Chapter 20 Nursing Care of Patients with Diabetes Mellitus

The nurse is conducting an educational session with a patient who is newly diagnosed with diabetes. Which statement indicates that additional teaching is required? 1. "6 million people have diabetes." 2. "23.1 million people have been diagnosed with diabetes." 3. "84.1 million people have prediabetes." 4. "7.2 million people have diabetes but have not been diagnosed."

Answer: 1 Explanation: 1. Approximately 30.3 million people have diabetes. 2. This chronic illness affects an estimated 23.1 million people. 3. Approximately 84.1 million people have prediabetes. 4. An estimated 7.2 million are undiagnosed. Page Ref: 595

The nurse is assessing a patient who has a family history of type 2 diabetes mellitus. Which finding would require follow-up by the nurse? 1. A new prescription for levothyroxine (Synthroid) for hypothyroidism 2. Decreased waist-to-hip ratio through dietary changes 3. Delivery of a baby that weighed 8 lbs. and 12 ounces 4. A fasting blood glucose level of 89 mg/dL

Answer: 1 Explanation: 1. Many drugs, including thyroid hormone, impair insulin secretion, precipitating DM in people with predisposing insulin resistance. 2. This is a desired finding. 3. This is an acceptable birth weight for a patient with diabetes. 4. This is a desirable level for a patient with diabetes. Page Ref: 297

A patient with type 1 diabetes mellitus has a serum hematocrit level of 24%. What additional finding should the nurse report to the healthcare provider? 1. Capillary blood glucose of 60 mg/dL 2. Glycosylated hemoglobin of 7.0 3. The presence of albumin in urine 4. The presence of glucose in urine

Answer: 1 Explanation: 1. Patients with low hematocrit levels will test falsely high. This patient's hematocrit is critically low. The serum glucose of 60 mg/dL may be a falsely high reading and the primary healthcare provider must be notified of this finding. 2. This glycosylated level does not require immediate notification of the healthcare provider. 3. The presence of albumin in the urine does not require immediate notification of the healthcare provider. 4. The presence of glucose in the urine does not require immediate notification of the healthcare provider. Page Ref: 610

A patient with type 2 diabetes mellitus is scheduled for laparoscopic adjustable gastric banding (LAGB) surgery. What should the nurse explain to the patient about this procedure and diabetes? 1. "Evidence indicates positive outcomes for many patients with diabetes who undergo surgical weight loss procedures." 2. "Surgical procedures can be dangerous for patients with diabetes." 3. "Do you feel that a surgical weight loss procedure will cure your obesity?" 4. "This procedure is more appropriate for a patient who has a diagnosis of type 1 diabetes mellitus."

Answer: 1 Explanation: 1. Studies of patients with DM who have gastrointestinal surgery for morbid obesity show improved insulin sensitivity and in some cases resolution of T2D. 2. While this is true, studies of patients with DM who have gastrointestinal surgery for morbid obesity show improved insulin sensitivity and in some cases resolution of T2D 3. The procedure is performed to decrease body weight. 4. The procedure is shown to elicit complete remission of type 2 DM in over three-fourths of the cases. Page Ref: 621

The nurse is planning care for a patient with type 1 diabetes mellitus. Which action should the nurse identify as being the most effective to reduce the development of complications? 1. Self-monitoring of blood glucose levels 2. Performance of effective foot care 3. The necessity of a yearly eye examination 4. Knowing symptoms of urinary tract infections

Answer: 1 Explanation: 1. The results of a 10-year DM Control and Complications Trial (DCCT), sponsored by the National Institutes of Health (NIH), have significant implications for the management of type 1 DM. People in the study who kept their blood glucose levels close to normal by frequent monitoring, several daily insulin injections, and lifestyle changes that included exercise and a healthier diet reduced by 60% their risk for the development and progression of complications involving the eyes, the kidneys, and the nervous system. 2. Effective foot care will not reduce the development of complications. 3. Yearly eye examinations will not reduce the development of complications. 4. Knowing the symptoms of a urinary tract infection will not reduce the development of complications. Page Ref: 609

A patient recently diagnosed with diabetes wants to check the urine for glucose instead of using capillary blood because of the cost. Which response should the nurse make to the patient? 1. "Urine testing is best when combined with serum testing." 2. "Urine testing is as reliable as finger stick testing." 3. "Yes, urine testing is cheaper than glucose test strips." 4. "Would you like to switch to this method of monitoring?"

Answer: 1 Explanation: 1. Urine testing may be used for glucose, ketones, and albumin. Urine analysis for increased glucose and ketones indicates hyperglycemia and ketosis. Urine tests for albumin are used to detect the early onset of kidney damage. 2. Advising the patient the method of testing is not reliable is not entirely correct and does not provide needed information to the patient. 3. Urine testing is not necessarily less expensive than glucose test strips. 4. It is inappropriate for the nurse to make such a suggestion about the method of testing to be utilized by the patient. Page Ref: 609

The nurse is caring for a healthy patient who has a serum glucose level of 60 mg/dL. Which counterregulatory serum hormonal changes should the nurse expect to occur in this patient? Select all that apply. 1. Increased epinephrine levels 2. Increased growth hormone levels 3. Increased insulin levels 4. Decreased thyroxine levels 5. Decreased glucocorticoid levels

Answer: 1, 2 Explanation: 1. If blood glucose falls, glucagon is released to raise hepatic glucose output, raising glucose levels. Epinephrine (often referred to as a glucose counterregulatory hormone) stimulates an increase in glucose in times of hypoglycemia, stress, growth, or increased metabolic demand. 2. If blood glucose falls, glucagon is released to raise hepatic glucose output, raising glucose levels. Growth hormone (often referred to as a glucose counterregulatory hormone) stimulates an increase in glucose in times of hypoglycemia, stress, growth, or increased metabolic demand. 3. Insulin is not released as a counterregulatory hormone. 4. Thyroxine level would increase with hypoglycemia. 5. Glucocorticoid levels would increase with hypoglycemia. Page Ref: 597

The nurse instructs a patient with type 2 diabetes mellitus on the use of a glucometer for self-monitoring. Which patient return demonstration and statement about glucometer performance indicate that teaching has been effective? Select all that apply. 1. Correctly apply the blood to the meter strip. 2. Follow manufacturer's recommendation regarding cleaning of meter. 3. A patient with sickle cell anemia may need another way to check blood glucose levels. 4. Grapefruit juice should not be ingested when using the glucometer. 5. A sufficient amount of blood must be applied to the strip.

Answer: 1, 2, 3, 5 Explanation: 1. Many factors may affect glucose meter performance, including correctly applying the blood to the meter strip. 2. Many factors may affect glucose meter performance, including failure to follow the manufacturer's recommendations regarding meter cleaning. 3. Many factors may affect glucose meter performance, including a diagnosis of anemia or sickle cell anemia. 4. The ingestion of grapefruit juice is not a known cause of poor meter performance. 5. Many factors may affect glucose meter performance, including insufficient amounts of blood on the meter strip. Page Ref: 610-611

The nurse is teaching a patient with diabetes about the illness. Which patient statement about pancreatic cells indicates that teaching has been effective? Select all that apply. 1. Alpha cells produce glucagon. 2. Beta cells secrete insulin. 3. Cephalon cells produce creatine. 4. Delta cells produce somatostatin. 5. Epsilon cells produce erythropoietin.

Answer: 1, 2, 4 Explanation: 1. Alpha cells produce the hormone glucagon, which stimulates the breakdown of glycogen in the liver, the formation of carbohydrates in the liver, and the breakdown of lipids in both the liver and adipose tissue. 2. Beta cells secrete the hormone insulin, which facilitates the movement of glucose across cell membranes into cells, decreasing blood glucose levels. 3. Cephalon cells are not pancreatic cells. 4. Delta cells produce somatostatin, which acts within the islets of Langerhans to inhibit the production of both glucagon and insulin. It also slows gastrointestinal motility, allowing more time for food to be absorbed. 5. Epsilon cells are not pancreatic cells. Page Ref: 596

The nurse is teaching a patient with type 2 diabetes mellitus about glyburide (DiaBeta). Which medication should the nurse instruct the patient to monitor for dizziness, lightheadedness, and sweating if taken with the hypoglycemic agent? Select all that apply. 1. Ibuprofen 2. Ranitidine 3. Cetirizine 4. Metoprolol 5. Docusate sodium

Answer: 1, 2, 4 Explanation: 1. Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is also taking nonsteroidal anti-inflammatory agents (NSAIDs) such as ibuprofen. 2. Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is taking ranitidine. 3. Zyrtec does not interact with glyburide. 4. Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is also taking a beta blocker such as metoprolol. 5. Colace does not interact with glyburide. Page Ref: 617

The nurse is preparing to administer insulin to an underweight patient. Which action should the nurse take when providing this injection? Select all that apply. 1. Ensure insulin is at room temperature. 2. Make sure no air bubbles are present in the syringe. 3. Massage the site of insertion. 4. Rotate injection sites. 5. Insert the needle at a 90-degree angle.

Answer: 1, 2, 4 Explanation: 1. Insulin is used at room temperature. 2. No air bubbles should be in the syringe. This will reduce complications and will aid in ensuring correct dosages. 3. Massage of administration sites will alter absorption rates. 4. Insulin injection sites should be rotated. 5. The thin individual will require an administration angle of 45 degrees. Page Ref: 614-616

The nurse is reviewing data collected from a patient with a predisposition to developing insulin resistance. Which medication should the nurse identify as potentially causing this patient to develop diabetes? Select all that apply. 1. Nicotinic acid (Niacor) 2. Acetaminophen (Tylenol) 3. Levothyroxine (Synthroid) 4. Furosemide (Lasix) 5. Phenytoin (Dilantin)

Answer: 1, 3, 4, 5 Explanation: 1. Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include nicotinic acid (Niacor). 2. Acetaminophen (Tylenol) is not a medication that impairs insulin secretion, precipitating DM in people with predisposing insulin resistance. 3. Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include levothyroxine (Synthroid), which is a thyroid hormone. 4. Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include furosemide (Lasix), which is a thiazide diuretic. 5. Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include phenytoin (Dilantin). Page Ref: 597

The nurse is caring for a patient experiencing diabetic ketoacidosis. What action should the nurse take when preparing this patient's insulin infusion? Select all that apply. 1. Attach insulin infusion to an intravenous pump. 2. Have one ampule of Dextrose 10% at the bedside. 3. Flush the tubing with the insulin solution before connecting. 4. Prepare an infusion of Dextrose 5% and 0.45% normal saline. 5. Discontinue the infusion after first dose of subcutaneous insulin.

Answer: 1, 3, 5 Explanation: 1. Insulin infusions are always administered using an intravenous pump. 2. Dextrose 50 should be kept at the bedside in the event of a hypoglycemic reaction. 3. Flush the intravenous tubing with 50 mL of insulin mixed with normal saline solution to saturate binding sites on the tubing before administering the insulin to the patient. 4. Insulin infusions are diluted in 0.9% or 0.45% saline. 5. Do not discontinue the intravenous infusion until subcutaneous administration of insulin is resumed. Page Ref: 603

A patient with type 2 diabetes mellitus has been instructed on an eating plan where 65% of all daily calories are to be carbohydrates. The patient's daily caloric intake is to be 1600 calories. If each serving of carbohydrates is 15 grams and each gram is 4 kilocalories, how many servings of carbohydrates should the patient be instructed to consume each day? Record your answer rounding to the nearest whole number.

Answer: 17 Explanation: First determine the total amount of carbohydrate calories permitted by multiplying 1600 × 65% = 1040. Then divide the total carbohydrate calories per day by 4 kilocalories or 1040/4 = 260 grams. Then divide the total number of carbohydrate grams by 15 or 260/15 = 17.3 or 17. Page Ref: 620

A patient with type 1 diabetes mellitus who had one episode of vomiting in the past 2 hours asks if the routine insulin injection should be taken. What action by the nurse is best at this time? 1. Contact the physician. 2. Explain the need to take the insulin. 3. Document the refusal and continue on with the planned care. 4. Check the patient's fasting serum glucose level.

Answer: 2 Explanation: 1. Contacting the physician at this time is premature. 2. Taking the insulin is the best course of action. The usual dose of insulin should be taken even if ill. 3. Documentation of the patient's refusal is premature, as efforts have not been made to discuss the need for the medication. 4. Checking the morning fasting serum glucose will not reflect the patient's current glucose level. Page Ref: 626

A group of patients with type 1 or 2 diabetes mellitus are planning to participate in an athletic triathlon. On which potential complication from this event should the nurse focus when teaching these patients? 1. Diabetic ketoacidosis 2. Hypoglycemia 3. Hyperosmolar hyperglycemic state 4. Impaired glucose tolerance

Answer: 2 Explanation: 1. Diabetic ketoacidosis is not associated with exercise. 2. One reason for the development of severe hypoglycemia is too much exercise. 3. Hyperosmolar hyperglycemic state is not associated with exercise. 4. Exercise does not impact glucose tolerance. Page Ref: 603

A patient with type 1 diabetes mellitus has difficulty swallowing and takes milk of magnesium every day for nausea and constipation. What should the nurse suspect is occurring with this patient? 1. Age-related changes 2. Visceral neuropathy 3. Peripheral neuropathy 4. Reaction to insulin injections

Answer: 2 Explanation: 1. Difficulty swallowing and nausea are not specifically attributed to aging. 2. The visceral neuropathies cause various manifestations, depending on the area of the autonomic nervous system involved. Gastrointestinal dysfunction caused by autonomic neuropathy causes changes in upper gastrointestinal motility, leading to dysphagia and nausea. Constipation is one of the most common gastrointestinal manifestations associated with diabetes, possibly a result of hypomotility of the bowel. 3. Peripheral neuropathies affect the sensory and motor function of the extremities. 4. Swallowing, nausea, and constipation are not adverse effects of insulin. Page Ref: 607

The nurse is instructing a 5-year-old patient with diabetes mellitus. In which way should the nurse explain the action of insulin? 1. Building blocks that help make protein into strong muscles 2. A wagon that carries sugar into the cells of the body 3. A mud pie that makes the blood vessels thick and sticky 4. Salty potato chips that make people feel very thirsty

Answer: 2 Explanation: 1. Insulin does not make protein into muscle. 2. The manifestations of type 1 DM are the result of a lack of insulin to transport glucose across the cell membrane into the cells. Insulin acts as a transport mechanism, allowing insulin into the body's cells. The analogy of the wagon carrying sugar into the cells of the body is appropriate for teaching a 5-year-old child about insulin therapy. 3. Insulin does not make blood vessels thick and sticky. 4. A scarcity of insulin may lead to polydipsia. Page Ref: 598

A patient at risk for the development of type 2 diabetes mellitus asks why weight loss will reduce risk of developing the health problem. Which response by the nurse is most accurate? 1. "The amount of foods taken in require more insulin to adequately metabolize them, resulting in diabetes." 2. "Excess body weight impairs the body's release of insulin." 3. "Thin people are less likely to become diabetic." 4. "The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin."

Answer: 2 Explanation: 1. This is not a true statement. 2. Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. 3. While obesity is a risk factor for the development of diabetes, this does not answer the patient's question. 4. Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin. Page Ref: 597

The nurse notes that a patient with type 2 diabetes mellitus is not prescribed aspirin 81 mg as recommended for the prevention of cardiovascular complications. What information in the patient's health history should the nurse use to understand why this medication has not been prescribed for the patient? Select all that apply. 1. Patient receives a vitamin B12 injection every month. 2. Patient admitted for gastrointestinal bleeding 3 months ago. 3. Patient prescribed warfarin (Coumadin) 2.5 mg by mouth every day. 4. Patient treated for chronic alcoholism and liver cirrhosis the past year. 5. Patient develops a rash and urticaria when taking medications with sulfa.

Answer: 2, 3, 4 Explanation: 1. Aspirin therapy is not contraindicated in individuals receiving vitamin B12 injections. 2. Aspirin therapy is contraindicated in patients with recent gastrointestinal bleeding. 3. Aspirin therapy is contraindicated in patients on anticoagulation therapy. 4. Aspirin therapy is contraindicated in patients with active liver disease. 5. Aspirin therapy is not contraindicated in patients with an allergy to sulfa medications. Page Ref: 618

The nurse is identifying patients at risk for needing insulin. Which patient should the nurse identify as potentially needing insulin to maintain a normal blood glucose level? Select all that apply. 1. Patients who are fasting or malnourished 2. Patients with type 2 diabetes who are diagnosed with an infection 3. Patients with type 2 diabetes who are undergoing surgical procedures 4. Patients with gestational diabetes 5. Patients receiving total parenteral nutrition

Answer: 2, 3, 4 Explanation: 1. Fasting and malnourished patients are not at increased risk for insulin and are often hypoglycemic. 2. Insulin may be necessary for patients with diabetes mellitus who are experiencing an infection. 3. Insulin may be necessary for patients with diabetes mellitus who are scheduled for surgery. 4. Insulin may be necessary for patients with gestational diabetes mellitus. 5. Patients receiving total parenteral nutrition are not identified as potentially needing insulin. Page Ref: 611

The nurse is assessing a patient with type 2 diabetes mellitus. What question should the nurse ask to determine the patient's risk for a lower extremity amputation? Select all that apply. 1. "Do you use insulin or oral hypoglycemic agents?" 2. "What were your glycosylated hemoglobin values over the past year?" 3. "Do you have any problems with your eyes related to diabetes?" 4. "Do you have any problems with your kidney related to diabetes?" 5. "When were you first diagnosed with diabetes mellitus?"

Answer: 2, 3, 4 Explanation: 1. The treatment of the diabetes is not a risk factor. 2. People with diabetes mellitus, especially those who are not meeting recommended glycemic goals, are at high risk for amputation of a lower extremity. 3. The high incidence of foot problems and amputations in people with diabetes mellitus is the result of angiopathy. 4. The high incidence of foot problems and amputations in people with diabetes mellitus is the result of angiopathy. 5. Age of diagnosis has no influence on the patient's risk of needing an amputation in the future. Page Ref: 608

The nurse is reviewing the actions that a patient with type 1 diabetes mellitus should take if mild hypoglycemia is experienced. What should the nurse include in this teaching? Select all that apply. 1. Test blood glucose 30 minutes after reaching a normal blood glucose level. 2. Ingest 4 ounces of fruit juice when mild hypoglycemia occurs. 3. Measure blood glucose 15 minutes after ingesting a carbohydrate source. 4. Add table sugar to 8 ounces of fruit juice when mild hypoglycemia occurs. 5. Ingest additional 15 grams of carbohydrate if blood glucose remains low after 15 minutes.

Answer: 2, 3, 5 Explanation: 1. There is no specific recommendation as to when to reassess blood glucose level. 2. When mild hypoglycemia occurs, immediate treatment is necessary. People experiencing hypoglycemia should take about 15 grams of a rapid-acting sugar. This amount of sugar is found in 1/2 cup (4 ounces) of fruit juice. 3. After eating a carbohydrate source, the patient should wait 15 minutes and then monitor blood glucose level. 4. Adding sugar to the fruit sugar already in the juice could cause a rapid rise in blood glucose, with persistent hyperglycemia. 5. If the blood glucose remains low after 15 minutes, eat another 15 grams of carbohydrate. Page Ref: 604

A patient is prescribed 120 units of U-100 regular insulin to be administered at 0700 and 1600 hours. The prescription is written for an equivalent dose of U-500 insulin to be provided. How many units of U-500 insulin should be given? Record your answer rounding to the nearest whole number.

Answer: 24 Explanation: U-500 units is 5 times more concentrated than U-100 insulin. The patient who is using 120 units of U-100 insulin will need 1/5 of the U-100 amount or 20% of the U-100 dose. 120 divided by 5 is 24. 24 units of U-500 insulin is equivalent to 120 units of U-100 insulin. Page Ref: 612

While conducting an educational session for a group of patients regarding the incidence and prevalence of diabetes, the nurse explains that approximately 25.1 million people have been diagnosed with the disorder, but 7.2 million people have not. Statistically, what is the percentage of people who have undiagnosed diabetes? Calculate to the first decimal point.

Answer: 28.6% Explanation: To calculate this percentage the nurse should divide the number who are not diagnosed by the total number of people with the disorder or 7.2/25.1 = 0.286. Then multiply this value by 100 or 0.286 × 100 = 28.6%. Page Ref: 595

The nurse is caring for a patient with type 1 diabetes mellitus. Which patient statement requires immediate intervention by the nurse? 1. "I am allergic to eggs." 2. "I will take my lispro insulin 15 minutes before I eat breakfast." 3. "I won't mix my cloudy regular insulin with other insulins." 4. "I will not use insulin detemir in my insulin pump."

Answer: 3 Explanation: 1. Allergies to eggs do not require immediate nursing intervention. 2. Lispro insulin is properly administered 15 minutes prior to a meal. 3. Regular insulin is clear in appearance. The patient may not understand insulin therapy or that regular insulin may be contaminated. 4. Insulin detemir is not used in insulin pumps. Page Ref: 611

The nurse is concerned that a patient with type 1 diabetes mellitus is at risk for developing diabetic ketoacidosis. What did the nurse assess to come to this conclusion? 1. Reports of anxiety 2. Pale, cool skin 3. Serum glucose level of 325 mg/dL 4. Ulcer on plantar aspect of right foot

Answer: 3 Explanation: 1. Anxiety is a symptom of hypoglycemia. 2. Pale, cool skin is a symptom of hypoglycemia. 3. In diabetic ketoacidosis, the blood glucose level is above 250 mg/dL. 4. An ulcer is not a symptom of diabetic ketoacidosis. Page Ref: 601

An older patient with type 2 diabetes mellitus is upset because family members do not believe the patient has an illness and resist helping with diet and activity modifications. What should the nurse suggest to help this patient? 1. Limit discussions about the illness with family members. 2. Store health-related items away from common family areas in the home. 3. Invite family to participate in a support group. 4. Explain the risk for family also to develop the illness.

Answer: 3 Explanation: 1. Chronic illness affects all dimensions of an individual's life, as well as the lives of family members and significant others. Limiting discussions about the illness will not help them understand the impact diabetes has on the patient. 2. Storing health-related items away from common family areas in the home strengthens denial of the health problem. 3. Chronic illness affects all dimensions of an individual's life, as well as the lives of family members and significant others. Sharing with others who have similar problems provides opportunities for mutual support and problem solving. Using available resources improves the ability to cope. 4. There is no evidence to suggest that family members are at risk for developing diabetes. Page Ref: 625

A patient with diabetes mellitus has albuminuria, hypertension, and edema. What should the nurse expect to be prescribed for this patient? 1. Restrict activity. 2. Increase salt intake. 3. Review weight loss strategies. 4. Provide antibiotic therapy as prescribed.

Answer: 3 Explanation: 1. Management of diabetic nephropathy includes control of hypertension with exercise. 2. Management of diabetic nephropathy includes control of hypertension with reduced salt intake. 3. Management of diabetic nephropathy includes control of hypertension with weight loss. 4. Management of diabetic nephropathy includes control of hypertension with ACE inhibitors. Page Ref: 606

The nurse teaches about the prevalence of type 2 diabetes in older adults. Which should the nurse include about the number of older adults with diabetes? 1. 10 out of 100 will have type 2 diabetes. 2. 17 out of 100 will have type 2 diabetes. 3. 21 out of 100 will have type 2 diabetes. 4. 33 out of 100 will have type 2 diabetes

Answer: 3 Explanation: 1. More than 10% will have type 2 diabetes. 2. More than 17% will have type 2 diabetes. 3. The Centers for Disease Control and Prevention estimates that 20.8% of the U.S. population over the age of 65 has DM. 4. Fewer than 33% will have type 2 diabetes. Page Ref: 599

The nurse is reviewing data collected for a patient's health history. Which factor should the nurse identify as increasing the patient's risk of developing type 2 diabetes mellitus? 1. Body mass index of 23 kg/m2 2. Blood pressure of 120/70 mmHg 3. Physical inactivity 4. Low waist-to-hip ratio

Answer: 3 Explanation: 1. Patients with obesity, defined as being at least 20% over desired body weight or having a body mass index (BMI) of at least 27 kg/m2 are at major risk for type 2 DM. A patient with a body mass index of 23 kg/m2 is not the patient most at risk for type 2 DM. 2. A blood pressure of 120/70 mmHg is normal and carries no increased risk for type 2 DM. 3. Physical inactivity is a major risk factor for type 2 DM. 4. A high waist-to-hip ratio is a risk factor for type 2 DM. A low waist-to-hip ratio carries no increased risk of the disease. Page Ref: 599

The nurse is trying to determine if a patient is experiencing manifestations of type 1 or type 2 diabetes mellitus. Which question should the nurse ask the patient to help determine the type? 1. "Have you been urinating in greater amounts than in the past?" 2. "Have you been drinking more liquids than in the past?" 3. "Have you been losing weight despite eating regularly?" 4. "Have you noticed any changes in your vision?"

Answer: 3 Explanation: 1. Type 1 and type 2 diabetes have similar manifestations, especially polyuria and polydipsia. 2. Type 1 and type 2 diabetes have similar manifestations, especially polyuria and polydipsia. 3. Weight loss despite eating regularly is a manifestation of type 1 diabetes mellitus. The person with type 2 diabetes mellitus may lose weight but will be obese. 4. Vision changes are seen in both type 1 and type 2 diabetes mellitus. Page Ref: 599

A patient recently diagnosed with type 1 diabetes mellitus does not understand why the disease developed because the patient is thin and eats all of the time. What is the most appropriate response by the nurse? 1. "Thin people can be diabetic, too." 2. "Your condition makes it impossible for you to gain weight." 3. "Diabetes makes it difficult for your body to obtain energy from the foods you eat." 4. "Your lab tests indicate the presence of diabetes."

Answer: 3 Explanation: 1. While the statement about diabetics being thin is correct, it does not answer the patient's question. 2. It is not impossible for diabetics to gain weight. 3. The patient with type 1 diabetes mellitus is unable to obtain the needed glucose for the body's cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin. 4. Although the laboratory tests might indicate the presence of diabetes, it does not meet the patient's needs for teaching. Page Ref: 598

A patient with type 1 diabetes mellitus voided 4000 mL of urine in the past 24 hours. The patient's skin turgor is poor, and the patient is reporting polyphagia and polydipsia. Which blood glucose level should the nurse expect when assessing this patient? 1. 60 mg/dL 2. 110 mg/dL 3. 125 mg/dL 4. 180 mg/dL

Answer: 4 Explanation: 1. A blood glucose level of 60 mg/dL is hypoglycemia. Polyuria is not a manifestation of hypoglycemia. 2. A blood glucose level of 110 mg/dL is considered as being a normal blood glucose level. Polyuria is not a manifestation of a normal blood glucose level. 3. A blood glucose level of 125 mg/dL is considered an impaired blood glucose level. Polyuria is not a manifestation with this level. 4. Hyperglycemia causes serum hyperosmolality, drawing water from the intracellular spaces into the general circulation. The increased blood volume increases renal blood flow, and the hyperglycemia acts as an osmotic diuretic. The resulting osmotic diuresis increases urine output. This condition is called polyuria. When the blood glucose level exceeds the renal threshold for glucose usually about 180 mg/dL glucose is excreted in the urine, a condition called glucosuria. The decrease in intracellular volume and the increased urinary output cause dehydration. The mouth becomes dry and thirst sensors are activated, causing the person to drink increased amounts of fluid (polydipsia). Page Ref: 609

An older patient without polyuria, polydipsia, or polyphagia has a serum glucose level of 130 mg/dL. What should the nurse conclude about this patient? 1. The patient might have eaten a meal with high sugar content prior to the testing. 2. The laboratory results might be erroneous. 3. The patient has type 1 diabetes mellitus. 4. The patient will need to be assessed for other manifestations of diabetes.

Answer: 4 Explanation: 1. A slight elevation in serum glucose level warrants further investigation. 2. There is no reason to question the laboratory results at this time. 3. There is inadequate information to make a diagnosis of type 1 diabetes mellitus. 4. Older adultterm-0s with diabetes might not present with the classic symptoms of polyuria, polyphagia, or polydipsia. Symptoms of diabetes in older patients can include hypotension, periodontal disease, infections, and strokes. A slight elevation in serum glucose level warrants further investigation. Page Ref: 599

A patient beginning insulin for type 2 diabetes is experiencing blurred vision and is concerned about becoming blind. What response by the nurse is most appropriate? 1. "I will make an appointment for you to see an ophthalmologist." 2. "I will call the physician to report your symptoms." 3. "Blurry vision is very common. Do not worry." 4. "This is a normal response when insulin therapy is initiated."

Answer: 4 Explanation: 1. It is beyond the scope of practice for the nurse to make a referral to another physician. 2. Contacting the physician is premature. 3. Telling the patient it is "nothing" minimizes the concerns voiced, and does not provide adequate information to the patient. 4. Vision changes are normal during the first weeks of insulin therapy. They will gradually resolve. Page Ref: 613

The nurse notes that a patient who has not been diagnosed with diabetes has a hemoglobin A1C level of 6%. What should the nurse suspect is occurring with the patient? 1. Severe hyperglycemia 2. Consistent with diabetes 3. Normal results 4. High risk for developing diabetes

Answer: 4 Explanation: 1. This is not severe hyperglycemia. If it were, the nurse would immediately notify the healthcare provider. 2. Diabetes is fasting blood glucose level of 126 mg/dL or greater. 3. A normal fasting blood glucose level is less than or equal to 100 mg/dL. 4. A hemoglobin A1C level of 5.7% to 6.4% indicates a high risk for developing diabetes. Page Ref: 609

The nurse is teaching a patient with diabetes about self-management. What should the nurse include regarding medications to treat diabetes mellitus? 1. Patients with type 1 diabetes may achieve normal blood glucose levels with oral medications. 2. Patients with type 1 diabetes may progress to type 2 if blood glucose levels are not well controlled. 3. Patients with type 2 diabetes will always need an exogenous source of insulin. 4. Patients with type 2 diabetes may achieve normal blood glucose levels with a combination of oral medications and insulin.

Answer: 4 Explanation: 1. Type 1 diabetes mellitus is not treated with oral medications. 2. Patients with diabetes do not progress from type 1 to type 2. 3. People with type 1 must have insulin. 4. People with type 2 diabetes mellitus are usually able to control glucose levels with an oral hypoglycemic medication, but they may require insulin if control is inadequate. Page Ref: 611

A patient with diabetes is diaphoretic, has a heart rate of 112 beats per minute, and is feeling nervous and shaky. What action should the nurse take first? 1. Provide the patient with a snack of milk and crackers. 2. Administer insulin utilizing the prescribed sliding scale dosages. 3. Contact the laboratory and order a serum glucose level. 4. Obtain a capillary serum glucose level reading with a glucose meter.

Answer: 4 Explanation: 1. While the patient is demonstrating manifestations consistent with hypoglycemia, providing a snack is not the first action the nurse should take. 2. The patient is hypoglycemic, so insulin administration would be incorrect, as it would only add to the problem. 3. It would be more appropriate to use the nursing unit's glucometer than to wait for the laboratory to obtain a reading. In addition, there is no indication an order for laboratory values exists. 4. The first action would be to verify the patient's blood glucose level. Page Ref: 603-604

The nurse is reviewing a teaching tool created for insulin therapy. Which statement on the tool should be corrected? Select all that apply. 1. Lispro is a rapid-acting insulin. 2. Regular insulin can be administered intravenously. 3. NPH insulin may be mixed with lispro insulin. 4. Insulin detemir is administered prior to each meal. 5. Insulin glargine may be used to treat gestational diabetes.

Answer: 4, 5 Explanation: 1. Lispro is a rapid-acting insulin. 2. Regular insulin can be administered intravenously. 3. NPH insulin may be mixed with lispro or regular insulin. 4. Insulin detemir is administered once or twice daily, not before each meal. 5. Insulin glargine is not used during pregnancy. Page Ref: 611-612