Ch 48 Diabetes Mellitus

A1C 9% (Lowering hemoglobin A1C (to less than 7%) reduces microvascular and neuropathic complications. Tighter glycemic control (normal hemoglobin A1C level, less than 6%) may further reduce complications but increases hypoglycemia risk. )

Analyze the following diagnostic finding for your patient with type 2 diabetes. Which result will need further assessment? A. A1C 9% B. BP 126/80 mmHg C. FBG 130mg/dL (7.2 mmol/L) D. LDL cholesterol 100 mg/dL (2.6mmol/dL)

a,c

During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which lab results (select all that apply) a. A1C of 7.5% b. glycosuria for 3+ c. FPG greater than or equal to 126 mg/dL (7.0 mmol/L) d. random blood glucose of 126 mg/dL (7.0 mmol/L) e. a 2 hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)

I'll know if I have sores or lesions on my feet because they will be painful

Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? A. "I should wash my feet daily with soap & warm water" B. "I should always wear shoes to protect my feet from injury" C. "If my feet are cold, I should wear socks instead of a heating pad" D. "I'll know if I have sores or lesions on my feet because they will be painful"

polydipsia

In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. fatigue b. polydipsia c. polyphagia d. recurrent infections

at mealtime or within 15 minutes of meals

Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. once a day b. one hour before meals c. 30 to 45 minutes before meals d. at mealtime or within 15 minutes of meals

check the bath water is not too hot

The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP) a. discuss complications of diabetes b. check the bath water is not too hot c. check the patients technique for drawing up insulin d. teach the patient to use a meter for self-monitoring of blood glucgose

mixing an evening dose of regular insulin with insulin glargine in one syringe for administration

The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration b. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator c. placing the insulin bottle currently in use in a small container on the bathroom countertop d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration

rapid respiration with deep inspirations

The nurse is assessing a newly admitted diabetic patient. Which observation should be addressed as the priority by the nurse? a. bilateral numbness of both hands b. stage II pressure ulcer on the right heel c. rapid respiration with deep inspirations d. areas of lumps and dents on the abdomen

c,e

What tissues require insulin to enable movement of glucose into the tissue cells (select all that apply) a. liver b. brain c. adipose d. blood cells e. skeletal muscles

Diabetes Mellitus (DM)

a chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both

Insulin resistance

a condition in which body tissues do not respond to the action of insulin because insulin receptors are unresponsive, are insufficient in number, or both

Hyperosmolar hyperglycemic syndrome (HHS)

a life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

It is more difficult to achieve strict glucose control than in younger patients

A 72-yr-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? A. It is more difficult to achieve strict glucose control than in younger patients B. Treatment is not warranted unless the patient develops severe hyperglycemia C. It does not include treatment with insulin because of limited dexterity and vision D. It usually requires that a younger family member be responsible for care of the patient

Eat 15 g of simple carbohydrates. (When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing, she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease her blood glucose.)

A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take? A. Eat a piece of pizza. B. Drink some diet pop. C. Eat 15 g of simple carbohydrates. D. Take an extra dose of rapid-acting insulin.

accelerates the transport of amino acids into cells and their synthesis into protein

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. enhances the breakdown of adipose tissue for energy b. stimulates hepatic glycogenolysis and gluconeogenesis c. prevents the transport of triglycerides into adipose tissue d. accelerates the transport of amino acids into cells and their synthesis into protein

Increased triglyceride levels (Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes.)

Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

Glycosylated hemoglobin level

The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level

a,c,e,f

The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level? Select all that apply: A. HA B. Unsteady gait C. Abdominal cramps D. Emotional changes E. Increase in uringation F. Weakness & fatigue

b,e,f (Autonomic neuropathy affects most body systems. Manifestations of autonomic neuropathy include erectile dysfunction in men and decreased libido, gastroparesis (N/V, gastroesophageal reflux & feeling full), painless myocardial infaction, postural hypotension, and resting tachycardia. The remaining options would occur with sensory neuropathy)

The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient? Select all that apply: A. Painless foot ulcers B. Erectile dysfunciton C. Burning foot pain at night D. Loss of fine motor control E. Vomiting undigested food F. Painless myocardial infarction

C,B,A,E,D,F

The patient with diabetes is brought to the ED by his family members, who say that he has had an infection, is not acting like himself, and he is more tired than usual. Put the nursing actions in the order of priority for this patient: A. Establish IV access B. Check blood glucose C. Ensure patent airway D. Begin continuous regular insulin drip E. Administer 0.9% NaCl solution at 1L/hr F. Establish time of last food and medication(s)

Glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)

The patient with type 2 diabetes has had trouble controlling his blood glucose with several OAs but wants to avoid the risks of insulin. The HCP told him a medication will be prescribed that will increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying. The nurse knows this is which medication that will have to be injected? A. Dopamine receptor agonists, bromocriptine (Cycloset) B. Dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin (Januvia) C. Sodium-glucose co-transporter 2 (SGLT2) inhibitor, canagliflozin (Invokana) D. Glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)

a,d,e

The patient with type 2 diabetes is being put on acarbose (precose) and wants to know why she is taking it. What should the nurse include in this patients teaching (select all that apply) a. take it with the first bite of each meal b. it is not used in patients with HF c. endogenous glucose production is decreased d. effectiveness is measured by 2 hour postprandial glucose e. it delays glucose absorption from the GI tract

Impaired glucose tolerance (IGT)

diagnosed if the 2-hour oral glucose tolerance test values are 140-199 mg/dL

Impaired fasting glucose (IFG)

diagnosed when fasting blood glucose levels are 100-125 mg/dL

Macrovascular complications

disease of the large and medium-size blood vessels that occur with greater frequency an with an earlier onset in people with diabetes

eat regular meals at regular times

individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times b. restrict calories to promote moderate weight loss c. eliminate sucrose and other simple sugars from the diet d. limit saturated fat intake to 30% of dietary calorie intake

Diabetic retinopathy

the process of microvascular damage to the retina as a result of chronic hyperglycemia, nephropathy, and hypertension in patients with diabetes.

a,b,c,d,e,f

what characterizes type 2 diabetes? SATA a. B cell exhaustion b. insulin resistance c. genetic predisposition d. altered production of adipokines e. inherited defect in insulin receptors f. inappropriate glucose production by the liver

tight glycemic control can be maintained

when teaching the patient with Type 1 diabetes, what should the nurse emphasize as the major disadvantage of using an insulin pump? a. tight glycemic control can be maintained b. errors in insulin dosing are less likely to occur c. complications of insulin therapy are prevented d. frequent blood glucose monitoring is unnecessary

Check the patient's blood glucose level (Blood glucose testing should be performed whenever hypoglycemia is suspected so that immediate action can be taken if necessary.)

What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? A. Call the physician B. Administer insulin as ordered C. Check the patient's blood glucose level D. Assess for other neurologic symptoms

Normal serum glucose & lipid levels

What should the goals of nutrition therapy for the patient with type 2 diabetes include? A. Ideal body weight B. Normal serum glucose & lipid levels C. A special diabetic diet using dietetic foods D. Five small meals per day with a bedtime snack

Diabetic nephropathy

a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidneys

Somogyi effect

a rebounding high blood sugar that is a response to low blood sugar.

Diabetic ketoacidosis (DKA)

caused by a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration

Dawn phenomenon

hyperglycemia that is present on awakening, but no hypoglycemia is present through the night (like with the somogyi effect)

Prediabetes

impaired glucose tolerance, impaired fasting glucose, or both; intermediate stage between normal glucose homeostasis and diabetes in which the blood glucose levels are elevated but not high enough to meet the diagnostic criteria for diabetes

Diabetic neuropathy

nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus

Intensive insulin therapy (aka physiologic insulin therapy)

term used to describe tight management of blood sugar levels consisting of multiple daily insulin injections together with frequent self-monitoring of blood glucose. The goal is to achieve a glucose level of 80-130 before meals.

fasting blood glucose result of 120 mg/dL

which lab results would indicate the patient has prediabetes? a. glucose tolerance result of 132mg/dL b. glucose tolerance result of 240 mg/dL c. fasting blood glucose result of 80 mg/dL d. fasting blood glucose result of 120 mg/dL

stimulate glucose output by the liver

why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. decrease glucose production b. stimulate glucose output by the liver c. increase glucose transport into the cells d. independently regulate glucose level in the blood

FPG for all individuals at age 45 and then every 3 years

A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? A. OGTT for all minority populations every year B. FPG for all individuals at age 45 and then every 3 years C. Testing people under the age of 21 for islet cell antibodies D. Testing for type 2 diabetes in all overweight or obese individuals

Midnight before the test (Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level.)

A 51-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? A. 6:00 PM on the evening before the test B. Midnight before the test C. 4:00 AM on the day of the test D. 7:00 AM on the day of the test

Cardiac monitoring to detect potassium changes (This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.)

A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI. C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration.

fluid shifts resulting from the osmotic effect of hyperglycemia

Polydipsia and Polyuria related to diabetes mellitus are primarily due to: A. the release of ketones from cells during fat metabolism B. fluid shifts resulting from the osmotic effect of hyperglycemia C. damage to the kidneys from exposure to high levels of glucose D. changes in RBCs resulting from attachment of excessive glucose to hemoglobin

Reduces glucose production by the liver and enhances insulin sensitivity. (Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.)

The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works? A. Increases insulin production from the pancreas. B. Slows the absorption of carbohydrate in the small intestine. C. Reduces glucose production by the liver and enhances insulin sensitivity. D. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.

Cleaning the puncture site with alcohol before the puncture

The nurse assesses the technique of the patient with diabetes for self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? A. Doing the SMBG before and after exercising B. Puncturing the finger on the side of the finger pad C. Cleaning the puncture site with alcohol before the puncture D. Holding the hand down for a few minutes before the puncture

a,e

The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type two diabetes. What information should be included? (select all that apply). a. maintain a healthy weight b. exercise for 60 minutes each day c. have BP checked regularly d. assess for visual changes on monthly basis e. monitor for polyuria, polyphagia, and polydipsia

The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome (Hyperosmolar hyperglycemic syndrome (HHS) is a life-threatening syndrome that can occur in a patient with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis (DKA) but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion. )

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? A. The patient must receive insulin therapy to prevent ketoacidosis B. The patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin. C. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections D. The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome

a,d,e

You are caring for a patient with newly diagnosed type I diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (Select all that apply) A. Insulin administration B. Elimination of sugar from diet C. Need to reduce physical activity D. Use of portable blood glucose monitor E. Hyperglycemia prevention, symptoms, and treatment

Rapid, deep respirations (Signs and symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to high ketone levels in the urine or blood.)

A diabetic patient has a serum glucose level of 824mg/dL (45.7 mol/dL) and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of A. polyuria B. Severe hydration C. Rapid, deep respirations D. Decreased serum potassium

With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." C."With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

A,C,D (The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH.)

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply)? A. The level may be increased as a result of dehydration that accompanies hyperglycemia. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The level is consistent with renal insufficiency that can develop with renal nephropathy. D. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. E. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.

a,c,d (Malnutrition does not cause sodium excretion accompanied by potassium retention; it is not a contributing factor to this patient's potassium level. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. You must consider the potential for metabolic ketoacidosis because potassium leaves the cell when hydrogen enters in an attempt to compensate for a low pH.)

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. Which factors could contribute to this laboratory result (select all that apply)? A. The level may be increased as a result of dehydration that accompanies hyperglycemia. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The level is consistent with renal insufficiency that can develop with renal nephropathy. D. The level may be raised because of metabolic ketoacidosis caused by hyperglycemia. E. The level may be raised because excess insulin is being given and causing potassium shifts.

monitor the glucose level at bedtime, between 2 AM and 4 AM, and on arising

A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first? a. increase the evening insulin dose to prevent the dawn phenomenon b. use a single-dose insulin regimen with an intermediate acting insuling c. monitor the glucose level at bedtime, between 2 AM and 4 AM, and on arising d. decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect

a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia

A patient with Type 1 diabetes uses 20 Units of Novolin 70/30 in the morning and at 6 pm. When teaching the patient about this regimen, what should the nurse emphasize? a. hypoglycemia is most likely to occur before the noon meal b. flexibility in food intake is possible because insulin is available 24 hours a day c. a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia d. premeal glucose checks are required to determine needed changes in daily dosing

Administer the usual insulin dosage

A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms, Which advice from the nurse with be the best for this patient? A. Administer the usual insulin dosage B. Hold fluid intake until the nausea subsides C. Come to the clinic immediately for evaluation & treatment D. Monitor the blood glucose every 1-2 ours and call if it rises over 150 mg/dL

Administer glucagon 1 mg IM or SQ (If a patient with diabetes is unconscious, immediate treatment for hypoglycemia must be given to prevent brain damage, and IM or SQ adminstration of 1 mg of glucagon should be done. If the unconsciousness has another cause, such as ketosis, the rise in glucose caused by the glucagon is not as dangerous as the low glucose level. Following administration of the glucagon, the patient should be transported to a medical facility for further treatment and evaluation. Oral carbohydrates cannot be given when patients are unconscious, and insulin is contraindicated without knowledge of the patient's glucose level.)

A patient with diabetes is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? A. Have the patient drink some orange juice B. Administer 10 U of regular insulin SQ C. Call for an ambulance to transport the patient to a medical facility D. Administer glucagon 1 mg IM or SQ

withdraws the NPH dose into the syringe first

A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. withdraws the NPH dose into the syringe first b. infects air equal to the NPH dose into the NPH vial first c. removes any air bubbles after withdrawing the first insulin d. adds air equal to the insulin dose into the regular vial and withdraws the dose

Obtain comprehensive dental care. (A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1c below 7%, and coughing and deep breathing with splinting would be important for any type of surgery, but not the priority with mitral valve replacement for this patient. )

A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? A. Avoid sick people and wash hands. B. Obtain comprehensive dental care. C. Maintain hemoglobin A1 c below 7%. D. Coughing and deep breathing with splinting

Advise the patient to discuss using herbal therapy with her HCP before using it

A patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medication. The patient tells the nurse she would rather control her blood sugar with herbal therapy. Which action should the nurse take? A. Teach the patient that herbal therapy is not safe and should not be used B. Advise the patient to discuss using herbal therapy with her HCP before using it C. Encourage the patient to give the prescriptive medication time to work before using herbal therapy D. Teach the patient that if she takes herbal therapy, she will have to monitor her blood sugar more often

Kussmaul respirations (In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. )

A patient, who is admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? A. Central apnea B. Hypoventilation C. Kussmaul respirations D. Cheyne-Stokes respirations

impaired glucose tolerance

The nurse determines that a patient with a 2 hour OGTT of 152 mg/dL has a. diabetes b. elevated A1C c. impaired fasting glucose d. impaired glucose tolerance

Chooses a puncture site in the center of the finger pad

The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? A. Chooses a puncture site in the center of the finger pad. B. Washes hands with soap and water to cleanse the site to be used. C. Warms the finger before puncturing the finger to obtain a drop of blood. D. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.

I should look at the condition of my feet every day.

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I am lucky my shoes fit so nice and tight because they give me firm support." D. "When I am allowed up out of bed, I should check the shower water with my toes."

I may have a hypoglycemic reaction if I drink alcohol on an empty stomach. (The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol. )

The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? A. "I plan to lose 25 pounds this year by following a high-protein diet." B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." C. "I should include more fiber in my diet than a person who does not have diabetes." D. "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."

Assess patient's perception of what it means to have diabetes.

The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention? A. Assess patient's perception of what it means to have diabetes. B. Ask the patient to write down current knowledge about diabetes. C. Set goals for the patient to actively participate in managing his diabetes. D. Assume responsibility for all of the patient's care to decrease stress level

cheese

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges

Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include? A. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. C. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. D. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes

Excessive thirst

The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision

A 48-year-old woman with a hemoglobin A1C of 8.4% (Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL.)

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? A. A 48-year-old woman with a hemoglobin A1C of 8.4% B. A 58-year-old man with a fasting blood glucose of 111 mg/dL C. A 68-year-old woman with a random plasma glucose of 190 mg/dL D. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

I can help control my blood pressure by avoiding foods high in salt. (Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.)

The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "Smokeless tobacco products decrease the risk of kidney damage." B. "I can help control my blood pressure by avoiding foods high in salt." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

I will take a brisk 30-minute walk 5 days per week and do resistance training 3 times a week. (The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days per week and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and teaching are light activity, and running is considered vigorous activity.)

The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control his blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? A. "I want to go fishing for 30 minutes each day; I will drink fluids and wear sunscreen." B. "I will go running each day when my blood sugar is too high to bring it back to normal." C. "I will plan to keep my job as a teacher because I get a lot of exercise every school day." D. "I will take a brisk 30-minute walk 5 days per week and do resistance training 3 times a week."

An insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy (When insulin is insufficient and glucose cannot be used for cellular energy, the body uses stored fats to meet energy needs. Free fatty acids from stored triglycerides are metabolized in the liver in such large quantities that ketones are formed. Ketones are acidic and alter the pH of the blood, causing acidosis. Osmotic diuresis from the elimination of both glucose and ketones in the urine causes dehydration, not ketosis. The loss of bicarbonate and skipping a meal after insulin administration do not cause ketosis.)

The nurse should observe the patient for symptoms of ketoacidosis when: A. Illnesses causing N/V lead to bicarbonate loss with body fluids. B. Glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss C. An insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy D. The patient skips meals after taking insulin, leading to rapid metabolism of glucose & breakdown of fats for energy

I will discard any insulin bottle that is cloudy in appearance. (Intermediate-acting insulin and combination premixed insulin will be cloudy in appearance. )

The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75o F) for up to a month."

10:30 PM to 1:30 AM (Regular insulin exerts peak action in 2 to 5 hours)

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM

Plan activity & food intake related to blood glucose levels

To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? A. Plan activity & food intake related to blood glucose levels B. When blood glucose is greater than 250 mg/dL and ketones are present C. When glucose monitoring reveals that blood glucose is in the normal range D. When blood glucose levels are high, because exercise always has a hypoglycemic effect

That is a good range for your glucose levels

Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 & 90 mg/dL. What is the best response by the nurse? A. "That is a good range for your glucose levels" B. "You should call your HCP because you need to have your insulin increased" C. "That level is too low in view of your recent hypoglycemia and you should increase your food intake" D. "You should take only half your insulin dosage for the next few days to get your glucose level back to normal"

a,b,c,d,e,f

What are manifestations of diabetic ketoacidosis (DKA)? Select all that apply: A. Thirst B. Ketonuria C. Dehydration D. Metabolic acidosis E. Kussmaul respirations F. Sweet, fruity breath odor

HHS requires greater fluid replacement to correct the dehydration (HHS requires greater fluid replacement because of the severe hyperosmolar state.)

What describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? A. DKA requires administration of bicarbonate to correct acidosis B. Potassium replacement is not necessary in management of HHS C. HHS requires greater fluid replacement to correct the dehydration D. Administration of glucose is withheld in HHS until blood glucose reaches a normal level

b,d

What disorders and diseases are related to macrovascular complications of diabetes? Select all that apply: A. Chronic kidney disease B. Coronary artery disease C. Microaneurysms and destruction of retinal vessels D. Ulceration & amputation of the lower extremities E. Capillary & arteriole membrane thickening specific to diabetes

achieving a normal weight

When caring for a patient with metabolic syndrome, what should the nurse give the highest priority to teach the patient about? a. achieving a normal weight b. performing daily aerobic exercise c. eliminating red meat from the diet d. monitoring blood glucose periodically

consistently use the same size of insulin syringe to avoid dosing errors

When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. pull back on the plunger after inserting the needle to check for blood b. consistently use the same size of insulin syringe to avoid dosing errors c. clean the skin at the injection site with an alcohol swab before each injection d. rotate the infection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies

a,c,e

Which are appropriate therapies for patients with diabetes mellitus? (select all that apply) A. Use of statins to treat dyslipidemia B. Use of diuretics to treat nephropathy C. Use of ACE inhibitors to treat nephropathy D. Use of serotonin agonists to decrease appetite E. Use of laser photocoagulation to treat retinopathy

biguanide

Which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because is reduces hepatic glucose production and enhances tissue uptake of glucose? a. insulin b. biguanide c. meglitinide d. sulfonylurea

a 34 year old woman whose parents both have type 2 diabetes

Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. an obese 50 year old hispanic woman b. a child whose father has type 1 diabetes c. a 34 year old woman whose parents both have type 2 diabetes d. a 12 year old boy whose father has maturity onset diabetes of the young (MODY)

A 73-year-old patient who takes propranolol (Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use â-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.)

Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness? A. A 58-year-old patient with diabetic retinopathy B. A 73-year-old patient who takes propranolol C. A 19-year-old patient who is on the school track team D. A 24-year-old patient with a hemoglobin A1C of 8.9%

It occurs with a higher frequency and earlier onset than in the nondiabetic population

Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? A. It can be prevented by tight glucose control B. It occurs with a higher frequency and earlier onset than in the nondiabetic population C. It is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes D. It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake

I am supposed to have a meal or snack if I drink alcohol

Which statement by the patient with type 2 diabetes is accurate? A. " I am supposed to have a meal or snack if I drink alcohol" B. "I am not allowed to eat any sweets because of my diabetes" C. "I do not need to watch what I eat because my diabetes is not the bad kind". D. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

Microvascular complications

result from thickening of the vessel membranes in the capillaries and arterioles in response to conditions of chronic hyperglycemia.