Med Surge Diabetes - from Mom
A, B, C, D, E, F, and H. Option A: Fruity odor breath or acetone breath occurs with elevated ketone levels. Insulin deficiency causes lipolysis into free fatty acids and glycerol. These free fatty acids are converted into ketones by the liver.
A 44-year-old woman with type 1 diabetes comes to the emergency department due to abdominal pain accompanied by nausea and vomiting. The patient had a history of chronic back pain due to a motor accident 20 years ago. Her situation renders her unable to work and pay for the increasing price of insulin, which has doubled during the last five years. The patient doesn't have medical coverage or insurance; therefore, she rations her insulin intake, making her unable to follow her prescribed therapeutic regimen for her diabetes. Because of her situation, the client is at high risk of developing diabetic ketoacidosis. As her nurse, which of the following symptoms would you anticipate the client to exhibit? Select all that apply. A. Fruity odor breath B. Deep and labored respirations C. Blurred vision D. Increased urination E. Increased thirst F. Fatigue G. Blood glucose level of 60 mg/dL H. Dehydration I. Respiratory rate of 8 bpm J. Hypernatremia K. Metabolic alkalosis
4.5 tablets 225,000 units X 1tablet/50,000 units = 4.5 tablets
A patient was recently discharged after being hospitalized due to type 1 diabetes mellitus and was given ergocalciferol (Vitamin D) 225,000 units PO daily. The patient have on hand ergocalciferol in 50,000 unit tablets. How many tablet(s) should the patient take?
A, B, D, and E. Options A, B, D, and E: Aging results in a reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to metabolic syndrome and a sedentary lifestyle. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth, and obesity — increases the risk of diabetes.
According to the National Diabetes Statistics Report, diabetes remains one of the leading causes of death in the United States since 2010. Which of the following factors are risks for the development of diabetes mellitus? Select all that apply. A. Age over 45 years B. Overweight with a waist/hip ratio >1 C. Having a consistent HDL level above 40 mg/dl D. Maintaining a sedentary lifestyle E. Polycystic ovary syndrome
D. The client will have moist clammy skin. Option D: Moist skin is the sign of hypoglycemia, which the client would experience if he injected himself with insulin and did not eat.
Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal? A. The client will be very thirsty. B. The client will complain of nausea. C. The client will need to urinate. D. The client will have moist clammy skin.
A. Below 5.7% HbA1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.
Blood sugar is well controlled when Hemoglobin A1C is: A. Below 5.7% B. Between 12%-15% C. Less than 180 mg/dL D. Between 90 and 130 mg/dL
C. More insulin During periods of infection or illness, diabetics may need even more insulin to compensate for increased blood glucose levels.
Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection? A. No changes B. Less insulin C. More insulin D. Oral antidiabetic agents
C. Stimulate the beta cells of the pancreas to secrete insulin. Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin.
Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus type 2. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase), is to: A. Induce hypoglycemia by decreasing insulin sensitivity. B. Improve insulin sensitivity and decrease hyperglycemia. C. Stimulate the beta cells of the pancreas to secrete insulin. D. Decrease insulin sensitivity by enhancing glucose uptake.
A. When the client is eating Option A: The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating to prevent hypoglycemia.
Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication? A. When the client is eating B. Thirty minutes before meals C. Fifteen minutes before meals D. When the meal trays arrive on the floor
A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl The seven risk criteria include: greater than 120% of standard body weight, Certain races but not including Caucasian, delivery of a baby weighing more than 9 pounds or a diagnosis of gestational diabetes, hypertensive, HDL greater than 35 mg/dl or triglyceride level greater than 250 or a triglyceride level of greater than 250 mg/dl, and, lastly, impaired glucose tolerance or impaired fasting glucose on prior testing
During a visit to a community, the nurse will recommend routine screening for diabetes when the person has one or more of seven risk criteria. Which of the following persons that the nurse comes in contact with most needs to be screened for diabetes based on the seven risk criteria? A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl B. A woman who is at 90% of standard body weight after delivering an eight-pound baby C. A middle-aged Caucasian male D. An older client who is hypotensive
C. African-American woman. Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
During a visit to the hospital, the student nurses are asked which of the following persons would most likely be diagnosed with diabetes mellitus. They are correct if they answered a 44-year-old: A. Caucasian woman. B. Asian woman. C. African-American woman. D. Hispanic male.
D. Smoking Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.
Nurse Pira is explaining to the client about type 2 diabetes mellitus. Risk factors of such condition include all of the following, except: A. Advanced age B. Physical inactivity C. Obesity D. Smoking
B. Biguanides Option B: Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver.
Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? A. Alpha-glucosidase inhibitors B. Biguanides C. Meglitinides D. Sulfonylureas
A. Physical exercise can slow the progression of type 2 diabetes mellitus. Option A: Physical exercise slows the progression of type 2 diabetes mellitus because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity.
Which of the following is accurate pertaining to physical exercise and type 2 diabetes mellitus? A. Physical exercise can slow the progression of type 2 diabetes mellitus. B. Strenuous exercise is beneficial when blood glucose is high. C. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia. D. Adjusting insulin regimen allows for safe participation in all forms of exercise.
D. IV bolus, followed by continuous infusion. Option D: An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose.
Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis? A. Subcutaneous B. Intramuscular C. IV bolus only D. IV bolus, followed by continuous infusion
C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of hypoglycemia Alcohol lowers blood glucose levels and disrupts the production of glucose in the liver. Sulfonylureas, when taken with alcohol, may produce a disulfiram-like reaction which may lead to flushing, hypotension, nausea, tachycardia, vertigo, and blurred vision. Metformin should be avoided in patients with a history of chronic alcohol use because they may be more predisposed to lactic acidosis.
You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent. The client mentions that he usually has a couple of beers each night and takes an aspirin each day to prevent heart attack and/or strokes. Which of the following responses would be best on the part of the nurse? A. As long as you only drink two beers and take one aspirin, this should not be a problem B. The aspirin is alright but you need to give up drinking any alcoholic beverages C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of hypoglycemia D. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug
D. Pancreatic tumor The onset of hyperglycemia in older adults can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumors.
A 50-year-old widower is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia. The gerontology nurse should anticipate which of the following secondary medical diagnoses? A. Impaired glucose tolerance B. Gestational diabetes mellitus C. Pituitary tumor D. Pancreatic tumor
B. "Insulin can't be in a pill because it is destroyed in stomach acid." Option B: Insulin must be injected because it is destroyed in the stomach acid if taken orally.
A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse? A. "Insulin must be injected because it needs to work quickly." B. "Insulin can't be in a pill because it is destroyed in stomach acid." C. "Have you talked to your doctor about taking pills instead?" D. "I know it is tough, but you will get used to the shots soon
A. Kussmaul's respirations and a fruity odor on the breath Coma and severe acidosis are ushered in with Kussmaul's respirations (very deep but not labored respirations) and a fruity odor on the breath (academia).
A client is in diabetic ketoacidosis (DKA) secondary to infection. As the condition progresses, which of the following symptoms might the nurse see? A. Kussmaul's respirations and a fruity odor on the breath B. Shallow respirations and severe abdominal pain C. Decreased respiration and increased urine output D. Cheyne-stokes respirations and foul-smelling urine
B. 6-14 hours after administration The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.
A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration
B. 0.9% normal saline solution Option B: The client is experiencing diabetic ketoacidosis. Initial priority in the treatment is to restore the extracellular fluid volume through the intravenous administration of 0.9% normal saline at 15-20 ml/kg/h.
A client was brought to the emergency room with complaints of slurring of speech, vomiting, dry mucosa, and dry skin turgor. Lab tests showing serum sodium 125 mEq/L and serum blood glucose of 350 mg/dL. Nurse Sophie will anticipate the physician to initially order which of the following intravenous solutions? A. 10% dextrose in water (D10W) B. 0.9% normal saline solution C. 5% dextrose in water (D5W) D. 0.45% normal saline solution
A. prednisone (Deltasone) Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.
A client with diabetes mellitus visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently, the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? A. prednisone (Deltasone) B. atenolol (Tenormin) C. phenelzine (Nardil) D. allopurinol (Zyloprim)
C. Administer the insulin as ordered A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered.
A client with type 1 diabetes mellitus has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should: A. Call the physician B. Encourage the intake of fluids C. Administer the insulin as ordered D. Give the client 1/2 c. of orange juice
B. Diaphoresis A hypoglycemic reaction activates a fight-or-flight response in the body which then triggers the release of epinephrine and norepinephrine resulting in diaphoresis.
A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A. Blurred vision B. Diaphoresis C. Nausea D. Weakness
C. The 42-year-old client who is 50 pounds overweight Option C: Obesity increases the likelihood of developing diabetes mellitus due to the overstimulation of the endocrine system.
A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at the highest risk for developing diabetes? A. The 50-year-old client who does not get any physical exercise B. The 56-year-old client who drinks three glasses of wine each evening C. The 42-year-old client who is 50 pounds overweight D. The 38-year-old client who smokes one pack of cigarettes per day
10 ml 1 tsp = 5ml 8mg/4mg X 5ml = 10ml
A health care provider prescribed ondansetron (Zofran) 8 mg p.o. T.i.d to a patient with Type 1 diabetes mellitus with complaints of vomiting.; Available stock of Zofran in a 100 ml bottle labeled 4 mg/tsp.; How many ml will the nurse administer for each dose?
B Option B: Maintaining adequate fluid, replacing vasopressin, and correcting underlying intracranial problems (typically lesions, tumors, or trauma affecting the hypothalamus or pituitary gland) are the main objectives in treating diabetes insipidus.
A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology? A. The client with diabetes mellitus. B. The client with diabetes insipidus. C. The client with diabetic ketoacidosis. D. The client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion.
D. All of the above Diabetic retinopathy is a complication of diabetes that is characterized by chronic and progressive damage to the retina. Symptoms include blurring of vision (due to macular edema), flashes of lights, and sudden loss of vision (due to retinal detachment).
A nurse is caring for a client admitted with diabetic retinopathy. Which of the following would the nurse expect to note on the assessment of this client: A. Blurred or distorted vision B. Flashes of lights or floaters C. Sudden loss of vision D. All of the above
A. High risk for deficient fluid volume Option A: Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options B, C, and D are not related specifically to the issue of the question.
A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be: A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalanced nutrition: less than body requirements D. Disabled family coping: compromised
D. Temperature An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.
A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse? A. Pulse B. Blood pressure C. Respiration D. Temperature
B. Signs of hypoglycemia earlier than expected. Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m.
A nurse went to a patient's room to do routine vital signs monitoring and found out that the patient's bedtime snack was not eaten. This should alert the nurse to check and assess for: A. Elevated serum bicarbonate and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Symptoms of hyperglycemia during the peak time of NPH insulin D. Sugar in the urine
A. Potassium Option A: Insulin causes potassium to move into the cell and may cause hypokalemia.
A patient was recently diagnosed with type 1 diabetes mellitus and received insulin. Which laboratory test will the nurse assess? A. Potassium B. AST (aspartate aminotransferase) C. Serum amylase D. Sodium
B. 1330 and 1930 The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.
Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330
A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.
An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B. It is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.
A. Try to limit simple sugars to between 10% and 20% of daily calories. Option A: It is recommended that carbohydrates provide 50% to 60% of the daily calories. Approximately 40% to 50% should be from complex carbohydrates. The remaining 10% to 20 % of carbohydrates could be from simple sugars.
During the lecture, the clinical instructor tells the students that 50% to 60% of daily calories should come from carbohydrates. What should the nurse say about the types of carbohydrates that can be eaten? A. Try to limit simple sugars to between 10% and 20% of daily calories. B. Simple carbohydrates are absorbed more rapidly than complex carbohydrates. C. Simple sugars cause a rapid spike in glucose levels and should be avoided. D. Simple sugars should never be consumed by someone with diabetes.
D. Lantus insulin 20U BID. Option D: Lantus insulin is usually prescribed once-a-day so an order for BID dosing should be validated with the physician.
During the morning rounds, Nurse AJ accompanied the physician in every patient's room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician? A. Use Humalog insulin for sliding scale coverage. B. Metformin (Glucophage) 1000 mg per day in divided doses. C. Administer regular insulin 30 minutes prior to meals. D. Lantus insulin 20U BID.
50 ml/hr Desired amount/have on hand X quantity = X 20 units/hr / 100 units X 250ml = 50ml/hr
Give Regular insulin by continuous I.V. infusion at 20 units/hr. The solution is 250 ml NS with 100 units of Regular insulin. What rate on the infusion pump will deliver the correct dose?
A. Extraction of energy Glucose catabolism is the main pathway for cellular energy production.
Glucose is an important molecule in a cell because this molecule is primarily used for: A. Extraction of energy B. Synthesis of protein C. Building of genetic material D. Formation of cell membranes
B. 5.7-6.4% Option B: Glycosylated hemoglobin levels between 5.7%-6.4% is considered as pre-diabetes.
Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. >5.6%
B. Somogyi phenomenon Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and an increase in ketones.
Harry is a diabetic patient who is experiencing a reaction to alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following? A. Uncontrolled diabetes B. Somogyi phenomenon C. Brittle diabetes D. Diabetes insipidus
D. Potassium Option D: Insulin forces potassium out of the plasma, back into the cells, causing hypokalemia. Potassium is needed to help transport glucose and insulin into the cells.
Insulin forces which of the following electrolytes out of the plasma and into the cells? A. Calcium B. Magnesium C. Phosphorus D. Potassium
B, C, and E. Options B, C, and E: Metformin (Glucophage) reduces insulin resistance, decreases sugar production in the liver, and should be taken with meals for the best absorption and effect.
Jansen is receiving metformin (Glucophage). What will be the best plan of the nurse with regard to patient education with this drug? Select all that apply. A. It stimulates the pancreas to produce more insulin. B. It must be taken with meals. C. It decreases sugar production in the liver. D. It inhibits the absorption of carbohydrates. E. It reduces insulin resistance.
C, D, and E Options C, D, and E: One function of your pancreas is to secrete insulin. The endocrine function of the pancreas is to secrete insulin. A consequence of diabetes mellitus type 1 is that without insulin, severe metabolic disturbances, such as ketoacidosis (DKA) will result.
Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol what this means. What is the best response by the nurse? Select all that apply. A. "Your alpha cells should be able to secrete insulin, but cannot." B. "The exocrine function of your pancreas is to secrete insulin." C. "Without insulin, you will develop ketoacidosis (DKA)." D. "The endocrine function of your pancreas is to secrete insulin." E. "It means your pancreas cannot secrete insulin."
B. Insulin lipodystrophy Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites.
Rotating injection sites when administering insulin prevents which of the following complications? A. Insulin edema B. Insulin lipodystrophy C. Insulin resistance D. Systemic allergic reactions
C. 1-2 weeks Rotation of sites for insulin injection should be done every week or two. Frequently using the same spot over time can cause fat cells to break down or build up (lipodystrophy) causing lumps under the skin and may interfere with insulin absorption.
Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: A. Third day B. Every other day C. 1-2 weeks D. 2-4 weeks
B. <130 mg/dl Option B: According to the American Diabetes Association, the recommended preprandial glucose target for an adult with diabetes is between 80-130 mg/dl.
The goal of preprandial blood glucose for those with type 1 diabetes mellitus is: A. <80 mg/dl B. <130 mg/dl C. <180 mg/dl D. >8%
B. Unlimited intake of total fat, saturated fat and cholesterol The guidelines for Carbohydrate Counting as medical nutrition therapy for diabetes mellitus include all of the following except unlimited intake of total fat, saturated fat and cholesterol.
The guidelines for carbohydrate counting as medical nutrition therapy for diabetes mellitus includes all of the following, except: A. Flexibility in types and amounts of foods consumed B. Unlimited intake of total fat, saturated fat, and cholesterol C. Including adequate servings of fruits, vegetables, and the dairy group D. Applicable to with either Type 1 or Type 2 diabetes mellitus
C. 50-60% Surgical procedures may result in a number of metabolic perturbations that can alter normal glucose homeostasis. Patients with type 1 diabetes mellitus who are using long-acting insulins, such as glargine, should continue these as normal when fasting. If the patient is prone to morning hypoglycemia, the dose can be reduced by 20%. Thus, the diabetic patient may receive 80% of his or her morning dose of insulin preoperatively. Patients taking premixed insulins or fixed-combination insulins are more of a challenge. It may not be feasible or economical to change the patient's premixed insulin just before surgery. In these situations, the patient can take ½ - ¾ of the morning dose, followed by administration of a dextrose-containing intravenous fluid and frequent blood glucose checks.
The nurse expects that a type 1 diabetic may receive how much of his or her morning dose of insulin preoperatively? A. 10-20% B. 25-40% C. 50-60% D. 85-90%
B. Palpitations, C. Diaphoresis, and D. Slurred speech Palpitations, an adrenergic symptom, occur as the glucose levels fall; the sympathetic nervous system is activated and epinephrine and norepinephrine are secreted causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.
The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. A. Thirst B. Palpitations C. Diaphoresis D. Slurred speech E. Hyperventilation
A. Hypoglycemia Option A: Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication.
The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth
B. Lispro (Admelog) Option B: Lispro is a rapid-acting insulin that works within 15 minutes after injection, a peak of 30-90 minutes, and a duration of 2-4 hours.
The nurse is teaching a client regarding the administration of insulin as part of the discharge plan. Which of the following insulin has the most rapid onset of action? A. insulin regular (Humulin R) B. lispro (Admelog) C. glargine (Toujeo) D. insulin NPH (Humulin N)
C. Lose a pound a week until the weight is within the normal range for height and exercise 30 minutes daily When Type II diabetics lose weight through diet and exercise they sometimes have an improvement in insulin efficiency sufficient to the degree they no longer require oral hypoglycemic agents.
The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of type 2 diabetes mellitus and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents? A. Comply with medication regimen 100% for 6 months B. Quit the use of any tobacco products by the end of three months C. Lose a pound a week until the weight is within the normal range for height and exercise 30 minutes daily D. Practice relaxation techniques for at least five minutes five times a day for at least five months
C. Increases blood glucose levels Glucagon, an insulin antagonist produced by the alpha cells in the islets of Langerhans, leads to the conversion of glycogen to glucose in the liver.
The nurse knows that glucagon may be given in the treatment of hypoglycemia because it: A. Inhibits gluconeogenesis B. Stimulates the release of insulin C. Increases blood glucose levels D. Provides more storage of glucose
B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected.
The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says: A. "I need to rub my forearm vigorously until warm before testing at this site." B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." C. "I have to make sure that my current glucose monitor can be used at an alternate site." D. "Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels."
B. Higher than 126 mg/dl Diabetes is diagnosed at a fasting blood glucose of greater than or equal to 126 mg/dl.
The nurse working in the physician's office is reviewing lab results on the clients seen that day. One of the clients who has classic diabetic symptoms had an eight-hour fasting plasma glucose (FPG) test done. The nurse realizes that diagnostic criteria developed by the American Diabetes Association for diabetes include classic diabetic symptoms plus which of the following fasting plasma glucose levels? A. Higher than 106 mg/dl B. Higher than 126 mg/dl C. Higher than 140 mg/dl D. Higher than 160 mg/dl
D. All of the above. One of the principal goals of therapy for older persons with diabetes mellitus and poor glycemic control is enhancing the quality of life due to the decline in physical performance and an increased risk of poor health outcomes due to physiologic vulnerability to clinical, functional, or psychosocial stressors. Decreasing the chance of complications is another goal of therapy for older persons with diabetes because diabetes complications can lead to serious illness and even death, which is why prevention is so important. As with all patients with diabetes, diabetes self-management education and ongoing diabetes self-management support are vital components of diabetes care for older adults and their caregivers. Through good self-management, people with diabetes can better their quality of life and diminish the risk of developing complications. It can also help lower the number of hospital admissions, or make those times when they do need to go into hospital, for whatever reason, a better experience, with a reduced length of stay.
The principal goals of therapy for older patients who have poor glycemic control are: A. Enhancing the quality of life. B. Decreasing the chance of complications. C. Improving self-care through education. D. All of the above.
D. Somogyi phenomenon Option D: Somogyi phenomenon ( post-hypoglycemic hyperglycemia) is characterized by a rebound high blood glucose level in the morning in response to low blood glucose that occurs at about 2-3 am in the morning.
Tony is a night shift nurse who is assigned to a patient whose glucose levels remain normal at bedtime but experiences hypoglycemia at 3 am and hyperglycemia at 7 am. The patient is likely experiencing what kind of complication of insulin therapy? A. Insulin resistance B. Dawn phenomenon C. Insulin lipohypertrophy D. Somogyi phenomenon
B. Human regular insulin Regular insulin (Humulin R) is short-acting insulin and is administered via IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood glucose becomes <13.9 mmol/L (<250 mg/dL). At this point, the insulin dose should be decreased by half, to 0.1 units/kg every 2 hours, until the resolution of DKA.
When a client is experiencing diabetic ketoacidosis, the insulin that would be administered is: A. Human NPH insulin B. Human regular insulin C. Insulin lispro injection D. Insulin glargine injection
C. Fluid replacement As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin.
When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide: A. Oxygen B. Carbohydrates C. Fluid replacement D. Dietary instruction
A, B, E, and F. Diabetes mellitus is associated with increased amounts of urine, a sweet or fruity odor, and glucose and ketone bodies in the urine. It does not affect the urine's pH or specific gravity.
When reviewing the urinalysis report of a client with newly diagnosed diabetes mellitus, the nurse would expect which urine characteristics to be abnormal? Select all that apply. A. Amount. B. Odor. C. pH. D. Specific gravity. E. Glucose level. F. Ketone bodies.
B. An increase in three areas: thirst, intake of fluids, and hunger The primary manifestations of diabetes type 1 are polyuria (increased urine output), polydipsia (increased thirst), polyphagia (increased hunger).
When taking a health history, the nurse screens for manifestations suggestive of diabetes type 1. Which of the following manifestations are considered the primary manifestations of type 1 diabetes mellitus and would be most suggestive and require follow-up investigation? A. Excessive intake of calories, rapid weight gain, and difficulty losing weight B. An increase in three areas: thirst, intake of fluids, and hunger C. Poor circulation, wound healing, and leg ulcers D. Lack of energy, weight gain, and depression
D. regular insulin (Novolin R) Option E: Regular insulins (Novolin R, Humulin R, Ilentin II Regular) are short-acting insulin usually given 30 minutes before a meal. They have an onset of 30-60 minutes, a peak of 2-3 hours, and a duration of 4-6 hours. Regular insulin is taken alone or in combination with other longer-acting insulins. Regular insulin is a clear solution and can be administered via IV.
Which insulin can be administered through continuous intravenous infusion? A. insulin glargine (Lantus) B. insulin aspart (Novolog) C. insulin detemir (Levemir) D. regular insulin (Novolin R)
B. Retinopathy, neuropathy, and coronary artery disease Option B: These are all chronic complications of diabetes.
Which of the following chronic complications is associated with diabetes? A. Dizziness, dyspnea on exertion, and coronary artery disease B. Retinopathy, neuropathy, and coronary artery disease C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts D. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias
3,265 ml 1 qt = 1,000 ml 1 oz = 30 ml 600 ml + 345 ml + 750 ml + 320 ml + 1,250 ml = 3,265 ml (Grits is not liquid at room temperature, so it is not included when calculating intake.)
Your patient has had the following intake: 2 ½ cups of coffee (240 mL/cup), 11.5 oz of grape juice, ¾ qt of milk, 320 mL of diet coke, 1 ¼ L of D5W IV and 2 oz of grits. What will you record as the total intake in mL for this patient?
