patho final test bank combined set

Which finding should the nurse expect when assessing a patient with symmetrical distal polyneuropathy due to​ diabetes? A. Distal pain in lower legs that worsens at night B. ​Sharp, shooting pain in the distal legs C. Distal sensory loss in one limb D. Leg pain that progresses from proximal to distal

A

Which laboratory values should the nurse expect in a patient with diabetic​ ketoacidosis? A. Serum bicarbonate​ > 18​ mEq/L B. Arterial pH​ > 7.3 C. Ketonuria D. Plasma glucose level of 200​ mg/dL

C

Which data indicates a diagnosis of diabetes in a patient being assessed for unexplained weight​ loss? A. Symptoms of diabetes plus casual plasma glucose concentration ≥ ​150mg/dL B. ​2-hour plasma glucose​ > 150​ mg/dL C. Fasting plasma glucose ≤ 126​ mg/dL D. A1C ≥ ​6.5%

D

when is An oral glucose tolerance test used to check for gestational diabetes

the 24th week of pregnancy

When teaching a patient newly diagnosed with type 1 diabetes about autonomic nervous system symptoms of​ hypoglycemia, which would the nurse​ include? A. Irritability and confusion B. Visual disturbances and drowsiness C. Sweating and tremors D. Incoordination and difficulty speaking

C

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct? a. Insulin is not used to control blood glucose in patients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.

C

Which statement by the parent of a child with an eating disorder indicates that more teaching is​ needed? A. ​"My child may experience uncontrolled​ diabetes." B. ​"If my child develops​ diabetes, the rate of complications may be higher than​ usual." C. ​"Diabetes is not connected to eating disorders in​ children." D. ​"Diabetic complications can be accelerated in children with eating​ disorders."

C

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about a. self-monitoring of blood glucose. b. using low doses of regular insulin. c. lifestyle changes to lower blood glucose. d. effects of oral hypoglycemic medications.

C The patient's impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

The nurse is assessing a patient with hyperglycemic hyperosmolar syndrome​ (HHS). Which finding would differentiate HHS from diabetic ketoacidosis​ (DKA)? A. Fluid volume deficit B. Electrolyte imbalances C. Hyperglycemia D. Lack of ketonuria

D

The public health nurse is conducting a community screening for diabetes. Which of the following people does the nurse identify as being at highest risk for type 1​ diabetes? A. A person with an affected father B. A person with an affected sibling C. A person with an affected mother D. A person with multiple affected​ first-degree relatives

D

during RAAS system, what gland releases antidiuretic hormone (ADH)

pituitary gland

Which metabolic state is characterized by the oxidation of free fatty acids by muscles?

postabsorptive state

A nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching? A. "Test your blood glucose levels every 8 hours." B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." C. "Withhold your usual daily dose of insulin." D. "Drink 240 to 360 milliliters of calorie-free liquids every 8 hours."

B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." This indicates DKA, pt should contact provider if he has moderate/large amounts of ketones in his urine. Pt should check BG level at least every 4-6 hr when he is also experiencing anorexia, nausea, and vomiting. During illness pt is at risk for hyperglycemia, so pt should take usual dose of insulin to keep BG levels w/in expected reference range. To prevent dehydration pt should drink 240-360 mL (8-12 oz) of calorie-free liquids every hour, if BG level is low he should drink fluids containing sugar.

When the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective?

"I will notify my health care provider if my blood glucose level is consistently greater than 250 mg/dL."

The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response? a. "Are you anorexic?" c. "Have you lost weight lately?" b. "Is your urine dark colored?" d. "Do you crave sugary drinks?"

C

When conducting community screening for​ diabetes, which population should the community health nurse recognize as being at highest​ risk? A. Caucasians B. ​Hispanics/Latinos C. African Americans D. Asian Americans

C

When preparing a nursing care plan for an adolescent with​ diabetes, which concept should the nurse keep in​ mind? A. More insulin is needed as more growth hormone is released during adolescence. B. More insulin is needed as adolescents begin to engage in sports. C. More insulin is needed as the adolescents ingests less calories. D. More insulin is needed during sleep in adolescents.

A

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic? a. Measure the ankle-brachial index. b. Check for changes in skin pigmentation. c. Assess for unilateral or bilateral foot drop. d. Ask the patient about symptoms of depression.

ANS: A Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial index is a procedure that can be done by UAP who have been trained in the procedure. The other assessments require more education and critical thinking and should be done by the registered nurse (RN).

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Ask the patient about home insulin doses. d. Start an insulin infusion at 0.1 units/kg/hr.

ANS: A Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. Discussion of home insulin and possible causes can wait until the patient is stabilized.

Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? a. The patient programs the pump for an insulin bolus after eating. b. The patient changes the location of the insertion site every week. c. The patient takes the pump off at bedtime and starts it again each morning. d. The patient plans a diet with more calories than usual when using the pump.

ANS: A In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used, but it does not provide for consuming a higher calorie diet. The pump will deliver a basal insulin rate 24 hours a day.

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test? a. The patient uses oral contraceptives. b. The patient runs several days a week. c. The patient has been pregnant three times. d. The patient has a family history of diabetes.

ANS: A Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values. Exercise and a family history of diabetes both can affect blood glucose but will not lead to misleading information from the OGTT. History of previous pregnancies may provide informational about gestational glucose tolerance but will not lead to misleading information from the OGTT.

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next? a. Give the patient 4 to 6 oz more orange juice. b. Administer the PRN glucagon (Glucagon) 1 mg IM. c. Have the patient eat some peanut butter with crackers. d. Notify the health care provider about the hypoglycemia.

ANS: A The "rule of 15" indicates that administration of quickly acting carbohydrates should be done two or three times for a conscious patient whose glucose remains less than 70 mg/dL before notifying the health care provider. More complex carbohydrates and fats may be used after the glucose has stabilized. Glucagon should be used if the patient's level of consciousness decreases so that oral carbohydrates can no longer be given.

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. The clinic nurse will plan to teach the patient to a. check glucose level before, during, and after swimming. b. delay eating the noon meal until after the swimming class. c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming.

ANS: A The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first? a. Infuse 1 L of normal saline per hour. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/

ANS: A The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be done after the infusion of normal saline is initiated.

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? a. Choose flat-soled leather shoes. b. Set heating pads on a low temperature. c. Use callus remover for corns or calluses. d. Soak feet in warm water for an hour each day.

ANS: A The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems.

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia? a. 10:00 AM c. 2:00 PM b. 12:00 AM d. 4:0 PM

ANS: A The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.

A 30-yr-old patient has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye examination a. every 2 years. c. when the patient is 39 years old. b. as soon as possible. d. within the first year after diagnosis.

ANS: B Because many patients have some diabetic retinopathy when they are first diagnosed with type 2 diabetes, a dilated eye examination is recommended at the time of diagnosis and annually thereafter. Patients with type 1 diabetes should have dilated eye examinations starting 5 years after they are diagnosed and then annually.

After change-of-shift report, which patient should the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12% b. A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL c. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202 mg/dL d. A 50-yr-old patient who uses exenatide (Byetta) and is complaining of acute abdominal pain

ANS: B Because the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness, seizures, and death. The nurse will rapidly assess and treat the patient with low blood glucose. The other patients also have symptoms that require assessments or interventions, but they are not at immediate risk for life-threatening complications.

The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? a. Ask the patient's family to participate in the diabetes education program. b. Assess the patient's perception of what it means to have diabetes mellitus. c. Demonstrate how to check glucose using capillary blood glucose monitoring. d. Discuss the need for the patient to actively participate in diabetes management.

ANS: B Before planning teaching, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.

Which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? a. The patient avoids injecting the insulin into the upper abdominal area. b. The patient cleans the skin with soap and water before insulin administration. c. The patient stores the insulin in the freezer after administering the prescribed dose. d. The patient pushes the plunger down while removing the syringe from the injection site.

ANS: B Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to a. give 50% dextrose. c. initiate O2 by nasal cannula. b. insert an IV catheter. d. administer glargine (Lantus) insulin.

ANS: B HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires O2. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.

The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? a. "I will need a bedtime snack because I take an evening dose of NPH insulin." b. "I can choose any foods, as long as I use enough insulin to cover the calories." c. "I can have an occasional beverage with alcohol if I include it in my meal plan." d. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."

ANS: B Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.

The nurse is taking a health history from a 29-yr-old pregnant patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take? a. Teach the patient about administering regular insulin. b. Schedule the patient for a fasting blood glucose level. c. Teach about an increased risk for fetal problems with gestational diabetes. d. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.

ANS: B Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be used to check for diabetes, but it would be done before the twenty-fourth week. Teaching plans would depend on the outcome of a fasting blood glucose test and other tests.

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness? a. Assess the patient for symptoms of hyperglycemia. b. Give the patient a snack of peanut butter and crackers. c. Have the patient drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours.

ANS: B Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration of IV glucose might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.

The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose a. washes the puncture site using warm water and soap. b. chooses a puncture site in the center of the finger pad. c. hangs the arm down for a minute before puncturing the site. d. says the result of 120 mg indicates good blood sugar control.

ANS: B The patient is taught to choose a puncture site at the side of the finger pad because there are fewer nerve endings along the side of the finger pad. The other patient actions indicate that teaching has been effective.

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider? a. Hemoglobin A1C level of 6.2% b. Blood pressure of 140/88 mmHg c. Heart rate at rest of 58 beats/minute d. High density lipoprotein (HDL) level of 65 mg/dL

ANS: B To decrease the incidence of macrovascular and microvascular problems in patients with diabetes, the goal blood pressure is usually 130/80 mm Hg. An A1C less than 6.5%, a low resting heart rate (consistent with regular aerobic exercise in a young adult), and an HDL level of 65 mg/dL all indicate that the patient's diabetes and risk factors for vascular disease are well controlled.

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? a. Chest x-ray b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria e. Complete blood count (CBC) f. Monofilament testing of the foot

ANS: B, C, D, F Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible microvascular and macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the patient with diabetes presents with symptoms of respiratory or infectious problems but are not routinely included in screening.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. The nurse will anticipate that the patient may a. need a diet higher in calories while receiving prednisone. b. develop acute hypoglycemia while taking the prednisone. c. require administration of insulin while taking prednisone. d. have rashes caused by metformin-prednisone interactions.

ANS: C Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone but will not need a diet that is higher in calories.

A 26-yr-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to a. use only the lispro insulin until the symptoms are resolved. b. limit intake of calories until the glucose is less than 120 mg/dL. c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.

ANS: C Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate short-term alterations in blood glucose.

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery. b. Discuss the reason for the use of insulin therapy during the immediate postoperative period. c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

ANS: C LPN/LVN education and scope of practice includes administration of insulin. Communication about patient status with other departments, planning, and patient teaching are skills that require RN education and scope of practice.

A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin? a. thigh. c. abdomen. b. buttock. d. upper arm.

ANS: C Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle

A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider? a. Hemoglobin A1C level is 7.9%. b. Last eye examination was 18 months ago. c. Glomerular filtration rate is decreased. d. Patient has questions about the prescribed diet.

ANS: C The decrease in renal function may indicate a need to adjust the dose of metformin or change to a different medication. In older patients, the goal for A1C may be higher in order to avoid complications associated with hypoglycemia. The nurse will plan on scheduling the patient for an eye examination and addressing the questions about diet, but the area for prompt intervention is the patient's decreased renal function.

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice.

ANS: C The patient's clinical manifestations are consistent with hypoglycemia, and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might be given if the patient's symptoms become worse or if the patient is unconscious.

After change-of-shift report, which patient will the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who was admitted with possible dawn phenomenon b. A 35-yr-old patient with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL c. A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa d. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain

ANS: C The patient's diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for signs of shock and determine whether increased fluid infusion is needed. The other patients also need assessment and intervention but do not have life-threatening complications.

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? a. The patient's blood glucose level is 174 mg/dL. b. The patient is scheduled for a chest x-ray in an hour. c. The patient has gained 2 lb (0.9 kg) in the past 24 hours. d. The patient's blood urea nitrogen (BUN) level is 52 mg/dL.

ANS: D The BUN indicates possible renal failure, and metformin should not be used in patients with renal failure. The other findings are not contraindications to the use of metformin.

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? a. "If I overeat at a meal, I will still take the usual dose of medication." b. "Other medications besides the Glucotrol may affect my blood sugar." c. "When I am ill, I may have to take insulin to control my blood sugar." d. "My diabetes won't cause complications because I don't need insulin."

ANS: D The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of glipizide.

A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.

ANS: D When the patient is ketotic, exercise may result in an increase in blood glucose level. Patients with type 1 diabetes should be taught to avoid exercise when ketosis is present.

The nurse is assigned to assist in caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). Which is the priority nursing action for this client who is in the acute phase?

Administer intravenous (IV) regular insulin.

The nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?

Apply a moisturizing lotion to dry feet, but not between the toes

The plan of care for a patient in diabetic​ ketoacidosis, with a blood glucose level of 450​ mg/dL, should include strategies​ for: A. administration of​ long-acting subcutaneous insulin. B. administration of intravenous​ short-acting insulin. C. administration of​ short-acting subcutaneous insulin. D. administration of oral hypoglycemic agents.

B

When developing a care plan for a patient with type 1​ diabetes, the nurse should consider which pathophysiological​ concept? A. In type 1​ diabetes, there is an over secretion of insulin. B. In type 1​ diabetes, there is a complete lack of insulin secretion. C. In type 1​ diabetes, there is insulin resistance. D. In type 1​ diabetes, there is a relative deficiency in insulin.

B

Which patient statement indicates to the nurse that the patient needs more teaching about type 2​ diabetes? A. ​"From time-to-time, I may need insulin to control my blood glucose​ levels." B. ​"Type 2 diabetes is also call​ juvenile-onset diabetes." C. ​"I am not dependent on insulin to control my blood glucose​ levels." D. ​"Most people with diabetes have type 2​ diabetes."

B

The nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. Which statement made by the client would indicate hyperglycemia and thus warrant health care provider notification?

"I am urinating a lot."

The nurse is assigned to care for a client at home who has a diagnosis of type 1 diabetes mellitus. When the nurse arrives to care for the client, the client tells the nurse that she has been vomiting and has diarrhea. Which additional statement by the client indicates a need for further teaching?

"I need to stop my insulin."

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise?

"I should not exercise in the late afternoon."

rapid-acting insulins peak in

1-3 hrs

How should the nurse respond when a patient with diabetes asks about the role of beta cells in the​ pancreas? A. ​"Beta cells secrete​ insulin." B. ​"Beta cells secrete​ glucagon." C. ​"Beta cells secrete​ somatostatin." D. ​"Beta cells secrete pancreatic​ polypeptide."

A

What is the most appropriate response by the nurse when a​ 20-year-old woman pregnant with her first child and diagnosed with gestational diabetes mellitus​ (GDM) asks if she will develop diabetes in the​ future? A. ​"There is a chance that you may develop diabetes in the next 10-20 ​years, so monitoring would be​ appropriate." B. ​"Your risk for developing diabetes in the future is high because you are​ young." C. ​"You cannot develop gestational diabetes​ (GDM) in future​ pregnancies, this only happens with your first​ pregnancy." D. ​"It is impossible to tell—we ​don't know anything about the risk factors for​ diabetes."

A

The staff development nurse is teaching a class on diabetes to newly hired nurses at General Hospital. The nurse explains that during glycogenolysis which of the following​ occurs? A. Insulin​ increases, glucagon decreases. B. Insulin and growth hormone​ increase, cortisol decreases. C. Insulin​ decreases; glucagon,​ cortisol, growth hormone and epinephrine increase. D. Insulin​ decreases, glucagon and​ norepinephrine/epinephrine increase.

D

In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]). a. Rotate NPH vial. b. Withdraw regular insulin. c. Withdraw 20 units of NPH. d. Inject 20 units of air into NPH vial. e. Inject 2 units of air into regular insulin vial.

ANS: A, D, E, B, C When mixing regular insulin with NPH, it is important to avoid contact between the regular insulin and the additives in the NPH that slow the onset, peak, and duration of activity in the longer-acting insulin.

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy? a. "Do you feel bloated after eating?" b. "Have you seen any skin changes?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"

ANS: A Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions are also appropriate to ask but would not help in identifying autonomic neuropathy.

To assist an older patient with diabetes to engage in moderate daily exercise, which action is most important for the nurse to take? a. Determine what types of activities the patient enjoys. b. Remind the patient that exercise improves self-esteem. c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity.

ANS: A Because consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions may be helpful but are not the most important in improving compliance.

After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective? a. "I may feel hungrier than usual when I take this medicine." b. "I will not need to worry about hypoglycemia with the Byetta." c. "I should take my daily aspirin at least an hour before the Byetta." d. "I will take the pill at the same time I eat breakfast in the morning."

ANS: C Because exenatide slows gastric emptying, oral medications should be taken at least 1 hour before the exenatide to avoid slowing absorption. Exenatide is injected and increases feelings of satiety. Hypoglycemia can occur with this medication.

A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to a. save the lunch tray for the patient's later return to the unit. b. ask that diagnostic testing area staff to start a 5% dextrose IV. c. send a glass of milk or orange juice to the patient in the diagnostic testing area. d. request that if testing is further delayed, the patient be returned to the unit to eat.

ANS: D Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items.

how is HHS treated

Aggressive fluid and electrolyte replacement and insulin

A nurse is caring for a client who has type I diabetes mellitus and is not following the guidelines for therapy. Which of the following should the nurse consider as contributing factors to the client's nonadherence? (Select all that apply.) A. Gender B. Culture C. Literacy D. Dexterity E. Motivation

B. Culture C. Literacy D. Dexterity E. Motivation Gender does not contribute to nonadherence. Culture (sociocultural background, beliefs, practices, values, and traditions). Literacy (ability to read and correctly administer med) and dexterity (physical ability to use equipment needed) affect adherence. Motivation to follow Tx plan and pt perception of seriousness of illness affect adherence.

A child diagnosed with type 1 diabetes six months ago is being seen in the clinic because the mother has questions about why her child has not needed insulin for the past week. Which response by the mother indicates that more teaching is​ needed? A. ​"The honeymoon period will most likely end in a few​ months." B. ​"I still need to check my​ child's blood glucose​ levels." C. ​"My child no longer has​ diabetes." D. ​"This period of insulin production is​ temporary."

C

A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication? A. Grapefruit juice B. Milk C. Alcohol D. Coffee

C. Alcohol The nurse should teach the pt to avoid alcohol while taking this med to prevent disulfiram reaction, such as nausea, headache, and hypoglycemia. Grapefruit juice can cause atorvastatin toxicity if used while taking atorvastatin. Milk, coffee, and caffeine do not interact with chlorpropamide.

Which laboratory finding indicates to the nurse that a patient has an impaired fasting glucose​ (IFG)? A. An blood glucose level 2 hours after an oral glucose tolerance test that is high but not diagnostic of diabetes B. A fasting blood glucose level is diagnostic for diabetes C. Increased insulin and decreased glucagon levels two hours after fasting D. A fasting blood glucose level or A1c higher than normal but not diagnostic for diabetes

D

The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The client's skin is warm and flushed, and the pulse and respiratory rate are elevated from the client's baseline. Which action should the nurse implement?

Check the client's capillary blood glucose.

A woman in her 26th week of pregnancy is undergoing a​ one-step 75-gram oral glucose tolerance test​ (OGTT). Which finding indicates that gestational diabetes is​ present? A. A​ 2-hour plasma glucose level of 145​ mg/dL B. A​ 3-hour plasma glucose level of 135​ mg/dL C. A​ 1-hour plasma glucose level of 160​ mg/dL D. A fasting plasma glucose level of 92​ mg/dL

D

The nurse caring for a patient with uncontrolled diabetes notes deep and rapid respirations. The nurse documents this respiratory pattern​ as: A. shortness of breath. B. orthopnea. C. ​Cheyne-Stokes respiration. D. Kussmaul respiration.

D

A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? A. "I am to take my blood sugar reading after meals." B. "Insulin allows me to eat ice cream at bedtime." C. "A weight reduction program will make me hypoglycemic." D. "I give the insulin injections in my abdominal area."

D. "I give the insulin injections in my abdominal area." Pt should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client states to the nurse, "I will call the doctor next time I can't eat for more than a day or so." The nurse plans care, understanding that which statement accurately reflects this client's level of knowledge?

The client needs immediate education before discharge.

The nurse is assisting in preparing a care plan for a client with diabetes mellitus who has hyperglycemia. The nurse should focus on which potential problem for this client?

Dehydration

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which finding should the nurse expect to note as confirming this diagnosis?

Elevated blood glucose and low plasma bicarbonate

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which signs/symptoms are indicative of this disorder?

Excessive thirst and urine output

During the postabsorptive state, what process provides glucose for the brain and nervous tissue?

Gluconeogenesis

A client with type 2 diabetes mellitus has a blood glucose of more than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the health care provider's documentation and would expect to note which diagnosis?

Hyperglycemic hyperosmolar state (HHS)

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific signs of this complication should be included on the list?

Increased thirst

In the absorptive state, what hormone stimulates glucose uptake into tissues?

Insulin

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse who is assisting with care for the client obtains which item in preparation for the treatment of this syndrome?

Intravenous (IV) infusion of normal saline

What is the role of aldosterone

It causes the kidneys to keep sodium and water.

The nurse is reinforcing instructions to a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse should teach the client that which result is a sign of hypoglycemia?

Less than 50 mg/dL

The nurse is reinforcing instructions with a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) regarding measures to prevent a recurrence. Which instruction is important for the nurse to emphasize?

Monitor blood glucose levels frequently.

long acting insulins peak

None (safer)

The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information should the nurse obtain from the client during data collection?

Plan for injection rotation

What metabolic state is characterized by a higher ratio of glucagon to insulin?

Postabsorptive state

A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge?

Rotate the insulin injection sites systematically.

The nurse reinforces teaching with a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops?

Shakiness

What happens to excess glucose during the absorptive state?

Stored as glycogen or lipids

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is reinforcing instructions to the client regarding the program. Which should the nurse include in the instructions?

Take a blood glucose test before exercising.

Which client complaint should alert the nurse to a possible hypoglycemic reaction?

Tremors and double vision

During RAAS activation, what gland releases aldosterone

adrenal cortex

When the patient is ketotic, exercise may result in

an increase in blood glucose

Autonomic neuropathy can cause

delayed gastric emptying

Patients should be taught not to administer insulin into a site that will be

exercised

hypoglycemia symptoms

hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin

When the RAAS is activated due to a change in body hemodynamics, the SNS stimulates the ___________________ cells in the kidneys to release renin

juxtaglomerular cells

hyperglycemia symptoms

lots of eating, peeing, drinking. blurred vision, fatigue, weight loss