Chapter 20 coursepoint
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."
A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be:
"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."
People with both type 1 and type 2 diabetes are at high risk for developing macrovascular disease. What are the risk factors for macrovascular disease in diabetics?
Elevated fibrinogen levels and hyperinsulinemia
Diabetic ketoacidosis (DKA) in a client with type 1 diabetes occurs when the lack of insulin leads to the release of which physiologic product?
Fatty acids
A 40-year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which 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.
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
Which client would be considered to be exhibiting manifestations of "prediabetes"?
A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL (10.49 mmol/L).
The nurse is preparing to administer short-acting insulin to a client with type 1 diabetes mellitus. Which insulin should the nurse administer to the client?
Regular
While reviewing the role of glucagon regarding the regulation of blood glucose, the nurse knows that which situation could lead to an inhibition of glucagon release?
An increase in glucose levels
The nurse is caring for a client with type 1 diabetes mellitus and polyuria. For which complication should the nurse monitor?
Dehydration
Which assessment finding of a client constitutes a criterion for a diagnosis of metabolic syndrome?
Has a high blood pressure that is consistently in the range of 140/90 mm Hg or greater
When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?
Hyperglycemia
A client with diabetes mellitus is reporting burning pain of the feet and some numbness. These symptoms are likely due to which cause?
Somatic neuropathy
A client with long-standing type 2 diabetes is surprised to see high blood sugar readings while recovering from an emergency surgery. Which factor may have contributed to the client's inordinately elevated blood glucose levels?
The stress of the event caused the release of adrenal corticol hormone
The pediatric nurse is caring for a client with type 1 diabetes mellitus. Which treatments should the nurse anticipate for the client?
insulin, exercise, diet.
The nurse knows that the client with which complication of diabetes has the greatest risk for the development of foot ulcers?
Sensory neuropathy
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% (0.52)
The nurse is assessing a client with type 1 diabetes mellitus and hypoglycemia who is experiencing neuroglycopenia. Which finding(s) does the nurse expect? Select all that apply.
Headache Confusion Slurred speech Seizures
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.
An extremely lethargic client arrives by ambulance at the emergency department. His blood glucose level is 32 mg/dL (1.78 mmol/L). The nurse will anticipate that this client will be diagnosed with:
Hypoglycemia
Which metabolic abnormalities can cause type 2 diabetes? Select all that apply.
Insulin resistance Increased glucose production by the liver Deranged secretion of insulin
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
A client with diabetes mellitus arrives at the hospital with a blood glucose level of 639 mg/dL (35.46). What assessment data would indicate type 2 diabetes mellitus rather than type 1?
Negative ketones in urine
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
Select the most common symptoms of diabetes. Select all that apply.
Polydipsia Polyuria Polyphagia
A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which effect will result from the action of insulin?
Promotion of glucose uptake by target cells
Infections are common in people with diabetes. Which infection is thought to be related to a neurogenic bladder?
Pyelonephritis
Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?
Somogyi effect
Which factors contribute to the severe hyperglycemia that precipitates hyperglycemic hyperosmolar state (HHS)?
Water loss causing dehydration
The nurse caring for a client diagnosed with hyperglycemic hyperosmolar state (HHS) knows that the client's elevated serum osmolality has pulled water out of the brain cells based on which assessment findings? Select all that apply.
Weakness one side of the body Body shakes rapidly and uncontrollably for a short period of time Increase in urine output in proportion to the increase in blood glucose Unable to respond verbally to questions
An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics?
Weight loss, glucose monitoring, and oral antihyperglycemic medications
While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which accurate information?
n skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.
A client with a history of diabetes presents to the emergency department following several days of polyuria and polydipsia with nausea/vomiting. On admission, the client labs show a blood glucose level of 480 mg/dL (26.64 mmol/L) and bicarbonate level of 7.8 mEq/L (7.8 mmol/L). The nurse suspects the client has diabetic ketoacidosis (DKA). The priority intervention should include:
Begin a loading dose of IV regular insulin followed by a continuous insulin infusion.
The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which pathophysiologic process underlies the client's new diagnosis?
Beta cell exhaustion due to long-standing insulin resistance
A diabetic client presents to the clinic. He is concerned his lower legs are "feeling funny." Which assessment findings lead the health care provider to suspect the client may have developed somatic neuropathy? Select all that apply.
Both legs appear to be the same as far as numbness is involved. Bilateral cool ankles and feet. With eyes closed, the client cannot identify where the health care provider is touching his feet.
Impaired and delayed healing in a person with diabetes is caused by long-term complications that include:
Chronic neuropathies
A client with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. Which conditions can account for this effect?
Dawn phenomenon
A client with diabetes has laboratory results that indicate the presence of microalbuminuria. Which priority self-care measures should the client's care team prescribe for this client?
Diet, exercise, and prescriptions to lower blood pressure below 140/80
