CH. 59: Diabetes Mellitus Health Promotion & Maintenance; Patient Care; Pathophysiology

When a patient with diabetes mellitus received insulin aspart at 8:00 a.m., at which time would the nurse anticipate a potential hypoglycemic event to occur? 8:30 a.m. 4:00 p.m. 8:30 p.m. 11:00 a.m.

11:00 a.m. Insulin aspart is a rapid-acting insulin with an onset of 15 minutes, a peak in 1 to 3 hours, and a duration of action of 3 to 5 hours. Episodes of hypoglycemia are more likely during the peak action of the medication. In this case, the time would be at 11:00 a.m.

To prevent hypoglycemia during surgery, which blood glucose level would the operating room nurse recognize as optimal during surgery? 90 mg/dL 120 mg/dL 130 mg/dL 150 mg/dL

150 mg/dL. A blood glucose level of 150 mg/dL is optimal. The Joint Commission's National Patient Safety Goals recommend a blood glucose level between 140 and 180 mg/dL. The values 90, 120, and 130 mg/dL are too low.

After a patient with diabetes receives teachings regarding nutrition therapy, which food item would the patient consume when becoming hypoglycemic at home? 1 teaspoon of sugar 1 tablespoon of honey 1 oz of skim milk 1 cup of fruit juice

1 tablespoon of honey. A patient with hypoglycemia can consume 1 tablespoon of honey to adjust his or her blood glucose level. The patient should have 8 oz of skim milk, not just 1 oz, to manage hypoglycemia. Half a cup of fruit juice, not a full cup, is generally sufficient to raise the glycemic level. The patient requires at least 4 teaspoons, not 1 teaspoon, of sugar to overcome hypoglycemia.

Which explanation best assists a patient in differentiating type 1 diabetes from type 2 diabetes? 1. People with type 1 diabetes are often obese. 2. Most patients with type 1 diabetes are born with it. 3. Those with type 2 diabetes make insulin, but in inadequate amounts. 4. People with type 2 diabetes do not develop typical diabetic complications.

3. Those with type 2 diabetes make insulin, but in inadequate amounts. People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for complications, especially cardiovascular complications.

When teaching a patient about insulin therapy, the nurse would explain that which injection site area has the best insulin absorption rate? Thigh Deltoid Buttocks Abdomen

Abdomen. Insulin absorption occurs the fastest in the abdomen, followed by the deltoid, thigh, and buttocks.

Which exercise would the nurse explain is appropriate for a patient with diabetic peripheral neuropathy? Select all that apply. One, some, or all responses may be correct. Yoga Walking Running Bicycling Swimming

Bicycling Swimming Bicycling and swimming are non-weight-bearing activities that a patient with diabetic peripheral neuropathy can participate in. Walking, running, and yoga are all weight-bearing exercises and are contraindicated for this patient.

When preparing to teach a patient with diabetes about a common side effect of metformin, the nurse would include which symptom of lactic acidosis? Diarrhea Restlessness Blurred vision Increased appetite

Diarrhea. Diarrhea is a common side effect of metformin. Restlessness, blurred vision, and increased appetite are not symptoms of lactic acidosis.

When assisting with health screenings, for which laboratory value would the nurse teach the patient about diabetes? A1C of 4.5% Fasting blood glucose of 127 mg/dL Random blood glucose of 198 mg/dL 2-hour glucose of 150 mg/dL during oral glucose tolerance test

Fasting blood glucose of 127 mg/dL. A fasting blood glucose of 127 mg/dL would indicate the patient may have diabetes. The A1c, random blood glucose test, and the 2-hour glucose test values are all within normal parameters.

Which interpretation would the nurse associate with a fasting blood glucose of 65 mg/dL? Hypoglycemia Hyperglycemia More information needed Normal result in range for fasting

Hypoglycemia. Hypoglycemia is a fasting blood glucose level lower than 74 mg/dL. Hyperglycemia is a fasting blood glucose level greater than 106 mg/dL. These are universal guidelines, so more information is not necessary. The normal range for fasting blood glucose levels is 74 to 106 mg/dL.

For the patient with diabetes and extremely elevated blood glucose levels, which mechanism causes the resulting electrolyte imbalances? Osmotic diuresis Cellular starvation Exhalation of acetone Free fatty acid release

Osmotic diuresis. Frequent and excessive urination results from osmotic diuresis caused by excess glucose in the blood and urine. With diuresis, electrolytes are excreted in the urine, causing imbalances. Cellular starvation occurs because insufficient insulin is available to facilitate the movement of glucose into the cells for energy. Free fatty acids are released because insulin is not present to facilitate glucose to be used for energy. Acetone is exhaled as the body attempts to reduce the buildup of excess hydrogen ions and carbon dioxide in the blood.

Which intervention would the nurse implement when a patient presents to the emergency department with vomiting and abdominal pain, as well as rapid, deep respirations and a current blood glucose of 480 mg/dL? Restrict fluids. Check the urine for ketones. Provide mechanical ventilation. Administer subcutaneous insulin.

Check the urine for ketones. The nurse should check the patient's urine for ketones to determine if the patient is experiencing diabetic ketoacidosis (DKA). After checking the urine, the initiated IV fluids would restore and maintain fluid and electrolyte balance. Administer IV insulin, not subcutaneous, to lower serum glucose levels quickly. This patient does not require mechanical ventilation when manifesting these symptoms.

When teaching patients with diabetes about the need for annual eye care, the nurse explains that which patient group is statistically at risk for foregoing annual eye care because of the cost or lack of insurance? SATA. White men Hispanics African Americans White women 18 to 30 years old Those with diagnosed visual problems

Hispanics African Americans Patients with diabetes who are Hispanic and African American, those patients who have less formal education, and those who are women between 40 and 64 years of age are likely to cite cost and lack of insurance as reasons to forego annual eye care. White men and those with diagnosed visual problems are less likely to skip annual eye care, and if they do, it is usually for reasons other than finances.

Which statement would the nurse associate with repaglinide? Patients may take repaglinide without regard to food. Repaglinide is effective in people with type 1 and type 2 diabetes. The medication increases the secretion of insulin from the pancreas. This drug works best when taken before the first meal of the day.

The medication increases the secretion of insulin from the pancreas. Repaglinide is a short-acting oral hypoglycemic agent that works by increasing insulin secretion from the pancreas. The patient should not take this medication if he or she skips a meal. Only patients with type 2 diabetes take this medication. Patients should take repaglinide three times daily, 1 to 30 minutes before each meal.

Which symptom would the nurse associate with autonomic neuropathy? SATA. Eye pain Paresthesia Atonic bladder Dried, cracked skin Asymmetric weakness Orthostatic hypotension

Atonic bladder Dried, cracked skin Orthostatic hypotension Atonic bladder; dried, cracked skin; and orthostatic hypotension are all symptoms of autonomic neuropathy. Eye pain is a symptom of focal neuropathy (focal ischemia). Paresthesia and asymmetric weakness are symptoms of distal symmetric polyneuropathy.

Which situation describes the etiology of type 1 diabetes mellitus (DM)? Beta cell failure Insulin resistance Progressive disorder Autoimmune disorder

Autoimmune disorder. Type 1 DM is an autoimmune disorder in which destruction of the beta cells occurs in a genetically susceptible person. Beta cell failure and insulin resistance are characteristics of type 2 DM. Type 2 DM is a progressive disorder.

Which method must a patient with diabetes implement regarding insulin safety? Shake insulin well before administration. Discard any unused insulin after 28 days. Refrigerate unused insulin at 32°F (0°C). Store prefilled syringes in a horizontal position

Discard any unused insulin after 28 days. The patient must discard any unused insulin after 28 days because a slight loss in potency may occur after the bottle has been in use for more than 30 days, even when the expiration date has not passed. Gently roll the bottle or the prefilled syringe between the hands, but do not shake vigorously before administration to prevent loss of potency. Prefilled syringes must be stored upright, with the needle pointing upward, to prevent clogging of the needle. To prevent loss of drug potency, do not expose unused insulin to temperatures below 36°F (2.2°C).

Which complication of diabetes would the nurse recognize as a chronic complication? SATA. Neuropathy Retinopathy Nephropathy Hypoglycemia Diabetic ketoacidosis Hyperglycemic-hyperosmolar state

Neuropathy Retinopathy Nephropathy Neuropathy, retinopathy, and nephropathy are all chronic complications of diabetes. Hypoglycemia, diabetic ketoacidosis, and hyperglycemic-hyperosmolar state are acute complications that require emergency treatment.

Which clinical manifestation (finding) would the nurse identify in a patient with type 2 diabetes mellitus? Hunger Obesity Weight loss Increased urine output

Obesity 60% to 80% of patients with type 2 diabetes mellitus are obese. Hunger, weight loss, and increased urine output are symptoms associated with type 1 diabetes mellitus.

For the patient with type 1 diabetes, which intervention would the nurse consider teaching when the patient reports multiple episodes of hypoglycemia? Administer insulin in the legs only. Check blood glucose every hour. Avoid the use of insulin aspart. Only use the fingertips for blood glucose checks.

Only use the fingertips for blood glucose checks. Patients with type 1 diabetes experiencing multiple episodes of low blood glucose are likely to be unaware of the physical changes of hypoglycemia as it develops and worsens, and this is called hypoglycemic unawareness. Patients with a history of hypoglycemic unawareness should only use the fingertips for blood glucose testing because studies indicate there is a wide variation between fingertips and alternate testing sites. The variation is most evident during times when blood glucose levels are changing rapidly. Patients should also know a lag time occurs for blood glucose levels between the fingertip and other sites when blood glucose levels change rapidly, and a fingertip reading is the only safe choice during those times. Patients do not need to administer insulin only in the legs or check their blood glucose every hour, and there is no indication the patient should limit insulin aspart use.

Which disorder would the nurse suspect in a patient with type 2 diabetes mellitus who experiences an eye hemorrhage and vision changes? Venous beading Optic nerve atrophy Closed-angle glaucoma Proliferative diabetic retinopathy

Proliferative diabetic retinopathy. Proliferative diabetic retinopathy is the growth of new retinal blood vessels. The new vessels are thin, fragile, and bleed easily, leading to eye hemorrhage and vision loss. Venous beading is the abnormal appearance of retinal veins in which areas of swelling and constriction along a segment of vein resemble links of sausage. It occurs in areas of retinal ischemia. Optic nerve atrophy would not affect blood vessel status. Vision changes would occur, but hemorrhage most likely would not with optic nerve atrophy. Closed-angle glaucoma is not associated with diabetes mellitus.

Which exercise would the nurse instruct the patient diagnosed with proliferative diabetic retinopathy to avoid? Walking Swimming Weightlifting Arm exercises

Weightlifting. Patients diagnosed with proliferative diabetic retinopathy should avoid weightlifting because the heavy lifting could cause complications. Walking, swimming, and arm exercises are not contraindicated.

For the patient with diabetes who received nutritional education and started regular exercise, which laboratory value obtained at a routine health screening visit potentially indicates a need to begin medication therapy? Triglyceride level of 130 mg/dL Premeal blood glucose level of 120 mg/dL Glycosylated hemoglobin (HbA1c) 7.0% Peak after meal blood glucose level of 170 mg/dL

Glycosylated hemoglobin (A1C) 7.0% An A1C level of 7.0% indicates that the patient's blood glucose levels are not controlled, even with nutrition and exercise. The triglyceride, premeal blood glucose, and peak after meal blood glucose levels are normal.

Which distinguishing characteristic would the nurse associate with proliferative diabetic retinopathy? Hard, fatty deposits in the eye Formation of new retinal blood vessels Sausage-like appearance of retinal veins Dilation of the capillary wall in the retinal veins

Formation of new retinal blood vessels Proliferative diabetic retinopathy refers to the formation of new retinal blood vessels or neovascularization. The new retinal blood vessels are thin, fragile, and bleed easily, leading to eye hemorrhage and vision loss. Non-proliferative diabetic retinopathy causes structural problems in retinal vessels, such as hard, fatty deposits in the eye and dilation of the capillary wall in retinal veins. Venous beading is the abnormal appearance of retinal veins, in which areas of swelling and constriction along a segment of vein resemble links of sausage.

To minimize gaining weight secondary to insulin resistance, the nurse would teach a patient with type 1 diabetes which action to implement? Restricting calories Increasing insulin Decreasing exercise Changing administration sites

Restricting calories To avoid weight gain from insulin resistance, the patient should restrict calories rather than increase insulin. Increasing insulin and decreasing exercise will add to the weight gain. Sites of administration will not affect weight.

For the patient with diabetes mellitus, which medication, if taken, protects the kidneys and helps prevent diabetic nephropathy? Digoxin Lisinopril Propranolol Metoclopramide

Lisinopril. Medications protecting the kidneys are the angiotensin-converting enzyme (ACE) inhibitors and the angiotensin receptor blockers (ARBs); lisinopril is an ACE inhibitor. Propranolol is a beta-adrenergic blocking agent used for hypertension, but it does not possess protective effects for the kidneys. Metoclopramide promotes gastric emptying for patients with diabetes who have gastroparesis. Digoxin is a glycoside to slow or strengthen the force of cardiac contraction in patients with atrial fibrillation or heart failure; it does not protect the kidneys from diabetic nephropathy.

When screening patients in a clinic, the nurse would associate which population with belonging to a higher-risk group for developing type 2 diabetes? SATA. Women Mexican Americans School-age children Patients diagnosed with type 1 diabetes Patients with glucose intolerance during pregnancy

Mexican Americans. Patients with glucose intolerance during pregnancy. Mexican Americans and women with glucose intolerance during pregnancy are at increased risk for developing type 2 diabetes. Women and school-age children are not at higher risk for developing type 2 diabetes. Patients with type 1 diabetes cannot develop type 2 diabetes.

Which distinguishing characteristic of glucagon would the nurse need to know when providing care for a patient with diabetes? 1 The secretion of glucagon occurs within 10 minutes of ingestion of food. 2 Glucagon triggers the release of glucose from cell storage sites. 3 The beta cells of the islets of Langerhans secrete glucagon. 4 Glucagon permits the body to take up, use, and store carbohydrates.

2 Glucagon triggers the release of glucose from cell storage sites. Glucagon is a "counterregulatory hormone" that prevents hypoglycemia by triggering the release of glucose from cell storage sites. The alpha cells of the islets of Langerhans secrete glucagon, and the beta cells of the islets of Langerhans secrete insulin. Insulin prevents hyperglycemia by allowing the body to take up, use, and store carbohydrates. When the glucose levels fall and insulin secretions stop, the release of glucagon occurs. The secretion of Insulin occurs within 10 minutes of ingestion of food and continues secretion until the blood glucose level is normal.

Which information would the nurse teach a patient with diabetes about foot care? Soaking feet once a week is important Wearing the same shoes most days is important Applying moisturizing cream between toes and on feet Checking bath water with a thermometer before stepping into the water

Checking bath water with a thermometer before stepping into the water. Checking the bath water temperature with a thermometer before stepping into the water is important for patients with diabetes. Patients with diabetes should not soak their feet, they should not put moisturizing cream between their toes, and they should avoid wearing the same shoes 2 days in a row.

Which oral medication lowers blood glucose levels by preventing kidney reabsorption of glucose and sodium filtered from the blood and allows excretion of the filtered glucose into the urine, rather than movement back into the blood? Alogliptin Exenatide Pramlintide Dapagliflozin

Dapagliflozin. Dapagliflozin is a sodium-glucose cotransport inhibitor that works by preventing kidney reabsorption of glucose and sodium filtered from the blood and allows excretion of the filtered glucose in the urine, rather than moving it back into the blood. Alogliptin is a DPP-4 inhibitor that works by preventing the enzyme DPP-4 from breaking down the natural gut hormones (GLP-1 and GIP), which then allows these natural substances to work with insulin to lower glucagon secretion from the pancreas. Pramlintide is an amylin analog that works by decreasing endogenous glucagon, delaying gastric emptying, and triggering satiety. Exenatide is an incretin mimetic (GLP-1 agonist) that works with insulin to lower blood glucose levels by reducing pancreatic glucagon secretion; reducing liver glucose production; and delaying gastric emptying, which slows the rate of nutrient absorption into the blood.

For a patient treated for cardiovascular disease and an increased risk for developing type 2 diabetes mellitus, on which health problem would the nurse focus the patient's assessment? Hypoglycemia Gestational diabetes Metabolic syndrome Autonomic neuropathy

Metabolic syndrome. Metabolic syndrome is the simultaneous presence of metabolic factors known to increase risk for developing type 2 diabetes mellitus and cardiovascular disease. Hypoglycemia is low blood glucose, which does not increase the risk of developing type 2 diabetes mellitus. Gestational diabetes is the development of diabetes while pregnant. There is no information to suggest that the patient is pregnant. Autonomic neuropathy is a type of diabetic neuropathy that develops after having diabetes for many years.

Which medication would the nurse associate with lowering blood glucose levels by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity? Pioglitazone Glipizide Glimepiride Metformin

Metformin. Metformin is a biguanide medication that lowers blood glucose levels by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity. Pioglitazone is a thiazolidinedione that lowers blood glucose levels by decreasing liver glucose production and improving the sensitivity of insulin. Glipizide and glimepiride are second-generation sulfonylurea agents that lower blood glucose levels by triggering the release of preformed insulin from beta cells.

For the patient with diabetes, which factor would the nurse associate with a risk for developing vision loss? SATA. Proteinuria Hyperalgesia Metatarsalgia Systolic hypertension Poor glucose regulation

Proteinuria Poor glucose regulation Proteinuria and poor glucose regulation are risk factors for vision loss in people with diabetes. Hyperalgesia and metatarsalgia are not related to vision loss and people with diabetes. Systolic hypertension is not related to vision loss; diastolic hypertension is.

For the patient with diabetes mellitus, which microvascular complication of the blood vessel structure may occur? SATA. Retinopathy Nephropathy Coronary heart disease Cerebral vascular disease Peripheral vascular disease

Retinopathy Nephropathy Retinopathy and nephropathy are microvascular complications that can occur with diabetes mellitus. Coronary heart disease, cerebral vascular disease, and peripheral vascular disease are macrovascular diseases that are complications of diabetes mellitus.

Which clinical manifestation would the nurse associate with a patient's autonomic neuropathy of the feet secondary to diabetes mellitus? Claw toe deformity Diabetic foot ulcer Reduced sensation Skin cracks and fissures

Skin cracks and fissures. Autonomic neuropathy causes loss of normal sweating and skin temperature regulation, resulting in dry, thinning skin. Skin cracks and fissures increase the risk for infection. Motor neuropathy causes claw toe deformity; toes are hyperextended and increase pressure on the metatarsal heads, resulting in ulceration. Sensory neuropathy causes numbness and reduced sensation; as a result, the patient does not notice injuries to the foot.

Which assessment finding would the nurse identify as a risk for type 2 diabetes mellitus (DM) and cardiovascular disease (CVD)? Blood pressure (BP) of 120/80 mm Hg Body mass index less than 25 kg/m2 Fasting blood glucose level of 90 mg/dL Waist circumference of 40 inches or more

Waist circumference of 40 inches or more. Abdominal obesity, indicated by a waist circumference of 40 inches or more in men and 35 inches or more for women, is a risk factor for type 2 DM and CVD. The risk for CVD is reduced if the body mass index is maintained at less than 25 kg/m 2. A fasting blood glucose level of 90 mg/dL, a systolic BP of 120 mm Hg, and a diastolic BP of 80 mg Hg are normal findings. A fasting blood glucose level of 100 mg/dL or more, or drug treatment for hyperglycemia or hypertension, increases the risk for type 2 DM and CVD.

For a patient diagnosed with peripheral neuropathy secondary to diabetes, which instruction about footwear would the nurse include in the teaching plan? Heels should be less than 1 inch high. Wear protective shoes fitted by the primary provider. Determine the proper fit of socks or stockings. Shoes should be 1 inch longer than the longest toe.

Wear protective shoes fitted by the primary provider. Patients with diabetes should wear properly fitting socks and stockings. An experienced shoe fitter, such as a certified podiatrist, should fit protective shoes to the patient. Shoes should be 1/2 to 5/8 inches longer than the longest toe. Heels should be less than 2 inches high.