🟠 Mastery Glucose Regulation

Which blood glucose levels would the nurse identify as hypoglycemia? 1. 68 mg/dL (3.8 mmol/L) 2. 78 mg/dL (4.3 mmol/L) 3. 88 mg/dL (4.9 mmol/L) 4. 98 mg/dL (5.4 mmol/L)

1. 68 mg/dL (3.8 mmol/L)

Which information would the nurse base a response on to a mother who asks for guidance regarding who to tell of the diagnosis of diabetes of her child, who plays on the soccer team? 1. Children with diabetes who participate in active sports can have episodes of hypoglycemia. 2. Children may have to leave athletic teams if school authorities learn that they have diabetes. 3. The school nurse will treat the child if clinical findings of hypoglycemia are recognized early. 4. The coach might violate confidentiality by discussing the child's condition with other faculty members.

1. Children with diabetes who participate in active sports can have episodes of hypoglycemia.

Which sign or symptom would the nurse expect to find on assessment of a client with a blood glucose level of 55 mg/dL? Select all that apply. One, some, or all responses may be correct. 1. Increased thirst 2. Abdominal pain 3. Frequent urination 4. Cold, clammy skin 5. 3+ glucose in urinalysis

4. Cold, clammy skin

Which information would the nurse include in a teaching plan about what causes diabetic acidosis? 1. A breakdown of fat stores for energy 2. Ingestion of too many highly acidic foods 3. Excessive secretion of endogenous insulin 4. Increased amounts of cholesterol in the extracellular compartment

1. A breakdown of fat stores for energy

Which is a gastrointestinal manifestation of infection in the newborn? Select all that apply. One, some, or all responses may be correct. 1. Lethargy 2. Irritability 3. Nasal flaring 4. Poor perfusion 5. Glucose instability

1. A breakdown of fat stores for energy

Why is blood glucose self-monitoring preferred over urine glucose testing? 1. Blood glucose monitoring is more accurate. 2. Blood glucose monitoring is easier to perform. 3. Blood glucose monitoring is done by the client. 4. Blood glucose monitoring is not influenced by medications.

1. Blood glucose monitoring is more accurate.

Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? Select all that apply. One, some, or all responses may be correct. 1. Confusion 2. Drowsiness 3. Diaphoresis 4. Nervousness 5. Heart rate 110 beats/min

1. Confusion 2. Drowsiness 3. Diaphoresis 4. Nervousness 5. Heart rate 110 beats/min

Which complication is the result of type 1 diabetes in a pregnant client? 1. Increased risk of hypertensive states 2. Abnormal placental implantation 3. Excessive weight gain because of increased appetite 4. Decreased amount of amniotic fluid as the pregnancy progresses

1. Increased risk of hypertensive states

The nurse is discussing insulin needs with an adolescent with recently diagnosed type 1 diabetes. Which information is important for the nurse to include concerning insulin administration? 1. Insulin will be required throughout life. 2. Insulin may be taken orally until adulthood. 3. Insulin needs increase with strenuous exercise. 4. Insulin needs decrease in the presence of an infection.

1. Insulin will be required throughout life.

The nurse is teaching an adolescent newly diagnosed with type 1 diabetes about self-care. Which is the primary long-term goal? 1. Maintaining normoglycemia 2. Complying with the diabetic diet 3. Adhering to an exercise program 4. Developing a nonstressful lifestyle

1. Maintaining normoglycemia

Which instruction would the nurse provide to a 6' 0", 160-pound client newly diagnosed with type 1 diabetes who wants to self-administer injections with an insulin pen? Select all that apply. One, some, or all responses may be correct. 1. Prime the needle with two units. 2. Use a 29-gauge insulin needle. 3. Give the injection at 45-degree angle. 4. Refrain from recapping the needle. 5. Dial the pen to deliver the unit dose.

1. Prime the needle with two units. 2. Use a 29-gauge insulin needle. 3. Give the injection at 45-degree angle. 4. Refrain from recapping the needle. 5. Dial the pen to deliver the unit dose.

During a teaching session about insulin injections, a client asks the nurse, "Why can't I take the insulin in pills instead of taking shots?" How will the nurse respond? 1. "Insulin cannot be manufactured in pill form." 2. "Insulin is destroyed by gastric juices, rendering it ineffective." 3. "Your health care provider decides the route of administration." 4. "Your health care provider will prescribe pills when you are ready."

2. "Insulin is destroyed by gastric juices, rendering it ineffective."

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops an infection with anorexia. Which advice will the nurse provide to the client? Select all that apply. One, some, or all responses may be correct. 1. Avoid solid food. 2. Continue to take the oral medication. 3. Drink fluids throughout the day. 4. Monitor capillary glucose levels. 5. Do not take medication until tolerating food.

2. Continue to take the oral medication. 3. Drink fluids throughout the day. 4. Monitor capillary glucose levels.

Which complication associated with type 1 diabetes should the nurse include in the teaching plan for parents of a newly diagnosed child? 1. Obesity 2. Ketoacidosis 3. Resistance to treatment 4. Hypersensitivity to other medications

2. Ketoacidosis Ketoacidosis is a complication of type 1 diabetes; children require close blood glucose monitoring because of the demands of growth and their erratic diets. Obesity is more often associated with children who have type 2 diabetes. Resistance to treatment during the school-aged years is not common; problems are related to the changing requirements associated with growth. Hypersensitivity to other medications is unrelated to either type 1 or type 2 diabetes.

When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report which clinical manifestation? 1. Nervousness 2. Polyuria 3. Nocturia 4. Diaphoresis

2. Polyuria

Which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? 1. Exercise regularly. 2. Rotate injection sites. 3. Use the Z-track technique. 4. Vigorously massage the injection site.

2. Rotate injection sites.

Which chemical buffers excessive acetoacetic acid? 1. Potassium 2. Sodium bicarbonate 3. Carbon dioxide 4. Sodium chloride

2. Sodium bicarbonate Sodium bicarbonate is a base and one of the major buffers in the body. Potassium, a cation, is not a buffer; only a base can buffer an acid. Carbon dioxide is carried in aqueous solution as carbonic acid (H 2CO 3); an acid does not buffer another acid. Sodium chloride is not a buffer; it is a salt.

Which hormone would the nurse identify as inhibiting insulin and glucagon secretion? 1. Amylin 2. Somatostatin 3. Triiodothyronine (T 3) 4. Pancreatic polypeptide

2. Somatostatin Somatostatin is a hormone that inhibits insulin and glucagon secretion, as well as growth hormone

A client newly diagnosed with type 1 diabetes asks why it is necessary to exercise on a regular basis. Which response is accurate? 1. "Exercise decreases insulin sensitivity." 2. "It stimulates glucagon production." 3. "Exercise improves the cellular uptake of glucose." 4. "It reduces metabolic requirements for glucose."

3. "Exercise improves the cellular uptake of glucose." Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise. Regular vigorous exercise increases cell sensitivity to insulin. Glucagon action raises blood glucose but does not affect cell uptake or use of glucose. Cellular requirements for glucose increase with exercise.

An adolescent who has just been found to have type 1 diabetes asks the nurse about exercise. Which is the best response by the nurse? 1. "Exercise should be restricted." 2. "Exercise will increase blood glucose." 3. "Extra snacks are needed before exercise." 4. "Extra insulin is required during exercise.

3. "Extra snacks are needed before exercise."

Between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage? 1. 10th and 12th weeks of gestation 2. 18th and 22nd weeks of gestation 3. 24th and 28th weeks of gestation 4. 36th and 40th weeks of gestation

3. 24th and 28th weeks of gestation At the end of the second trimester and the beginning of the third trimester, insulin needs increase because of an increase in maternal resistance to insulin. During the earlier part of pregnancy, fetal demands for maternal glucose may cause a tendency toward hypoglycemia. During the last weeks of pregnancy, maternal resistance to insulin decreases, and insulin needs decrease accordingly.

While obtaining the client's health history, which factor would the nurse identify that predisposes the client to type 2 diabetes? 1. Having diabetes insipidus 2. Eating low-cholesterol foods 3. Being 20 pounds (9 kg) overweight 4. Drinking a daily alcoholic beverage

3. Being 20 pounds (9 kg) overweight Excessive body weight is a known predisposing factor to type 2 diabetes; the exact relationship is unknown. Diabetes insipidus is caused by too little antidiuretic hormone (ADH) and has no relationship to type 2 diabetes. High-cholesterol diets and atherosclerotic heart disease are associated with type 2 diabetes. Alcohol intake is not known to predispose a person to type 2 diabetes.

The health care provider prescribes an oral hypoglycemic medication for the client with type 2 diabetes. Which statement will the nurse need to consider when developing the teaching plan? 1. Oral hypoglycemics work by decreasing absorption of carbohydrates. 2. Oral hypoglycemics work by stimulating the pancreas to produce insulin. 3. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. 4. Serious adverse effects are not a problem for oral hypoglycemic

3. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the medication prescribed. Oral hypoglycemic medications can have serious adverse effects.

An insulin pump is instituted for a client with type 1 diabetes. The nurse plans discharge instructions. Which short-term goal is the priority for this client? 1. Plan daily intake incorporating diabetic diet guidelines. 2. Demonstrate proper subcutaneous insulin injection technique. 3. Demonstrate correct use of the insulin pump. 4. List three self-care activities that help control the diabetes.

3. Demonstrate correct use of the insulin pump.

A client's breath has a sweet, fruity odor. Which condition is affecting this client? 1. Gum disease 2. Uremic acidosis 3. Diabetic acidosis 4. Infection inside a cast

3. Diabetic acidosis

Why is 15 g of a simple sugar administered when a client with diabetes experiences hypoglycemia? 1. Inhibits glycogenesis 2. Stimulates release of insulin 3. Increases blood glucose levels 4. Provides more storage of glucose

3. Increases blood glucose levels

Glucose transportation into the cells through cell membranes takes place in which order? 1. Transformation of proinsulin into active insulin 2. Attachment of insulin to receptors 3. Secretion of proinsulin by beta cells 4. Storage of proinsulin in the pancreas

3. Secretion of proinsulin by beta cells 4. Storage of proinsulin in the pancreas 1. Transformation of proinsulin into active insulin 2. Attachment of insulin to receptors Proinsulin is a prohormone that is secreted by beta cells and is stored in the beta cells of islets of Langerhans of the pancreas. Active insulin is a protein made up of 51 amino acids; it is produced when C-peptide is removed from the proinsulin. Insulin attaches to receptors present on the target tissues, such as adipose tissue or muscle, where the promotion of glucose transport into the cells through cell membranes occurs.

When teaching a client with type 2 diabetes, which statement by the nurse reflects accurate information about preparing for a serum glucose test? 1. "Eat your usual breakfast." 2. "Have clear liquids for breakfast." 3. "Take your medication before the test." 4. "Do not ingest anything before the test."

4. "Do not ingest anything before the test."

A client with type 2 diabetes takes one glyburide tablet daily. The client asks whether an extra tablet should be taken before exercise. Which response will the nurse provide? 1. "You will need to decrease how much you are exercising." 2. "An extra pill will help your body use glucose when exercising." 3. "The amount of medication you need to take is not related to exercising." 4. "Do not take an extra pill because you may become hypoglycemic when exercising."

4. "Do not take an extra pill because you may become hypoglycemic when exercising."

A client who receives NPH insulin every morning reports feeling nervous at 4:30 PM. The nurse observes that the client's skin is moist and cool. Which condition is the client likely experiencing? 1. Hyperosmolar hyperglycemic nonketotic state 2. Ketoacidosis 3. Glycogenesis 4. Hypoglycemia

4. Hypoglycemia

A full-term infant who is large for gestational age (LGA) should be monitored for which risk? 1. Hypotension 2. Hypothermia 3. Hypocalcemia 4. Hypoglycemia

4. Hypoglycemia Infants that are LGA are considered at risk for hypoglycemia, and their glucose should be monitored following a protocol. LGA infants are not at an increased risk for hypotension, hypothermia, or hypocalcemia.

A client with type 1 diabetes receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM. At 3:30 PM, the client becomes diaphoretic, weak, and pale. With which condition would the nurse determine that these physiological responses are associated? 1. Diabetic coma 2. Hyperosmolar hyperglycemic nonketotic syndrome 3. Diabetic ketoacidosis 4. Hypoglycemic reaction

4. Hypoglycemic reaction These are sympathetic nervous system responses to hypoglycemia;

In which parts of the kidney are glucose and amino acids reabsorbed? 1. Distal tubule 2. Loop of Henle 3. Collecting duct 4. Proximal tubule

4. Proximal tubule Glucose, amino acids, electrolytes, and bicarbonate are reabsorbed in the proximal tubule.

Which mechanism of action explains how glyburide decreases serum glucose levels? 1. Stimulates the pancreas to produce insulin 2. Accelerates the liver's release of stored glycogen 3. Increases glucose transport across the cell membrane 4. Decreases absorption of glucose from the gastrointestinal system

1. Stimulates the pancreas to produce insulin

A client with type 1 diabetes asks what causes several brown spots on the skin. What would be the best response by the nurse? 1. "The brown spots reflect the accumulation of blood fats in the skin; they should disappear." 2. "Those spots indicate a high glucose content in the skin that may get infected if left untreated." 3. "They are the result of diseased small vessels in the shins and may spread if not treated soon." 4. "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot."

4. "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot." Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot" is an accurate explanation for the client's concern; brown spots are caused by the deposit of hemosiderin in the tissue.

Which finding is indicative of hypothermia in a newborn? Select all that apply. One, some, or all responses may be correct. 1. Seizures 2. Diaphoresis 3. Flushed skin 4. Poor feeding 5. Hypoglycemia

5. Hypoglycemia Hypoglycemia in a newborn can indicate hypothermia or cold stress. Seizures, diaphoresis, flushed skin, and poor feeding are indicative of hyperthermia.