Chapter 33 Diabetes Patho

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

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

A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be:

"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."

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?

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

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

2 hour oral GTT 175 mg/dl

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

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

Which of the following clients would be considered to be exhibiting manifestations of "prediabetes"?

A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL.

A 48-year-old male client diagnosed with type 2 diabetes presents with the following: • Blood glucose level of 46 mg/dL • Very lethargic • Has cool, clammy skin. Select the most appropriate intervention.

Administer injectable glucagon

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?

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

The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin?

Beta cells

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?

Brain

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

A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing:

Dawn phenomenon

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)?

Dry lips, excess urine output, and seizures.

A 15-year-old who has just been diagnosed with type 1 diabetes says she read on the Internet that diabetes is the leading cause of acquired blindness among Americans. She asks you if she will lose her sight. In addition to explaining that new treatment technologies are being worked on every day, which of the following would be the most appropriate response?

Explain that almost all people with type 1 diabetes do experience some degree of vision loss

A 40 year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which of the following aspects of the man's obesity likely contributed to his new health problem?

Free fatty acids contribute to problems such as beta cell dysfunction and insulin resistance.

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?

Glycosylated hemoglobin 5.2%

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?

Hyperglycemia

While working on the med-surg floor, the nurse has a client who is experiencing an insulin reaction. The client is conscious and can follow directions. The most appropriate intervention would be:

Immediately administer 15 g of glucose (preferably via oral route if the client is alert enough to swallow) and wait for 15 minutes. Then repeat this if necessary.

While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which of the following accurate information?

In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.

The diagnosis of type 1 diabetes would be confirmed by:

Insulin is not available for use by the body.

The nurse knows that metabolic abnormalities that lead to type 2 diabetes include which of the following? Select all that apply.

Insulin resistance • Beta cell failure • Hepatic glycogenolysis

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?

Maintain healthy blood pressure and blood sugar levels.

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

Orange juice orally

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?

Random blood glucose 85 mg/dl

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

Somogyi effect

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:

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

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?

The patient is achieving normal glycemic control.

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?

Vomiting after eating

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?

Woman with a family history of diabetes

How does insulin participate in cellular metabolism? Select all that apply.

• Transports glucose into skeletal muscle • Promotes triglyceride synthesis in the liver • Increases use of fatty acids as fuel

Infections are common in people with diabetes. Which infection is thought to be related to a neurogenic bladder?

Pyelonephritis

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?

Random blood glucose 195 mg/dl

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

Using an insulin infusion pump

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

Inspect the feet for blisters daily

What are the hallmark signs of diabetes mellitus?

Polyuria, polydipsia, and polyphagia

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

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

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.

• Fat storage • Glucose uptake by muscle and adipose tissue • Protein synthesis

Which complications may be experienced by a client with diabetic neuropathies? Select all that apply

• Foot ulcers • Gastroparesis • Erectile dysfunction • Urinary retention

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

• Polydipsia • Polyuria • Polyphagia

A diabetic client presents to a clinic for routine visit. Blood work reveals a HbA1C of 11.0% (high)? Which response by the patient may account for this abnormal lab result?

"My meter broke so I have not been checking my blood glucose levels for a while."

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?

Administration of intravenous fluids

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?

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

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

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

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:

Glycosylated hemoglobin, hemoglobin A1C (HbA1C)

A patient is evaluated for diabetes. Which of the following signs and symptoms would the nurse identify as indications of increased blood glucose levels? Select all that apply.

• Blurred vision • Thirst • Fatigue • Skin infections

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.

• Blurred vision • Weight loss • Thirst

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

Foot problems

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:

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

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:

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

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:

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

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?

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

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.

9

Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia?

Altered cerebral function and headache

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

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

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?

Blood glucose will elevate.

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?

Elevated fibrinogen levels and hyperinsulinemia

A nurse is teaching a patient with newly diagnosed type 1 diabetes about the importance of blood glucose control to decrease the risk of which of the following potential chronic complications of diabetes? Select all that apply.

Gastroparesis • Nephropathy • Retinopathy • Neuropathy

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?

Give the client a concentrated carbohydrate.

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?

Glargine (Lantus)

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?

Headaches, dizziness, change in level of consciousness.

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?

Hypoglycemia

A client is admitted to the emergency department and diagnosed with diabetic ketoacidosis (DKA). The client would most likely manifest:

Ketosis

Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk?

Kidneys and eyes

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:

Lispro

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

Loss of feeling or touch in the feet.

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.

The client is achieving normal glycemic control.

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

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

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

• Polydipsia • Polyuria • Polyphagia

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

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

A diabetic client presents to the clinic. He is concerned his lower legs are "feeling funny." Which of the following assessment findings lead the health care provider to suspect the client may have developed somatic neuropathy? Select all that apply.

• Both legs appear to be the same as far as numbness is involved. • Bilateral cool ankles and feet. • With eyes closed, the client cannot identify where the HCP is touching his feet.

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.

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

The nurse screening for diabetes mellitus at a health fair does not have enough supplies for all of the clients attending. Which clients should be given screening priority?

• Female age 30, history GDM • Male age 45, BMI 32 • Male age 65, hypertension

A young adult has been experiencing some extreme fatigue, changes in vision and unexpected weight loss. At the health clinic, the healthcare provider is assessing for hyperglycemia. Which would be considered the most commonly identifiable signs/symptoms of diabetes? Select all that apply.

• Frequent thirst • Excess urination • Ravaging hunger

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.

• Glyburide • Insulin

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.

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

A pregnant client asks the nurse if she is at risk for developing gestational diabetes. The nurse reviews the risk factors with the client. The most important information for the nurse to provide would be: Select all that apply.

• Polycystic ovary disease • Glycosuria • Severe obesity

The nurse knows that increased blood glucose levels will pull water out of cells and result in which of the following? Select all that apply.

• Polydipsia • Polyuria

A client presents to the emergency room with fatigue, weakness, dehydration and thirst. What additional symptoms would correlate with a diagnosis of type 2 diabetes mellitus? Select all that apply

• Polyuria • Blurred vision • Candida infection