CHAPTER 64 Care of Patients With Diabetes Mellitus

A patient diagnosed with diabetes has received education regarding safety with exercise. What statement by the patient demonstrates a need for further teaching? -'I will examine my feet after exercising.' -'I should not exercise if my blood sugar is over 150 mg/dL.' -'The peak onset of my insulin is not at a time I will be exercising.' -'If it has been more than an hour since I ate, I will have a carbohydrate snack.'

-'I should not exercise if my blood sugar is over 150 mg/dL.'

A patient newly diagnosed with diabetes is being instructed when to perform blood glucose monitoring. At what times does the nurse instruct the patient to check blood glucose? Select all that apply. -After eating -Before meals -Frequently if you are ill -If you are thirsty and urinate frequently -One hour after taking a rapid-acting insulin

-Before meals -Frequently if you are ill -If you are thirsty and urinate frequently

The nurse has provided education about factors responsible for increased rates of diabetes among minority groups. Which factor identified by the patient indicates a need for further teaching? -Lifestyle issues -Increased financial resources -Mistrust of the health care system -Lack of knowledge about glucose control and complications

-Increased financial resources

Which is a feature of metabolic syndrome? -A1C 5.0% -Triglycerides 220 mg/dL -Waist 33 inches for a female -Blood pressure 128/86 mm Hg

-Triglycerides 220 mg/dL

Which blood glucose level does the operating room nurse recognize as optimal during surgery to prevent hypoglycemia? 90 mg/dL 120 mg/dL 130 mg/dL 150 mg/dL

150 mg/dL

Which food will the nurse provide to a patient who has hypoglycemia and a blood glucose level of 60 mg/dL? 16 oz of milk 4 tbsp of honey Eight cubes of sugar A half cup of fruit juice

A half cup of fruit juice

The nurse is caring for a patient who is receiving sitagliptin. Which finding requires immediate attention? Hemoglobin A 1c 7% Creatinine 1 mg/dL Amylase 546 mg/dL Arterial blood pH 7.35

Amylase 546 mg/dL

What best describes the etiology of type 1 diabetes mellitus? Beta-cell failure Insulin resistance Progressive disorder Autoimmune disorder

Autoimmune disorder

Which hormones raise blood glucose levels? Select all that apply. Insulin Cortisol Glucagon Epinephrine Growth hormone Incretin hormones

Cortisol Glucagon Epinephrine Growth hormone

What macrovascular complications may occur as a result of diabetes mellitus? Select all that apply. Retinopathy Neuropathy Nephropathy Cardiovascular disease Cerebrovascular disease

Cardiovascular disease Cerebrovascular disease

A patient with diabetes mellitus reports a burning or tingling sensation in the toes. A primary health care provider suspects distal symmetric neuropathy. The nurse recognizes that which findings indicate motor alterations in the intrinsic muscles of the foot associated with this condition? Select all that apply. Foot drop Claw toes High arch Hammertoes Carpal tunnel syndrome

Claw toes High arch Hammertoes

What symptoms should be assessed for in a patient diagnosed with hypoglycemia? Select all that apply. Ketones Confusion Weakness Dehydration Cool, clammy skin

Confusion Weakness Cool, clammy skin

A patient has just been diagnosed with diabetes. Which factor is most important for the nurse to assess in the patient before providing instruction about the disease and its management? Current lifestyle Sexual orientation Current energy level Educational and literacy level

Educational and literacy level

Which manifestation is associated with hyperglycemia in a patient with diabetes mellitus? Pallor Irritability Diaphoresis Excessive urination

Excessive urination

The nurse is providing screening for diabetes. What findings are consistent with both type 1 and type 2 diabetes diagnosis? Select all that apply. Fatigue Polyuria Polydipsia Weight loss Hypertension

Fatigue Polyuria Polydipsia

The nurse is caring for an older adult patient with diabetes mellitus, acute renal failure, history of a thyroid tumor, and periodic angina. Which drug can be safely administered to control the patient's diabetes? Glipizide Liraglutide Metformin Pioglitazone

Glipizide

Which hormone is responsible for maintaining blood glucose levels during periods of fasting from food? Insulin Amylin Glucagon Proinsulin

Glucagon

Which of the following is the process of converting proteins to glucose? Proteolysis Ketogenesis Glycogenesis Gluconeogenesis

Gluconeogenesis

The nurse is providing nutritional education to a patient newly diagnosed with diabetes. What should be considered for optimal adherence to the plan? Select all that apply. Lifestyle Family history Financial status Cultural background Mental health history

Lifestyle Financial status Cultural background

The nurse is caring for a patient who has been on a hunger strike for 30 days and has no body fat and poor muscle definition. What mechanisms have been providing this patient with energy? Select all that apply. Lipolysis Proteolysis Ketogenesis Glycogenesis Glycogenolysis

Lipolysis Proteolysis

Which medication taken by a patient with diabetes mellitus will protect the kidneys and help prevent diabetic nephropathy? Digoxin Lisinopril Propranolol Metoclopramide

Lisinopril

What recommendations regarding exercise should the nurse provide to a high-risk diabetic patient? Select all that apply. Aerobic Resistance Weight lifting Low intensity Short periods

Low intensity Short periods

What teaching should be included for a patient with a new diagnosis of type 1 diabetes? Select all that apply. -Sick day rules -Avoidance of exercise -Daily inspection of feet -Reporting any vision changes -Weekly blood work for the first year

Sick day rules Daily inspection of feet Reporting any vision changes

The nurse is caring for a patient with diabetes who has autonomic neuropathy of the feet. What is the effect of this condition? Claw toe deformity Diabetic foot ulcer Reduced sensation Skin cracks and fissures

Skin cracks and fissures

What area of the patient's feet would the nurse identify as correct for assessing for plantar ulcers? Top of the foot Sole of the foot Side of the foot Between the toes

Sole of the foot

What intervention is most important to prevent complications for the patient diagnosed with diabetes? Low-calorie diet Tight glucose control Annual vision exams Daily foot inspection

Tight glucose control

Which signs and symptoms of hypoglycemia will a nurse instruct a patient who is prescribed insulin therapy to report? Select all that apply. Polyuria Tremors Polydipsia Headache Polyphagia

Tremors Headache

What findings are consistent with a diagnosis of hyperglycemia? Select all that apply. Hunger Nervousness Warm, moist skin Ketones in urine Kussmaul's respirations

Warm, moist skin Ketones in urine Kussmaul's respirations

Which instructions would the nurse include when educating a patient with diabetes about how to prevent fasting hyperglycemia known as "dawn phenomenon"? -"Administer Humalog (insulin lispro) between 5 and 6 a.m." -"Administer Humulin R (insulin [human recombinant]) between 5 and 6 a.m." -"Administer Lantis (insulin glargine) at 10 p.m. instead of with the evening meal." -"Administer Humulin 70/30 (insulin isophane and insulin regular) at 10 p.m. instead of with the evening meal."

-"Administer Humulin 70/30 (insulin isophane and insulin regular) at 10 p.m. instead of with the evening meal."

The nurse is triaging a patient diagnosed with type 2 diabetes who is prescribed metformin. It is suspected that the patient is having an adverse drug interaction. What question by the nurse is priority? -'Has anyone else been taking your medication?' -'Do you know how to properly use an insulin syringe?' -'Are you currently taking any over-the-counter medications?' -'Is there a chance you could have given yourself the wrong insulin?'

-'Are you currently taking any over-the-counter medications?'

A 5'8', 225-pound patient with metabolic syndrome has a blood pressure of 158/96 mm Hg, a high-density lipoprotein cholesterol level of 39 mg/dL, and a waist size of 44 inches. Which recommendation does the nurse make to this patient? -'Do not consume any concentrated sweets.' -'Consume fewer calories to reduce your weight.' -'Measure your abdominal circumference weekly.' -'Drink plenty of water to reduce your blood pressure.'

-'Consume fewer calories to reduce your weight.'

The nurse is caring for a patient who has just developed a meal plan after being diagnosed with diabetes. Which statement by the patient reflects an accurate understanding of the teaching provided? -'I am glad I'll be able to still eat some of my usual foods.' -'I will not need to monitor my blood glucose as frequently now.' -'Any meal adjustments will be based on my glucose monitoring.' -'Eating at different times a couple of days a week should not affect my blood glucose.'

-'I am glad I'll be able to still eat some of my usual foods.'

The nurse is providing discharge teaching to a patient with diabetes about injury prevention for peripheral neuropathy. Which statement by the patient indicates a need for further teaching? -'I should quit smoking.' -'I should never go barefoot.' -'I can break in my shoes by wearing them all day.' -'I need to monitor my feet daily for blisters or skin breaks.'

-'I can break in my shoes by wearing them all day.'

The nurse is teaching a patient with diabetes about proper foot care. Which statement by the patient indicates that teaching was effective? -'I should go barefoot in my house so that my feet are exposed to air.' -'I must inspect my shoes for foreign objects before putting them on.' -'I will soak my feet in warm water to soften calluses before trying to remove them.' -'I must wear canvas shoes as much as possible to decrease pressure on my feet.'

-'I must inspect my shoes for foreign objects before putting them on.'

The nurse is teaching a patient with type 2 diabetes about the importance of weight control. Which comment by the patient indicates a need for further teaching? -'I should monitor my diet.' -'Weight loss can be a sign of diabetic ketoacidosis.' -'I should begin exercising for at least an hour every day.' -'If I lose weight, I may be able to use less insulin.'

-'I should begin exercising for at least an hour every day.'

The nurse is teaching a patient about the manifestations and emergency treatment of hypoglycemia. In assessing the patient's knowledge, the nurse asks the patient what he or she should do if feeling hungry and shaky. Which response by the patient indicates a correct understanding of hypoglycemia management? -'I should sit down and rest.' -'I should drink a glass of water.' -'I should eat three graham crackers.' -'I should give myself 1 mg of glucagon.'

-'I should eat three graham crackers.'

The nurse is evaluating teaching that has been provided to a patient who was recently diagnosed with diabetes. What statement indicates a need for further teaching? -'I will avoid trans fats.' -'I will avoid eating fatty fish.' -'I will limit my cholesterol to less than 200 mg/day.' -'I will limit my fat intake to about 25% of my daily calories.'

-'I will avoid eating fatty fish.'

Which patient statements indicate that he or she has understood teaching regarding neuropathy? Select all that apply. -'I will soak my feet every night.' -'I will inspect my feet every day.' -'I will apply lotion between my toes.' -'I will take my prescribed gabapentin.' -'I will try to keep my blood glucose level steady.'

-'I will inspect my feet every day.' -'I will take my prescribed gabapentin.' -'I will try to keep my blood glucose level steady.'

A patient newly diagnosed with type 1 diabetes mellitus receives teaching about prevention of eye changes. Which statement indicates that additional teaching is required? -'I will need to have eye examinations every year.' -'Double vision could mean that my blood glucose is too low.' -'Blurred vision could mean that my blood glucose is too high.' -'In 5 years, I will need to have an eye examination every year.'

-'I will need to have eye examinations every year.'

The nurse is teaching a patient who has just been prescribed insulin glargine about administration. What statements by the patient indicate a need for further teaching? Select all that apply. -'I will administer it subcutaneously.' -'I cannot mix this with other insulins.' -'The insulin will start working in 2-4 hours.' -'I will take this before meals and at bedtime.' -'If I am hospitalized, I can receive this medication intravenously.'

-'I will take this before meals and at bedtime.' -'If I am hospitalized, I can receive this medication intravenously.'

The nurse is instructing a patient with diabetes about exenatide. Which patient statement indicates a correct understanding of the teaching? -'I should take these tablets before breakfast and dinner.' -'If I miss a dose, I should take it as soon as I remember.' -'I'll need to learn how to administer injections to myself.' -'I should not take any other diabetes medications if I take exenatide.'

-'I'll need to learn how to administer injections to myself.'

The nurse is providing discharge teaching to a patient with newly diagnosed diabetes. Which statement by the patient indicates a correct understanding about the need to wear a MedicAlert bracelet? -'I may need to be admitted to the hospital suddenly.' -'If I become hyperglycemic, it is a medical emergency.' -'If I become hypoglycemic, I could become unconscious.' -'Medical personnel may need confirmation of my insurance.'

-'If I become hypoglycemic, I could become unconscious.'

The nurse is caring for a 29-year-old patient who presents to the primary care clinic for an annual well exam. The patient asks the nurse, 'Should I be tested for diabetes?' What is the nurse's best response? Select all that apply. -'If you have a first-degree relative with diabetes, you should be tested for diabetes.' -'If your body mass index (BMI) is greater than 23 kg/m 2, you should be tested for diabetes.' -'If you have been diagnosed with vascular disease, you should be screened for diabetes.' -'Unless you have a family history for diabetes, it is recommended that screening for diabetes begins at the age of 50.' -'Unless you have a family history for diabetes, it is recommended that screening for diabetes begins at the age of 30.'

-'If you have a first-degree relative with diabetes, you should be tested for diabetes.' -'If you have been diagnosed with vascular disease, you should be screened for diabetes.'

The nurse is providing instructions to a patient scheduled for a fasting plasma glucose (FPG) test for diabetes screening. What statement by the patient reflects a need for further teaching? -'It is OK to have water the day of the blood work.' -'I won't take my insulin before my blood is drawn.' -'One elevated result does not mean I have diabetes.' -'It is important not to eat 12 hours before the labs are drawn.'

-'It is important not to eat 12 hours before the labs are drawn.'

The nurse is providing teaching for a patient newly diagnosed with type 1 diabetes. Which statements by the patient indicate an understanding of the teaching provided about continuous glucose monitoring? Select all that apply. -'The continuous monitoring will replace fingersticks.' -'I will not need to calibrate the continuous glucose monitoring system.' -'It is important to check fingersticks with continuous glucose monitoring.' -'I should purchase disposable sensors for the continuous glucose monitor system.' -'I will give myself an insulin bolus when my monitor shows my blood sugar is elevated.'

-'It is important to check fingersticks with continuous glucose monitoring.' -'I should purchase disposable sensors for the continuous glucose monitor system.'

The nurse is instructing a patient who has been newly diagnosed with diabetes mellitus. Which intervention does the nurse teach the patient that will help prevent microvascular complications of diabetes? -'Do not walk without shoes.' -'Avoid urinating frequently.' -'Have your eyes checked annually.' -'Keep your blood sugar in good control.'

-'Keep your blood sugar in good control.'

A patient expresses fear and anxiety over the life changes associated with diabetes, stating, 'I am scared I can't do it all and I will get sick and be a burden on my family.' What is the nurse's best response? -'It is overwhelming, isn't it?' -'Other people do it just fine.' -'Let's tackle it piece by piece. What is most scary to you?' -'Let's see how much you can learn today so you are less nervous.'

-'Let's tackle it piece by piece. What is most scary to you?'

The nurse is providing teaching about signs of hypoglycemia to a patient diagnosed with type 2 diabetes who is being discharged after an episode of hypoglycemia. Which statement by the patient indicates a need for further teaching? -'I may experience weakness.' -'It can cause a fast heart rate.' -'Sometimes it causes vomiting.' -'I might feel anxious or nervous.'

-'Sometimes it causes vomiting.'

The nurse is teaching the parents of a pediatric patient who has recently been diagnosed with type 1 diabetes mellitus. What statement will the nurse include about the pathophysiology of the disease? -'The body starts to attack itself and destroy the cells that convert insulin in the liver.' -'The body starts to attack itself and destroy the cells that make insulin in the pancreas.' -'Consistently high insulin levels leads to the inability of the cells to recognize and utilize the insulin.' -'Consistently high glucose levels leads to the increase in insulin secretion that cannot be utilized by the cells.'

-'The body starts to attack itself and destroy the cells that make insulin in the pancreas.'

The nurse is caring for a patient who is experiencing diabetic ketoacidosis. The patient's family member asks the nurse, 'Why is my brother breathing so fast and taking such deep breaths?' What is the nurse's best response? -'It is likely the breathing pattern and rate is caused by the fever that the condition causes.' -'It is likely the breathing pattern and rate is caused by the infection that the condition causes.' -'The brain is triggered to increase the depth and rate of breaths in order to correct the acid-base balance of the blood.' -'The brain is triggered to increase the depth and rate of breaths in order to correct the elevated glucose level in the blood.'

-'The brain is triggered to increase the depth and rate of breaths in order to correct the acid-base balance of the blood.'

The nurse is assessing an older adult patient with type 2 diabetes and notes that the patient has optic nerve atrophy. What statement will the nurse include when teaching the patient about this condition? -'This results from growth of new vessels.' -'This results from lack of oxygen vessel swelling.' -'This results from increased permeability of the vessels.' -'This results from chronic over-production of insulin and stress hormones.'

-'This results from lack of oxygen vessel swelling.'

A home health nurse is providing education to a patient with type 2 diabetes mellitus. The patient asks the nurse, 'Why do some diabetics have eye and kidney problems?' What is the nurse's best response? Select all that apply. -'Too much glucose affects the organ's cell integrity.' -'Chronic high blood sugar thins basement membranes, leading to organ failure.' -'Chronic high blood sugar thickens basement membranes, leading to organ failure.' -'Low oxygen in the vessels due to increased blood glucose causes low oxygen to the organs.' -'Too much glucose increases insulin delivery to the cells, weakening the cell membrane.'

-'Too much glucose affects the organ's cell integrity.' -'Chronic high blood sugar thickens basement membranes, leading to organ failure.' -'Low oxygen in the vessels due to increased blood glucose causes low oxygen to the organs.'

A patient recently diagnosed with type 2 diabetes mellitus (DM) states, 'I don't understand how I got diabetes. I don't eat sugary foods.' How does the nurse respond? -'Type 2 diabetes is an autoimmune disease.' -'Individuals with type 2 diabetes are born with the disease.' -'Individuals with type 2 diabetes are typically young and their pancreas is not fully developed.' -'Type 2 diabetes is the result of resistance to insulin combined with an inability to secrete sufficient insulin.'

-'Type 2 diabetes is the result of resistance to insulin combined with an inability to secrete sufficient insulin.'

A diabetic patient has a glycosylated hemoglobin (A1C) level of 9.4%. What does the nurse say to the patient regarding this finding? -'This is not good at all.' -'You need more insulin.' -'Keep up the good work.' -'What are you doing differently?'

-'What are you doing differently?'

The nurse is providing discharge instructions for a patient who was admitted with diabetic ketoacidosis. What information does the nurse include when teaching the patient about the pathophysiology of the condition? -'When insulin is deficient, fats break down, causing acidosis.' -'When glucose is increased, fats break down, causing acidosis.' -'When insulin is deficient, proteins break down, causing acidosis.' -'When glucose is increased, proteins break down, causing acidosis.'

-'When insulin is deficient, fats break down, causing acidosis.'

The nurse is caring for a patient who has type 2 diabetes with poorly controlled blood glucose levels. The patient asks the nurse, 'When my blood sugar is high, why am I always hungry, even when I constantly eat?' What is the nurse's best response? Select all that apply. -'When insulin is not present, increased hunger persists.' -'Despite eating, insulin is very high and increases hunger.' -'Despite eating, glucose is not being used at the cellular level.' -'When cellular glucose is low, cell starvation triggers excessive hunger.' -'When cellular glucose is high, cell starvation triggers excessive hunger.'

-'When insulin is not present, increased hunger persists.' -'Despite eating, glucose is not being used at the cellular level.' -'When cellular glucose is low, cell starvation triggers excessive hunger.'

The nurse is caring for a patient with diabetes mellitus who tells the nurse, 'I sometimes have episodes of seeing double. What causes that?' Which response would the nurse give? -'You are likely experiencing diabetic retinopathy.' -'You are likely experiencing optic nerve atrophy.' -'You are likely experiencing an episode of low blood sugar when this happens.' -'You are likely experiencing an episode of high blood sugar when this happens.'

-'You are likely experiencing an episode of low blood sugar when this happens.'

A patient with type 2 diabetes has been admitted for surgery, and the health care provider has placed the patient on insulin in addition to the current dose of metformin. The patient wants to know the purpose of taking the insulin. What is the nurse's best response? -'You can't take your metformin while in the hospital.' -'Your diabetes is worse, so you will need to take insulin.' -'Your body is under more stress, so you'll need insulin to support your medication.' -'You must take insulin from now on because the surgery will affect your diabetes.'

-'Your body is under more stress, so you'll need insulin to support your medication.'

In reviewing the health care provider admission requests for a patient admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis? -1 ampule NaHCO 3 IV now -IV regular insulin at 2 units/hr -IV normal saline at 100 mL/hr -20 mEq KCl for each liter of IV fluid

-1 ampule NaHCO 3 IV now

The nurse is reviewing the implications of culture on the development of diabetes. Which patient will the nurse determine has the greatest risk for developing type 2 diabetes mellitus? -44-year-old healthy American Indian patient with a family history of type 2 diabetes -60-year-old Asian American patient with an unknown family history of type 2 diabetes -55-year-old healthy non-Hispanic white patient with a family history of cardiovascular disease -22-year-old healthy Hispanic patient with an unknown family history of type 2 diabetes

-44-year-old healthy American Indian patient with a family history of type 2 diabetes

Which of these patients with diabetes does the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit? -76-year-old who was admitted with fatigue and shortness of breath -58-year-old with sensory neuropathy who needs teaching about foot care -68-year-old with diabetic ketoacidosis who has an IV running at 250 mL/hr -70-year-old who needs blood glucose monitoring and insulin before each meal

-70-year-old who needs blood glucose monitoring and insulin before each meal

Which patient does the nurse identify as needing screening for type 2 diabetes? -A 44-year-old patient with 2 children -A 29-year-old patient with a BMI 24 kg/m -A 46-year-old patient with no health history -A 35-year-old patient with a fasting blood glucose of 90

-A 46-year-old patient with no health history

The nurse is assigned the following four patients. Which patient should the nurse see first? -A patient diagnosed with diabetes with a blood glucose level of 38 mg/dL -A patient diagnosed with new-onset type 1 diabetes who is ready for discharge -A patient diagnosed with diabetic ketoacidosis (DKA) who has an insulin drip running at a rate of 4 units/hr -A patient diagnosed with hyperglycemic-hyperosmolar state (HHS) who has a blood glucose of 425 mg/dL

-A patient diagnosed with diabetes with a blood glucose level of 38 mg/dL

The nurse is assigned the following four patients. Which patient should the nurse see first? -A patient diagnosed with hypoglycemia with a blood glucose level of 72 mg/dL -A patient diagnosed with diabetic ketoacidosis (DKA) who is now scheduled for subcutaneous insulin -A patient diagnosed with new-onset type 1 diabetes who now has positive ketones in his urine -A patient diagnosed with hyperglycemic-hyperosmolar state (HHS) who is receiving 0.45% sodium chloride at 100 mL/hr

-A patient diagnosed with new-onset type 1 diabetes who now has positive ketones in his urine

A patient who received insulin glargine subcutaneously 30 minutes ago is now cool, clammy, and anxious. The patient states 'Something is wrong with me.' The blood glucose level is 54. What action by the nurse is should be taken? -Administer IV insulin -Administer IV dextrose -Administer IM glucagon -Administer a carbohydrate replacement

-Administer a carbohydrate replacement

Which is the best referral that the nurse can suggest to a patient who has been newly diagnosed with diabetes? -Health care provider office -Pharmaceutical representative -American Diabetes Association -Centers for Disease Control and Prevention

-American Diabetes Association

A registered nurse is teaching a group of nursing students about the recommendation of the American Diabetes Association (ADA) regarding indications for testing an individual with type 2 diabetes. Which individual suggested by a nursing student for testing indicates a need for further education? -An individual who has been diagnosed with polycystic ovary syndrome -An individual who has been diagnosed with gestational diabetes mellitus (GDM) -An individual who is 45 years old with a body mass index (BMI) less than 25 kg/m2 -An individual who has impaired fasting glucose and impaired glucose tolerance on testing

-An individual who is 45 years old with a body mass index (BMI) less than 25 kg/m2

A patient with type 2 diabetes who is taking metformin is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (A1C) is 8.2%. Which action does the nurse plan to take next? -Ask the patient about current dietary intake and medication use. -Discuss the need to check blood glucose several times every day. -Talk about the possibility of adding rapid-acting insulin to the regimen. -Instruct the patient to continue with the current diet and metformin use.

-Ask the patient about current dietary intake and medication use.

The nurse is providing education to a patient with a new diagnosis of type 1 diabetes. What action by the patient indicates a need for further teaching? -Utilizing only the abdomen for injections -Grasping a skin fold and injecting at a 90-degree angle -Aspirating for blood return before administering the medication -Mixing regular human insulin with isophane insulin NPH for injection

-Aspirating for blood return before administering the medication

The nurse is caring for a patient with diabetes mellitus with autonomic neuropathy. What nursing intervention will the nurse perform for this patient? Select all that apply. -Assess the patient for urine retention -Apply lotion to areas of dry, cracked skin -Determine if the patient has any loss of sensation in the toes -Instruct the patient to move positions slowly to avoid getting dizzy -Assess the patient for asymmetric weakness of the lower extremities

-Assess the patient for urine retention -Apply lotion to areas of dry, cracked skin -Instruct the patient to move positions slowly to avoid getting dizzy

Which nursing action can the home health nurse delegate to a home health aide who is making daily visits to a patient with newly diagnosed type 2 diabetes? -Inspect the extremities for evidence of poor circulation. -Evaluate the patient's use of a home blood glucose monitor. -Assist the patient's spouse in choosing appropriate dietary items. -Assist the patient with washing the feet and applying moisturizing lotion.

-Assist the patient with washing the feet and applying moisturizing lotion.

Which symptoms indicate autonomic neuropathy? Select all that apply. -Eye pain -Paresthesias -Atonic bladder -Dried, cracked skin -Asymmetric weakness -Orthostatic hypotension

-Atonic bladder -Dried, cracked skin -Orthostatic hypotension

What are the distinguishing characteristics of type 1 diabetes mellitus (DM) that the nurse should remember? Select all that apply. -Resistance to insulin -Autoimmune disorder -Beta cells are destroyed -Triggered by viral infections -Decreased secretion of insulin

-Autoimmune disorder -Beta cells are destroyed -Triggered by viral infections

A patient with type 1 diabetes and a limited income is under nursing care. What nutritional teachings will the nurse provide to the patient? Select all that apply. -Avoid gaining weight. -Food intake should remain the same on all days. -See the registered dietician at least once every two years. -Dietary information should be shared with the person who prepares the meals. -If you are in a low-income bracket, you may seek less frequent evaluation and counseling.

-Avoid gaining weight. -Dietary information should be shared with the person who prepares the meals.

What techniques should a patient with diabetes use to administer insulin injections? Select all that apply. -Avoid injecting insulin on scarred sites. -Inject insulin on the thigh for faster absorption. -Inject insulin into a different anatomic site every day. -Avoid injecting within a 2-inch radius around the navel. -Grasp a fold of the skin and inject insulin subcutaneously.

-Avoid injecting insulin on scarred sites. -Avoid injecting within a 2-inch radius around the navel. -Grasp a fold of the skin and inject insulin subcutaneously.

The nurse is concerned that a patient with diabetes mellitus is at risk for developing chronic kidney disease (CKD). What findings did the nurse use to make this clinical determination? Select all that apply. -Blood pressure 168/90 mm Hg -Increased urine output during the night -12-year history of type 2 diabetes mellitus -Fasting blood glucose levels between 180 and 200 mg/dL -Stopped taking prescribed angiotensin receptor blocker (ARB)

-Blood pressure 168/90 mm Hg -12-year history of type 2 diabetes mellitus -Fasting blood glucose levels between 180 and 200 mg/dL -Stopped taking prescribed angiotensin receptor blocker (ARB)

The nurse is providing teaching about weight gain secondary to insulin resistance to a patient with type 1 diabetes. What actions by the patient can minimize this complication? -Calorie restriction -Increasing insulin -Decreasing exercise -Changing administration sites

-Calorie restriction

A patient newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the patient and the patient's family? -Dietary control -Insulin administration -Causes and treatment of hypoglycemia -Causes and treatment of hyperglycemia

-Causes and treatment of hypoglycemia

Which are priority interventions for a diabetic patient to reduce modifiable risk factors associated with cardiovascular disease? Select all that apply. -Ceasing smoking -Reviewing family history -Controlling hypertension -Controlling hyperglycemia -Controlling high triglycerides

-Ceasing smoking -Controlling hypertension -Controlling hyperglycemia -Controlling high triglycerides

Which is a chronic complication that can occur in patients with diabetes? -Cell death from macrovascular changes -Hypoglycemia from too much insulin or too little glucose -Diabetic ketoacidosis caused by lack of insulin and ketosis -Hyperglycemic-hyperosmolar state caused by insulin deficiency and profound dehydration

-Cell death from macrovascular changes

A patient with type 1 diabetes arrives in the emergency department breathing deeply and stating, 'I can't catch my breath.' The patient's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38/min, BP 91/54 mm Hg, and O 2 saturation 99% on room air. Which action does the nurse take first? -Offer reassurance. -Administer oxygen. -Attach a cardiac monitor. -Check the blood glucose.

-Check the blood glucose.

The nurse is providing education regarding sick day rules to a patient with diabetes. What information does the nurse include in the teaching plan? Select all that apply. -Avoid solid food. -Check urine for ketones. -Monitor blood glucose at least every 4 hours. -Do not take medications for diarrhea or nausea. -Drink 8 to 12 ounces of sugar-free liquid every hour while awake.

-Check urine for ketones. -Monitor blood glucose at least every 4 hours. -Drink 8 to 12 ounces of sugar-free liquid every hour while awake.

The nurse is caring for a patient with continuous glucose monitoring (CGM) and obtains an elevated reading. Which action would the nurse take first? -Administer insulin. -Notify the provider. -Continue to monitor hourly readings. -Confirm the results with a finger stick test.

-Confirm the results with a finger stick test.

Which assessment findings are consistent with hypoglycemia in a patient? Select all that apply. -Cool and clammy skin -Fruity odor in the breath -Glucose level of 35 mg/dL -Heart rate of 150 beats/min -Presence of ketones in the urine

-Cool and clammy skin -Glucose level of 35 mg/dL

The nurse receives a report on a 52-year-old patient with type 2 diabetes. Which complication of diabetes does the nurse report to the provider? -Visual changes -Respiratory distress -Poor glucose control -Decreased peripheral perfusion

-Decreased peripheral perfusion

Which are microvascular complications of diabetes mellitus? Select all that apply. -Diabetic neuropathy -Diabetic nephropathy -Cardiovascular disease -Male erectile dysfunction -Eye and vision complications

-Diabetic neuropathy -Diabetic nephropathy -Male erectile dysfunction -Eye and vision complications

What method must the patient with diabetes use with regard to 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.

What teaching regarding insulin administration should the nurse include in patient teaching? Select all that apply. -Insulin syringe needles are 28 gauge. -All insulin syringes come in 100 unit dosage. -Disposable syringes should be used only once. -It is important to use the same type of syringe regularly. -If the needle tip bends gently bend it back before administering insulin.

-Disposable syringes should be used only once. -It is important to use the same type of syringe regularly.

A patient has 0700 fingerstick blood glucose readings of 353-286 for 3 mornings in a row, and the nurse is concerned the patient may have dawn phenomenon. Which finding is consistent with this phenomenon? -Postprandial glucose elevations -Early morning glucose elevations -Bedtime hypoglycemia unless a snack is eaten -Morning glucose elevations preceded by hypoglycemia during the night

-Early morning glucose elevations

The nurse has provided teaching about exercise to a patient diagnosed with type 1 diabetes. What action by the patient demonstrates effective teaching? -Restrict vigorous activity to after meals. -Administer a normal insulin dosage prior to exercise. -Eat a carbohydrate snack if participating in unplanned exercise. -Check the capillary blood glucose level midway through exercise.

-Eat a carbohydrate snack if participating in unplanned exercise.

When providing teaching about nutrition to a patient diagnosed with diabetes, what instruction should the nurse include? -It is important to avoid snacks. -Decrease calories when exercising. -Carbohydrates should be restricted to once a day. -Eat consistent amounts of food at consistent times.

-Eat consistent amounts of food at consistent times.

Which outcome is essential for the nurse to include in the plan of care for a patient who has been newly diagnosed with diabetes mellitus? -Emphasizing the importance of daily foot inspection -Ensuring the patient recognizes the signs and symptoms of hypoglycemia -Ensuring that the family or caregiver can administer insulin prior to patient discharge -Teaching the patient to recognize how many carbohydrate units may be consumed with each meal

-Ensuring the patient recognizes the signs and symptoms of hypoglycemia

What information about exercise should the nurse include for patients diagnosed with diabetes? Select all that apply. -Exercise increases insulin sensitivity. -Hypoglycemia can occur from increased muscle glucose uptake. -Blood glucose levels are only affected for 2-4 hours after exercise. -Exercise can lead to hyperglycemia and ketones if diabetes is not controlled. -Low insulin levels block the release of glucagon to increase glucose production.

-Exercise increases insulin sensitivity. -Hypoglycemia can occur from increased muscle glucose uptake. -Exercise can lead to hyperglycemia and ketones if diabetes is not controlled.

The patient with diabetes is at risk for eye and vision complications. What is the distinguishing characteristic of 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

The nurse is providing teaching to a patient at risk for the development of type 2 diabetes. The nurse explains which benefits of exercise for this patient? Select all that apply. -Glucose tolerance -Reduced body weight -Prevention of renal disease -Increased insulin resistance -Decreased carbohydrate metabolism

-Glucose tolerance -Reduced body weight

A patient diagnosed with type 2 diabetes is being seen for routine health screening. The patient has received nutritional education and begun regular exercise. What lab value indicates the patient may need to begin medication therapy? -Triglyceride level of 130 mg/dL -Premeal blood glucose level of 120 -Glycosylated hemoglobin (A1C) 7.0% -Peak after meal blood glucose level of 170

-Glycosylated hemoglobin (A1C) 7.0%

Which laboratory assessment finding may be indicative of diabetes mellitus? -Glycosylated hemoglobin of 7.5% in a 30-year-old adult -Fasting blood glucose of 100 mg/dL in an 80-year-old adult -Glucose tolerance test of 139 mg/dL in a 23-year-old pregnant woman -Random blood glucose level of 126 mg/dL in a patient asymptomatic for hyperglycemia

-Glycosylated hemoglobin of 7.5% in a 30-year-old adult

What should the nurse expect to assess in a patient with diabetes diagnosed with distal symmetric polyneuropathy? Select all that apply. -Eye pain -Hammertoes -Urinary retention -Loss of sensation of the lower legs -Tingling sensation in the feet and legs

-Hammertoes -Loss of sensation of the lower legs -Tingling sensation in the feet and legs

The nurse is teaching patients with diabetes about the need for annual eye care. Which groups of patients are statistically at risk of foregoing annual eye care because of the cost involved or the lack of insurance? Select all that apply. -White men -Hispanics -African Americans -White women 18-30 years old -Those with less formal education -Those with diagnosed visual problems

-Hispanics -African Americans -Those with less formal education

What information does the nurse include when planning teaching for a patient with diabetes? Select all that apply. -Importance of foot care -Need to avoid exercise -Correct storage for insulin -Protein sources for periods of hypoglycemia -Understanding of why the insulin is being prescribed

-Importance of foot care -Correct storage for insulin -Understanding of why the insulin is being prescribed

What is the role of incretin hormones in glucose regulation? Select all that apply. -Slow insulin secretion -Increase insulin secretion -Slow rate of gastric emptying -Prevent hypoglycemia after meals -Prevent hyperglycemia after meals -Increase the rate of gastric emptying

-Increase insulin secretion -Slow rate of gastric emptying -Prevent hyperglycemia after meals

The nurse is teaching a patient about insulin administration. Which actions by the patient demonstrate an accurate understanding of the teaching provided? Select all that apply. -Inserting needle at 90-degree angle -Recapping needle after administration -Rubbing the area after injecting insulin -Turning bottle upside down to withdraw insulin -Drawing air out of bottle before withdrawing insulin

-Inserting needle at 90-degree angle -Turning bottle upside down to withdraw insulin

A patient with type 2 diabetes mellitus is experiencing cardiovascular autonomic neuropathy (CAN). What should the nurse include on this patient's care plan to address safety? -Instruct to change positions slowly. -Ambulate for at least 30 minutes each day. -Report areas of skin breakdown immediately. -Encourage drinking 2 liters of fluid every day.

-Instruct to change positions slowly.

A patient newly diagnosed with type 1 diabetes is receiving education about the types of premeal insulin. What selection by the patient indicates the teaching was effective? -Insulin aspart -Insulin detemir -Insulin glargine -Isophane insulin NPH

-Insulin aspart

Which statement about pre-diabetes is correct? -It describes an overweight person with insulin-dependent diabetes. -It involves an inability to respond to insulin or make sufficient insulin in the pancreas. -It is a form of type 1 diabetes that tends to occur in people over age 50 years who are slender. -It describes people at risk for type 2 diabetes who have a fasting glucose level of 100 to 125 mg/dL.

-It describes people at risk for type 2 diabetes who have a fasting glucose level of 100 to 125 mg/dL.

Which statement about repaglinide is correct? -It may be taken without regard to food. -It is effective in people with type 1 and type 2 diabetes. -It increases the secretion of insulin from the pancreas. -It works best when taken before the first meal of the day.

-It increases the secretion of insulin from the pancreas.

The nurse is caring for a patient with diabetes. What distinguishing characteristic of glucagon must the nurse be aware of? -It is secreted within 10 minutes of ingestion of food. -It triggers the release of glucose from cell storage sites. -It is secreted by the beta cells of the islets of Langerhans. -It allows the body to take up, use, and store carbohydrates.

-It triggers the release of glucose from cell storage sites.

The nurse is reviewing the medical record of a patient with type 2 diabetes mellitus. What information suggests that the patient has been focusing on changing modifiable risk factors? -Blood pressure 156/88 mm Hg -Sits down after walking 100 steps -Latest low-density lipoprotein (LDL) cholesterol level 68 mg/dL -Seen in the outpatient clinic 2 weeks ago for exacerbation of chronic obstructive pulmonary disease (COPD)

-Latest low-density lipoprotein (LDL) cholesterol level 68 mg/dL

In teaching a patient about the prevention of complications from type 2 diabetes mellitus, which instruction does the nurse include? -Avoid hypoglycemic episodes. -Maintain a hemoglobin A 1c level less than 6%. -Try to eat in the morning before taking insulin. -Keep morning blood glucose under 150 mg/dL.

-Maintain a hemoglobin A 1c level less than 6%.

The nurse is screening patients in a clinic. What groups have a higher risk of developing type 2 diabetes? Select all that apply. -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

During a clinic visit, a patient with type 2 diabetes mellitus has a sudden onset of nausea and vomiting. What should the nurse suspect is occurring with the patient? -Hypoglycemia -Myocardial infarction -Diabetic ketoacidosis -Hyperglycemic-hyperosmolar state

-Myocardial infarction

What should the nurse include when reviewing microvascular complications of a patient with type 2 diabetes mellitus? Select all that apply. -Neuropathy -Retinopathy -Nephropathy -Coronary heart disease -Peripheral vascular disease

-Neuropathy -Retinopathy -Nephropathy

Which complications of diabetes are considered chronic complications? Select all that apply. -Neuropathy -Retinopathy -Nephropathy -Hypoglycemia -Diabetic ketoacidosis -Hyperglycemic-hyperosmolar state

-Neuropathy -Retinopathy -Nephropathy

What can slow the progression of diabetic neuropathies? -Daily exercise -Avoiding high-fat foods -Controlling blood pressure -Normal blood glucose levels

-Normal blood glucose levels

Which information should be included when providing education to a patient about sick day rules? Select all that apply. -Avoid antidiarrheal medications. -Notify the healthcare provider if ill. -Drink 8 to 12 ounces of sugar-free liquid each hour while awake. -Test urine for ketones if blood glucose level is greater than 180 mg/dL. -If unable to eat, consume liquids equal to the carbohydrate content normally eaten.

-Notify the healthcare provider if ill. -Drink 8 to 12 ounces of sugar-free liquid each hour while awake. -If unable to eat, consume liquids equal to the carbohydrate content normally eaten.

A patient diagnosed with diabetes plans to engage in strenuous exercise. The patient has a blood sugar level of 285 mg/dL. What action by the patient demonstrates an understanding of the teaching about diabetes? -Patient administers bolus insulin. -Patient checks urine for ketone bodies. -Patient engages in strenuous exercise. -Patient contacts the health care provider.

-Patient checks urine for ketone bodies.

The nurse has just taken a change-of-shift report on a group of patients on the medical-surgical unit. Which patient does the nurse assess first? -Patient taking glyburide who is dizzy and sweaty -Patient taking metformin who has abdominal cramps -Patient taking repaglinide who has nausea and back pain -Patient taking pioglitazone who has bilateral ankle swelling

-Patient taking glyburide who is dizzy and sweaty

The nurse has just received a change-of-shift report on the endocrine unit. Which patient does the nurse see first? -Newly diagnosed patient with type 1 diabetes who is reporting thirst -Patient with type 2 diabetes who has a blood glucose of 150 mg/dL -Patient with type 2 diabetes with a blood pressure of 150/90 mm Hg -Patient with type 1 diabetes whose insulin pump is beeping 'occlusion'

-Patient with type 1 diabetes whose insulin pump is beeping 'occlusion'

A patient with type 2 diabetes experiences a stroke and the nurse is caring for the patient in the intensive care unit (ICU). What factor puts this patient at greater risk for a poor clinical outcome? -Patients with diabetes do not seek the care needed when having a stroke. -Patient with diabetes experience increased vessel damage to the brain during a stroke due to elevated insulin levels. -Patients with diabetes do not present the same way as other patients without diabetes who are having a stroke. -Patients with diabetes experience brain damage that would normally not cause damage in a patient without diabetes.

-Patients with diabetes experience brain damage that would normally not cause damage in a patient without diabetes.

Which statement about blood pressure, as it relates to diabetes mellitus, is correct? -Individuals with diabetes and hypertension are at increased risk for liver damage. -Patients with diabetes should keep their blood pressure below 130/80 mm Hg. -Diabetic ketoacidosis is of higher concern in people with type 2 diabetes than is hypertension. -People with diabetes and hypertension are at higher risk for visual impairment from cataracts.

-Patients with diabetes should keep their blood pressure below 130/80 mm Hg.

A patient with diabetes mellitus has had a cholecystectomy. The nurse prioritizes blood glucose management in the patient's plan of care for which reason? -Patients who are diagnosed with diabetes have increased anxiety. -Patients with postoperative hyperglycemia are prone to poor wound healing. -Patients with diabetes who undergo surgery are likely to develop hypoglycemia. -Patients with diabetes should not receive insulin when they do not eat a meal.

-Patients with postoperative hyperglycemia are prone to poor wound healing.

The nurse is providing teaching to a patient with visual impairment about safe insulin administration. Which action by the patient indicates effective teaching? -Avoids moving plunger in and out -Has home health aides administer insulin -Places rubber band around fast-acting insulin -Places the bottle on a flat surface while withdrawing insulin

-Places rubber band around fast-acting insulin

What measure should the caregiver of a patient with diabetes take to treat moderate hypoglycemia? -Provide half a cup of fruit juice. -Offer 4 cubes, or teaspoons, of sugar. -Subcutaneously inject 1 mg of glucagon. -Provide 15 g of carbohydrate and cheese.

-Provide 15 g of carbohydrate and cheese.

The nurse is determining the learning needs of a patient diagnosed with diabetes. What items should the nurse include in this assessment? Select all that apply. -Family history -Psychosocial concerns -Current mental health status -Nutrition history and practices -Notes from previous hospital stays

-Psychosocial concerns -Current mental health status -Nutrition history and practices

Which action is correct when drawing up a single dose of insulin? -Wash hands thoroughly and don sterile gloves. -Shake the bottle of insulin vigorously to mix the insulin. -Recap the needle and save the syringe for the next dose of insulin. -Pull back plunger to draw air into the syringe equal to the insulin dose.

-Pull back plunger to draw air into the syringe equal to the insulin dose.

The nurse is providing education to a patient with diabetes mellitus who has manifestations of cardiovascular disease. What is the nurse's priority action? -Reverse disease processes -Reduce modifiable risk factors -Determine the severity of disease -Identify non-modifiable risk factors

-Reduce modifiable risk factors

Which measure helps the patient with type 1 diabetes mellitus (DM) who uses an insulin pump to appropriately manage blood glucose levels? -Managing hyperglycemia by increasing insulin dosage -Avoiding additional carbohydrates after unplanned exercise -Consuming additional carbohydrates after planned exercise -Reducing the insulin dosage before planned physical exercise

-Reducing the insulin dosage before planned physical exercise

The nurse is teaching a patient about the storage of NPH and regular insulins. Which information does the nurse convey? -Insulin vials must be refrigerated after they are opened. -Do not draw insulin more than 24 hours in advance of injecting it. -Refrigerate insulin vials not in use, or if the ambient temperature exceeds 86° F. -When storing premixed syringes with NPH and regular insulins, shake the syringe before using.

-Refrigerate insulin vials not in use, or if the ambient temperature exceeds 86° F.

What microvascular complications of the blood vessel structure can occur in the patient with diabetes mellitus? Select all that apply. -Retinopathy -Nephropathy -Coronary heart disease -Cerebral vascular disease -Peripheral vascular disease

-Retinopathy -Nephropathy

The nurse is administering metformin to a patient with type 2 diabetes prior to breakfast. Which finding during administration requires further follow-up by the nurse? -Episode of diarrhea overnight -Pulse oximetry reading of 95% at 7 AM -Premeal blood glucose level of 120 mg/dL -Scheduled angiogram of the leg later today

-Scheduled angiogram of the leg later today

A patient with diabetes mellitus tells the nurse that he has been experiencing bloating, gas, and diarrhea. What pathophysiological finding, common in diabetes mellitus, does the nurse recognize as the likely cause of the patient's complaint? -Rapid gastric emptying -Delay in gastric emptying -Sluggish movement of the small intestine -Retained carbon dioxide within the intestine

-Sluggish movement of the small intestine

The nurse is providing teaching to a patient diagnosed with peripheral neuropathy secondary to diabetes. Which instructions regarding footwear should be included for the patient? -Heels should be less than 1 inch high. -All shoes should be fitted by a podiatrist. -Socks or stockings should be fitted properly. -Shoes should be 1 inch longer than the longest toe.

-Socks or stockings should be fitted properly.

The nurse is providing teaching on meal planning to an older adult patient who reports three episodes of hypoglycemia in the past several months. What action by the nurse is most appropriate? -Discuss nursing home placement. -Suggest a referral for home health care. -Evaluate the need for antidiabetic medications. -Explain the importance of following a healthy diet.

-Suggest a referral for home health care.

The nurse is providing preoperative instructions to a patient with diabetes. What instructions should the nurse include? -Sulfonylureas should be discontinued one day before surgery. -Opioid analgesics are contraindicated in patients with diabetes. -It is common to have an increased length of stay of 2 to 3 days. -The goal is to keep preoperative blood glucose to less than 250 mg/dL.

-Sulfonylureas should be discontinued one day before surgery.

The nurse is preparing teaching material for a patient newly diagnosed with type 1 diabetes mellitus. What should the nurse include about the main metabolic effects of insulin? Select all that apply. -Stimulates protein and lipid synthesis -Suppresses liver production of glucose -Stimulates glucose uptake in heart muscle -Stimulates glucose uptake in skeletal muscle -Suppresses liver production of very-low-density lipoproteins

-Suppresses liver production of glucose -Stimulates glucose uptake in heart muscle -Stimulates glucose uptake in skeletal muscle -Suppresses liver production of very-low-density lipoproteins

The nurse is teaching a group of nursing students about the American Diabetes Association (ADA) recommendations for patient care. Which recommendation made by a nursing student indicates understanding? -The patient's blood pressure should be below 120/70 mm Hg. -The patient's high-density lipoprotein (HDL) cholesterol level should be below 40 mg/dL. -The low-density lipoprotein (LDL) cholesterol should be below 140 mg/dL for patients with signs of cardiovascular disease (CVD). -The LDL cholesterol should be below 100 mg/dL for patients without signs of CVD.

-The LDL cholesterol should be below 100 mg/dL for patients without signs of CVD.

A patient with type 2 diabetes, retinopathy, and complaints of painful 'pins and needles' sensations in the feet presents to the primary care clinic. The nurse notes the patient's low-density lipoprotein cholesterol (LDL) level is at 75 mg/dL. What can the nurse determine regarding the patient's LDL level? -The level is higher than the recommended level and should be addressed by the health care provider. -The level is lower than the recommended level and is considered to be in appropriate range for the patient. -The level is higher than the recommended level but may still be within range for the patient's clinical presentation. -The level is lower than the recommended level but may still need to be corrected due to the patient's clinical presentation.

-The level is higher than the recommended level and should be addressed by the health care provider.

What role does the liver play in the production, conversion, and release of insulin? -The liver produces and stores insulin before releasing it into the bloodstream. -The liver converts a simple sugar into insulin before releasing it into the bloodstream. -The liver converts a prohormone into insulin before releasing it into the bloodstream. -The liver produces a prohormone of insulin, and the pancreas releases it into the bloodstream.

-The liver converts a prohormone into insulin before releasing it into the bloodstream.

Which oral medication lowers blood glucose levels by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine, allowing for the filtered glucose to be excreted in the urine rather than moved back into the blood? Alogliptin (Nesina) Exenatide (Byetta) Pramlintide (Symlin) Dapagliflozin (Farxiga)

Dapagliflozin (Farxiga)

The nurse is providing education for a patient newly diagnosed with diabetes. The patient is discussing healthy sources of carbohydrates. What sources should be included? Select all that apply. Fish Fruits Legumes Margarine Low-fat milk products

Fruits Legumes Low-fat milk products

The home health care nurse is providing teaching to an insulin-dependent patient regarding infection. What symptom is priority for the patient to report to the health care provider? Pain Fatigue Open sores Hyperglycemia

Hyperglycemia

Which conditions are typical features of metabolic syndrome? Select all that apply. Hypertension Hyperglycemia Hyperlipidemia Atherosclerosis Abdominal obesity

Hypertension Hyperglycemia Hyperlipidemia Abdominal obesity

What initial electrolyte imbalance can the nurse anticipate in a patient experiencing hyperglycemia? Hypokalemia Hyperkalemia Hyponatremia Hypernatremia

Hypokalemia

The nurse is admitting a patient with diabetic ketoacidosis to the intensive care unit (ICU). What arterial blood gas (ABG) result will the nurse likely find when reviewing the patient's laboratory results? High pH, low CO 2, low HCO 3 Low pH, low CO 2 , high HCO 3 Low pH, low CO 2, low HCO 3 High pH, high CO 2, high HCO 3

Low pH, low CO 2, low HCO 3

A patient being treated for cardiovascular disease has factors that increase the risk for developing type 2 diabetes mellitus. On which health problem should the nurse focus when assessing this patient? Hypoglycemia Gestational diabetes Metabolic syndrome Autonomic neuropathy

Metabolic syndrome

A patient with chronic renal insufficiency was recently diagnosed with type 2 diabetes. The nurse should contact the health care provider and hold which medication? Acarbose Glipizide Metformin Pioglitazone

Metformin

Which medication lowers blood glucose levels by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity? Pioglitazine (Actos) Glipizide (Glucotrol) Glimepiride (Amaryl) Metformin (Glucophage)

Metformin (Glucophage)

An intensive care patient with diabetic ketoacidosis (DKA) is receiving an insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make? Urine output Potassium level Rate of IV fluids 12-lead electrocardiogram (ECG)

Potassium level

The nurse is treating a patient with diabetes. Which are risk factors for development of vision loss in patients with diabetes? Select all that apply. Proteinuria Hyperalgesia Metatarsalgia Systolic hypertension Poor glucose regulation

Proteinuria Poor glucose regulation

The nurse is caring for a patient with diabetes mellitus who is being screened for nephropathy. What laboratory test will the nurse reference as the test used to screen for early nephropathy? Serum creatinine Urine for albumin Urine for ketones Blood urea nitrogen

Urine for albumin

While teaching a patient about insulin injection technique, the nurse explains that injecting into which area will cause the insulin to be most rapidly absorbed? Thigh Deltoid Buttocks Abdomen

Abdomen

What does a fasting blood glucose of 65 mg/dL indicate? -Hypoglycemia -Hyperglycemia -More information needed -Normal result in range for fasting

-Hypoglycemia

A patient presents to the emergency department with vomiting, abdominal pain, and rapid, deep respirations. The patient's blood glucose is 480 mg/dL. What nursing action should be taken? -Restrict fluids -Check urine for ketones -Provide mechanical ventilation -Administer subcutaneous insulin

-Check urine for ketones

The nurse is aware that insulin deficiency leads to metabolic acidosis. Which manifestation is a result of metabolic acidosis? -Frequent urination -Excessive hunger -Fruity odor on the breath -Decreased respiration rate

-Fruity odor on the breath

A patient with type 2 diabetes mellitus is experiencing an eye hemorrhage and vision changes. What should the nurse suspect is occurring with this patient? -Venous beading -Optic nerve atrophy -Closed-angle glaucoma -Proliferative diabetic retinopathy

-Proliferative diabetic retinopathy

What is an important feature of the glycosylated hemoglobin A 1c (HbA 1c) test? -The results are not altered by eating habits 24 hours before the test. -The patient must drink a 75 g glucose load an hour before the test. -It determines the average blood glucose levels of the previous 14 days. -The patient must not have any caloric intake for at least 8 hours before the test.

-The results are not altered by eating habits 24 hours before the test.

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

-Those with type 2 diabetes make insulin, but in inadequate amounts.

The nurse is assessing a patient for diabetic foot problems. What should the nurse include in this assessment? Select all that apply. -Toenails -Tinea pedis -Toe contractures -History of previous ulcer -Ankle joint range of motion

-Toenails -Tinea pedis -History of previous ulcer

Which statements about the etiology and genetic risk for diabetes mellitus are correct? Select all that apply. -Type 1 diabetes results from genetic susceptibility. -Pancreatic beta cells are destroyed in type 2 diabetes. -Viral infections may act as a trigger for type 1 diabetes. -Metabolic syndrome is a known cause for type 1 diabetes. -Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors.

-Type 1 diabetes results from genetic susceptibility. -Viral infections may act as a trigger for type 1 diabetes. -Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors.

Under what circumstances does the nurse teach a patient with diabetes to contact the primary health care provider? Select all that apply. -Fever greater than 100.1°F -Unable to take food or fluids -Illness lasting longer than 12 hours -Ketonuria lasting longer than 24 hours -Blood glucose greater than 150 mg/dL

-Unable to take food or fluids -Ketonuria lasting longer than 24 hours

A patient diagnosed with type 1 diabetes has had multiple episodes of hypoglycemia. What teaching by the nurse is indicated? -Administer insulin in legs only. -Check blood glucose every hour. -Avoid the use of insulin aspart. -Use the fingertip only for blood glucose checks.

-Use the fingertip only for blood glucose checks.

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

-Waist circumference of 40 inches or more

A patient received insulin aspart at 0700. At what time should the patient be assessed for signs of hypoglycemia? 0900 1100 1200 1400

0900

Consuming which item is appropriate for the patient who becomes hypoglycemic at home? 1 tsp of sugar 1 tbsp of honey 1 oz of skim milk 1 cup of fruit juice

1 tbsp of honey

The nurse is teaching a patient about the movement of glucose in the body. Arrange the sequence of events that take place when blood glucose levels drop in the correct order. 1. Insulin secretion stops and glucagon is released. 2. Proteolysis, or the breakdown of proteins, takes place. 3. Lipolysis, or the breakdown of fat, takes place. 4. Glycogenolysis and gluconeogenesis take place.

1. Insulin secretion stops and glucagon is released. 2. Glycogenolysis and gluconeogenesis take place. 3. Lipolysis, or the breakdown of fat, takes place. 4. Proteolysis, or the breakdown of proteins, takes place.

The nurse is teaching a patient with diabetes mellitus how to inject a mixture of NPH and regular insulins. In which order does the nurse instruct the patient to prepare and administer the insulin? 1. Wash the hands. 2. Wipe the skin with alcohol. 3. Draw up NPH insulin. 4. Swab the rubber stoppers of the vials with alcohol. 5. Draw up regular insulin. 6. Inject the insulin at a 90-degree angle.

1. Wash the hands. 2. Swab the rubber stoppers of the vials with alcohol. 3. Draw up regular insulin. 4. Draw up NPH insulin. 5. Wipe the skin with alcohol. 6. Inject the insulin at a 90-degree angle.

The nurse is providing teaching for a patient with diabetic peripheral neuropathy. What exercises are appropriate for this patient? Select all that apply. Yoga Walking Running Bicycling Swimming

Bicycling Swimming

Which are counterregulatory hormones? Select all that apply. Insulin Cortisol Glucagon Epinephrine Norepinephrine Growth hormone

Cortisol Glucagon Epinephrine Norepinephrine Growth hormone

A patient has received teaching about the use of basal insulin for glucose stabilization. What selection indicates the teaching has been effective? Insulin lispro Insulin aspart Insulin glargine Insulin glulisine

Insulin glargine

The nurse is planning nutritional education for a patient newly diagnosed with diabetes. Who should be included as part of the treatment team? Select all that apply. Nurse Pharmacist Social worker Patient's family Registered dietician

Nurse Patient's family Registered dietician

Which finding is seen in a patient with type 2 diabetes mellitus? Hunger Obesity Weight loss Increased urine output

Obesity

What mechanism causes electrolyte imbalances in the patient with diabetes who is experiencing extremely elevated blood glucose levels? Osmotic diuresis Cellular starvation Exhalation of acetone Free fatty acid release

Osmotic diuresis