DM Study Guide Questions
Goals for blood glucose levels during pregnancy are ___________ or less before meals and _____________ or less 2 hours after meals
Goals for blood glucose levels during pregnancy are 105 mg/dL or less before meals and 130 mg/dL or less 2 hours after meals
Why does hyperglycemia develop during pregnancy?
Hyperglycemia develops during pregnancy because the secretion of placental hormones, which causes insulin resistance.
___________ is the most common risk of insulin pump therapy.
Ketoacidosis is the most common risk of insulin pump therapy.
List the clinical manifestations characteristic of hyperglycemic hyperosmolar syndrome.
profound dehydration, hypotension, tachycardia, and variable neurologic signs (seizures, hemiparesis, alteration of sensorium).
A finding of _____________ is the basic criterion for the diagnosis of diabetes.
A finding of elevated BG levels is the basic criterion for the diagnosis of diabetes.
An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What condition does the nurse suspect the patient is experiencing? a. Systemic inflammatory response syndrome b. Hyperglycemic hyperosmolar syndrome c. Multiple-organ dysfunction syndrome d. Diabetic ketoacidosis
An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What condition does the nurse suspect the patient is experiencing? a. Systemic inflammatory response syndrome b. Hyperglycemic hyperosmolar syndrome c. Multiple-organ dysfunction syndrome d. Diabetic ketoacidosis
Albert, a 35-year-old patient with insulin dependent diabetes, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of neutral protamine Hagedorn (NPH). 1. Every morning Albert is given NPH insulin at 7:30 AM. Meals are served at 8:30 AM, 12:30 PM, and 6:30 PM. Between what hours does the nurse expect that the NPH insulin will reach its maximum effect (peak)? 2. A bedtime snack is provided for Albert. This is based on the knowledge that intermediate acting insulins are effective for what duration of time? 3. Albert refuses his bedtime snack. What is a priority for the nurse to assess due to his refusal of a snack?
Between what hours does the nurse expect that the NPH insulin will reach its maximum effect (peak)? Between 11:30 AM and 7:30 PM. A bedtime snack is provided for Albert. This is based on the knowledge that intermediate acting insulins are effective for what duration of time? 16 to 20 hours. What is a priority for the nurse to assess due to his refusal of a snack? Signs of hypoglycemia earlier than expected.
It is estimated that more than ____________ million people in the United States have diabetes, although almost one third of these cases are undiagnosed.
It is estimated that more than 25.8 million people in the United States have diabetes, although almost one third of these cases are undiagnosed.
When educating a patient with diabetes about increasing fiber Intake, what risks should discussed?
One risk involved in suddenly increasing fiber intake is that it may require adjusting the dosage of insulin or oral agents to prevent hypoglycemia. Other problems may include abdominal fullness, nausea, diarrhea, increased flatulence, and constipation if fluid intake is inadequate.
How do sulfonylureas act for patients with type II diabetes?
Sulfonylureas act by directly stimulating the beta cells of the pancreas to secrete insulin (cannot be used in patients with type 1 diabetes).
The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse? a. "Eating the fruit is more satisfying than drinking the juice. You will get full faster" b. "Eating the fruit will give you more vitamins and minerals than the juice will" c. "The fruit has less sugar than the juice" d. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption"
The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse? a. "Eating the fruit is more satisfying than drinking the juice. You will get full faster" b. "Eating the fruit will give you more vitamins and minerals than the juice will" c. "The fruit has less sugar than the juice" d. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption"
A nurse is caring for a patient with diabetes that has a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? a. Albumin b. Bacteria c. Red blood cells d. White blood cells
A nurse is caring for a patient with diabetes that has a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? a. Albumin b. Bacteria c. Red blood cells d. White blood cells
A female patient with diabetes who weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 lb/wk, approximately what should her daily caloric intake be? a. 1000 calories b. 1200 calories c. 1500 calories d. 1800 calories
A female patient with diabetes who weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 lb/wk, approximately what should her daily caloric intake be? a. 1000 calories b. 1200 calories c. 1500 calories d. 1800 calories
A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? a. Make sure that the patient is aware that quantity of foods will be limited b. Ensure that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found c. Determine whether the patient is on insulin or taking oral antidiabetic medication d. Review the patient's diet history to identify eating habits, and lifestyle and cultural eating patterns
A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? a. Make sure that the patient is aware that quantity of foods will be limited b. Ensure that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found c. Determine whether the patient is on insulin or taking oral antidiabetic medication d. Review the patient's diet history to identify eating habits, and lifestyle and cultural eating patterns
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) a. Ketosis prone b. Little endogenous insulin c. Obesity at diagnoses d. Younger than 30 years of age e. Older than 65 years of age
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) a. Ketosis prone b. Little endogenous insulin c. Obesity at diagnoses d. Younger than 30 years of age e. Older than 65 years of age
A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? a. Hypokalemia b. Hyperkalemia c. Hyperglycemia d. Hyponatremia
A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? a. Hypokalemia b. Hyperkalemia c. Hyperglycemia d. Hyponatremia
A woman at average risk for the development of hyperglycemia during pregnancy should be tested at __________ weeks of gestation
A woman at average risk for the development of hyperglycemia during pregnancy should be tested at 24-28 weeks of gestation
An older adult patient that has diabetes type 2 comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater.' What does the nurse understand is most likely the reason for the decrease in temperature sensation? a. A faulty heater b. Autonomic neuropathy c. Peripheral neuropathy d. Sudomotor neuropathy
An older adult patient that has diabetes type 2 comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater.' What does the nurse understand is most likely the reason for the decrease in temperature sensation? a. A faulty heater b. Autonomic neuropathy c. Peripheral neuropathy d. Sudomotor neuropathy
Because insulin normally inhibits ___________ and ______________ these processes occur in an unrestrained fashion in people with insulin deficiency and contribute further to hyperglycemia.
Because insulin normally inhibits glycogenolysis and gluconeogenesis these processes occur in an unrestrained fashion in people with insulin deficiency and contribute further to hyperglycemia.
Classic clinical manifestations of diabetes include the three "Ps": ____________, _______________, and ___________
Classic clinical manifestations of diabetes include the three "Ps": polydipsia, polyphagia, and polyuria
Gestational diabetes occurs in as many as _________% of pregnant women and increases their risk for hypertensive disorders during pregnancy
Gestational diabetes occurs in as many as 18% of pregnant women and increases their risk for hypertensive disorders during pregnancy
___________, _______________, and _______________ are the three metabolic derangements that occur in diabetic ketoacidosis
Hyperglycemia, ketosis, and metabolic acidosis are the three metabolic derangements that occur in diabetic ketoacidosis
In the United States, diabetes is the leading cause of ____________, ______________ and _____________
In the United States, diabetes is the leading cause of nontraumatic amputation, blindness, and end stage kidney dz
Describe how insulin regulation is altered in the diabetic state.
Insulin regulates the production and storage of glucose. In diabetes, either the pancreas stops producing insulin or the cells stop responding to insulin. Hyperglycemia results and can lead to acute metabolic complications such as diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Long-term complications can contribute to macro vascular or microvascular complications.
What are two main problems related to insulin in type 2 diabetes?
Insulin resistance and impaired insulin secretion.
Insulin resistance refers to a _________________ tissue sensitivity to insulin.
Insulin resistance refers to a decreased tissue sensitivity to insulin.
The major classifications of diabetes are: ______________, _______________, ________________ and diabetes associated with other conditions or syndromes.
The major classifications of diabetes are: type I, type II, gestational and diabetes associated with other conditions or syndromes.
The nurse expects that a patient with type 1 diabetes may receive what percentage of the usual morning dose of insulin preoperatively? a. 10% to 20% b. 25% to 40% C. 50% to 60% d. 85% to 90%
The nurse expects that a patient with type 1 diabetes may receive what percentage of the usual morning dose of insulin preoperatively? a. 10% to 20% b. 25% to 40% C. 50% to 60% d. 85% to 90%
The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? a. NPH b. Regular c. Lispro d. Lantus
The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? a. NPH b. Regular c. Lispro d. Lantus
The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? (Select all that apply.) a. Leakage of fluid or serum (exudates) b. Microaneurysms c. Focal capillary single closure d. Detachment e. Blurred optic discs
The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? (Select all that apply.) a. Leakage of fluid or serum (exudates) b. Microaneurysms c. Focal capillary single closure d. Detachment e. Blurred optic discs
The nurse is caring for a patient with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results? a. Lower than 50 to 60 mg/dL b. Between 60 and 80 mg/dL c. Between 75 and 90 mg/dL d. 95 mg/dL
The nurse is caring for a patient with an abnormally low blood glucose concentration, What glucose level will the nurse observe when assessing laboratory results? a. Lower than 50 to 60 mg/dL b. Between 60 and 80 mg/dL c. Between 75 and 90 mg/dL d. 95 mg/dL
The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? (Select all that apply.) a. May improve blood glucose levels b. Decrease the need for exogenous insulin c. Help reduce cholesterol levels d. May reduce postprandial glucose levels e. Increase potassium levels
The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? (Select all that apply.) a. May improve blood glucose levels b. Decrease the need for exogenous insulin c. Help reduce cholesterol levels d. May reduce postprandial glucose levels e. Increase potassium levels
The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids would the nurse anticipate infusing for this patient? a. D5W b. 0.9% normal saline c. 0.45% normal saline d. D5 normal saline
The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids would the nurse anticipate infusing for this patient? a. D5W b. 0.9% normal saline c. 0.45% normal saline d. D5 normal saline
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? a. NPH b. Iletin II c. Humalog d. Glargine
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? a. NPH b. Iletin II c. Humalog d. Glargine
Type 2 diabetes is the __________ cause of death and affects approximately ______% of older adults.
Type 2 diabetes is the 7th cause of death and affects approximately 20% of older adults.
Uncontrolled type 2 diabetes may lead to an acute problem: ___________________
Uncontrolled type 2 diabetes may lead to an acute problem: hyperglycemic hyperosmolar syndrome
Betty, an 18-year-old type 1 patient with diabetes, is unconscious when admitted to the hospital. Her daily dose of insulin has been 32 units of NPH each morning. Her mother informs the nurse that Betty and her boyfriend just broke un prior to both going away to college and she hasn't been eating well since the breakup. 1. What factors may have contributed to the development of Betty's hypoglycemia? 2. Betty is given 1 mg of glucagon hydrochloride, subcutaneously, in the emergency department. What latent symptoms should the nurse monitor for related to the action of the glucagon? 3. After Betty is medically stabilized, she is admitted to the clinical area for observation and health teaching. What warning symptoms should the nurse educate Betty about associated with hypoglycemia? 4. What information can the nurse provide to Betty to help prevent future events of hypoglycemia?
What factors may have contributed to the development of Betty's hypoglycemia? Stress due to the breakup, lack of dietary intake. What latent symptoms should the nurse monitor for related to the action of the glucagon? Symptoms of rebound hypoglycemia. What warning symptoms should the nurse educate Betty about associated with hypoglycemia? Emotional changes, slurred speech and double vision, staggering gait, weakness, diaphoresis, and lack of coordination. What information can the nurse provide to Betty to help prevent future events of hypoglycemia? Eating regularly scheduled meals, eating snacks to cover the peak time of insulin, increasing food intake when engaging in increased levels of physical exercise.
Christine, a 64-year-old woman, is admitted to the clinical area with a diagnosis of diabetic ketoacidosis. Christine lives alone and is frequently nonadherent with her dietary and medication regimen. She has had several admissions prior to this one. On admission, she is drowsy yet responsive. 1. What priority actions should the nurse take in caring for Christine? 2. What rehydrating intravenous solution does the nurse expect to infuse? 3. What laboratory results would the nurse expect to find that may be associated with Christine's condition? 4. The healthcare provider orders an insulin drip to be started at 5 units/hr. When hanging the drip, what should the nurse do prior to connecting the drip to the patient? 5. As blood glucose levels approach normal, what electrolyte imbalance should the nurse assess for?
What priority actions should the nurse take in caring for Christine? Monitoring urinary output by means of an indwelling catheter, evaluating serum electrolytes, testing for glucosuria and acetonuria, blood glucose testing, and vital signs. What rehydrating intravenous solution does the nurse expect to infuse? 0.9% sodium chloride. What laboratory results would the nurse expect to find that may be associated with Christine's condition? Hyperkalemia. When hanging the drip, what should the nurse do prior to connecting the drip to the patient? When hanging the insulin drip, the nurse must flush the insulin solution through the entire IV infusion set and discard the first 50 mL of fluid. Insulin molecules adhere to the inner surface of plastic IV infusion sets; therefore, the initial fluid may contain a decreased concentration of insulin. As blood glucose levels approach normal, what electrolyte imbalance should the nurse assess for? Hypokalemia.
When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes, which is called ________________
When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes, which is called osmotic diuresis
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? a. Hypoglycemia b. Hyponatremia c. Ketonuria d. Polyphagia
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? a. Hypoglycemia b. Hyponatremia c. Ketonuria d. Polyphagia