandial). Female patients with type 2 DM actually are hyperglycemic not hypoglycemic. Hyperinsulinemia usually would create normal blood glucose levels, but in stage 3 T2DM, insulin resistance creates hyperglycemia.
A patient with type 2 diabetes mellitus (T2DM) has had an elevated blood glucose after eating and in the mornings before eating. The patient asks why an insulin regimen is now being recommended. Which response should the nurse make to this patient? ANSWER INCORRECT Unselected "You are now in stage 3 T2DM, which means your blood glucose levels will increase only after eating." Correct THE CORRECT ANSWER "You are now in stage 3 T2DM, which means your blood glucose levels will increase after eating and when fasting." Incorrect YOU WERE UNSURE AND INCORRECT "You are now in stage 2 T2DM, which means your blood glucose levels will increase after eating." Unselected "You are now in stage 2 T2DM, which means your blood glucose levels will increase when fasting."
Stage 3 type 2 diabetes mellitus (T2DM) occurs as insulin resistance continues to increase. Hyperglycemia causes the pancreatic beta cells to become toxic and, eventually, decline in insulin production. Free fatty acids are produced at a greater rate and lead to even more insulin resistance.
The nurse prepares to assess a patient with suspected diabetes mellitus (DM). Which clinical manifestation should the nurse expect to assess in this patient? ANSWER I DON'T KNOW YET Unselected Hypertension Unselected Weight gain Unselected Decreased urination Correct THE CORRECT ANSWER Tachycardia
Tachycardia is a clinical manifestation of DM. Hypertension, weight gain, and decreased urination are not clinical manifestations of diabetes mellitus.
Which statement explains the genetic cause for the development of type 2 diabetes mellitus (T2DM)? ANSWER I DON'T KNOW YET Unselected An important gene responsible for insulin secretion becomes the target of an autoimmune dysfunction. Unselected A virus triggers genetic mutation. Correct THE CORRECT ANSWER An important gene responsible for glucose transport can become defective, leading to a higher baseline HbA1c. Unselected The exact mode is unknown.
The C allele at rs8192675 has been found to contribute to a defect in glucose metabolism, resulting in a higher baseline HbA1c. A recent study found that treating carriers of this gene with metformin resulted in better glycemic control. Despite the findings of the study, type 2 diabetes mellitus (T2DM) is known to be a polygenetic disorder. Autoimmune dysfunction may lead to type 1 diabetes mellitus (T1DM). Although T2DM is a polygenetic disorder, there is evidence to support the identification of specific genetic defects. Viral infections have been implicated in the development of T1DM.
Which condition accurately describes the process that occurs after ingestion of carbohydrates in a healthy adult patient? ANSWER I DON'T KNOW YET Unselected Free fatty acids are released from adipose tissue. Correct THE CORRECT ANSWER Insulin levels rise to stimulate glucose uptake. Unselected Sleepiness occurs as a result of a higher ratio of glucagon to insulin. Unselected Plasma glucose levels are increased through glycogenolysis.
The absorptive state occurs after intake of carbohydrates. Insulin levels rise to stimulate glucose uptake. A higher rate of glucagon to insulin, glycogenolysis, and release of free fatty acids occur during the postabsorptive state.
A patient with diabetes mellitus (DM) is shaking and diaphoretic and has a blood glucose level of 42 mg/dL. Which step should the nurse take first? ANSWER I DON'T KNOW YET Unselected Prepare to administer insulin. Unselected Draw blood for a comprehensive metabolic panel. Correct THE CORRECT ANSWER Give the patient a glass of orange juice and then recheck the blood glucose. Unselected Check the urine for ketones.
The patient is displaying signs of hypoglycemia. Increasing blood glucose is the priority. Obtaining a comprehensive metabolic panel or checking the urine for ketones are not appropriate at this time. Administering insulin will worsen the hypoglycemia.
The nurse notes that a patient with type 1 diabetes mellitus is prescribed insulin. Which should the nurse realize as the primary function of insulin? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Activation of receptors in the cell wall that facilitate the transport of glucose into the cell Unselected Breakdown of carbohydrates Unselected Assistance in the formation of glucose from noncarbohydrate sources Unselected Production of ketones
The primary functions of insulin include the synthesis of glycogen in the liver and muscle, the synthesis of protein in the liver and muscle, and the synthesis of triglycerides in adipose tissue and, to a smaller extent, in muscle. Insulin is necessary for glycolysis and glucose transport into insulin-sensitive tissues, such as muscle. Most important, insulin suppresses gluconeogenesis, glycogenolysis, and lipolysis. Breakdown of carbohydrates, gluconeogenesis, and production of ketones are not functions of insulin.
The nurse is reviewing type 1 diabetes mellitus with a group of new nurses. Which risk factor should the nurse identify as being associated with type 1 diabetes mellitus (T1DM)? ANSWER I DON'T KNOW YET Unselected Hypertension Correct THE CORRECT ANSWER Family history Unselected Obesity Unselected Polycystic ovary syndrome
The risk of developing T1DM is approximately 0.4% in the general population; while children with an affected family member have a 5% risk of developing T1DM by age 20. Obesity, defined as being at least 20% over desired body weight or having a body mass index of 25.1 or greater, is a risk factor associated with type 2 diabetes mellitus (T2DM). Polycystic ovary syndrome is a risk factor associated with type 2 diabetes mellitus. A blood pressure of greater or equal than 130/85 mmHg is a risk factor associated with type 2 diabetes mellitus.
The nurse is teaching the parent of a toddler with type 1 diabetes mellitus (T1DM). Which statement by the parent indicates to the nurse that the teaching is effective? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER "My child is a picky eater. My child will be at risk for hypoglycemia if the child refuses to eat after insulin is administered." Unselected "Insulin should be given prior to each meal." Unselected "Because my child's blood sugar is controlled with insulin, I do not need to worry about how much my child eats." Unselected "If my child refuses to eat, I can adjust the insulin dose."
Toddlers and young children may be "picky eaters" and struggle with food intake. It is important to note that a child's refusal to eat after administration of insulin places the child at a high risk for hypoglycemia. Insulin should be given after the child eats. Insulin doses should not be adjusted. If a child refuses to eat after administration of insulin, there is a high risk for hypoglycemia.
The nurse is teaching a patient recently diagnosed with type 1 diabetes mellitus (T1DM). The patient has over 80% loss of pancreatic beta-cell mass. For which patient statement should the nurse follow up? ANSWER INCORRECT Unselected "My twin is at risk for developing T1DM." Unselected "I will need insulin replacement as, eventually, my body will no longer produce insulin." Correct THE CORRECT ANSWER "I will have relative insulin deficiency for the rest of my life." Incorrect YOU WERE UNSURE AND INCORRECT "Insulin production may increase slightly in the short term, but eventually, my body will cease to produce insulin."
Type 1 diabetes mellitus (T1DM) leads to absolute insulin deficiency as the pancreatic beta cells eventually cease to produce insulin. During the honeymoon period, which can last for up to one year, the remaining beta cells work hard to keep up with insulin demand. However, they will eventually be unable to keep up and will cease to produce insulin. Insulin production may increase slightly in the short term, but eventually the remaining beta cells will cease to produce insulin. A patient whose identical twin has been diagnosed with T1DM is at risk of developing T1DM. In T1DM, the patient's body will eventually cease to produce insulin.
A patient newly diagnosed with type 1 diabetes mellitus (T1DM) has over 80% loss of pancreatic beta-cell mass. Which statement should the nurse include when teaching the patient about this disease process? ANSWER I DON'T KNOW YET Unselected "We will be able to review your history and pinpoint the environmental trigger that caused the damage." Unselected "You will have relative insulin deficiency for the rest of your life." Correct THE CORRECT ANSWER "You may see insulin production increase slightly, but eventually, it will cease." Unselected "A decrease in tissue sensitivity to insulin triggers the body to stop producing insulin."
Type 1 diabetes mellitus (T1DM) leads to absolute insulin deficiency as the pancreatic beta cells eventually cease to produce insulin. During the honeymoon period, which can last for up to one year, the remaining beta cells work hard to keep up with insulin demand. However, they will eventually be unable to keep up and will cease to produce insulin. T1DM results in absolute insulin deficiency. An environmental trigger may never be determined. Type 2 diabetes mellitus (T2DM) is caused by a decrease in tissue sensitivity to insulin.
The nurse prepares teaching for a community group on the increase in the incidence of type 2 diabetes mellitus (T2DM). Which statement should the nurse include when teaching about this disorder? ANSWER I DON'T KNOW YET Unselected "Urbanization is a nonmodifiable risk factor for T2DM." Unselected "Low socioeconomic status greatly decreases the risk of developing T2DM." Unselected "Central body obesity is a major risk factor in the development of type 1 diabetes mellitus (T1DM)." Correct THE CORRECT ANSWER "Minor modifications such as adding exercise or decreasing daily calorie intake can greatly reduce the risk of developing T2DM."
Urbanization is associated with changes in diet, physical activity, obesity, and socioeconomic status. Low socioeconomic status increases the risk for development of T2DM. Urbanization is a risk factor for T2DM, but lifestyle modifications can mitigate this risk. Central body obesity is a risk factor for T2DM, not type 1 diabetes mellitus (T1DM).
in which order, from greatest to least, might the listed clients develop type 1 diabetes mellitus? 3-year-old diagnosed with hepatitis A virus 2-year-old who drinks three 8-oz glasses of cow's milk daily 14-year-old whose pancreatic beta-cell mass has decreased 75% 7-year-old boy whose twin sister was recently diagnosed with T1DM
1. 14-year-old whose pancreatic beta-cell mass has decreased 75% 2. 7-year-old boy whose twin sister was recently diagnosed with T1DM 3. 3-year-old diagnosed with hepatitis A virus 4. 2-year-old who drinks three 8-oz glasses of cow's milk daily Nice Work! Rationale: The most common cause of type 1 diabetes mellitus (T1DM) is the autoimmune destruction of pancreatic beta cells. When beta-cell mass is reduced by 80dash90%, insulin production is impaired, and T1DM develops. Familial predisposition to T1DM does exist. If a monozygotic (identical) twin develops T1DM, the risk is 50% for the remaining twin. If a dizygotic twin is diagnosed with T1DM, the risk to the remaining twin decreases to 19%. Some microbes, such as hepatitis A virus and Helicobacter pylori, have been associated with a low T1DM risk. Research has not supported the idea that cow's milk increases the risk of T1DM.
Which instruction should the nurse provide a client about the pathophysiology of diabetes mellitus (DM)? A. Diabetes mellitus eventually leads to increased free fatty acid production. B. Insulin resistance leads to increased glucose uptake by muscles. C. Obesity and genetics typically lead to insulin insufficiency. D. Insulin insufficiency will lead to episodes of hypoglycemia.
A. Diabetes mellitus eventually leads to increased free fatty acid production. Rationale: In diabetes mellitus (DM), the ability of insulin to decrease lipolysis is impaired, leading to increased free fatty acid production. Insulin insufficiency will lead to episodes of hyperglycemia, not hypoglycemia. Insulin resistance leads to decreased, not increased, glucose uptake by the muscles. Autoimmune and genetic factors contribute to the development of insulin insufficiency. Genetics, obesity, nutrition, and exercise are contributing risk factors for the development of insulin resistance.
A client with type 2 diabetes mellitus (T2DM) has been diagnosed with hyperglycemic hyperosmolar syndrome (HHS). Which clinical manifestation should the nurse assess in the client? (Select all that apply.) A. Electrolyte imbalances B. Hemiparesis C. Severe dehydration D. Ketonuria E. Fruity breath
A. Electrolyte imbalances B. Hemiparesis C. Severe dehydration Rationale: Clients with hyperglycemic hyperosmolar syndrome (HHS) have clinical symptoms of hyperglycemia including fluid volume deficit and electrolyte imbalances. However, unlike diabetic ketoacidosis (DKA), clients will not have symptoms related to metabolic acidosis or ketosis. Hyperglycemia, dehydration, and serum hyperosmolality are usually much more severe with HHS than in DKA. Neurologic symptoms of HHS include hemiparesis, seizures, and coma due to severe cerebral dehydration.
he nurse is caring for a client with diabetes mellitus (DM). Which clinical manifestation might be related to the effects of polyuria? (Select all that apply.) A. Fatigue B. Hypotension C. Proteinuria D. Bladder infection E. Glucosuria
A. Fatigue B. Hypotension E. Glucosuria Rationale: Polyuria in clients with diabetes mellitus (DM) is a result of osmotic diuresis, which can lead to dehydration and volume depletion. Clinical manifestations of diabetes mellitus that are related to the effects of polyuria include polyphagia, polydipsia, fatigue, weight loss, hypotension, tachycardia, and glucosuria. Frequent infections of the bladder, vagina, and skin are due to decreased immune system function from consistently high blood sugar levels. Proteinuria is a sign of damage to the kidneys (nephropathy) related to complications of diabetes mellitus and is not a direct result of the osmotic diuresis that occurs with polyuria.
A client is being evaluated for diabetes mellitus (DM). Which laboratory test should the nurse expect to be prescribed for this client? (Select all that apply.) A. Glycosylated hemoglobin (HbA1c) level B. Serum amylase and lipase levels C. Fasting plasma glucose level (FPG) D. Random serum glucose level E. Two-hour oral glucose tolerance test (OGTT)
A. Glycosylated hemoglobin (HbA1c) level C. Fasting plasma glucose level (FPG) D. Random serum glucose level Rationale: Diabetes is diagnosed if the random serum glucose level is 200 mg/dL and accompanied by clinical manifestations of diabetes. An HbA1c level of 6.5% or higher is diagnostic for diabetes mellitus. FPG levels of 126 mg/dL or greater on at least two occasions are diagnostic of DM. Two-hour oral glucose tolerance test (OGTT) is no longer recommended for the routine diagnosis of diabetes, but the test is used to diagnose gestational diabetes mellitus or impaired glucose tolerance (IGT). Serum amylase and lipase levels are helpful in determining diagnosis of pancreatitis and pancreatic cancer, but not used as a routine diagnostic test for diabetes mellitus.
The nurse is instructing a client recently diagnosed with type 1 diabetes mellitus (T1DM) and decreased insulin production. Which explanation should the nurse use to help the client understand when insulin may be needed? A. "After eating carbohydrates, insulin levels should rise to stimulate the body's use of glucose in tissue building." B. "After eating carbohydrates, the brain relies on ketones for fuel." C. "When insulin levels are high, lipids are broken down for fuel for the body." D. "After eating carbohydrates, insulin levels should drop to promote tissue growth
A. "After eating carbohydrates, insulin levels should rise to stimulate the body's use of glucose in tissue building." Rationale: After eating carbohydrates, the client will be in the absorptive state. Insulin levels should rise to stimulate glucose uptake by the tissues, primarily muscle. The effect of the hormone insulin is tissue growth. Because insulin production has decreased and will eventually cease, it is during the absorptive state that insulin will be needed.
A client with type 2 diabetes mellitus (T2DM) has a microalbuminuria level of 75 mg albumin/24 hr. Which client statement should the nurse address? A. "Because I am having no symptoms and the lab result is only slightly elevated, there is not a need for treatment at this time." B. "Better glucose control will help prevent further kidney damage." C. "If kidney failure develops I may need dialysis." D. "I should check my blood pressure daily.
A. "Because I am having no symptoms and the lab result is only slightly elevated, there is not a need for treatment at this time." Rationale: Aggressive treatment of even minor elevations in blood pressure can preserve kidney function and delay the progression of nephropathy. Diabetic nephropathy develops in several stages, with the first sign being an elevated microalbuminuria, although the client is typically asymptomatic. Glucose control and the duration of type 2 diabetes mellitus (T2DM) impact the development of diabetic nephropathy. As diabetic nephropathy progresses hypertension and severe proteinuria develop. Glomerular filtration rate (GFR) will decrease as serum creatinine increases. Eventually, the result is end-stage kidney failure, which requires dialysis.
The nurse prepares to care for a client with diabetes mellitus. Which statement should the nurse make to describe this disease process to the client? A. "Diabetes is a group of metabolic disorders characterized by the inability to effectively metabolize carbohydrates, proteins, and fats." B. "Diabetes is a group of disorders that affects primarily the cardiovascular system." C. "Diabetes is the result of poor eating habits and excessive intake of glucose." D. "Diabetes is group of disorders that alters kidney functioning."
A. "Diabetes is a group of metabolic disorders characterized by the inability to effectively metabolize carbohydrates, proteins, and fats." Rationale: Diabetes mellitus (DM) is a group of metabolic disorders characterized by the inability to effectively metabolize carbohydrates, proteins, and fats as a result of defects in insulin secretion, insulin action, or both, which results in hyperglycemia. It affects the endocrine functions of the pancreas. Diabetes can affect the cardiovascular system and kidney functioning, but these are not the best description. Poor eating habits and excessive intake of glucose are associated with type 2 diabetes mellitus (T2DM), but this is not the best description.
Which client is at risk for developing type 2 diabetes mellitus (T2DM)? (Select all that apply.) A. 42-year-old Mexican American who is slightly overweight and lives a Westernized lifestyle B. 23-year-old Pima Indian living in the Southwest United States C. 33-year-old client whose mother had gestational diabetes and was a high-birth-weight infant D. 45-year-old client whose parents have been diagnosed with T2DM, but who tries to follow a healthy diet E. 35-year-old non-Hispanic white who exercises for 30 minutes a day, 5 times a week
A. 42-year-old Mexican American who is slightly overweight and lives a Westernized lifestyle B. 23-year-old Pima Indian living in the Southwest United States C. 33-year-old client whose mother had gestational diabetes and was a high-birth-weight infant D. 45-year-old client whose parents have been diagnosed with T2DM, but who tries to follow a healthy diet Rationale: Genetics and ethnicity play a role in the development of type 2 diabetes mellitus (T2DM). If one parent has been diagnosed with T2DM, children have a 15dash20% risk of developing T2D; however, that risk increases to 75% if both parents have been diagnosed with T2DM. Minorities are disproportionally affected by T2DM. A Westernized lifestyle, specifically high-calorie intake and low levels of physical activity, contribute greatly to the risk of developing T2DM. Urbanization leads to a greater risk for T2DM, as can be seen in comparing the Pima Indians of the Southwest United States who have a 50% chance of developing T2DM to their relatives in Mexico who have a very low risk of developing T2DM. Both mother and baby are at risk for developing T2DM when the mother has gestational diabetes, and the infant is born with a high birth weight.
A client is being tested for diabetes mellitus. Which diagnostic test result should the nurse expect for this client? (Select all that apply.) A. HbA1c is 5.5% or less. B. Fasting plasma glucose level is 126 mg/dL or higher on at least 2 occasions. C. Random glucose level is 200 mg/dL or higher. D. HbA1c is 6.5% or greater. E. Two-hour oral glucose tolerance test (OGTT) is 100 mg/dL or lower.
B. Fasting plasma glucose level is 126 mg/dL or higher on at least 2 occasions. C. Random glucose level is 200 mg/dL or higher. D. HbA1c is 6.5% or greater Rationale: Typical diagnostic findings in clients with diabetes include: HbA1c 6.5% or greater, it reflects glycemia for the previous 3 months as related to the RBC. The fasting plasma glucose level is 126 mg/dL or higher on at least 2 occasions indicating the glucose is not being transported into the cells by the insulin. When the random glucose level is 200 mg/dL or higher, it indicates glucose is not being transported into the cells by the insulin resulting in an elevated blood sugar level. The 2-hour glucose tolerance test (OGTT) is no longer recommended for the routine diagnosis of diabetes.
The nurse is teaching a client with type 1 diabetes mellitus (T1DM). Which client statement requires follow-up? A. "Cardiovascular disease, neuropathies, and delayed wound healing are consequences of poorly controlled blood sugar." B. "I understand T1DM means I have an absolute insulin deficiency." C. "As long as my blood sugar is under control, I do not need to follow up with my eye doctor." D. "Hyperglycemia is caused by a lack of insulin production."
C. "As long as my blood sugar is under control, I do not need to follow up with my eye doctor." Rationale: Even when blood glucose is under control, annual eye exams are necessary. If diabetic retinopathy is detected prior to the onset of symptoms, treatment can delay the progress of the disease and preserve vision.
A client with type 2 diabetes mellitus is diaphoretic, shaky, and very drowsy. Which measurement should the nurse expect to assess in this client? A. Oxygen saturation 92% B. Blood pressure 100/72 mmHg C. Blood glucose 210 mg/dL D. Blood glucose 42 mg/dL
D. Blood glucose 42 mg/dL Rationale: Clinical manifestations of hypoglycemia are classified as autonomic nervous system (ANS) symptoms and neuroglycopenic symptoms. ANS symptoms include sweating, palpitations, tremors, and hunger. Neuroglycopenic symptoms result from lack of glucose to the central nervous system (CNS) and include difficulty speaking, visual disturbances, drowsiness, confusion, seizures, and coma.
A client with type 1 diabetes mellitus (T1DM) is experiencing nausea, vomiting, fatigue, and abdominal pain. Which risk factor should the nurse most likely associate with this client? A. Decreased caloric intake B. Increase in insulin dose C. Development of type 2 diabetes mellitus (T2DM) D. Infection
D. Infection Rationale: Nausea, vomiting, fatigue, and abdominal pain are clinical manifestations of diabetic ketoacidosis (DKA). DKA is characterized by hyperglycemia, metabolic acidosis, and ketonemia. A decrease in insulin due to missed doses or administering lower than prescribed doses can precipitate DKA. The most common precipitating factor in the development of DKA is infection. Eating disorders in adolescents can cause DKA due to the clients withholding insulin doses in an effort to lose weight. DKA is most closely associated with T1DM.
Which is a finding from the Diabetes Prevention Program that impacts the way type 2 diabetes mellitus (T2DM) is treated? A. It was discovered that individuals with prediabetes will eventually develop T2DM, despite interventions. B. Genetic disposition was found to have the most significant impact on the risk of developing T2DM. C. Metformin was found to be more effective at reducing the incidence of T2DM than lifestyle modification. D. The lifestyle intervention program was more successful at preventing T2DM than treatment with metformin.
D. The lifestyle intervention program was more successful at preventing T2DM than treatment with metformin. Rationale: Lifestyle interventions decreased the incidence of type 2 diabetes mellitus (T2DM) by 58%, while treatment with metformin decreased the incidence of T2DM by 31%. Genetic disposition was not part of the Diabetes Prevention Program study. Lifestyle interventions were found to be more effective at preventing T2DM than treatment with metformin or no treatment at all. Lifestyle modifications or treatment with metformin were both found to help prevent the development of T2DM in some individuals with prediabetes.
A client with type 2 diabetes mellitus (T2DM) has a glycosylated hemoglobin (HbA1c) level of 8.5%. Which interpretation about the test result is accurate? A. The test result is within the acceptable levels for HbA1c. B. The test result is below the recommended levels for HbA1c. C. The test result is in the dangerous levels for HbA1c. D. The test result is above the recommended levels for HbA1c.
D. The test result is above the recommended levels for HbA1c Rationale: HbA1c blood test reflects average blood glucose levels over a period of three months. For clients with diabetes, the recommended levels for HbA1c are between 6% and 7%, which corresponds to blood glucose levels of 120 to 140 mg/dL. The result of 8.5% is above the recommended level and corresponds to serum blood glucose levels of 200 mg/dL. HbA1c levels of 13% or higher are dangerously high, corresponding to serum blood glucose levels of 300 mg/dL or greater.
The nurse is teaching a client with type 1 diabetes mellitus (T1DM) about the signs and symptoms of diabetic ketoacidosis (DKA). Which client statement indicates to the nurse that the teaching has been effective? A. "Increased thirst is a normal symptom of diabetes." B. "Blurred vision and fatigue may indicate a need to increase the amount of sleep I get each night." C. "Weight gain may indicate hyperglycemia." D. "Increased thirst may indicate that I need to check my blood glucose."
D. "Increased thirst may indicate that I need to check my blood glucose." Rationale: Increased thirst indicates dehydration, possibly due to hyperglycemia and diabetic complications. Fluid volume depletion due to hyperglycemia results in weight loss. Hyperglycemia causes osmotic diuresis, which results in dehydration. Increased thirst is a compensatory mechanism for dehydration. Blurred vision and fatigue are clinical manifestations of hyperglycemic hyperosmolar syndrome (HHS). Blurred vision is a result of fluid accumulation in the lens in response to hyperglycemia. Fatigue occurs in response to altered metabolism of carbohydrates, proteins, and lipids.
Which risk factor for type 2 diabetes mellitus (T2DM) should the nurse assess in a client? (Select all that apply.) A. History of miscarriages B. Socioeconomic factors C. African American descent D. Exposure to toxins E. Obesity and physical inactivity
Socioeconomic factors C. African American descent E. Obesity and physical inactivity Rationale: Risk factors for type 2 diabetes mellitus (T2DM) include obesity and physical inactivity, genetics and family history, diet, socioeconomic factors, and education. Ethnic groups that are at high risk for T2DM include African Americans, American Indians, Hispanics, and Pima Indians. Unexplained miscarriage or stillbirth is a risk factor for gestational diabetes mellitus, not T2DM. Exposure to toxins is a risk factor for type 1 diabetes mellitus (T1DM), but not for T2DM.
