Ch. 33 PrepU quiz

Loss of feeling or touch in the feet.

A patient with distal symmetric polyneuropathy usually begins by complaining of:

Complete failure of insulin secretion

Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes?

Exogenous insulin injections

A 23-year-old man is admitted to the hospital. He is experiencing polyphagia, polyuria, and polydipsia. He states that the condition has come on very suddenly. This client is likely to require what treatment?

glyburide insulin

A woman in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate? Select all that apply.

Blood glucose level greater than 250 mg/dL; bicarbonate less than 15 mEq/L and pH less than 7.3

Diabetic ketoacidosis is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA?

NPO before surgery

In which situation would an increase of glucagon be expected?

Elevated fibrinogen levels and hyperinsulinemia

Macrovascular disease includes coronary artery disease, cerebrovascular disease, and peripheral vascular disease. People with both type 1 and type 2 diabetes are at high risk for developing macrovascular disease. What are the risk factors for macrovascular disease in diabetics?

Somogyi effect

Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?

Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?

Deranged secretion of insulin Insulin resistance Increased glucose production by the liver

Type 2 diabetes is caused by metabolic abnormalities in the presence of insulin. What are these metabolic abnormalities? (Select all that apply.)

"Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road."

A 15 year-old boy with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which of the following responses by his mother is most accurate?

foot problems

Diabetics are hospitalized for a number of reasons. What is the most common complication of diabetes requiring hospitalization?

Hypoglycemia

A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?

"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."

A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by participants should the nurse follow up first?

A 45-year-old obese woman with a sedentary lifestyle

A nurse is evaluating patients for the risk of developing type 2 diabetes. Which of the following patients has the highest risk?

Dry lips, excess urine output, and seizures.

A pancreatitis patient is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parental nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the patient for which clinical manifestations (listed below)?

"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." "I need to carefully limit my protein consumption."

A patient diagnosed with type 2 diabetes has been instructed about managing her condition with diet. Which of the following statements by the patient indicates a need for additional education? Select all that apply.

Headaches, dizziness, change in level of consciousness.

A patient has been admitted with diabetic ketoacidosis. The Emergency Department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which of the following clinical manifestations?

Hyperglycemia

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?

"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars."

Following an oral glucose tolerance, a 36 year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous pregnancies. What should her primary care provider tell her about this new health problem?

Polydipsia Polyuria Polyphagia

Select the most common symptoms of diabetes. Select all that apply.

Insulin is not available for use by the body.

The diagnosis of type 1 diabetes would be confirmed by:

Glucose is unused without insulin, so body fats are used for energy.

The family of a client in the hospital with diabetes mellitus out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond?

"Take the medication 15 to 30 minutes before each meal."

The health care provider has prescribed Repaglinide 2 mg for a client diagnosed with type 2 diabetes. The most important information for the nurse to give the client would be:

"Insulin is destroyed by the stomach contents and has to be administered by injection."

The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is:

Brain

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which of these organs does the nurse recognize is reliant on glucose as the major energy source?

Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.

When educating a patient about glargine (Lantus), the nurse should explain that this medication:

Hemoglobin A1c 9.1% 2 hour oral GTT 245 mg/dl

Which laboratory values for a newly admitted client indicate a diagnosis of diabetes mellitus? Select all that apply.

2 hour oral GTT 175 mg/dl

Which manifestation indicates a client is at risk for developing diabetes mellitus?

Glucose uptake by muscle and adipose tissue Fat storage Protein synthesis

A patient hospitalized with type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following are processes of insulin? Select all that apply.

Infections that are less serious in healthy people are often more virulent in people with diabetes due to hyperglycemia and glucosuria.

A 45-year-old client with type 1 diabetes has just been admitted with osteomyelitis. Which reason for diabetic susceptibility to infection is the most significant?

Give the client a concentrated carbohydrate.

The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority?

Vomiting after eating

The nurse is caring for a client with diabetes who has developed gastroparesis. Which of these symptoms does the nurse expect the client to report?

hypoglycemia

A 30-year-old man who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half marathon. Which phenomenon is likely to be the cause of his symptoms?

Oral antihyperglycemic medications and weight loss measures.

A 46 year-old man who is obese has received news that he has type 2 diabetes. He is in the process of determining a plan of care with an interdisciplinary team at a hospital-based diabetes clinic. The nurse knows that the most likely treatment plan for the man will include:

The client states that he has been unable to maintain an erection in recent years. The client complains of bloating after eating a meal, and states that he is unable to eat much food at any one sitting. He states that his bowel movements are almost always loose.

A 54 year-old male who lives alone and has poorly controlled type 1 diabetes has been admitted to hospital for treatment of sepsis resulting from a chronic foot ulcer. Which of the other findings from the man's admission assessment and history would his care team be likely to attribute to his diabetes? Select all that apply.

"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads."

A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. The nurse determines further teaching is necessary when the client states:

Clawing of toes and denervation of the small muscles of the foot

Peripheral neuropathies occur in people with diabetes mellitus. With the loss of sensation in the lower extremities, diabetics become predisposed to what?

Administration of intravenous fluids

The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL. The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?

9

The nurse educates a patient newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that one gram of fat will provide _____ kcal of energy.

Glucose that exceeds metabolic needs is converted and stored by the liver.

Which of the following statements best describes an aspect of the normal process of glucose metabolism?

Production of fatty acids and glycerol Ketone production by the liver Breakdown of triglycerides Decrease in pH Low serum insulin levels

A woman with poorly controlled type 1 diabetes has been admitted to a hospital unit for the treatment of ketoacidosis. Place the following events in the pathophysiology of ketoacidosis in the correct chronological order. Use all the options.

Promoting glucose uptake by target cells. Inhibiting protein breakdown Facilitating triglyceride synthesis from glucose in fat cells

A 30 year-old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin? Select all that apply.

Hypoglycemia

A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room complaining of headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints?

Administration of 15 to 20 g of glucose in a concentrated carbohydrate source.

A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?

Helping the client make meaningful changes to his diet and activity level.

A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?

Onset before age 20 Abrupt onset of symptoms Autoimmune beta cell damage

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

positive urine ketones low serum bicarbonate

A client is brought to the emergency department with a suspected diagnosis of DKA (diabetic ketoacidosis). Select the assessment/diagnostic data to confirm the diagnosis. Select all that apply.

Glycosylated hemoglobin 5.2%

A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

The client is achieving normal glycemic control.

A client is managing his diabetes with exercise and diet. The health care provider reviews the client's most recent lab results: fasting blood sugar level at 80 mg/dL and a hemoglobin A1C of 5%. Select the response that best identifies the client.

Recent weight loss Polyuria Blurred vision

A client presents to the emergency room with fatigue, weakness, dehydration and thirst. What additional symptoms would correlate with a diagnosis of type 1 diabetes mellitus? Select all that apply.

Glycosylated hemoglobin, hemoglobin A1C (HbA1C)

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes .The best diagnostic indicator that would support the client's response would be:

"You could regulate your diet, exercise regularly, and lose weight."

A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse?

Short acting

A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 12.1 mmol/l and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?

Check blood glucose

A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first?

check blood glucose at 2am

A client with diabetes mellitus reports morning hyperglycemia for several days. What action should taken?

Maintain healthy blood pressure and blood sugar levels.

A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information?

Orange juice orally

A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided?

Using an insulin infusion pump

A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?

Hyperglucagonemia Glycosuria and dehydration Hepatic glycogenolysis Insulin deficiency

A patient is diagnosed with hyperglycemic hyperosmolar state (HHS). Which of the following factors contribute to the severe hyperglycemia that precipitates HHS? Select all that apply

Hypertriglyceridemia Body mass index (BMI) greater than 30 Coronary artery disease Elevated fasting blood glucose (FBG)

A patient is diagnosed with metabolic syndrome. Frequent concomitants of this syndrome include which of the following? Select all that apply.

The patient is achieving normal glycemic control.

A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume?

Glargine (Lantus)

A patient with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of the following might the nurse suggest as a long-acting insulin to provide a consistent basal level?

Chronic neuropathies Vascular impairment

A patient with diabetes has been injured. The nurse will tell the patient that healing of the injury may be delayed due to which of the following diabetic complications? Select all that apply.

"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."

A three year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes?

Random blood glucose 85 mg/dl

A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

Inspect the feet for blisters daily

Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes.

Thirst Weight loss Blurred vision

The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply.

Blood glucose will elevate.

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause?

Glucocorticoids Oral contraceptives Loop diuretics

The nurse and nursing student are performing medication reconciliation. Which of these medications taken by the client does the nurse teach the student are implicated in causing hyperglycemia? Select all that apply.

Lispro

The nurse has just completed teaching a client newly diagnosed with type 1 diabetes about rapid-acting insulin. The nurse determines that teaching was effective when the client selects:

Somatic neuropathy

The nurse is caring for a client diagnosed with diabetes mellitus who is reporting burning pain of his feet. The nurse would interpret this as:

A 45-year-old obese female with a sedentary lifestyle

The nurse is reviewing assessment data on four clients. Select the client at highest risk for developing type 2 diabetes.

Loop diuretics Oral contraceptives Total parenteral nutrition Antipsychotics

The nurse is teaching a client with diabetes about medications that will increase the blood glucose level. The most important information for the nurse to provide would be: Select all that apply.

The brain relies on blood glucose as its main energy source.

The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be:

Random blood glucose 195 mg/dl

The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary healthcare provider for further evaluation?

Woman with a family history of diabetes

The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which of these risk factors in the teaching?