PrepU CH. 33

A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by participants should the nurse follow up first?

"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."

A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. The nurse determines further teaching is necessary when the client states:

"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads."

A patient diagnosed with type 2 diabetes has been instructed about managing her condition with diet. Which of the following statements by the patient indicates a need for additional education? Select all that apply.

"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." "I need to carefully limit my protein consumption."

The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is:

"Insulin is destroyed by the stomach contents and has to be administered by injection."

The health care provider has prescribed Repaglinide 2 mg for a client diagnosed with type 2 diabetes. The most important information for the nurse to give the client would be:

"Take the medication 15 to 30 minutes before each meal."

A three year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes?

"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."

A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse?

"You could regulate your diet, exercise regularly, and lose weight."

Following an oral glucose tolerance, a 36 year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous pregnancies. What should her primary care provider tell her about this new health problem?

"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars."

Which manifestation indicates a client is at risk for developing diabetes mellitus?

2 hour oral GTT 175 mg/dl

The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL. The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?

Administration of intravenous fluids

The nurse educates a patient newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that one gram of fat will provide _____ kcal of energy.

9

The nurse is reviewing assessment data on four clients. Select the client at highest risk for developing type 2 diabetes.

A 45-year-old obese female with a sedentary lifestyle

Which clients with diabetes mellitus would the nurse anticipate to have persistent elevation of blood glucose levels? Select all that apply.

A client with high anxiety A client with COPD taking steroids A client with a leg fracture

A 48-year-old male client diagnosed with type 2 diabetes presents with the following: • Blood glucose level of 46 mg/dL • Very lethargic • Has cool, clammy skin. Select the most appropriate intervention.

Administer injectable glucagon

A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?

Administration of 15 to 20 g of glucose in a concentrated carbohydrate source.

Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia?

Altered cerebral function and headache

While reviewing the role of glucagon in regards to regulation of blood glucose, the nurse knows which of the following situations could lead to an inhibition of glucagon release?

An increase in glucose levels.

The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin?

Beta cells

Diabetic ketoacidosis is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA?

Blood glucose level greater than 250 mg/dL; bicarbonate less than 15 mEq/L and pH less than 7.3

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause?

Blood glucose will elevate.

A patient is evaluated for diabetes. Which of the following signs and symptoms would the nurse identify as indications of increased blood glucose levels? Select all that apply.

Blurred vision Thirst Fatigue Skin infections

A patient is diagnosed with metabolic syndrome. Frequent concomitants of this syndrome include which of the following? Select all that apply.

Body mass index (BMI) greater than 30 Hypertriglyceridemia Coronary artery disease Elevated fasting blood glucose (FBG)

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which of these organs does the nurse recognize is reliant on glucose as the major energy source?

Brain

A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first?

Check blood glucose

A client with diabetes mellitus reports morning hyperglycemia for several days. What action should taken?

Check blood glucose at 2 AM

A patient with diabetes has been injured. The nurse will tell the patient that healing of the injury may be delayed due to which of the following diabetic complications? Select all that apply.

Chronic neuropathies Vascular impairment

Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes?

Complete failure of insulin secretion

For which conditions is diabetes mellitus a risk factor? Select all that apply.

Coronary artery disease• Cerebrovascular accident • Chronic kidney disease

The family of a client in the hospital with diabetes mellitus out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond?

Glucose is unused without insulin, so body fats are used for energy.

A woman with poorly controlled type 1 diabetes has been admitted to a hospital unit for the treatment of ketoacidosis. Place the following events in the pathophysiology of ketoacidosis in the correct chronological order. Use all the options.

Decrease in pH Breakdown of triglycerides Low serum insulin levels Ketone production by the liver Production of fatty acids and glycerol

Type 2 diabetes is caused by metabolic abnormalities in the presence of insulin. What are these metabolic abnormalities? (Select all that apply.)

Deranged secretion of insulin Increased glucose production by the liver Insulin resistance

A pancreatitis patient is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parental nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the patient for which clinical manifestations (listed below)?

Dry lips, excess urine output, and seizures.

A 15-year-old who has just been diagnosed with type 1 diabetes says she read on the Internet that diabetes is the leading cause of acquired blindness among Americans. She asks you if she will lose her sight. In addition to explaining that new treatment technologies are being worked on every day, which of the following would be the most appropriate response?

Explain that almost all people with type 1 diabetes do experience some degree of vision loss.

A 23-year-old man is admitted to the hospital. He is experiencing polyphagia, polyuria, and polydipsia. He states that the condition has come on very suddenly. This client is likely to require what treatment?

Exogenous insulin injections

A 15-year-old girl who has just been diagnosed with type 1 diabetes says she read on the Internet that diabetes is the leading cause of acquired blindness among Canadians. She asks nurse if she will lose her sight. In addition to explaining that new treatment technologies are being worked on every day, which response would be the most appropriate?

Explain that most people with type 1 diabetes do experience some loss of sight by about 20 years from the onset of their disease.

A 40 year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which of the following aspects of the man's obesity likely contributed to his new health problem?

Free fatty acids contribute to problems such as beta cell dysfunction and insulin resistance.

A nurse is teaching a patient with newly diagnosed type 1 diabetes about the importance of blood glucose control to decrease the risk of which of the following potential chronic complications of diabetes? Select all that apply.

Gastroparesis • Nephropathy • Retinopathy • Neuropathy

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?

Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen

The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority?

Give the client a concentrated carbohydrate.

A patient with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of the following might the nurse suggest as a long-acting insulin to provide a consistent basal level?

Glargine (Lantus)

Hormones that counteract insulin's storage function when regulating blood glucose during times when glucose intake is limited or glucose stores are depleted are called counterregulatory hormones. What are the counterregulatory hormones? (Select all that apply.)

Glucocorticoids Growth Hormone Catecholamines Glucagon

Which of the following statements best describes an aspect of the normal process of glucose metabolism?

Glucose that exceeds metabolic needs is converted and stored by the liver.

A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

Glycosylated hemoglobin 5.2%

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes .The best diagnostic indicator that would support the client's response would be:

Glycosylated hemoglobin, hemoglobin A1C (HbA1C)

When educating a patient about glargine (Lantus), the nurse should explain that this medication:

Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.

A patient has been admitted with diabetic ketoacidosis. The Emergency Department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which of the following clinical manifestations?

Headaches, dizziness, change in level of consciousness.

A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?

Helping the client make meaningful changes to his diet and activity level.

Which laboratory values for a newly admitted client indicate a diagnosis of diabetes mellitus? Select all that apply.

Hemoglobin A1c 9.1% 2 hour oral GTT 245 mg/dl

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?

Hyperglycemia

A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room complaining of headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints?

Hypoglycemia

A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?

Hypoglycemia

A 45-year-old client with type 1 diabetes has just been admitted with osteomyelitis. Which reason for diabetic susceptibility to infection is the most significant?

Infections that are less serious in healthy people are often more virulent in people with diabetes due to hyperglycemia and glucosuria.

A 30 year-old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin? Select all that apply.

Inhibiting protein breakdown Facilitating triglyceride synthesis from glucose in fat cells Promoting glucose uptake by target cells

The diagnosis of type 1 diabetes would be confirmed by:

Insulin is not available for use by the body.

The nurse knows that metabolic abnormalities that lead to type 2 diabetes include which of the following? Select all that apply.

Insulin resistance Beta cell failure Hepatic glycogenolysis

A client is admitted to the emergency department and diagnosed with diabetic ketoacidosis (DKA). The client would most likely manifest:

Ketosis

Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk?

Kidneys and eyes

The nurse has just completed teaching a client newly diagnosed with type 1 diabetes about rapid-acting insulin. The nurse determines that teaching was effective when the client selects:

Lispro

The nurse is teaching a client with diabetes about medications that will increase the blood glucose level. The most important information for the nurse to provide would be: Select all that apply.

Loop diuretics Oral contraceptives Total parenteral nutrition Antipsychotics

A patient with distal symmetric polyneuropathy usually begins by complaining of:

Loss of feeling or touch in the feet.

Gestational diabetes mellitus is a disorder of glucose intolerance that occurs during pregnancy. It is associated with increased risk for developing type 2 diabetes and with fetal abnormalities. What fetal abnormalities are associated with gestational diabetes mellitus?

Macrosomia and hypocalcemia

A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information?

Maintain healthy blood pressure and blood sugar levels.

In which situation would an increase of glucagon be expected?

NPO before surgery

A client admitted to the hospital with elevated blood glucose is diagnosed with type 2 diabetes mellitus. What characteristics commonly differentiate type 2 diabetes mellitus from type 1 diabetes mellitus? Select all that apply.

Onset after age 35 Overweight

A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2 diabetes mellitus? Select all that apply.

Onset before age 20 Autoimmune beta cell damage Abrupt onset of symptoms

A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2 diabetes mellitus? Select all that apply:

Onset before age 20 Autoimmune beta cell damage Abrupt onset of symptoms

A 46 year-old man who is obese has received news that he has type 2 diabetes. He is in the process of determining a plan of care with an interdisciplinary team at a hospital-based diabetes clinic. The nurse knows that the most likely treatment plan for the man will include:

Oral antihyperglycemic medications and weight loss measures.

A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided?

Orange juice orally

A male patient is being evaluated for metabolic syndrome. Which of the following are diagnostic criteria for this syndrome? Select all that apply.

Patient's body mass index (BMI) is 31. Patient's high-density lipoprotein (HDL) cholesterol is 25. Patient's blood pressure (BP) is 150/90 mm Hg.

Secondary diabetes occurs because of disorders that produce hyperglycemia by stimulating the hepatic production of glucose or decrease the cellular use of glucose. Which disorders can be causes of secondary diabetes?

Pheochromocytoma and Cushing syndrome

A client has been experiencing elevated blood glucose levels. The nurse anticipates that the client assessment data would include:

Polydipsia

The nurse knows that increased blood glucose levels will pull water out of cells and result in which of the following? Select all that apply.

Polydipsia • Polyuria

The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary healthcare provider for further evaluation?

Random blood glucose 195 mg/dl

A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

Random blood glucose 85 mg/dl

A client presents to the emergency room with fatigue, weakness, dehydration and thirst. What additional symptoms would correlate with a diagnosis of type 1 diabetes mellitus? Select all that apply.

Recent weight loss Polyuria Blurred vision

A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 12.1 mmol/l and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?

Short acting

The nurse is caring for a client diagnosed with diabetes mellitus who is reporting burning pain of his feet. The nurse would interpret this as:

Somatic neuropathy

Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?

Somogyi effect

A diabetic patient's most recent blood work indicated a decreased glomerular filtration rate, and urine testing revealed microalbuminuria. Which of the following self-care measures should the nurse suggest to the patient? Select all that apply.

Stop smoking. Maintain systolic pressure below 130 mm Hg. Restrict protein consumption.

A client with type 1 diabetes has been deemed to be a candidate for the use of a continuous subcutaneous infusion of insulin (insulin pump). Which educational points should the nurse address in anticipation of this treatment regimen? Select all that apply.

Teaching the client how to load and maintain the insulin pump. Educating the client about the necessity of frequent blood glucose checks. Educating the client about the potential complications of pump use.

The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be:

The brain relies on blood glucose as its main energy source.

A 54 year-old male who lives alone and has poorly controlled type 1 diabetes has been admitted to hospital for treatment of sepsis resulting from a chronic foot ulcer. Which of the other findings from the man's admission assessment and history would his care team be likely to attribute to his diabetes? Select all that apply.

The client complains of bloating after eating a meal, and states that he is unable to eat much food at any one sitting. He states that his bowel movements are almost always loose. The client states that he has been unable to maintain an erection in recent years.

A client is managing his diabetes with exercise and diet. The health care provider reviews the client's most recent lab results: fasting blood sugar level at 80 mg/dL and a hemoglobin A1C of 5%. Select the response that best identifies the client.

The client is achieving normal glycemic control.

A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume?

The patient is achieving normal glycemic control.

The nurse is teaching a client about a sulfonylurea medication. Which of these points should be included in the discussion? Select all that apply.

These medications cause insulin to be released from the pancreas. Hypoglycemia may result from this type of medication.

A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?

Using an insulin infusion pump

The nurse is caring for a client with diabetes who has developed gastroparesis. Which of these symptoms does the nurse expect the client to report?

Vomiting after eating

The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which of these risk factors in the teaching?

Woman with a family history of diabetes

Select the most common symptoms of diabetes. Select all that apply.

• Polydipsia • Polyuria • Polyphagia

The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply.

• Blurred vision • Weight loss • Thirst

A patient hospitalized with type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following are processes of insulin? Select all that apply.

• Fat storage • Glucose uptake by muscle and adipose tissue • Protein synthesis

The nurse screening for diabetes mellitus at a health fair does not have enough supplies for all of the clients attending. Which clients should be given screening priority?

• Female age 30, history GDM • Male age 45, BMI 32 • Male age 65, hypertension

A woman in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate? Select all that apply.

• Glyburide • Insulin

The nurse and nursing student are performing medication reconciliation. Which of these medications taken by the client does the nurse teach the student are implicated in causing hyperglycemia? Select all that apply.

• Loop diuretics • Glucocorticoids • Oral contraceptives