Pathopharm Exam 2
SELECT ALL THAT APPLY Clients can prevent or delay the onset of Type 2 Diabetes by doing which of the following: a. maintain a healthy weight b. eat a healthy diet c. be more active d. eat a high carb, low protein diet
a, b, c
SELECT ALL THAT APPLY Macrovascular complications of hyperglycemia include which of the following: a. myocardial infarction b. stroke c. atherosclerosis d. periodontal disease
a, b, c
SELECT ALL THAT APPLY the nurse is assessing a client with diabetic ketoacidosis. which clinical manifestations would the nurse expect? a. dry skin b. abdominal pain c. kussmaul respirations d. absence of ketones in the urine e. blood glucose level of less than 72mg/dL (3.3 mmol/L)
a, b, c
SELECT ALL THAT APPLY the nurse suspects that a client has diabetes mellitus. which statement made by the client helped the nurse reach this conclusion? a. "i am 65 years old" b. "i quite often feel thirsty" c. "i eat food every 2 hours" d. "i have excessive sweating" e. " i sometimes experience shortness of breath"
a, b, c
SELECT ALL THAT Which of the following are characteristic symptoms of diabetic ketoacidosis (DKA)? a. fruity odor to the breath b. tachycardia c. acidosis d. Kussmaul respirations e. alkalosis
a, b, c, d
SELECT ALL THAT APPLY which client is at risk for developing type 2 diabetes mellitus? a. 15-year-old male who plays video games 6 hours per day b. 36-year-old female with a history of gestational diabetes c. 47-year-old male who weighs 250 pounds and is 5'9" tall d. 28-year-old female with polycystic ovarian syndrome (POS) e. 60-year-old male of native american decent who abuses alcohol
a, b, c, d, e
SELECT ALL THAT APPLY which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? a. confusion b. drowsiness c. diaphoresis d. nervousness e. heart rate 110 beats/min
a, b, c, d, e
SELECT ALL THAT APPLY which instruction would the nurse provide to a 6'0", 160-pound client newly diagnosed with type 1 diabetes who wants to self-administer injections with an insulin pen? a. prime the needle with two units b. use a 29-gauge insulin needle c. give the injection at 45-degree angle d. refrain from recapping the needle e. dial the pen to deliver the unit dose
a, b, c, d, e
SELECT ALL THAT APPLY a client with type 1 diabetes for 25 years states, " I have been really bad for the past 15 years. I have not paid attention to my diet and have done little to control my diabetes." which common complications of diabetes might the nurse expect to identify when assessing this client? a. leg ulcers b. loss of visual acuity c. thick, yellow toenails d. increased growth of body hair e. decreased sensation in the feet
a, b, c, e
SELECT ALL THAT APPLY Risk factors for insulin resistance include: a. obesity b. inactivity c. low-fat diet d. age e. medications
a, b, d, e
SELECT ALL THAT APPLY which complication of diabetes would the nurse assess for in a client with a long history of the disease? a. leg ulcers b. loss of visual acuity c. increased creatine clearance d. prolonged capillary refill in the toes e. decreased sensation in the lower extremities
a, b, d, e
SELECT ALL THAT APPLY Which of the following symptoms are most likely to present in a client with diabetes mellitus who is experiencing a hypoglycemic reaction? a. tremors b. nervousness c. extreme thirst d. flushed skin e. profuse perspiration
a, b, e
SELECT ALL THAT APPLY Which factors increase the risk for the development of type 2 diabetes mellitus? a. hypertension b. weight gain during pregnancy c. BMI (body mass index) >25g/m d. pancreatic injury
a, c
SELECT ALL THAT APPLY the nurse is providing instructions about foot care for a client with diabetes mellitus. which would the nurse include in the instructions? a. wear shoes when out of bed b. soak the feet in warm water daily c. dry between the toes after bathing d. remove corns as soon as they appear e. use a heating pad when the feet feel cold
a, c
SELECT ALL THAT APPLY which manifestation would the nurse include when teaching a client about ketoacidosis? a. confusion b. hyperactivity c. excessive thirst d. fruity-scented breath e. decreased urinary output
a, c, d
SELECT ALL THAT APPLY which newborn would the nurse anticipate will experience hypoglycemia? a. preterm infant b. infant with down syndrome c. small-for-gestational-age infant d. large-for-gestational-age infant e. appropriate-for-gestational-age infant
a, c, d
SELECT ALL THAT APPLY A client is taught how to recognize signs of hypoglycemic reaction. which symptoms identified by the client indicate to the nurse that the teaching was effective? a. fatigue b. nausea c. weakness d. nervousness e. increased thirst f. increased perspiration
a, c, d, f
SELECT ALL THAT APPLY the nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. which instruction would the nurse include in the teaching plan? a. the client should obtain a finger-stick blood glucose before reading before each meal b. the client does not need to follow a specific diet until insulin is required c. the teaching plan should include signs and symptoms of hypoglycemia d. the teaching plan should include how to administer regular insulin e. the teaching plan should include sick day rules
a, c, e
SELECT ALL THAT APPLY which child would the nurse recommend screening for type 2 diabetes mellitus during a local health screening? a. child who recently turned 10 years old, has not yet entered puberty, and has no other risk factors b. 7-year-old child, body mass index (BMI) in the 80th percentile, no other risk factors c. african-american child, BMI in the 87th percentile, family history of diabetes d. 9-year-old hispanic child, BMI in the 90th percentile, no other risk factors e. caucasian child, BMI in the 96th percentile, signs of insulin resistance
a, c, e
SELECT ALL THAT APPLY upon assessment, the nurse finds the client is experiencing weight gain as well as elevated lipid and blood glucose levels. which medication on the clients prescription list is most likely to cause these metabolic side effects? a. clozapine b. asenapine c. quetiapine d. olanzapine e. ziprasidone
a, d
SELECT ALL THAT APPLY which clinical finding supports the conclusion by a nurse that a client had a hypoglycemic reaction to insulin? a. Irritability b. glycosuria c. dry, hot skin d. heart palpations e. fruity odor of breath
a, d
The nurse is taking care of a client who has type 2 diabetes hospitalized because of hyperglycemic-hyperosmolar-non-ketotic-syndrome (HHNKS). The student nurse notes that arterial blood gases to measure blood pH have not been ordered and asks the nurse why. The nurse explains: a. "because the pH of the blood is not changed with HHNKS as it is with DKA (diabetic ketoacidosis)." b. "because hyperglycemia with HHNKS is not as bad as it is with DKA (diabetic ketoacidosis)." c. "because acetone is formed with HHNKS instead of ketones and does not show up in the pH." d. "because alkalosis occurs with HHNKS instead of acidosis and that cannot be measured by blood pH."
a. "because the pH of the blood is not changed with HHNKS as it is with DKA (diabetic ketoacidosis)."
how will the nurse respond to a client with a new diagnosis of type 1 diabetes who becomes agitated and says, "i am scared of shots. if that is my only option, i'll just have to go into a coma and die!" when told that lifelong insulin will be needed? a. "injections are not the only option available for insulin" b. "it won't be so bad; you will get used to it if you only try" c. "this is one of those time when you need to act like an adult" d. "clients have the right to refuse treatment, but i need you to sign this form that removes us from liability for your decision"
a. "injections are not the only option available for insulin"
a child is prescribed insulin glargine before breakfast. which instruction is the MOST appropriate for the nurse to give the patient regarding a bedtime snack? a. "offer a snack to prevent hypoglycemia during the night" b. " give the child a snack if signs of hyperglycemia are present" c. "avoid a snack because the child is being treated with long-acting insulin" d. "keep a snack at the bedside in case the child gets hungry during the night"
a. "offer a snack to prevent hypoglycemia during the night"
The nurse is administering lispro insulin at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the patient expect the drug to exert its peak action? a. 0900 b. 1200 c. 1400 d. 1700
a. 0900
What is the onset of regular insulin? a. 30-60 min b. 15-30 min c. 10-20 min d. 1-2 hours
a. 30-60 min
A 2-hour postprandial blood glucose is normal for a type 1 diabetic patient if it is: a. <180mg/dL b. >180mg/dL c. <6.0% d. >7.5%
a. <180mg/dL
A nurse is caring for a client being treated for type 1 diabetes mellitus (DM). The primary care provider ordered 22 units of NPH and 4 units of Regular insulin via subcutaneous (SQ) injection. Which of the following is the appropriate method to mix the two insulins? a. Air to NPH, air to Regular, draw up Regular, draw up NPH b. Air to Regular, air to NPH, draw up NPH, draw up Regular c. Air to Regular, air to NPH, draw up Regular, draw up NPH d. Air to NPH, air to Regular, draw up NPH, draw up Regular
a. Air to NPH, air to Regular, draw up Regular, draw up NPH
Which lab shows an average of blood glucose over several months? a. HgbA1C b. C-reactive protein c. Fasting blood glucose d. Random blood glucose
a. HgbA1C
the nurse is teaching a client newly diagnosed with type 1 diabetes about self-care. which is the primary long-term goal? a. Maintaining normoglycemia b. complying with the diabetic diet c. adhering to an exercise program d. developing a non-stressful lifestyle
a. Maintaining normoglycemia
_____ Americans have diabetes. a. Over 34 million b. Over 20 million c. Under 10 million d. Over 90 million
a. Over 34 million
TRUE OR FALSE If your patient's parent has Type 2 diabetes, then the patient is at a higher risk of developing it. a. True b. False
a. True
TRUE OR FALSE Hypokalemia may occur after a loss of extra potassium via the urine when in DKA. a. True b. False
a. True
TRUE OR FALSE Patients in DKA may have ketonuria. a. True b. False
a. True
a client is admitted to the medical unit for complications of long-term, poorly controlled type 2 DM. which of the following would the nurse expect to find in addition to elevated glucose? a. atherosclerosis b. anemia c. elevated liver enzymes d. metabolic alkalosis
a. atherosclerosis
A client is diagnosed with type 1 diabetes and is unable to produce insulin. The pancreatic cells that are most likely damaged are the: a. beta b. alpha c. c-peptide d. delta
a. beta
which physiological changes would the nurse expect to find in a client with a 20-year history of type 2 diabetes? a. blurry, spotty, or hazy vision b. arthritic changes in the hands c. hyperactive knee and ankle jerk reflexes d. dependent pallor of the feet and lower legs
a. blurry, spotty, or hazy vision
a client is admitted to the hospital with diabetic ketoacidosis. the nurse concludes that the clients ketone level is caused by incomplete oxidation of which nutrient? a. fats b. sodium c. protiens d. potassium
a. fats
A client who has just received 15 units of regular insulin loses consciousness and has a blood glucose level of 45 mg/dL. The nurse should administer which of the following? a. glucagon b. NPH insulin c. orange juice d. pramlintide
a. glucagon
which medication would be administered to a client who reports sweating, tachycardia, and tremors with a laboratory report that reveals serum cortisol less than normal and a blood glucose level of 60 mg/dL? a. glucagon b. kayexalate c. hydrocortisone d. insulin with dextrose in normal saline
a. glucagon
which is the priority concern of a 10-year-old child who was recently diagnosed with type 2 diabetes? a. how much school might be missed b. whether the diabetes can be controlled c. how a parent will react to the diagnosis d. whether having diabetes means future sterility
a. how much school might be missed
Clients with type 1 diabetes that drink excess alcohol can have which of the following adverse effects several hours after consumption: a. hypoglycemia b. hyperglycemia c. increased risk for infection d. constipation
a. hypoglycemia
When patients with diabetes drink alcohol, it can cause _____. a. hypoglycemia. b. hyperglycemia. c. an increased risk for infection. d. an increased risk for toxicity.
a. hypoglycemia.
an adolescent with type 1 diabetes mellitus is admitted to the intensive care unit in ketoacidosis with a blood glucose level of 170 mg/dL (9.4 mmol/L). a continuous insulin infusion is started. which adverse reaction to the insulin is most important for the nurse to monitor? a. hypokalemia b. hypovolemia c. hypernatremia d. hypercalcemia
a. hypokalemia
which laboratory value supports the presence of diabetic ketoacidosis? a. increased serum lipids b. decreased hematocrit level c. increased serum calcium levels d. decreased blood urea nitrogen levels
a. increased serum lipids
an adolescent with a history of type 1 diabetes is admitted in ketoacidosis. which cause would the nurse suspect as precipitating the episode of ketoacidosis. a. infection b. increased exercise c. recent weight loss d. overdose of insulin
a. infection
the nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. which information would the nurse give to this client? a. insulin needs will increase during the second trimester b. insulin needs will decrease during the second trimester c. insulin needs will not change during the second trimester d. insulin will be switched to an oral anti-diabetic medication during the second trimester
a. insulin needs will increase during the second trimester
which information will the nurse include when teaching a client with type 1 diabetes about the use of an insulin pump? a. insulin pumps mimic the way a healthy pancreas works b. the insulin pumps needle should be changed every day c. pumps are implanted in a subcutaneous pocket near the abdomen d. the insulin pumps advantage is that it only requires glucose monitoring once a day
a. insulin pumps mimic the way a healthy pancreas works
which information is important for the nurse to include concerning insulin administration when discussing insulin needs with an adolescent with recently diagnosed type 1 diabetes? a. insulin will be required throughout life b. insulin may be taken orally until adulthood c. insulin needs will increase with strenuous activity d. insulin needs decrease in the presence of an infection
a. insulin will be required throughout life
which initial intervention would the nurse expect the primary health care provider to order for a client admitted to the hospital with a diagnosis of diabetic ketoacidosis? a. intravenous (IV) fluids b. potassium c. NPH insulin (Novolin N) d. sodium polystyrene sulfonate (kayexalate)
a. intravenous (IV) fluids
a client with type 1 diabetes has dry, hot, flushed skin; a fruity odor to the breath; and is having Kussmaul respirtations. which complication does the nurse suspect that the client is experiencing? a. ketoacidosis b. somogyi phenomenon c. hypoglycemic reaction d. hyperosmolar nonketotic coma
a. ketoacidosis
an increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus? a. ketones b. glucose c. lactic acid d. glutamic acid
a. ketones
which of the following indicated metformin toxicity? a. lactic acidosis b. hypokalemia c. genital fungal infection d. hypoglycemia
a. lactic acidosis
for a pregnant client with type 1 diabetes, which action is most likely to reduce the risks of disease-related complications? a. monitor and control blood glucose levels b. limit pregnancy weight gain to an average of 25 pounds c. plan an elective cesarean section delivery d. attend all prenatal office visits
a. monitor and control blood glucose levels
which statements would a nurse make about other adults and type 2 diabetes? a. older adults seldom develop ketoacidosis b. older adults secrete no endogenous insulin c. older adults have a lower risk of complications d. older adults develop a sudden onset of symptoms
a. older adults seldom develop ketoacidosis
the nurse plans to teach a school-aged child with type 1 diabetes who is receiving both intermediate-acting insulin and regular insulin daily how to self-administer the insulin before discharge. which procedure would the nurse teach the child? a. practice using the non-medicated insulin pen first b. alternate sites until the best one to use is found c. draw up the Novolin N first and then draw up the regular insulin d. self-inject the insulin immediately after being taught the technique
a. practice using the non-medicated insulin pen first
A nurse has received an order to administer 5 units of insulin intravenously (IV). Which of the following is the safest insulin to administer IV? a. regular b. lispro c. NPH d. lantus
a. regular
a client was admitted with diabetic ketoacidosis. which manifestations does the nurse monitor the client most closely for with DKA? a. shortness of breath and confusion b. decreased urine output and hyperkalemia c. excessive thirst and frequent urination d. nausea and vomiting
a. shortness of breath and confusion
which mechanism of action explains how glyburide decreases serum glucose levels? a. stimulates the pancreas to produce insulin b. accerlerates the liver's release of stored glycogen c. increases glucose transport across the cell membrane d. decrease absorption of glucose from the gastrointestinal system
a. stimulates the pancreas to produce insulin
which education would the nurse provide the parents of a child with type 1 diabetes who ask why they should test the child's urine for ketones during periods of stress or illness, even though blood glucose testing is being done four times a day? a. urine should be tested for ketones during illness and when blood glucose level is increased b. blood glucose testing before meals and bedtime may be stopped once the child is stabilized on insulin c. urine testing remains the most accurate way to check for a high glucose level if double-voided specimens are used d. the short-term glucose level is more accurately reflected in a urine specimen than in a blood specimen, especially in children
a. urine should be tested for ketones during illness and when blood glucose level is increased
the nurse is assessing a client admitted with diabetic ketoacidosis. which statement made by the client indicates a need for further education on sick day management? a." i will stop taking my insulin when i am ill because i am not eating" b. " i will check my urine for ketones when my blood sugar is over 250" c. " i will alternate drinking gatorade and water throughout the day while ill" d. "i will continue all my insulin including my glargine when i am sick"
a." i will stop taking my insulin when i am ill because i am not eating"
metformin excretion
almost entirely unchanged by the kidneys
which complication associated with type 1 diabetes should the nurse include in the teaching plan for the parent of a newly diagnosed child? a. obesity b ketoacidosis c. resistance to treatment d. hypersensitivity to other medications
b ketoacidosis
SELECT ALL THAT APPLY the nurse is caring for a client with hypoglycemia. the nurse anticipates a prescription for which medications? a. insulin b. glucagon c. intravenous (IV) glucose d. oral hydrocortisone e. somatostatin
b, c, d
SELECT ALL THAT APPLY which advise will the nurse provide to a client who is taking an oral hypoglycemic daily for type 2 diabetes who develops an infection with anorexia? a. avoid solid food b. continue to take the oral medication c. drink fluids throughout the day d. monitor capillary glucose levels e. do not take medication until tolerating food
b, c, d
SELECT ALL THAT APPLY which responses would the nurse expect a client experiencing hypoglycemia to exhibit? a. nausea b. palpations c. tachycardia d. nervousness e. warm, dry skin f. increased respirations
b, c, d
SELECT ALL THAT APPLY which responses would the nurse expect a client experiencing hypoglycemia to exhibit? a. nausea b. palpations c. tachycardia d. nervousness e. warm, dry skin f. increased respirations
b, c, d
SELECT ALL THAT APPLY A client who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. The nurse should do all of the following except: a. check the client's blood sugar b. administer additional NPH insulin c. consider administering glucose to the client d. administer a bolus of normal saline IV
b, d
A nurse is providing teaching to a client who has type 2 diabetes mellitus (DM) and is starting repaglinide. Which of the following statements by the client indicates an understanding of the administration of this medication? a. "I'll take this medication after I eat." b. "I'll take this medication 30 minutes before I eat." c. "I'll take this medication just before I go to bed." d. "I'll take this medication as soon as I wake up in the morning."
b. "I'll take this medication 30 minutes before I eat."
A client with newly diagnosed type 2 diabetes mellitus (DM) asks the student nurse what "type 2" means in relation to diabetes. Which of the following statements by the student indicates an understanding of type 2 diabetes mellitus (DM)? a. "Patients with type 2 diabetes mellitus (DM) are totally dependent on insulin." b. "Patients with type 2 diabetes mellitus (DM) have decreased amounts of insulin and their cells are more resistant to the insulin that is produced." c. "Patients with type 2 diabetes mellitus (DM) have an immune system that destroys the cells in the pancreas that produce insulin." d."Patients with type 2 diabetes mellitus (DM) have a liver that does not activate the pancreas to secrete insulin."
b. "Patients with type 2 diabetes mellitus (DM) have decreased amounts of insulin and their cells are more resistant to the insulin that is produced."
When a diabetic client asks about maintaining adequate blood glucose levels, which of the following statements by the nurse relates most directly to the necessity of maintaining blood glucose levels no lower than about 70 mg/dL? a. "Glucose is the only type of fuel used by body cells to produce the energy needed for physiologic activity." b. "The central nervous system cannot store glucose and needs a continuous supply of glucose for fuel." c. "Without a minimum level of glucose circulating in the blood, erythrocytes cannot produce ATP." d." The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis."
b. "The central nervous system cannot store glucose and needs a continuous supply of glucose for fuel."
which response would a nurse give to a client who asks "why can't I take the insulin in pills instead of taking shots?" during a teaching session about insulin injections? a. "insulin cannot be manufactured in pill form" b. "insulin is destroyed by gastric juices, rendering it ineffective" c. "your heath care provider decides the route of administration" d. "your health care provider will prescribe pills when you are ready"
b. "insulin is destroyed by gastric juices, rendering it ineffective"
which response would a nurse give to a client diagnosed with type 1 diabetes who states " i hate shots. why can't i take the insulin in tablet form"? a. "your diabetic conditon is too serious for oral insulin" b. "insulin is poorly absorbed orally, so it is not available in a tablet" c. "insulin by mouth causes a high incidence of allergic and adverse reactions" d. "once your diabetes is controlled, your primary health care provider might consider oral insulin"
b. "insulin is poorly absorbed orally, so it is not available in a tablet"
which information would the nurse provide to a client with type 1 diabetes who requests information about the differences between penlike insulin delivery devices and syringes? a. "the penlike devices have a shorter injection time" b. "penlike devices provide a more accurate dose delivery" c." the penlike delivery system uses a smaller-gague needle" d. "penlike devices cost less by having reusable insulin cartridges"
b. "penlike devices provide a more accurate dose delivery"
a child is receiving 45 units of intermediate-acting insulin at 7:00 AM and 7:00 PM. which statement by the nurse is the most appropriate when discussing bedtime snacks with the parent? a. "offer a snack at bedtime if there are signs of hyperglycemia." b. "provide a bedtime snack to prevent hypoglycemia during the night" c. "withhold the snack after dinner to prevent hyperglycemia during sleep" d. "leave a snack at the bedside in case the child becomes hungry during the night"
b. "provide a bedtime snack to prevent hypoglycemia during the night"
When a patient with diabetes is hypoglycemic, they should initially consume _____ grams of carbohydrates. a. 30 b. 15 c. 10 d. 60
b. 15
a client is taking NPH insulin daily every morning. the nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: a. 2-4 hours after administration b. 4-12 hours after administration c. 16-18 hours after administration d. 18-24 hours after administration
b. 4-12 hours after administration
the primary health care provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. which is the goal of fasting glucose levels for a client with diabetes mellitus? a. 40 to 65 mg/dL (2.2-3.6 mmol/L) of blood b. 70 to 105 mg/dL (3.9-5.8 mmol/L) of blood c. 110 to 145 mg/dL (6.1-8.0 mmol/L) of blood d. 150 to 175 mg/dL (8.3-9.7 mmol/L) of blood
b. 70 to 105 mg/dL (3.9-5.8 mmol/L) of blood
A prolonged inflammatory phase in clients with long-term hyperglycemia can lead to which of the following? a. Hyperosmolar hyperglycemic state b. Decreased immune response c. Diabetic retinopathy d. Autonomic retinopathy
b. Decreased immune response
TRUE OR FALSE Diabetic Ketoacidosis (DKA) will lead to Cheyne-Stokes breathing. a. True b. False
b. False
TRUE OR FALSE Increased energy is a sign/symptom of hypoglycemia. a. True b. False
b. False
TRUE OR FALSE Patients with Type 2 diabetes always need medications. a. True b. False
b. False
TRUE OR FALSE Patients with diabetes can not be given desserts. a. True b. False
b. False
There are modifiable and non-modifiable risk factors for Type 1 diabetes. a. True b. False
b. False
DKA may result in which of the following? a. Metabolic alkalosis b. Metabolic acidosis c. Respiratory alkalosis d. Respiratory acidosis
b. Metabolic acidosis
Which statement is accurate about the long-term control of diabetes? a. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. b. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage. c. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. d. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled.
b. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.
The nurse is caring for a client with Type II Diabetes. Which of the following is the most important daily physical assessment? a. review of dietary options b. assessment of feet and skin integrity c. importance of daily insulin regimen d. fingerstick blood sugars every 6 hours
b. assessment of feet and skin integrity
when will the nurse monitor for a potential hypoglycemic reaction after administering daily regular insulin to a client with type 1 diabetes at 8AM? a. at breakfast b. before lunch c. before dinner d. in the early afternoon
b. before lunch
which purpose is served by an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin? a. encouragement to stay on the diet b. food to counteract late insulin activity c. added calories to promote weight gain d. high carbohydrates to provide nourishment for immediate use
b. food to counteract late insulin activity
a student with type 1 diabetes asks the nurse which primary hormone causes the blood glucose level to rise. which hormone would the nurse report? a. insulin b. glucagon c. epinephrine d. adrenocorticotropic hormone (ACTH)
b. glucagon
The purpose of insulin is to: a. help keep sucrose levels stable b. help glucose enter the cells c. lower cholesterol levels d. help glucose out of the cells
b. help glucose enter the cells
a continuous insulin infusion is started in an adolescent with a blood glucose level of 700 mg/dL (38.9 mmol/L). which complication would the nurse make a priority of detecting while the adolescent is receiving the infusion? a. hypovolemia b. hypokalemia c. hypernatremia d. hypercalcemia
b. hypokalemia
a 19-year old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 mg/dL, urine glucose and ketones 4+, and arterial pG 7.20. her parents state that she has been sick with the "flu" for a week. which of the following statements best explains her acidotic state? a. increased insulin levels led to protien breakdown and ketone formation b. insulin deficiency led to lipid metabolism and ketone formation c. low serum insulin led to lipid storage and corresponding release of ketones d. her uncontrolled diabetes has led to renal failure
b. insulin deficiency led to lipid metabolism and ketone formation
which insulin would the nurse conclude has the fastest onset of action? a. NPH insulin b. insulin lispro c. regular insulin d. insulin glargine
b. insulin lispro
which type of insulin would the nurse recognize as compatible with IV solutions when caring for a client with diabetes mellitus who is scheduled to receive an intravenous (IV) administration 25 units of insulin in 250 mL normal saline? a. NPH insulin b. insulin lispro c. insulin detemir d. insulin glargine
b. insulin lispro
Insulin is important for the body because _____. a. it helps keep sucrose levels stable. b. it helps glucose enter the cells. c. it lowers cholesterol levels. d. it helps glucose out of the cells.
b. it helps glucose enter the cells.
which explanation would the nurse share regarding the reversal of hypoglycemia after administering a tube of glucose gel to a client? a. it liberates glucose from heptaic stores of glycogen b. it provides a glucose source that is rapidly absorbed c. insulin action is blocked as it competes for tissue sites d. glycogen is supplied to the brain as well as other vital organs
b. it provides a glucose source that is rapidly absorbed
which molecule excessively accumulates in the blood to precipitate the signs and symptoms associated with a diabetic coma? a. sodium bicarbonate, causing alkalosis b. ketones as a result of rapid fat breakdown, causing acidosis c. nitrogen from protein catabolism, causing ammonia intoxication d. glucose from rapid carbohydrate metabolism, causing drowsiness
b. ketones as a result of rapid fat breakdown, causing acidosis
for which reason may insulin requirements of a client with type 1 diabetes decrease during the first trimester? a. body metabolism is sluggish in the first trimester b. morning sickness may result in decreased food intake c. fetal requirements of glucose in this period are minimal d. hormones of pregnancy increase the body's need for insulin
b. morning sickness may result in decreased food intake
The management of diabetes is most successful when _____. a. there is a priority focus on medications. b. patients are committed to self management. c. there is a priority focus on an appropriate diet. d. there is a priority focus on regular healthcare provider check ups.
b. patients are committed to self management.
A client who is overweight is being evaluated for diabetes. The client has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this client most likely has which condition? a. diabetes mellitus b. prediabetes c. hypoglycemia d. euglycemia
b. prediabetes
which common cause of diabetic ketoacidosis would the nurse consider when caring for a postoperative client with diabetes? a. emotional stress b. presence of infection c. increased insulin dose d. inadequate food intake
b. presence of infection
A nurse is providing patient education to a newly diagnosed type 2 diabetes mellitus (DM) client who has been prescribed metformin. Which of the following adverse effects should the nurse report immediately to the provider? a. constipation and abdominal distention b. rapid breathing with shortness of breath c. fluid retention and edema to lower extremities d. weight gain and diaphoresis
b. rapid breathing with shortness of breath
which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? a. exercise regularly b. rotate injection sites c. use the z-track technique d. vigorously massage the injection site
b. rotate injection sites
which hormone would the nurse identify as inhibiting insulin and glucagon secretion? a. amylin b. somatostatin c. triiodothyronine d. pancreatic polypeptide
b. somatostatin
A client with diabetes mellitus complains of difficulty seeing. Which factor would the nurse suspect as being the cause? a. lack of glucose in the retina b. the growth of new retina blood vessels or "neovascularization" c. inadequate glucose supply to rods and cones d. destructive effect of ketones on retinal metabolism
b. the growth of new retina blood vessels or "neovascularization"
SELECT ALL THAT APPLY A nurse is providing care for a client who is being treated for type 1 diabetes mellitus (DM). The client is to receive 2 units of insulin. Which of the following are the most common sites for insulin injection? a. deltoid b. vastus lateralis c. posterior upper arm d. abdomen e. ventrogluteal
c, d
SELECT ALL THAT APPLY which factors can predispose a client with type 1 diabetes to a diabetic ketoacidotic coma? a. taking too much insulin b. getting too much exercise c. excessive emotional stress d. running a fever with the flu e. eating fewer calories than prescribed
c, d
SELECT ALL THAT APPLY Which assessment finding would the nurse associate with a client with diabetic ketoacidosis? a. diaphoresis b. retinopathy c. acetone breath d. increased arterial bicarbonate level e. decreased arterial carbon dioxide level
c, e
SELECT ALL THAT APPLY which information would the nurse include in a teaching plan when teaching a client with diabetes about the advantages of using an insulin pump? a. it prevents ketoacidosis b. it helps cause weight loss c. it can improve A1c levels d. an insulin pump costs less than subcutaneous injections e. clients may be able to exercise without eating more carbohydrates
c, e
A client whose father has Type 1 Diabetes Mellitus asks the student nurse about her chances of developing Type I Diabetes. Which statement made by the student nurse indicates further teaching is needed? a. "You have a greater chance of developing the disease." b."There is a genetic risk for the development of Type I Diabetes." c. "You have a 50% chance of developing Type II diabetes, not Type I." d. "Total destruction of the pancreas leads to Type I diabetes."
c. "You have a 50% chance of developing Type II diabetes, not Type I."
which is the priority short-term goal when teaching a client with type 1 diabetes who is placed on an insulin pump to control the diabetes? a. "the client will adhere to the medical regimen" b. "the client will remain normoglycemic for 3 weeks" c. "the client will demonstrate correct use of the insulin pump" d. "the client will list three self-care activities that are necessary to control the diabetes"
c. "the client will demonstrate correct use of the insulin pump"
which information would the nurse include when teaching a type 2 diabetic controlled with oral antidiabetic medications who is prescribed regular insulin when admitted for elective surgery? a. "you will need a higher serum glucose level while on bed rest" b. "the stress of surgery may cause hypoglycemia" c. "with insulin, dosage can be adjusted to your changing needs during recovery from surgery" d. "the possibility of surgical complications is greater when a client takes oral hypoglycemics"
c. "with insulin, dosage can be adjusted to your changing needs during recovery from surgery"
which initial response would the nurse make to a 67-year-old man with type 2 diabetes who sadly confides in the nurse that he has been unable to have an erection for several years? a. 'at your age, sex isn't that important' b. 'that is a natural occurrence at your age' c. ' you sound upset about not being able to have an erection' d. 'maybe it's time for you to speak to your primary health care provider about this'
c. ' you sound upset about not being able to have an erection'
the nurse is teaching a 12-year-old child about the action of insulin injections. which statement indicates the child understands how insulin works in the body? a. 'glucose is released as fats break down' b. 'it keeps glucose from being stored in the liver' c. 'glucose is carried into cells where it is used for energy' d. 'it stops the wasting of blood glucose by converting it to glycogen'
c. 'glucose is carried into cells where it is used for energy'
What is the most common insulin concentration? a. 50 units/mL b. 50 units/10 mL c. 100 units/mL d. 100 units/10 mL
c. 100 units/mL
between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage? a. 10th and 12th weeks of gestation b. 18th and 22nd weeks of gestation c. 24th and 28th weeks of gestation d. 36th and 40th weeks of gestation
c. 24th and 28th weeks of gestation
A prolonged inflammatory phase in patients with long-term hyperglycemia can lead to which of the following? a. Hyperosmolar hyperglycemic state (HHS) b. Decreased immune response c. Diabetic retinopathy d. Autonomic neuropathy
c. Diabetic retinopathy
The nurse associates which assessment finding in the diabetic client with decreasing renal function? a. Ketone bodies in the urine during acidosis b. Glucose in the urine during hyperglycemia c. Protein in the urine during a random urinalysis d. White blood cells in the urine during a random urinalysis
c. Protein in the urine during a random urinalysis
which action would be taken by the nurse caring for a client with type 1 diabetes mellitus who has a finger-stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime and a prescription for sliding-scale regular insulin? a. call the health care provider b. encourage intake fo fluids c. administer the insulin as prescribed d. give the client 4 ounces of orange juice
c. administer the insulin as prescribed
which cause of tremors, pallor, and diaphoresis would be suspected in a client with type 1 diabetes? a. overeating b. viral infection c. aerobic exercise d. missed insulin dose
c. aerobic exercise
while obtaining a clients health history, which factor would the nurse identify as predisposing the client to type 2 diabetes? a. having diabetes insipidus b. eating low-cholesterol foods c. being 20 pounds (9kg) overweight d. drinking a daily alcoholic beverage
c. being 20 pounds (9kg) overweight
Type 1 diabetes is caused by which of the following? a. sedentary lifestyle b. BMI of over 35 c. body attacking itself d. pregnancy
c. body attacking itself
which cellular process associated with type 1 diabetes mellitus results in increased client fatigue? a. increased metabolism at the cellular level b. increased glucose absorption from the intestine c. decreased production of insulin by the pancreas d. decreased glucose secretion into the renal tubules
c. decreased production of insulin by the pancreas
which cellular process associated with type 1 diabetes mellitus results in increased client fatigue? a. increased metabolism at the cellular level b. increased glucose absorption from the intestine c. decreased production of insulin by the pancreas d. decreased glucose secretion into the renal tubules
c. decreased production of insulin by the pancreas
which short-term goal is the priority for a client with a new insulin pump who is receiving discharge instructions? a. plan daily intake incorporating diabetic diet guidelines b. demonstrate proper subcutaneous insulin injection technique c. demonstrate correct use of insulin pump d. list three self-care activities that help control the diabetes
c. demonstrate correct use of insulin pump
during assessment of a client with a 15-year history of diabetes, the nurse notes that the client reports loss of tactile sensation in both feet. which action does the nurse take first? a. document the finding in the clients chart b. notify the health care provider c. examine and assess the clients hands & feet d. complete a thorough abdominal assessment
c. examine and assess the clients hands & feet
which condition would the nurse identify as the likely cause of profound weakness and nervousness in a client that became confused shortly after self-administering the morning dose of 10 units of regular insulin and 25 units of NPH insulin after a light breakfast with no additional intake in the 3 hours since that time? a. hyperglycemia b. hyperinsulinemia c. hypoglycemia d. hypoinsulinemia
c. hypoglycemia
which laboratory value supports the presence of diabetic ketoacidosis in a client with type 1 diabetes? a. decreased serum glucose levels b. decreased serum calcium levels c. increased blood urea nitrogen levels d. increased serum bicarbonate levels
c. increased blood urea nitrogen levels
why is 15g of a simple sugar administered when a client with diabetes experiences hypoglycemia? a. inhibits glycogenesis b. stimulates release of insulin c. increases blood glucose levels d. provides more storage of glucose
c. increases blood glucose levels
which insulin will the nurse prepare for the emergency treatment of ketoacidosis? a. glargine b. NPH insulin c. insulin aspart d. insulin detemir
c. insulin aspart
the laboratory findings of an obese hypertensive adolescent reveal hyperinsulinemia and dyslipidemia. which condition would the nurse anticipate incorporating into the plan of care? a. pulmonary disease b. musculoskeletal disease c. insulin resistance syndrome d. nonalcoholic fatty liver disease
c. insulin resistance syndrome
which complication of diabetes would the nurse suspect when a health care provider prescribes one tube of glucose gel for a client with type 1 diabetes? a. diabetic acidosis b. hyperinsulin secretion c. insulin-induced hypoglycemia d. idiosyncratic reactions to insulin
c. insulin-induced hypoglycemia
which fluid shift will the nurse take into consideration when assessing a client with type 1 diabetes who is experiencing a fluid imbalance? a. intravascular to interstitial as a result of glycosuria b. extracellular to interstitial as a result of hypoproteinemia c. intracellular to intravascular as result of hyperosmolarity d. intercellular to intravascular as a result of increased hydrostatic pressure
c. intracellular to intravascular as result of hyperosmolarity
which unique response is associated with diabetic ketoacidosis that is not exhibited with hyperglycemic hyperosmolar nonketoitic syndrome? a. fluid loss b. glycosuria c. kussmaul respirations d. increased blood glucose level
c. kussmaul respirations
which adverse effect of metformin will a nurse teach a client with type 2 diabetes to monitor for when used as monotherapy? a. weight gain b. constipation c. lactic acidosis d. hypoglycemia
c. lactic acidosis
A nurse is caring for a client who has been taking acarbose long-term for type 2 diabetes mellitus (DM). Which of the following laboratory tests should the nurse plan to monitor? a. WBC b. serum potassium c. liver function tests d. platelet count
c. liver function tests
which time range would a nurse teach as the HIGHEST risk for hypoglycemia to a client with type 1 diabetes who self-administers neutral protamine hagedorn (NPH) insulin ever morning at 8:00 AM? a. 9:00 AM to 10:00AM b. 10:00 AM to 11:00 AM c. noon to 8:00PM d. 8:00 PM to midnight
c. noon to 8:00PM
Insulin cannot be given by _____. a. subcutaneous route. b. inhalation. c. oral route. d. parenteral route.
c. oral route.
Insulin lispro is what type of insulin? a. short acting b. intermediate acting c. rapid acting d. long acting
c. rapid acting
A nurse is teaching clients in an outpatient facility about the use of insulin to treat Type 1 Diabetes Mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak effect of 1 to 5 hours after administration? a. insulin glargine b. NPH insulin c. regular insulin d. insulin lispro
c. regular insulin
which eye problem is the leading cause of blindness in clients with diabetes? a. cataracts b. glaucoma c. retinopathy d. astigmatism
c. retinopathy
when planning care for a client with type 1 diabetes, which change in insulin requirements would the nurse anticipate on the first postpartum day? a. slow decrease b. rapid increase c. sudden decrease d. gradual increase
c. sudden decrease
a client is being treated for a hyperglycemic- hyperosmolar non-ketonic state. which clinical manifestation most indicates to the nurse that the treatment needs to be adjusted? a. serum potassium level has increased from 2.8 to 3.7 mEq/L b. urine has remained negative for ketone bodies for the past 3 hours c. the client becomes confused and is difficult to arouse d. blood osmolarity has decreased from 350 to 330 mOsm?
c. the client becomes confused and is difficult to arouse
SELECT ALL THAT APPLY Management of diabetes mellitus (DM) includes all of the following except: a. work with a healthcare professional b. eat a healthy diet c. stay physically active d. avoid exercise since it always leads to hypoglycemia e. sleep 10 - 12 hours daily
d, e
when teaching a client with type 2 diabetes, which statement by the nurse reflects accurate information about preparing for a serum glucose test? a. "eat your usual breakfast" b. "have clear liquids for breakfast" c. "take your medication before the test" d. " do not ingest anything before the test"
d. " do not ingest anything before the test"
which response will the nurse provide to a client with type 2 diabetes taking one glyburide tablet daily who asks whether an extra tablet should be taken before exercise? a. "you will need to decrease how much you are exercising" b. "an extra pill help your body use glucose when exercising" c. "the amount of medication you need to take is not related to exercising" d. "do not take an extra pill because you may become hypoglycemic when exercising"
d. "do not take an extra pill because you may become hypoglycemic when exercising"
which statement made by a client prescribed metformin extended release to control type 2 diabetes mellitus indicates the need for further education? a. "i will take the medication with food" b. "i must swallow my medication whole and not crush or chew it" c. "i will notify my doctor if i develop muscular of abdominal discomfort" d. "i will stop taking metformin for 24 hours before and after having a test involving dye"
d. "i will stop taking metformin for 24 hours before and after having a test involving dye"
which instruction about medications would the nurse include when teaching a client with type 1 diabetes who tells the nurse, "I take guaifenesin cough syrup when I have a cold"? a. "Substitute an elixir for the cough syrup" b. "increase fluid intake and use a humidifier to control the cough" c. "the small amounts of sugar in medications are not a concern with diabetes" d. "include the glucose in the cough syrup when calculating daily carbohydrate allowance"
d. "include the glucose in the cough syrup when calculating daily carbohydrate allowance"
which instruction will the nurse provide to a client with type 2 diabetes who develops gout when teaching about the administration of allopurinol? a. "allopurinol masks symptoms of hypoglycemia" b. "increase your oral hypoglycemic medications" c. "increase attention to diabetic foot care" d. "monitor blood glucose levels more frequently"
d. "monitor blood glucose levels more frequently"
the nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. which statement by the nurse correctly identifies when insulin needs decrease? a. 'insulin needs often decrease when puberty is reached' b. "when there is an infection present, the body requires less insulin' c. 'emotional stress can cause insulin needs to decrease' d. 'increased muscle activity such as exercise, cause insulin needs to decrease"
d. 'increased muscle activity such as exercise, cause insulin needs to decrease"
which is an appropriate response to a 24-year-old client with type 1 diabetes who asks how her pregnancy will affect her diet and insulin needs? a. ' insulin needs will decrease; the excess glucose will be used for fetal growth' b. 'diet and insulin needs wont change, and maternal and fetal needs will be met' c. 'protein needs will increase, and adjustments to insulin dosage will be necessary' d. 'insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring'
d. 'insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring'
which period of time would a nurse recognize as the greatest risk of hypoglycemia when caring for a client who receives regular insulin daily at 8:00AM? a. 8:30AM to 9:30AM b. 8:00PM to 12:00 AM c. 1:00PM to 8:00 PM d. 10:00AM to 1:00 PM
d. 10:00AM to 1:00 PM
the nurse teached an adolescent with type 1 diabetes about peak action of NPH insulin and the risk for hypoglycemia. the nurse determines teaching has been effective when the adolescent identifies insulin peak action within which time frame? a. 1 to 2 hours b. 2 to 4 hours c. 5 to 10 hours d. 4 to 12 hours
d. 4 to 12 hours
Type 2 diabetes makes up approximately _____% of diagnosed cases of diabetes. a. 50 b. 70 c. 30 d. 90
d. 90
which angle would an obese client be taught to self-administer an insulin injection at? a. 30-degree angle b. 60-degree angle c. 45-degree angle d. 90-degree angle
d. 90-degree angle
A client is scheduled to start taking insulin glargine. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? a. Peak effect achieved in 2 to 4 hours b. Mealtime coverage of blood glucose c. Less frequent blood glucose monitoring d. Blood glucose control for 24 hours
d. Blood glucose control for 24 hours
Which of the following is a result of damage to the autonomic nervous system? a. Renal failure b. Blindness c. Peripheral neuropathy d. Diabetic gastroparesis
d. Diabetic gastroparesis
_____ is not a beneficial effect of exercise in people with diabetes. a. Weight loss b. Reduction of triglycerides c. Hypertension control d. Hypoglycemia
d. Hypoglycemia
Clients with Type 1 diabetes may require which of the following changes to their daily routine during periods of infection? a. Meticulous foot care b. Oral antidiabetic agents c. Less insulin d. Monitoring ketones frequently
d. Monitoring ketones frequently
A microvascular complication would include which of the following? a. Myocardial infarction b. Stroke c. Atherosclerosis d. Periodontal disease
d. Periodontal disease
Type 2 diabetes differs from Type 1 diabetes because _____. a. people with Type 2 diabetes require more insulin. b. Type 1 diabetes is caused by insulin resistance. c. people with Type 2 diabetes have chronic complications that occur more rapidly. d. Type 1 diabetes is caused by an over active autoimmune response.
d. Type 1 diabetes is caused by an over active autoimmune response.
a client with type 1 diabetes receives Humulin R insulin in the morning. shortly before lunch the nurse identifies that the client is diaphoretic and trembling. which intervention is appropriate? a. administer insulin to the client b. give the client lunch immediately c. encourage the client to drink fluids d. assess the clients blood glucose level
d. assess the clients blood glucose level
which type of cells are destroyed in type 1 diabetes? a. alpha b. neurologia c. stem d. beta
d. beta
which laboratory results support the nurse's suspicion that a client diagnosed with type 1 diabetes is experiencing ketoacidosis? a. blood glucose of 40mg/100mL (2.2 mmol/L), blood pH of 7.37 b. blood glucose of 130mg/100mL (7.2 mmol/L), blood pH of 7.35 c. blood glucose of 650mg/100mL (36.1 mmol/L), blood pH of 7.42 d. blood glucose of 300mg/ 100mL (16.7 mmol/L), blood pH of 7.20
d. blood glucose of 300mg/ 100mL (16.7 mmol/L), blood pH of 7.20
a client experiences ineffective control of type 1 diabetes. the client's study results indicate that a sudden decrease in blood glucose level is followed by rebound hyperglycemia. when this event occurs, which action would the nurse take? a. give the client 8oz (240mL) of orange juice b. seek a prescription to increase the insulin dose at bedtime c. encourage the client to eat smaller, more frequent meals d. collaborate with the primary healthcare provider to alter the insulin prescription
d. collaborate with the primary healthcare provider to alter the insulin prescription
which clinical finding supports the diagnosis of diabetic ketoacidosis? a. nervousness and tachycardia b. erythema toxicum rash and pruritus c. diaphoresis and altered mental state d. deep respirations and fruity odor to the breath
d. deep respirations and fruity odor to the breath
Which of the following drugs should a health care professional have available for a client who is experiencing an insulin overdose? a. naloxone b. dipgenhydramine c. acetylcystine d. glucagon
d. glucagon
which laboratory test would the nurse expect to be prescribed that will reveal the effectiveness of a diabetic regimen for a child with type 1 diabetes? a. serum glucose b. glucose tolerance c. fasting blood sugar d. glycosylated hemoglobin
d. glycosylated hemoglobin
what causes the chronic microvascular complications of DM? a. pancreatic changes b. hyperinsulinemia c. ketone toxicity d. hyperglycemia
d. hyperglycemia
which condition is likely being experienced by a client receiving NPH insulin every morning who reports feeling nervous at 4:30 PM and has skin that is moist and cool? a. hyperosmolar hyperglycemic nonketotic state b. ketoacidosis c. glycogenesis d. hypoglycemia
d. hypoglycemia
with which condition would the nurse associate the response of diaphoresis, weakness, and pallor at 3:30 PM in a client with type 1 diabetes who receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM? a. diabetic coma b. hyperosmolar hyperglycemic nonketotic syndrome c. diabetic ketoacidosis d. hypoglycemic reaction
d. hypoglycemic reaction
a 15-year-old adolescent is found to have type 1 diabetes. which would the nurse include when teaching the adolescent about type 1 diabetes? a. it does not always require insulin b. it involves early vascular changes c. it occurs more often in obese adolescents d. it has a more rapid onset that does type 2 diabetes
d. it has a more rapid onset that does type 2 diabetes
which condition would cause a nontender 5-cm indurated region on the upper arm of a client with type 1 diabetes who says to the nurse, " that is where i give myself insulin shots'"? a. callus b. an allergy c. an infection d. lipodystrophy
d. lipodystrophy
what is the purpose of the glycosylated hemoglobin test? a. measuring fasting glucose levels b. checking for hyperlipidemia c. detecting acute complications of diabetes d. monitoring long-term serum glucose control
d. monitoring long-term serum glucose control
The nurse is planning an evening snack for a child receiving NPH insulin. the nurse offers a snack for which reason? a. it encourages the child to stay on the diet b. energy is needed for immediate utilization c. extra calories will help the child gain weight d. nourishment helps counteract late insulin activity
d. nourishment helps counteract late insulin activity
an 11-year-old is newly diagnosed with type 1 DM. which classic symptoms should the nurse assess the client for? a. recurrent infections, headaches, fatigue, and numbness b. weakness, vomiting, hypotension, and mental confusion c. vomiting, abdominal pain, sweet, fruity breath, dehydration, and kussmal breathing d. polydipsia, polyuria, polyphagia, and weight loss
d. polydipsia, polyuria, polyphagia, and weight loss
which rationale explains why intravenous (IV) potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? a. potassium loss occurs rapidly from diaphoresis present during coma b. potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts c. potassium is quickly used up during rapid series of catabolic reactions stimulated by insulin and glucose d. serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment
d. serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment
when teaching a client with diabetes about monitoring for episodes of hypoglycemia, which symptom would the nurse include in the teaching plan? a. thirst b. nausea c. anorexia d. sweating
d. sweating
A diabetic client has proliferative retinopathy, nephropathy, and peripheral neuropathy. Which of the following is the most appropriate form of exercise? a. jogging for 20 minutes/day 5-7 days/week b. any vigorous activity for 1 hour/day c. avoid all exercise d. swimming or water aerobics 30 minutes/day 5-7 days/week
d. swimming or water aerobics 30 minutes/day 5-7 days/week
An adolescent with diabetes had a 6:30 AM fasting blood glucose level of 180mg/dL (10.0 mmol/L). which nursing action is a priority? a. encourage the adolescent to start exercising b. ask the adolescent to obtain an immediate glucometer reading c. inform the adolescent that a complex carbohydrate such as cheese should be eaten d. tell the adolescent that the prescribed dose of rapid-acting insulin should be administered
d. tell the adolescent that the prescribed dose of rapid-acting insulin should be administered
which results would the nurse expect to find when assessing the laboratory values of a client with type 2 diabetes? a. ketones in the blood but not in the urine b. glucose in the urine but not in the blood c. urine and blood positive for glucose and ketones d. urine negative for ketones and positive glucose in the blood
d. urine negative for ketones and positive glucose in the blood
the nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. which statement made by the client shows that the teaching was effective? a. "i should massage my feet and legs with oil or lotion" b. "i should apply heat intermittently to my feet and legs" c. "i should eat foods high in protein and carbohydrate kilocalories" d." i should control my blood glucose with diet, exercise, and medication."
d." i should control my blood glucose with diet, exercise, and medication."
a mother asks the neonatal nurse why her infant must be monitored closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. how would the nurse best respond? a. 'a healthy newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes.' b. ' a newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred.' c. ' babies of mothers with diabetes do not have large stores of glucose at birth, so it is difficult for them to maintain the blood glucose level within an acceptable range.' d.' babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mother during pregnancy, so the glucose level may drop.'
d.' babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mother during pregnancy, so the glucose level may drop.'
empagliflozin distribution
enters red blood cells
glyburide adverse effects
erythema multiforme and aplastic anemia
empagliflozin excretion
excreted in feces and urine
Exenatide excretion
excreted mostly by glomerular filtration followed by degradation
pioglitazone metabolism
extensively metabolized by the liver
true or false clear solutions are always short-acting
false
true or false once a patient's blood sugar is stabilized, the patient will be able to maintain control with oral drugs
false
true or false there is no ideal percentage of calories that should be ingested from carbohydrates, proteins, and fats.
false
stiagliptin absorption
following oral administration
NPH insulin distribution
freely within plasma
insulin glargine distribution
freely within plasma
insulin lispro distribution
freely within plasma
regular insulin distribution
freely within plasma
repaglinide adverse effects
hypoglycemia
NPH insulin adverse reactions
hypoglycemia and anaphylaxis
insulin degludec adverse reactions
hypoglycemia and anaphylaxis
insulin glargine adverse reactions
hypoglycemia and anaphylaxis
insulin lispro adverse reactions
hypoglycemia and anaphylaxis
regular insulin adverse effects
hypoglycemia and anaphylaxis
pioglitazone action
improves sensitivity to insulin by acting as an agonist at receptor sites involved in insulin responsiveness and subsequent glucose production and utilization
empagliflozin actions
inhibits proximal renal tubular sodium-glucose co-transporter 2 which determines reabsorption of glucose from the tubular lumen
stiagliptin action
inhibits the enzyme dipeptidyl peptidase-4 which slows the inactivation of incretin hormones, resulting in increased levels of active incretin hormones
empagliflozin adverse effects
ketoacidosis, necrotizing fasciitis of perineum, urosepsis, anaphylaxis
acarbose metabolism
kidneys
metformin adverse effects
lactic acidosis
acarbose action
lowers blood glucose by inhibiting the enzyme alpha-glucosidase in the GI tract
NPH insulin action
lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat
insulin degludec action
lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat
insulin glargine action
lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat
insulin lispro action
lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat
glyburide action
lowers blood sugar by stimulating the release of insulin at receptor sites
regular insulin metabolism
metabolized by liver, spleen, kidney and muscle
NPH insulin metabolism
metabolized by liver, spleen, kidney, and muscle
insulin lispro metabolism
metabolized by liver, spleen, kidney, and muscle
exenatide action
mimics the action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucose-lowering
acarbose excretion
minimal amounts in the kidneys
pioglitazone excretion
minimal unchanged
empagliflozin metabolism
minmally
insulin glargine metabolism
partially metabolized at the site of injection to active insulin metabolites; metabolized by liver, spleen, kidney, and muscle
repaglinide excretion
primarily in feces
Which of the following signs indicates that a diabetic client is experiencing decreased renal function as a complication of chronic hyperglycemia? a. ketoacidosis b. glycosuria c. protienuria d. polyuria
protienuria
NPH insulin absorption
rapidly absorbed from subcutaneous administration sites
regular insulin absorption
rapidly absorbed from subcutaneous administration sites
glyburide distribution
reaches high concentrations in bile and crosses the placenta
glyburide excretion
renally
insulin degludec excretion
renally
insulin glargine excretion
renally
insulin lispro excretion
renally
regular insulin excretion
renally
insulin degludec absorption
slow and delayed
stiagliptin adverse effects
stevens-johnson syndrome, rhabdomyolysis, anaphylaxis
regular insulin action
stimulating glucose uptake in skeletal muscle and fat
acarbose absorption
systemically absorbed; mainly local in GI tract
exenatide adverse effects
thyroid c-cell tumors, pancreatitis, thrombocytopenia
true or false saturated fats should be limited to less than 10% of total calories
true
true or false the primary goal of treating diabetes is to prevent long-term complications and manage symptoms of hyperglycemia
true
true or false administering insulin or sulfonylurea drugs and not eating can cause serious effects from the blood sugar going too low
true
true or false blood sugar control will best be achieved if the patient follows a plan created by the healthcare providers
true
true or false exercise improves cellular response to insulin
true
true or false insulin therapy with one long-term agent that mimics the body's basal insulin secretion and another short-acting agent to cover eating more closely mimics normal functioning
true
true or false most long-term complications of diabetes occur secondary to disruption of blood flow?
true
true or false tight glucose control decreases the incidence of kidney failure
true
true or false treatment can be monitored by blood or urine
true
true or false weight loss is always needed to decrease the patient's insulin requirements
true
metformin metabolism
unchanged
stiagliptin excretion
unchanged in urine
insulin lispro absorption
very rapidly absorbed from subcutaneous administration site
glyburide absorption
well absorbed following oral administration
pioglitazone absorption
well absorbed following oral administration
repaglinide absorption
well absorbed following oral administration
exenatide absorption
well absorbed following subcutaneous administration
empagliflozin absorption
well following oral administration
insulin degludec distribution
widely
insulin pumps can administer insulin by: a. basal mode b. bolus mode c. both basal and bolus mode d. neither basal mode nor bolus mode
c. both basal and bolus mode
Which condition is considered the ultimate cause of death in a client with diabetes? a. renal disease b. stroke c. cardiovascular disease d. cancer
c. cardiovascular disease
which statement will the nurse need to consider when developing the teaching plan for a client with type 2 diabetes prescribed an oral hypoglycemic medication? a. oral hypoglycemics work by decreasing absorption of carbohydrates b. oral hypoglycemics work by stimulating the pancreas to produce insulin c. clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control d. serious adverse effects are not a problem for oral hypoglycemics
c. clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control
when determining the main difference between type 1 and type 2 diabetes, the nurse recognizes which clinical presentation about type 1? a. onset of the disease is slow b. excessive weight is a contributing factor c. complications are not present at the time of diagnosis d. treatment involves diet, exercise, and oral medications
c. complications are not present at the time of diagnosis
a client's breath has a sweet, fruity odor. which condition is affecting the client? a. gum disease b. uremic acidosis c. diabetic acidosis d. infection inside a cast
c. diabetic acidosis
which medication is responsible for neonatal hypoglycemia? a. warfarin b. simvastatin c. tolbutamine d. methimazole
c. tolbutamine
metformin absorption
50-60% absorbed after oral administration
repaglinide action
Stimulates the release of insulin from pancreatic beta cells by closing potassium channels, which results in the opening of calcium channels in beta cells
when obtaining the history of a client recently diagnosed with type 1 diabetes, which symptom would the nurse expect to see? a. edema b. anorexia c. weight loss d. hypoglycemic episodes
c. weight loss
SELECT ALL THAT APPLY Which of the following are beneficial effects of exercise in clients with diabetes? a. weight loss b. reduction of triglycerides c. hypertension control d. hypoglycemia
a, b, c
insulin degludec metabolism
metabolized by liver, spleen, kidney, and muscle
stiagliptin metabolism
minor metabolism
acarbose adverse effects
abdominal pain, diarrhea, flatulence
glyburide metabolism
by the liver
metformin action
decreases hepatic glucose production, intestinal glucose absorption, increases sensitivity to insulin
insulin glargine absorption
provides slower prolonged absorption and a relatively constant concentrations over 24 hr
for which condition is an oral hypoglycemic agent indicated? a. ketoacidosis b. obesity c. pancreatitis d. reduced insulin production
d. reduced insulin production
A client with type 1 diabetes is eating breakfast at 0730. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The client's blood sugar level is 317 mg/dL. Which insulin should the nurse prepare to administer? a. no insulin should be administered b. NPH insulin c. 70/30 mix insulin d. regular insulin
d. regular insulin
before having surgery, a client with type 1 diabetes insulin requirements would the nurse anticipate for this client postoperatively? a. decrease b. fluctuate c. increase sharply d. remain elevated
d. remain elevated
repaglinide metabolism
by the liver
metformin distribution
enters breast milk in concentrations similar to plasma
NPH insulin excretion
renally