Complications of Diabetes Mellitus EAQs
Which drug would the nurse give to a patient who has type 2 diabetes and the presence of albumin in the urine? a) lisinopril b) duloxetine c) pregabalin d) bethanechol
A The presence of albumin in the urine indicates nephropathy in patients with diabetes. Angiotensin-converting enzyme inhibitors such as lisinopril may delay the progression of nephropathy in diabetic patients. Duloxetine is a selective serotonin reuptake inhibitor that is used for symptomatic treatment of sensory neuropathy. Pregabalin is an antiseizure medication used for neuropathic pain in diabetic patients. Bethanechol is a cholinergic agonist that is indicated for the treatment of neurogenic bladder.
A patient with type 1 diabetes mellitus has received a prescription for a β-adrenergic blocker. Which issue would the nurse recognize as the major concern for this patient? a) frequent night sweats b) lessened ability to sense hypoglycemia c) more frequent episodes of hyperglycemia d) the need for an increased basal insulin dosage
B Patients who are hypoglycemic experience a drop in blood glucose level below normal and most often complain of weakness, nervousness, tremors, and diaphoresis. β-adrenergic blockers can mask hypoglycemia-induced tachycardia, thereby decreasing the diabetic patient's ability to sense a drop in blood sugar. β-adrenergic blockers do not cause night sweats or require an increased insulin dosage. Diabetic and nondiabetic patients may notice a slight increase in blood sugar, but this is not as significant a priority as the patient's not being able to sense hypoglycemia.
Which information would the nurse include in a teaching plan about vascular complications for a patient with diabetes? a) Macroangiopathy does not occur in type 1 diabetics but rather in type 2 diabetics who have severe disease. b) Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. c) Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. d) Macroangiopathy causes slowed gastric emptying and the sexual impotence experienced by a majority of patients with diabetes.
B Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotence and slowed gastric emptying result from microangiopathy and neuropathy.
Which information would be appropriate for the nurse to include in a teaching session about nephropathy as a complication of diabetes? a) vessels may begin to bleed, resulting in permanent blindness b) controlling blood sugar and BP will reduce the risk fo kidney injury c) organ damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control d) this will not occur if one does not require insulin to control diabetes
B Microangiopathy occurs in diabetes mellitus. When the kidneys are affected, the patient has nephropathy. Maintaining control of blood sugar and BP will decrease microvascular organ damage and help to preserve kidney function. Blindness occurs as a result of microvascular damage, not bleeding. Organ damage is caused from small vessel damage. Regardless of the treatment type, nephropathy can occur if blood sugars are not controlled properly.
The nurse is instructing a diabetic patient who has infrequent voiding and a weak stream of urine. Which action by the patient indicates the need for additional teaching? a) emptying the bladder every three hours b) emptying the bladder in a sitting position c) loosening the abdominal muscles during voiding d) massaging downwards over the lower abdomen and bladder
C The abdominal muscles should be tightened for complete voiding of the urine and to prevent urine stasis. Difficulty in voiding the urine in patients with diabetes is due to autonomic neuropathy. Emptying the bladder every three hours helps to prevent stasis and subsequent infections. Emptying the bladder in a sitting position helps to void the urine completely. Massaging downwards over the lower abdomen and bladder may promote complete bladder emptying.
