ch 48 sectn 3
Which self-care activities would the patient who has a neurogenic bladder identify to facilitate bladder emptying to help to prevent urinary stasis and infection? Select all that apply. 1 Sitting to void 2 Using the Credé maneuver when voiding 3 Emptying the bladder at least three times a day 4 Tightening the abdominal muscles when voiding 5 Maintaining a fluid restriction of 1200 mL per day
1, 2, 4 Sitting to void, the Credé maneuver, and tightening the abdominal muscles when voiding all aid in fully emptying the bladder, which will help to prevent urinary stasis and infection. The patient should also empty the bladder every three hours. Fluid restriction will not aid in emptying the bladder.
Which conditions may lead to a coma in patients with diabetic ketoacidosis if left untreated? Select all that apply. 1 Dehydration 2 Hypoglycemia 3 Cerebral edema 4 Metabolic acidosis 5 Electrolyte imbalance
1, 4, 5 Dehydration, metabolic acidosis, and electrolyte imbalance may lead to a coma if untreated. Hypoglycemia and cerebral edema are not associated with coma in patients with diabetic ketoacidosis.
A patient with a history of type 2 diabetes is diagnosed with heart failure. Which medication would be a poor choice for controlling the patient's diabetes? 1 Acarbose 2 Glyburide 3 Nateglinide 4 Pioglitazone
4 Pioglitazone can worsen heart failure. Therefore it should be avoided in diabetic patients with heart failure. Glyburide, acarbose, and nateglinide are not contraindicated in patients with heart failure.
A patient with a 15-year history of diabetes has been complaining of intermittent pain in the legs. Which other symptoms would the nurse assess if the patient has the complication of peripheral arterial disease? Select all that apply. 1 Cold feet 2 Loss of hair 3 Dependent rubor 4 Urinary retention 5 Bowel incontinence
1, 2, 3 Peripheral arterial disease causes decreased blood flow to the lower extremities. Cold feet, loss of hair, and dependent rubor are the signs of peripheral arterial disease. Urinary retention and bowel incontinence are symptoms of autonomic neuropathy.
A patient with diabetes has an increased serum osmolality and a blood glucose level of 610 mg/dL. The nurse would monitor this patient for which complication? 1 Acidosis 2 Seizures 3 Hyperkalemia 4 Cerebral edema
2 Blood glucose level more than 600 mg/dL indicates hyperosmolar hyperglycemic syndrome, which increases the serum osmolality and produces severe neurologic manifestations, such as seizures. Acidosis is mainly associated with diabetic ketoacidosis. Fluid losses may cause mild deficits in potassium leading to hypokalemia but not hyperkalemia. Cerebral edema is a complication associated with rapid administration of IV fluids.
When assessing for signs of ketoacidosis in a patient with diabetes, which respiratory pattern would the nurse expect to find? 1 Central apnea 2 Hypoventilation 3 Kussmaul respirations 4 Cheyne-Stokes respirations
3 In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and unlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.
The laboratory reports of a patient brought to the emergency department with symptoms of dehydration show high glucose levels in the blood, large ketone bodies in the urine, decreased serum bicarbonate levels, and acidic pH of the blood. Administration of which prescribed interventions would help stabilize this patient? Select all that apply. 1 Glucagon IM 2 50% glucose IV 3 Fast-acting carbohydrates orally 4 Short-acting insulin IV 5 Fluids and electrolytes IV
4, 5 IV administration of short-acting insulin helps to stabilize the blood glucose levels. IV administration of fluids and electrolytes may help to rectify the fluid electrolyte balance and normalize the blood pH. Administering glucagon, 50% glucose, and fast-acting carbohydrates increase the blood sugar level, so these interventions are appropriate for hypoglycemia.
What is the correct order of the events leading to ketoacidosis?
Ketoacidosis begins with a deficiency of insulin. The lack of insulin leads to decreased glucose utilization. Fat stores are broken down for energy use when glucose is not available. The breakdown of fat stores results in the production of ketones, which accumulate and cause a metabolic acidic state: ketoacidosis.
A patient with type 1 diabetes mellitus presents to the emergency department with a 2-day history of vomiting, weakness, increased thirst, and increased urination. Serum electrolyte results include sodium 155 mEq/L, potassium 3.0 mEq/L, glucose 550 mg/dL, and sodium bicarbonate 10 mEq/L. Which nursing intervention is appropriate? 1 Administer IV potassium 2 Administer a long-acting insulin preparation 3 Recheck a bedside glucose level 4 Implement a sodium restriction
1 The patient is experiencing diabetic ketoacidosis (DKA). A potassium level of 3.0 mEq/L is low and requires replacement by IV supplementation. Insulin therapy in the setting of DKA is with regular insulin administered intravenously, not a long-acting preparation, since the IV regular insulin will rapidly correct the hyperglycemia and be easier to titrate. Rechecking a bedside glucose level via fingerstick is not appropriate when there is a critically high serum level available. The elevated sodium level is due to dehydration, not overconsumption of sodium, so sodium restriction is not warranted. IV fluid replacement would be ordered, which will correct the sodium imbalance.
Which complication of diabetes mellitus can be monitored by fundus photography? 1 Neuropathy 2 Retinopathy 3 Nephropathy 4 Dermatopathy
2
Which statement made by a patient demonstrates the need for further teaching about diabetes management? 1 "I will exercise daily." 2 "I will drink fruit juices daily." 3 "I will walk wearing shoes daily." 4 "I will have a yearly influenza vaccination."
2 Having fruit juices daily does not help in diabetes management because it contains sugars that are easily absorbed. Exercising daily helps to maintain good health. Wearing shoes daily will help to avoid injuries to feet, which is important because wound healing is delayed in diabetic patients. Diabetic patients have weakened immune systems and are more prone to flu. Therefore annual vaccination against influenza is required.
Which information would be appropriate for the nurse to include in a teaching session about nephropathy as a complication of diabetes? 1 Vessels may begin to bleed, resulting in permanent blindness. 2 Controlling blood sugar and BP will reduce the risk of kidney injury. 3 Organ damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. 4 This will not occur if one does not require insulin to control diabetes.
2 Microangiopathy occurs in diabetes mellitus. When the kidneys are affected, the patient has nephropathy. Maintaining control of blood sugar and BP will decrease microvascular organ damage and help to preserve kidney function. Blindness occurs as a result of microvascular damage, not bleeding. Organ damage is caused from small vessel damage. Regardless of the treatment type, nephropathy can occur if blood sugars are not controlled properly.
Which statement made by the patient with diabetes indicates a need for further teaching about management of hypoglycemia? 1 "I will not eat large quantities of quick-acting carbohydrates." 2 "I will recheck my glucose level 30 minutes after eating 15 g of carbohydrate." 3 "I will not contact the health care provider if my symptoms subside after two doses of carbohydrate." 4 "I will not eat candy bars and ice cream because they have a lot of sugar and fat in them, which is not good for my health."
2 When teaching about how to manage hypoglycemia, the nurse should instruct that treatment consists of ingesting 15 g of simple carbohydrate and rechecking the glucose levels 15 minutes later, not 30 minutes later. If the levels are still below 70 mg/dL, then the treatment is repeated two to three times. Overtreatment with large quantities of quick-acting carbohydrates should be avoided to prevent rapid fluctuation to hyperglycemia. If improvement is not observed, then the health care provider should be contacted. Fats are present in candy bars and ice cream, which may slow down the absorption of glucose and delay the response to treatment.
Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis? 1 Electrolytes 2 Insulin therapy 3 Sodium bicarbonate 4 IV fluids
2 When the body cannot utilize glucose for energy, it burns fat for energy, resulting in the production of ketones. Insulin therapy is useful for reducing the serum ketone levels. Electrolytes are given to correct the electrolyte imbalance. Sodium bicarbonate is given to treat metabolic acidosis. IV fluids are indicated for correction of dehydration.
A patient with type 1 diabetes mellitus complains of severe dehydration, dry mouth, fever associated with chills, and fruity odor of the breath. Which interprofessional treatment would be included in the plan of care? Select all that apply. 1 Monitor serum calcium levels. 2 Administer potassium to correct hypokalemia. 3 Administer sodium bicarbonate if severe acidosis is present. 4 Administer 0.9% sodium chloride (NaCl) to correct fluid imbalance. 5 Administer 5% to 10% dextrose when the glucose levels are below 250 mg/dL.
2, 3, 4 Severe dehydration, dry mouth, fever associated with chills, fruity odor of breath, and a burning sensation while urinating are the clinical manifestations of diabetic ketoacidosis. It is a complication of untreated type I diabetes mellitus. The line of treatment is to administer potassium, sodium bicarbonate, and 0.9% NaCl to correct the acid-base balance in the body. Monitoring serum calcium levels is not related to diabetes. A solution of 5% to 10% dextrose is given when the glucose levels approach 250 mg/dL, not when they are below 250.
Which medications would be beneficial in a patient with diabetes mellitus who complains of numbness and a tingling sensation in the lower extremities? Select all that apply. 1 Losartan 2 Duloxetine 3 Gabapentin 4 Bethanechol 5 Amitriptyline
2, 3, 5 Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor that is used for treatment of sensory neuropathy in patients with diabetes. Gabapentin is an antiseizure medication that decreases the release of neurotransmitters that transmit pain in patients with neuropathy. Amitriptyline is a tricyclic antidepressant used in the treatment of sensory neuropathy. Losartan is an angiotensin receptor blocker used to delay the progression of kidney damage in patients with diabetes. Bethanechol is used for the treatment of neurogenic bladder, which is caused by autonomous neuropathy.
A nurse is caring for a 62-year-old man with a history of hypertension and type 2 diabetes who has been admitted to the inpatient unit for pneumonia. The nurse enters the patient's room to complete an admission assessment and notices that the patient has slurred speech and right-sided weakness. After calling the rapid response team, which action would the nurse take next? 1 Obtain vital signs. 2 Obtain a crash cart. 3 Check blood glucose. 4 Perform a neurologic assessment.
3 A patient's blood glucose levels in hyperosmolar hyperglycemic syndrome can be very high; they increase serum osmolality and produce severe neurologic manifestations, such as aphasia and hemiparesis. It is critical to check the patient's blood glucose level for correct diagnosis and treatment because these signs and symptoms resemble those of a stroke. Obtaining vital signs is not the next action to take; that can happen later. Obtaining the crash cart is not necessary in this situation. Performing a neurologic assessment can be done, but it is not the next action the nurse should take.
A patient with diabetes mellitus has a blood glucose level of 680 mg/dL and minimal ketone levels in the urine. Which other finding would the nurse observe in the laboratory reports? 1 Decreased blood pH 2 Increased potassium 3 Increased serum osmolality 4 Decreased serum bicarbonate
3 Blood glucose of 680 mg/dL and a minimal amount of ketones in the urine indicate that the patient has hyperosmolar hyperglycemic syndrome; the patient will also have increased serum osmolality. Decreased blood pH is associated with diabetic ketoacidosis. Patients with hyperosmolar hyperglycemic syndrome may have milder potassium deficits (hypokalemia) due to fluid losses. Decreased serum bicarbonate is observed with diabetic ketoacidosis.
Which treatment would be done initially for a patient with diabetic ketoacidosis who arrived at the hospital with clinical symptoms of dry mucous membranes, tachycardia, and orthostatic hypotension? 1 Infusion of 5% to 10% dextrose 2 Subcutaneous injection of 1 mg glucagon 3 Infusion of 0.45% or 0.9% sodium chloride (NaCl) 4 IV administration of 25 to 50 mL of 50% glucose
3 Dry mucous membranes, tachycardia, and orthostatic hypotension indicate severe dehydration. Infusion of 0.45% or 0.9% NaCl is given for fluid replacement to prevent dehydration. Infusion of 5% to 10% dextrose is given to prevent hypoglycemia. If the patient has severe hypoglycemia and is in an unconscious state, a subcutaneous injection of 1 mg glucagon or IV administration of 25 to 50 mL of 50% glucose is given.
Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis? 1 Polyuria 2 Hypokalemia 3 Cerebral edema 4 Metabolic acidosis
3 Incorrect fluid replacement especially with hypotonic fluids may cause a sudden drop in serum sodium resulting in cerebral edema. Polyuria is a manifestation of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Hypokalemia may be seen with severe dehydration. Metabolic acidosis is observed with diabetic ketoacidosis due to fluid losses.
Which statement by the patient demonstrates effective learning about insulin therapy? 1 "I will remove the needle immediately after injection." 2 "I will not push the needle straight into the pinched-up area." 3 "I will not use the insulin if any particles appear in the solution." 4 "I will not rotate the injection within one anatomic site for at least one week."
3 Insulin should be discarded if any particles appear in the solution. The needle should be left in place for 5 seconds to ensure that all of the insulin dose has been injected, and then the needle may be removed. The needle should be pushed straight into the pinched-up area. The injection site should be rotated in a single anatomic spot, such as the abdomen, for at least one week before using a different site to allow better insulin absorption.
Which condition would be related to the laboratory findings of a patient with diabetes?
3 Laboratory findings of blood glucose level greater than 250 mEq/L, arterial blood pH less than 7.30, serum bicarbonate level less than 16 mEq/L, and the presence of moderate to large ketone bodies in the urine or serum indicate diabetic ketoacidosis. Diabetic retinopathy is microvascular damage to the retina; it may not be associated with these manifestations. Diabetic neuropathy is nerve damage due to diabetes mellitus. Diabetic nephropathy is damage to nephrons due to hyperglycemia.
Which symptom would the nurse teach the caregiver of a patient with diabetes to identify as a manifestation of hypoglycemia? 1 Increase in urination 2 Abdominal cramps 3 Nervousness and tremors 4 Nausea and vomiting
3 Nervousness and tremors; cold, clammy skin; and numbness of the fingers and toes are some of the manifestations of hypoglycemia that the caregiver should watch for out in the patient. An increase in urination, abdominal cramps, and nausea and vomiting are manifestations of hyperglycemia.
Which complication of diabetes can be diagnosed by the ankle-brachial index? 1 Diabetic neuropathy 2 Diabetic nephropathy 3 Peripheral arterial disease 4 Hyperosmolar hyperglycemic syndrome
3 The ankle-brachial index is used to diagnose peripheral arterial disease. Diabetic neuropathy is diagnosed based on the symptoms and by examining the patient's lower extremities. Increased serum creatinine, decreased glomerular filtration rate, and albuminuria are indicative of diabetic nephropathy. Hyperosmolar hyperglycemic syndrome is suspected if the blood glucose levels are more than 600 mg/dL, with a marked increase in serum osmolality.
Which statement made by a patient with diabetes indicates the need for additional learning about foot care? 1 "I will wear only padded socks." 2 "I will wash my feet daily with gentle soap." 3 "I will check my feet for swelling and cuts every day." 4 "I will sleep with a hot water bottle to warm my feet."
4 A patient suffering from severe diabetes may have sensory neuropathy. Hot water is not recommended because the patient will not be able to sense the degree of warmth of the water and may get burns. Using padded socks will protect the patient from cuts. Washing the feet daily with gentle soap will reduce the risk of infection. By checking for swelling and cuts every day, the patient can get timely treatment if needed.
A patient who is in diabetic ketoacidosis (DKA) is on a continuous short-acting insulin infusion and is receiving a continuous infusion of normal saline solution. Which assessment is the highest priority for this patient? 1 Urine output 2 Temperature 3 Respiratory rate 4 Cardiac monitoring
4 A patient with DKA is receiving a continuous insulin infusion, which causes potassium to move from the extracellular space to the intracellular space. This shift causes a decrease in the serum potassium level and can cause cardiac dysrhythmias; therefore, assessment of the cardiac monitor is the nurse's highest priority. Urine output is important to monitor for patients with DKA, but it is not the highest priority. All patients would have their temperature monitored, but it is not a priority in with this patient. The respiratory rate is important to monitor, but it is not the highest priority.
Which intervention will be beneficial for a patient with a blood glucose level of 250 mg/dL who is receiving treatment for hyperosmolar hyperglycemic syndrome? 1 Administering 0.9% NaCl 2 Administering 0.1 unit/kg/hr of insulin 3 Administering IM glucagon 4 Administering IV fluids containing glucose
4 A patient with hyperosmolar hyperglycemic syndrome whose blood glucose level approaches 250 mg/dL should receive IV fluids containing glucose to prevent hypoglycemia. NaCl 0.9% is administered in patients with diabetic ketoacidosis. Administering 0.1 unit/kg/hr of insulin is indicated to correct hyperglycemia and hyperketonemia. IM glucagon is administered in hypoglycemic patients who are unconscious.
While caring for a patient whose pancreas has been transplanted, which instruction given by the student nurse to the patient would need correction by the nursing instructor? 1 "Exogenous insulin is not required." 2 "Dietary restrictions are not required." 3 "Immunosuppression is required for life." 4 "Regular monitoring of glucose level is required."
4 After pancreatic transplantation, homeostasis of glucose level is achieved. There is no need for regular monitoring of the glucose level. Pancreatic transplantation helps in maintaining a normal glucose level, so exogenous insulin is not required. Many dietary restrictions can be lifted. Lifetime immunosuppression is very important to avoid organ rejection, which may happen after pancreatic transplantation.
A nurse, answering a patient's call bell, notices upon entering the patient's room that the patient is sweating profusely, pale, and anxious. The patient states, "I feel really dizzy and my vision is blurred." Which intervention is the highest priority? 1 Obtain vital signs. 2 Administer glucagon. 3 Have the patient lie flat. 4 Check blood glucose level.
4 Any patient exhibiting signs and symptoms of hypoglycemia—such as diaphoresis, pallor, anxiety, visual disturbances, or dizziness—should have his or her blood glucose level checked immediately. Obtaining vital signs is not an immediate intervention that needs to be implemented. Having the patient lie flat is not an intervention that needs to be done immediately. Administering glucagon is not an intervention to be performed unless the patient is worsening or unconscious.
A patient whose laboratory report shows a blood glucose level of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 is on therapeutic management. At a follow-up visit, the patient has severe hypokalemia (2 mEq/L). Which therapeutic intervention might have caused severe hypokalemia in this patient? 1 Administration of 0.9% NaCl 2 Administration of 1 mg glucagon 3 Administration of 5% to 10% dextrose 4 Administration of 0.1 U/kg/hr of insulin
4 Blood glucose of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 indicates that the patient has diabetic ketoacidosis. Administration of 0.1 U/kg/hr of insulin is responsible for the severe hypokalemia. Administration of 0.9% NaCl is useful for fluid restoration in patients with dehydration. Administration of 1 mg glucagon is beneficial for patients with severe hypoglycemia; 5% to 10% dextrose is added to the fluid regimen of diabetic ketoacidosis patients when blood sugar level approaches 250 mg/dL.
Which foods would the nurse encourage a patient with diabetes mellitus and coronary artery disease to limit intake of to help reduce the percentage of saturated fat in their diet? 1 Chicken and turkey 2 Frozen and canned vegetables 3 Enriched flour products 4 Dairy products
4 Cheese and dairy products are higher in fat and calories than vegetables, fruit, enriched flour products, or poultry and should be limited.
Which factor would the nurse explain to a diabetic patient might be the cause of the hypoglycemia he or she is experiencing? 1 Mild illness with fever 2 Insufficient injection of insulin 3 Overeating at a family holiday dinner 4 Exercising without a carbohydrate-based snack
4 Exercising without a carbohydrate-based snack could result in hypoglycemia. Mild illness, insufficient insulin dosage, and overeating are situations that would cause hyperglycemia, or an increased blood glucose level.
After giving 6 oz of orange juice to a patient with hypoglycemia, the nurse finds that the patient's blood glucose level is 65 mg/dL. Which nursing intervention would be the most appropriate in this situation? 1 Giving an additional 15 g of carbohydrate 2 Administering 5% to 10% dextrose infusion 3 Giving 25 to 50 mL of 50% glucose IV 4 Administering 1 mg IM glucagon
1 A patient with a blood glucose level less than 70 mg/dL should be given 15 g of carbohydrates (5 to 6 oz. of fruit juice) initially. If the glucose is still less than 70 mg/dL and the patient is stable and conscious, then an additional 15 g of carbohydrates should be given. Dextrose (5% to 10%) is added to the fluid regimen in patients who are on treatment for diabetic ketoacidosis if the blood glucose level approaches 250 mg/dL. Administering 25 to 50 mL of 50% glucose IV and 1 mg IM glucagon is indicated for an unconscious patient or if the symptoms of hypoglycemia are worsening.
Which complication of diabetes can cause hypoglycemic unawareness? 1 Diabetic neuropathy 2 Diabetic dermopathy 3 Diabetic ketoacidosis 4 Diabetic nephropathy
1 Autonomic neuropathy is a type of diabetic neuropathy. Autonomic neuropathy can affect all the systems in the body leading to hypoglycemic unawareness. Diabetic dermopathy may cause acanthosis nigricans and necrobiosis lipoidica diabeticorum. Diabetic ketoacidosis may cause dehydration, metabolic acidosis, and electrolyte disturbance. Diabetic nephropathy leads to reduction in the glomerular filtration rate of the kidneys.
Which complication of diabetes can be treated with hyperbaric oxygen? 1 Diabetic foot ulcers 2 Diabetic nephropathy 3 Neuropathic arthropathy 4 Peripheral vascular disease
1 Hyperbaric oxygen is used for wound healing in diabetic foot ulcers. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are used in the treatment of diabetic nephropathy. Neuropathic arthropathy results in ankle and foot changes and increases the chances of developing foot ulcers. Peripheral vascular disease is one of the macrovascular complications of diabetes. Management includes smoking cessation and control of hypertension.
After administering an intramuscular glucagon injection to an unconscious patient, which rationale would explain why the nurse would then turn the patient on their side? 1 To prevent aspiration 2 To avoid postural hypotension 3 To promote the patient's comfort 4 To help the patient regain consciousness
1 IM glucagon is administered for hypoglycemia. Because nausea is a common reaction after glucagon injection, the patient should be turned to one side until gaining consciousness in order to prevent aspiration if vomiting occurs. Glucagon is not associated with manifestation of postural hypotension, nor does a side-lying position help to manage postural hypotension. Because the patient is unconscious, turning to the side will not promote the patient's comfort. The patient who is unconscious due to severe hypoglycemia will regain consciousness due to administration of the glucagon injection.
While caring for a patient showing signs of dawn phenomenon, the student nurse teaches the patient ways to avoid an increased level of blood glucose in the morning. Which instruction indicates a need for further learning? 1 "Decrease your insulin intake." 2 "Take a sufficient amount of insulin before going to bed." 3 "Check your blood glucose level in the morning regularly." 4 "Notify the health care provider for dosage adjustments."
1 In dawn phenomenon, there is a rise in the blood glucose level in the night, which causes hyperglycemia in the morning. Therefore the treatment for dawn phenomenon is increasing the insulin intake. If insulin is taken before sleeping at night, then it will help to normalize the blood glucose level in the morning. A regular check on the blood glucose level in the morning will help to know the medication time, amount, and diet plan for maintaining an appropriate glucose level in the blood.
While caring for a patient with diabetic ketoacidosis, the nurse finds that the patient is experiencing rapid, deep breathing due to dyspnea. Which physiologic cause does the nurse suspect? 1 Altered pH balance 2 Dry mucous membranes 3 Increased serum osmolality 4 Increased endogenous insulin secretion
1 Rapid, deep breathing due to dyspnea is a characteristic feature of Kussmaul respirations, which occur due to metabolic acidosis. Altered pH balance in the body is responsible for metabolic acidosis. Dry mucous membranes are one of the manifestations of severe dehydration. Increased serum osmolality results in neurologic manifestations such as somnolence, coma, seizures, hemiparesis, and aphasia in patients with hyperosmolar hyperglycemic syndrome (HHS). Increased endogenous insulin secretion results in hypoglycemia.
The nurse advises a diabetic patient on insulin therapy who reports headaches on awakening and a history of night sweats to reduce the dose of insulin and have a bedtime snack. Which finding supports the nurse's instructions? 1 Blood glucose levels: 60 mg/dL between 2 AM and 4 AM 2 Blood glucose levels: 60 mg/dL between 2 PM and 4 AM 3 Blood glucose levels: 60 mg/dL between 2 PM and 4 PM 4 Blood glucose levels: 60 mg/dL between 2 AM and 4 PM
1 Reducing the dose of insulin and having a bedtime snack are the instructions given to a patient who is experiencing morning hyperglycemia. The Somogyi effect is characterized by morning hyperglycemia. If a patient is experiencing morning hyperglycemia, blood glucose levels between 2 AM and 4 AM will be low. The patient may report headaches on awakening and recall having night sweats or nightmares. A bedtime snack, a reduction in the dose of insulin, or both can help to prevent the Somogyi effect. Blood glucose levels of 60 mg/dL between 2 PM and 4 AM, blood glucose levels of 60 mg/dL between 2 AM and 4 PM, and blood glucose levels of 60 mg/dL between 2 PM and 4 PM are not associated with the Somogyi effect.
Which complication can be monitored by annual screening using a monofilament? 1 Diabetic neuropathy 2 Diabetic retinopathy 3 Diabetic dermopathy 4 Diabetic nephropathy
1 Sensory neuropathy is a type of diabetic neuropathy in which loss of protective sensation (LOPS) is common. LOPS may lead to lower extremity amputation. Therefore annual screening using a monofilament is important in monitoring the patient for diabetic neuropathy. Diabetic retinopathy is monitored by annual fundoscopic examination. Examining the skin changes is important in diabetic patients to monitor for diabetic dermopathy. Serum creatinine and urinalysis for microalbuminuria help to monitor for diabetic nephropathy.
Which symptom indicates that a patient with newly diagnosed type 2 diabetes mellitus is experiencing hyperglycemia? 1 Polydipsia 2 Weight gain 3 Diaphoresis 4 Loss of appetite
1 Symptoms of hyperglycemia, as seen in both forms of diabetes mellitus, include polydipsia (increased thirst), polyuria, polyphagia, and weight loss. Patients with hyperglycemia due to diabetes mellitus do not manifest weight gain or loss of appetite. Diaphoresis is a manifestation of hypoglycemia (low blood sugar).
Which drug would the nurse give to a patient who has type 2 diabetes and the presence of albumin in the urine? 1 Lisinopril 2 Duloxetine 3 Pregabalin 4 Bethanechol
1 The presence of albumin in the urine indicates nephropathy in patients with diabetes. Angiotensin-converting enzyme inhibitors such as lisinopril may delay the progression of nephropathy in diabetic patients. Duloxetine is a selective serotonin reuptake inhibitor that is used for symptomatic treatment of sensory neuropathy. Pregabalin is an antiseizure medication used for neuropathic pain in diabetic patients. Bethanechol is a cholinergic agonist that is indicated for the treatment of neurogenic bladder.
During a follow-up visit to learn about management of hypoglycemia, a patient's blood glucose level was found to be 65 mg/dL. Which action by the patient might be responsible for this? 1 Including whole milk in the diet 2 Including more fruits and juices in the diet 3 Performing moderate amounts of exercise 4 Including large quantities of rapid-acting carbohydrates in the diet
1 Whole milk contains a high-fat content and will reduce glucose absorption, and it may cause hypoglycemia. Fruit and juice in the diet cause a sudden rise in blood glucose level, resulting in hyperglycemia for a short period of time. Performing moderate amounts of exercise may help to maintain steady blood glucose levels. Including large quantities of rapid-acting carbohydrates may cause a rapid fluctuation to hyperglycemia.
Which rationales are correct when giving 1 mg of glucagon to treat hypoglycemia? Select all that apply. 1 IV access is not available. 2 The patient is unconscious or unable to swallow. 3 Deltoid muscle injection gives a faster response. 4 The patient prefers IM glucagon administration. 5 IM doses are smaller than IV doses.
1, 2, 3 The best reasons to administer 1 mg of glucagon by IM or subcutaneous injection are when the patient has no IV access or is unable to swallow oral glucose. Also, a deltoid muscle IM injection does produce a faster treatment response, which is desirable during an acute hypoglycemic emergency. This is because glucagon stimulates rapid glycogenolysis in the liver, making glucose readily available. If the patient can swallow and tells the nurse his or her preferred medication administration route, oral glucose is the best route and not an IM injection. Although it is true that the IM injection is smaller (1 mg/1 mL) compared to the IV injection (50% dextrose in 20 mL to 50 mL), the IV injection is better only in an acute care setting for a patient with patent IV access and not due to any dose size considerations.
Which clinical manifestations would be assessed in a patient who is in diabetic ketoacidosis (DKA)? Select all that apply. 1 Tachycardia 2 Kussmaul respirations 3 Orthostatic hypotension 4 Hypovolemic shock state 5 Reduced bowel movements 6 Manifestations that mimic alcohol intoxication state
1, 2, 3, 4 DKA is caused by profound deficiency of insulin, characterized by hyperglycemia, ketosis, acidosis, and dehydration. Tachycardia in DKA results from inadequate blood supply to the tissues. Kussmaul respirations, which involve rapid, deep breathing with dyspnea, are one of the characteristic symptoms of DKA. A hypovolemic shock state is a result of acid accumulation. Orthostatic hypotension may occur because the body is unable to maintain an even distribution of fluids in its various compartments. Reduced bowel movements are not associated with DKA. Symptoms that mimic an alcohol intoxication state are present in a hypoglycemic condition.
Which instructions would the nurse give the patient who has a history of diabetes about foot care? Select all that apply. 1 "Wear shoes and socks." 2 "Walk regularly and exercise." 3 "Clean the wounds with iodine." 4 "Apply oil and cream between the toes." 5 "Protect the feet from extreme heat and cold."
1, 2, 5 Wearing shoes and socks helps to protect the feet from any sharp objects that may cause injury. Physical activities, such as walking and exercise, are advised for weight management and to improve circulation to the extremities. Protecting the feet from extreme temperatures prevents injury. Iodine should not be used for cleaning wounds because it may cause further localized tissue damage. The area between the toes should always be kept dry, and applying creams and oils should be avoided.
Which symptoms may be observed in patients with diabetic ketoacidosis (DKA)? Select all that apply. 1 Lethargy 2 Flushed, moist skin 3 Hypoventilation 4 Soft and sunken eyes 5 Sweet fruity odor of breath
1, 4, 5 Dehydration in patients with DKA results in lethargy, soft and sunken eyes, and sweet fruity odor of breath. Skin would be flushed and dry, not moist. Patients with DKA typically experience a rapid, deep-breathing pattern known as Kussmaul respirations, not hypoventilation, as a means of correcting the acid-base imbalance caused by the condition.
Which process is related to nonproliferative retinopathy? 1 Hemorrhage 2 Microaneurysm 3 Neovascularization 4 Retinal detachment
2 Partial occlusion of the small blood vessels in the retina causes microaneurysms in nonproliferative retinopathy. Hemorrhage is seen in proliferative retinopathy because of fragile, newly formed blood vessels. In proliferative retinopathy, the retinal capillaries become occluded, resulting in the formation of new vessels. This process is called neovascularization. Partial or complete retinal detachment occurs if the new blood vessels pull the retina while the vitreous contract.
A patient with type 1 diabetes mellitus has received a prescription for a β-adrenergic blocker. Which issue would the nurse recognize as the major concern for this patient? 1 Frequent night sweats 2 Lessened ability to sense hypoglycemia 3 More frequent episodes of hyperglycemia 4 The need for an increased basal insulin dosage
2 Patients who are hypoglycemic experience a drop in blood glucose level below normal and most often complain of weakness, nervousness, tremors, and diaphoresis. β-adrenergic blockers can mask hypoglycemia-induced tachycardia, thereby decreasing the diabetic patient's ability to sense a drop in blood sugar. β-adrenergic blockers do not cause night sweats or require an increased insulin dosage. Diabetic and nondiabetic patients may notice a slight increase in blood sugar, but this is not as significant a priority as the patient's not being able to sense hypoglycemia.
To which patient would it be dangerous to administer glucagon? 1 Patient with cerebral edema 2 Patient with alcoholic liver disease 3 Patient with chronic hyperglycemia 4 Patients with peripheral vascular disease
2 Patients with alcohol-related hepatic disease may have minimal glycogen stores and will not respond to glucagon. Cerebral edema is related to a rapid decrease in the blood glucose levels. Patients with chronic hyperglycemia may develop chronic complications of diabetes mellitus. Peripheral vascular disease is one of the macrovascular complications of diabetes.
The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. Which statement made by the patient indicates the patient understands the principles of foot care? 1 "I should only walk barefoot in nice dry weather." 2 "I should look at the condition of my feet every day." 3 "I am lucky my shoes fit so nice and tight because they give me firm support." 4 "When I am allowed up out of bed, I should check the shower water with my toes."
2 Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. The patient should not walk barefoot. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.
Which drug may result in weight gain as a side effect? 1 Biguanides 2 Meglitinides 3 Dopamine agonist 4 Dipeptidyl peptidase-4 inhibitors
2 Weight gain is a common side effect seen with meglitinides. Biguanides, dopamine agonists, and dipeptidyl peptidase-4 inhibitors may not result in weight gain.
The nurse is instructing a diabetic patient who has infrequent voiding and a weak stream of urine. Which action by the patient indicates the need for additional teaching? 1 Emptying the bladder every three hours 2 Emptying the bladder in a sitting position 3 Loosening the abdominal muscles during voiding 4 Massaging downwards over the lower abdomen and bladder
3 The abdominal muscles should be tightened for complete voiding of the urine and to prevent urine stasis. Difficulty in voiding the urine in patients with diabetes is due to autonomic neuropathy. Emptying the bladder every three hours helps to prevent stasis and subsequent infections. Emptying the bladder in a sitting position helps to void the urine completely. Massaging downwards over the lower abdomen and bladder may promote complete bladder emptying.
Administration of which prescribed intervention may help to prevent further complications in an unconscious patient with a history of diabetes whose blood sugar level is found to be 65 mg/dL? 1 100 mL of whole milk orally 2 15 g of fast-acting carbohydrate orally 3 25 to 50 mL of 50% glucose IV 4 20 to 40 U of 30/70 insulin subcutaneously
3 The patient should be immediately administered 25 to 50 mL of 50% glucose IV, which would rapidly raise the glucose concentration in the bloodstream. An oral route of administration of fast-acting carbohydrate is not appropriate in an unconscious patient. Treatment with carbohydrate that contains fats, such as whole milk, should be avoided because the fat will decrease the absorption of glucose and delay the response. Insulin is to be administered in patients with hyperglycemia.
Which is a symptom of autonomic neuropathy? 1 Aphasia 2 Glaucoma 3 Paresthesia 4 Gastroparesis
4 Gastroparesis is delayed gastric emptying, which is one of the complications of autonomic neuropathy. Aphasia is one of the severe neurologic manifestations of hyperosmolar hyperglycemic syndrome. Glaucoma may occur due to diabetic retinopathy. Paresthesia is seen in sensory neuropathy.
Which instruction would the nurse include in the teaching plan about emptying the bladder for a patient who has diabetes and a neurogenic bladder? 1 Empty the bladder every five hours. 2 Relax abdominal muscles during voiding. 3 Massage the lower abdomen horizontally. 4 Use the Credé maneuver to completely empty the bladder.
4 The nurse should instruct the patient with neurogenic bladder to use the Credé maneuver to completely empty the bladder. The Credé maneuver involves mild downward massage over the lower abdomen and bladder. The nurse should also instruct the patient to empty the bladder every three hours in a sitting position to prevent stasis and subsequent infection. The patient should tighten the abdominal muscles and massage the lower abdomen downward to empty the bladder completely.