Diabetes Mellitus

The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs using one (1) syringe. Tip: Identify the steps in this procedure by listing them in priority order, simply drag and drop the choices below. Invert NPH vial and withdraw NPH dose Inject air equal to regular dose into regular dose Invert regular insulin bottle and withdraw regular insulin dose Inject air equal to NPH dose into NPH vial

Inject air equal to NPH dose into NPH vial Inject air equal to regular dose into regular dose Invert regular insulin bottle and withdraw regular insulin dose Invert NPH vial and withdraw NPH dose

Serafica who has diabetes mellitus type 1 is found unresponsive in the clinical setting. Which nursing action is a priority? TIP: To arrange all answers in the correct order, simply drag and drop the choices below. Assess the vital signs. Treat the client for hypoglycemia. Call a code. Call the physician STAT.

Treat the client for hypoglycemia. Call the physician STAT. Assess the vital signs. Call a code.

A client with diabetes mellitus states, "I cannot eat big meals; I prefer to snack throughout the day." The nurse should carefully explain that: A. Regulated food intake is basic to control B. Salt and sugar restriction is the main concern C. Small, frequent meals are better for digestion D. Large meals can contribute to a weight problem

A. Regulated food intake is basic to control An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two between meals snacks need to be tailored to the client's specific needs, with due regard for activity, diet, and therapy.

A health care provider prescribed ondansetron (Zofran) 8 mg p.o. T.i.d to a patient with Type 1 diabetes mellitus with complaints of vomiting.; Available stock of Zofran in a 100 ml bottle labeled 4 mg/tsp.; How many ml will the nurse administer for each dose? Fill in the blank.

Correct Answer: 10 ml

Your patient has had the following intake: 8 oz glasses of iced tea, 4 oz cartons of grape juice, ¾ pt of ice cream, 32 oz of juice, 1 ½ L of D5W IV and 6 oz of cottage cheese. What will you record as the total intake in mL for this patient? Fill in the blank.

Correct Answer: 3,195 ml Rationale:1 pt = 500 ml1 oz = 30 ml240 ml + 120 ml + 375 ml + 960 ml + 1,500 ml = 3,195 ml (Cottage cheese is not liquid at room temperature, so it is not included when calculating intake.)

Your patient has had the following intake: 2 ½ cups of coffee (240 mL/cup), 11.5 oz of grape juice, ¾ qt of milk, 320 mL of diet coke, 1 ¼ L of D5W IV and 2 oz of grits. What will you record as the total intake in mL for this patient? Fill in the blank.

Correct Answer: 3,265 ml Rationale:1 qt = 1,000 ml 1 oz = 30 ml 600 ml + 345 ml + 750 ml + 320 ml + 1,250 ml = 3,265 ml (Grits is not liquid at room temperature, so it is not included when calculating intake.)

A patient was recently discharged after being hospitalized due to type 1 diabetes mellitus and was given ergocalciferol (Vitamin D) 225,000 units PO daily. The patient have on hand ergocalciferol in 50,000 unit tablets. How many tablet(s) should the patient take? Fill in the blank.

Correct Answer: 4.5 tablets

Give Regular insulin by continuous I.V. infusion at 20 units/hr. The solution is 250 ml NS with 100 units of Regular insulin. What rate on the infusion pump will deliver the correct dose? Fill in the blank.

Correct Answer: 50 ml/hr

Gregory is a 52-year-old man identified as high-risk for diabetes mellitus. Which laboratory test should a nurse anticipate a physician would order for him? Select all that apply. A. Fasting Plasma Glucose (FPG) B. Two-hour Oral Glucose Tolerance Test (OGTT) C. Glycosylated hemoglobin (HbA1C) D. Fingerstick glucose three times daily E. Urinalysis and urine culture

Correct Answer: A & B. When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. An FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal.

After suffering an acute MI, a client with a history of type 1 diabetes is prescribed metoprolol (Lopressor) I.V. Which nursing interventions are associated with I.V. administration of metoprolol? Select all that apply. A. Monitor glucose levels closely. B. Monitor for heart block and bradycardia. C. Monitor blood pressure closely. D. Mix the drug in 50 ml of dextrose 5% in water and infuse over 30 minutes. E. Be aware that the drug is not compatible with morphine.

Correct Answer: A, B, & C. Metoprolol is a cardioselective beta-1-adrenergic receptor inhibitor that competitively blocks beta1-receptors with minimal or no effects on beta-2 receptors at oral doses of less than 100 mg in adults. It decreases cardiac output by negative inotropic and chronotropic effects.

Nurse Shey is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply. A. Cakes, candies, cookies, and regular soft drinks should be avoided. B. Gestational diabetes increases the risk that the mother will develop diabetes later in life. C. Gestational diabetes usually resolves after the baby is born. D. Insulin injections may be necessary. E. The mother should strive to gain no more weight during pregnancy. F. The baby will likely be born with diabetes

Correct Answer: A, B, C, & D. Gestational diabetes can occur between the 16th and 28th week of pregnancy. If not responsive to diet and exercise, insulin injections may be necessary. Concentrated sugars should be avoided.

According to the National Diabetes Statistics Report, diabetes remains one of the leading causes of death in the United States since 2010. Which of the following factors are risks for the development of diabetes mellitus? Select all that apply. A. Age over 45 years B. Overweight with a waist/hip ratio >1 C. Having a consistent HDL level above 40 mg/dl D. Maintaining a sedentary lifestyle E. Polycystic ovary syndrome

Correct Answer: A, B, D, & E. Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels. The main subtypes of DM are Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM), which classically result from defective insulin secretion (T1DM) and/or action (T2DM).

When reviewing the urinalysis report of a client with newly diagnosed diabetes mellitus, the nurse would expect which urine characteristics to be abnormal? Select all that apply. A. Amount. B. Odor. C. pH. D. Specific gravity. E. Glucose level. F. Ketone bodies.

Correct Answer: A, B, E, & F. Diabetes mellitus is associated with increased amounts of urine, a sweet or fruity odor, and glucose and ketone bodies in the urine. It does not affect the urine's pH or specific gravity.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? A. "The best time for me to exercise is every afternoon." B. "The best time for me to exercise is right after I eat." C. "The best time for me to exercise is after breakfast." D. "The best time for me to exercise is after my morning snack."

Correct Answer: A. "The best time for me to exercise is every afternoon." A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication.

During a visit to a community, the nurse will recommend routine screening for diabetes when the person has one or more of seven risk criteria. Which of the following persons that the nurse comes in contact with most needs to be screened for diabetes based on the seven risk criteria? A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl B. A woman who is at 90% of standard body weight after delivering an eight-pound baby C. A middle-aged Caucasian male D. An older client who is hypotensive

Correct Answer: A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl The seven risk criteria include: greater than 120% of standard bodyweight, certain races but not including Caucasian, delivery of a baby weighing more than 9 pounds or a diagnosis of gestational diabetes, hypertensive, HDL greater than 35 mg/dl or triglyceride level greater than 250 or a triglyceride level of greater than 250 mg/dl, and, lastly, impaired glucose tolerance or impaired fasting glucose on prior testing.

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: A. Administer regular insulin intravenously B. Administer 5% dextrose intravenously C. Correct the acidosis D. Apply an electrocardiogram monitor

Correct Answer: A. Administer regular insulin intravenously Lack (absolute or relative) of insulin is the primary cause of DK1. Intravenous insulin by continuous infusion is the standard of care. A more recent prospective randomized trial demonstrated that a bolus is not necessary if patients are given hourly insulin infusion at 0.14 U/kg/hr.

Billy is being asked concerning his health in the emergency department. When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about the history of: A. Alcohol use B. Cigarette smoking C. Diabetes mellitus D. High-protein diet

Correct Answer: A. Alcohol use. Alcohol use is one of the most common risk factors for pancreatitis in the United States. In the majority of cases, alcohol use, gallstones, and hypertriglyceridemia cause acute pancreatitis. A thorough history regarding alcohol use and medications should be gathered, keeping in mind that over five years of heavy alcohol use is often needed to induce alcohol-related pancreatitis.

Mr. Wesley is newly diagnosed with Type I DM and is being seen by the home health nurse. The doctor's orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar QID. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be: A. Anxiety, paleness, and pulse of 110 bpm B. Lethargic with hot dry skin and rapid deep respirations C. Alert and cooperative with BP of 130/80 mm Hg and respirations of 12 breaths per minute D. Short of breath, with distended neck veins and bounding pulse of 96 bpm

Correct Answer: A. Anxiety, paleness, and pulse of 110 bpm Hypoglycemia triggers the release of epinephrine (adrenaline), the "fight-or-flight" hormone which can cause symptoms such as confusion, paleness, and tachycardia. NPH insulin has a somewhat higher risk of hypoglycemia. Inadequate resuspension is thought to contribute to the high day-to-day variability in the pharmacodynamic and pharmacokinetic profile of NPH insulin, leading to hypoglycemia.

Blood sugar is well controlled when Hemoglobin A1C is: A. Below 5.7% B. Between 12%-15% C. Less than 180 mg/dL D. Between 90 and 130 mg/dL

Correct Answer: A. Below 5.7% HbA1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. A1C of 6% to 6.5% is considered prediabetes. Tighter control is shown by levels of HbA1c in the 7% range or lower, were correlated with a 35-76% decrease in microvascular complications, like retinopathy, nephropathy, and neuropathy, in patients with type 1 diabetes.

A client with diabetes mellitus has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse's primary responsibility to: A. Check the client's serum glucose level B. Assist the client out of bed to the chair C. Place the client in a High-Fowler's position D. Ensure that the client's residual limb is elevated

Correct Answer: A. Check the client's serum glucose level Because the client has diabetes, it is essential that the blood glucose level is determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage. Integrating CGMs as part of a glycemic control protocol can lead to better management of glucose levels with fewer hyperglycemia episodes and lower glucose level variability resulting in better post-surgical outcome.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? A. Elevated blood glucose level and a low plasma bicarbonate B. Decreased urine output C. Increased respiration and an increase in pH D. Comatose state

Correct Answer: A. Elevated blood glucose level and a low plasma bicarbonate In diabetic acidosis, the arterial pH is less than 7.35, plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration.

Glucose is an important molecule in a cell because this molecule is primarily used for: A. Extraction of energy B. Synthesis of protein C. Building of genetic material D. Formation of cell membranes

Correct Answer: A. Extraction of energy Glucose catabolism is the main pathway for cellular energy production. It is a ubiquitous source of energy for every organism in the world and is essential to fuel both aerobic and anaerobic cellular respiration. Once glucose is in the body, it travels through the blood and to energy-requiring tissues.

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B. It is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

Correct Answer: A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as needed. Regular insulin is used in an insulin pump.

A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be: A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalanced nutrition: less than body requirements D. Disabled family coping: compromise

Correct Answer: A. High risk for deficient fluid volume Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe.

A client is in diabetic ketoacidosis (DKA) secondary to infection. As the condition progresses, which of the following symptoms might the nurse see? A. Kussmaul's respirations and a fruity odor on the breath B. Shallow respirations and severe abdominal pain C. Decreased respiration and increased urine output D. Cheyne-stokes respirations and foul-smelling urine

Correct Answer: A. Kussmaul's respirations and a fruity odor on the breath Coma and severe acidosis are ushered in with Kussmaul's respirations (very deep but not labored respirations) and a fruity odor on the breath. Kussmaul's breathing, which is labored, deep, and tachypneic, may occur. Some providers may appreciate a fruity scent to the patient's breath, indicative of the presence of acetone.

Which of the following is accurate pertaining to physical exercise and type 2 diabetes mellitus? A. Physical exercise can slow the progression of type 2 diabetes mellitus. B. Strenuous exercise is beneficial when blood glucose is high. C. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia. D. Adjusting insulin regimen allows for safe participation in all forms of exercise.

Correct Answer: A. Physical exercise can slow the progression of type 2 diabetes mellitus. Physical exercise slows the progression of type 2 diabetes mellitus because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, contributes to weight loss, and improves well-being.

A patient was recently diagnosed with type 1 diabetes mellitus and received insulin. Which laboratory test will the nurse assess? A. Potassium B. AST (aspartate aminotransferase) C. Serum amylase D. Sodium

Correct Answer: A. Potassium Insulin causes potassium to move into the cell and may cause hypokalemia. Insulin shifts potassium into cells by stimulating the activity of Na+-H+ antiporter on cell membrane, promoting the entry of sodium into cells, which leads to activation of the Na+-K+ ATPase, causing an electrogenic influx of potassium. IV insulin leads to a dose-dependent decline in serum potassium levels

During the lecture, the clinical instructor tells the students that 50% to 60% of daily calories should come from carbohydrates. What should the nurse say about the types of carbohydrates that can be eaten? A. Try to limit simple sugars to between 10% and 20% of daily calories. B. Simple carbohydrates are absorbed more rapidly than complex carbohydrates. C. Simple sugars cause a rapid spike in glucose levels and should be avoided. D. Simple sugars should never be consumed by someone with diabetes.

Correct Answer: A. Try to limit simple sugars to between 10% and 20% of daily calories. It is recommended that carbohydrates provide 50% to 60% of the daily calories. Approximately 40% to 50% should be from complex carbohydrates. The remaining 10% to 20 % of carbohydrates could be from simple sugars.

Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication? A. When the client is eating B. Thirty minutes before meals C. Fifteen minutes before meals D. When the meal trays arrive on the floor

Correct Answer: A. When the client is eating The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating to prevent hypoglycemia. Insulin lispro is a new type of insulin. It starts working sooner than other insulin types. It also reaches peak activity faster and goes away sooner.

A client with diabetes mellitus visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently, the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? A. prednisone (Deltasone) B. atenolol (Tenormin) C. phenelzine (Nardil) D. allopurinol (Zyloprim)

Correct Answer: A. prednisone (Deltasone) Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Prednisone may interfere with blood glucose control and reduce the effectiveness of metFORMIN and other diabetic medications. Monitor blood sugar levels closely. The client may need a dose adjustment of the diabetic medications during and after treatment with prednisone.

Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select all that apply. A. The nurse could have given the insulin subcutaneously. B. The nurse should have contacted the physician. C. The nurse should have used regular insulin (Humulin R). D. The nurse used the correct insulin. E. The nurse could have given the insulin intramuscularly.

Correct Answer: B & C. Insulin lispro is an insulin analog that is FDA-approved for the treatment of patients with diabetes mellitus types 1 and 2 to control hyperglycemia. Regular insulin, short-acting human insulin, is a synthetic protein hormone, which, just as the naturally occurring endogenous insulin, exerts a wide range of physiologic effects.

Jansen is receiving metformin (Glucophage). What will be the best plan of the nurse with regard to patient education with this drug? Select all that apply. A. It stimulates the pancreas to produce more insulin. B. It must be taken with meals. C. It decreases sugar production in the liver. D. It inhibits the absorption of carbohydrates. E. It reduces insulin resistance.

Correct Answer: B, C, & E. Metformin (Glucophage) reduces insulin resistance, decreases sugar production in the liver, and should be taken with meals for the best absorption and effect. Metformin, FDA-approved in 1994, is an antidiabetic agent used in type 2 diabetes mellitus. Metformin comes in both immediate-release and extended-release and is available in several combination products with other antidiabetic agents.

A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse? A. "Insulin must be injected because it needs to work quickly." B. "Insulin can't be in a pill because it is destroyed in stomach acid." C. "Have you talked to your doctor about taking pills instead?" D. "I know it is tough, but you will get used to the shots soon."

Correct Answer: B. "Insulin can't be in a pill because it is destroyed in stomach acid." Insulin must be injected because it is destroyed in the stomach acid if taken orally. Insulin is a particularly difficult drug to ingest orally. It is a protein that degrades in the stomach and small intestine, making it almost impossible to design oral delivery which works.

Which of the following, if stated by the nurse, is correct about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)? A. "This syndrome occurs mainly in people with type 1 diabetes." B. "It has a higher mortality rate than diabetic ketoacidosis." C. "The client with HHNS is in a state of overhydration." D. "This condition develops very rapidly."

Correct Answer: B. "It has a higher mortality rate than diabetic ketoacidosis." It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. The mortality rate in HHS can be as high as 20% which is about 10 times higher than the mortality seen in diabetic ketoacidosis. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus.

The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says: A. "I need to rub my forearm vigorously until warm before testing at this site." B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." C. "I have to make sure that my current glucose monitor can be used at an alternate site." D. "Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels."

Correct Answer: B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected. AST (Alternate Site Testing) means using a part of the body other than the fingertips to obtain blood for blood sugar testing.

A client was brought to the emergency room with complaints of slurring of speech, vomiting, dry mucosa, and dry skin turgor. Lab tests showing serum sodium 125 mEq/L and serum blood glucose of 350 mg/dL. Nurse Sophie will anticipate the physician to initially order which of the following intravenous solutions? A. 10% dextrose in water (D10W) B. 0.9% normal saline solution C. 5% dextrose in water (D5W) D. 0.45% normal saline solution

Correct Answer: B. 0.9% normal saline solution The client is experiencing diabetic ketoacidosis. Initial priority in the treatment is to restore the extracellular fluid volume through the intravenous administration of 0.9% normal saline at 15-20 ml/kg/h. Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. Hydration improves glycemic control independent of insulin.

Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330

Correct Answer: B. 1330 and 1930 The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.

Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. >5.6%

Correct Answer: B. 5.7-6.4% Glycosylated hemoglobin levels between 5.7%-6.4% are considered as pre-diabetes. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person's level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. Anyone with an HbA1c value of 5.7 % to 6.4 % is considered to be prediabetic

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration

Correct Answer: B. 6-14 hours after administration The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.

The goal of preprandial blood glucose for those with type 1 diabetes mellitus is: A. <80 mg/dl B. <130 mg/dl C. <180 mg/dl D. >8%

Correct Answer: B. <130 mg/dl According to the American Diabetes Association, the recommended preprandial glucose target for an adult with diabetes is between 80-130 mg/dl. In the management of diabetes, health care providers usually assess glycemic control with fasting plasma glucose (FPG) and premeal glucose measurements, as well as by measuring HbA1c.

When taking a health history, the nurse screens for manifestations suggestive of diabetes type 1. Which of the following manifestations are considered the primary manifestations of type 1 diabetes mellitus and would be most suggestive and require follow-up investigation? A. Excessive intake of calories, rapid weight gain, and difficulty losing weight B. An increase in three areas: thirst, intake of fluids, and hunger C. Poor circulation, wound healing, and leg ulcers D. Lack of energy, weight gain, and depression

Correct Answer: B. An increase in three areas: thirst, intake of fluids, and hunger The primary manifestations of diabetes type 1 are polyuria (increased urine output), polydipsia (increased thirst), polyphagia (increased hunger). Patients most commonly present hyperglycemic with polydipsia, polyuria, and polyphagia. Polyuria is secondary to osmotic diuresis, which is caused by hyperglycemia. Young children may present with nocturnal enuresis. Polydipsia is related to hyperosmolality and dehydration from increased urination.

Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? A. Alpha-glucosidase inhibitors B. Biguanides C. Meglitinides D. Sulfonylureas

Correct Answer: B. Biguanides Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Metformin is a biguanide drug that reduces blood glucose levels by decreasing glucose production in the liver, decreasing intestinal absorption, and increasing insulin sensitivity.

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A. Blurred vision B. Diaphoresis C. Nausea D. Weakness

Correct Answer: B. Diaphoresis A hypoglycemic reaction activates a fight-or-flight response in the body which then triggers the release of epinephrine and norepinephrine resulting in diaphoresis. Low blood sugars can affect activity in the autonomic nervous system (ANS), which is responsible for reactions that people cannot control, such as sweating and digestion. The cholinergic system is a part of the ANS, and it regulates the production of sweat and other secretions. Activation of this system can lead to sweating.

The nurse working in the physician's office is reviewing lab results on the clients seen that day. One of the clients who has classic diabetic symptoms had an eight-hour fasting plasma glucose (FPG) test done. The nurse realizes that diagnostic criteria developed by the American Diabetes Association for diabetes include classic diabetic symptoms plus which of the following fasting plasma glucose levels? A. Higher than 106 mg/dl B. Higher than 126 mg/dl C. Higher than 140 mg/dl D. Higher than 160 mg/dl

Correct Answer: B. Higher than 126 mg/dl Diabetes is diagnosed at a fasting blood glucose of greater than or equal to 126 mg/dl. Random venous blood glucose of at or above 11.1mmol/L (?200 mg/dL), or fasting blood glucose at or above 7 mmol/L (?126 mg/dL) on two or more separate occasions indicates the client is likely to have diabetes.

When a client is experiencing diabetic ketoacidosis, the insulin that would be administered is: A. Human NPH insulin B. Human regular insulin C. Insulin lispro injection D. Insulin glargine injection

Correct Answer: B. Human regular insulin Regular insulin (Humulin R) is short-acting insulin and is administered via IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood glucose becomes <13.9 mmol/L (<250 mg/dL). At this point, the insulin dose should be decreased by half, to 0.1 units/kg every 2 hours, until the resolution of DKA.

Rotating injection sites when administering insulin prevents which of the following complications? A. Insulin edema B. Insulin lipodystrophy C. Insulin resistance D. Systemic allergic reactions

Correct Answer: B. Insulin lipodystrophy Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites. Lipodystrophy is associated with increased glycemic variability and unexplained episodes of hypoglycemia further driving up healthcare costs while affecting patient compliance. Studies have shown that the correct rotation technique of insulin sites has the strongest protective value in preventing lipohypertrophy.

The nurse is teaching a client regarding the administration of insulin as part of the discharge plan. Which of the following insulin has the most rapid onset of action? A. insulin regular (Humulin R) B. lispro (Admelog) C. glargine (Toujeo) D. insulin NPH (Humulin N)

Correct Answer: B. Lispro (Admelog) Lispro is a rapid-acting insulin that works within 15 minutes after injection, a peak of 30-90 minutes, and a duration of 2-4 hours. Insulin lispro is a rapid-acting, human insulin analog that works parenterally to lower blood glucose by regulating the metabolism of carbohydrates, proteins, and fats. It works by binding to a glycoprotein receptor specific to insulin on the surface of target cells.

The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client complains of headache and nausea. Based on the serum laboratory results below, how would the nurse interpret the client's acid-base balance? Lab Results: pH: 7.34HCO3-: 19 mEq/LPaCO2: 35 mm HgPaO2: 88 mm HgPotassium: 5.3 mEq/LChloride: 102 mEq/LCalcium: 10.4 mg/dlAnion gap: 30 mEq/L A. Metabolic alkalosis. B. Metabolic acidosis. C. Respiratory acidosis. D. Respiratory alkalosis.

Correct Answer: B. Metabolic acidosis. This client has metabolic acidosis, which typically manifests with a low pH, low bicarbonate level, normal to low PaCO2 , and normal PaO2 . The client's serum electrolyte levels also support metabolic acidosis, which include an elevated potassium level, normal to elevated chloride level, and normal calcium level. The client's anion gap of 30 mEq/L is high, also indicative of metabolic acidosis. This kind of metabolic acidosis occurs with diabetic ketoacidosis and other disorders.

Rosemary has been taking glargine (Lantus) to treat her condition. One of the benefits of glargine (Lantus) insulin is its ability to: A. Release insulin rapidly throughout the day to help control basal glucose. B. Release insulin evenly throughout the day and control basal glucose levels. C. Simplify the dosing and better control blood glucose levels during the day. D. Cause hypoglycemia with other manifestations of other adverse reactions.

Correct Answer: B. Release insulin evenly throughout the day and control basal glucose levels. Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels. Insulin glargine is long-acting insulin injected once daily and provides a basal level of insulin throughout the day.

Which of the following chronic complications is associated with diabetes? A. Dizziness, dyspnea on exertion, and coronary artery disease B. Retinopathy, neuropathy, and coronary artery disease C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts D. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias

Correct Answer: B. Retinopathy, neuropathy, and coronary artery disease These are all chronic complications of diabetes. Regardless of the specific type of diabetes, complications involve microvascular, macrovascular, and neuropathic issues. Microvascular and macrovascular complications vary according to the degree and the duration of poorly controlled diabetes and include nephropathy, retinopathy, neuropathy, and ASCVD events, especially if it is associated with other comorbidities like dyslipidemia and hypertension.

Harry is a diabetic patient who is experiencing a reaction to alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following? A. Uncontrolled diabetes B. Somogyi phenomenon C. Brittle diabetes D. Diabetes insipidus

Correct Answer: B. Somogyi phenomenon The Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and an increase in ketones. The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia.

A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology? A. The client with diabetes mellitus. B. The client with diabetes insipidus. C. The client with diabetic ketoacidosis. D. The client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion.

Correct Answer: B. The client with diabetes insipidus. Maintaining adequate fluid, replacing vasopressin, and correcting underlying intracranial problems (typically lesions, tumors, or trauma affecting the hypothalamus or pituitary gland) are the main objectives in treating diabetes insipidus. Diabetes insipidus (DI) is a disease process that results in either decreased release of or response to antidiuretic hormone (ADH, also known as vasopressin or AVP), which can cause electrolyte imbalances.

The guidelines for carbohydrate counting as medical nutrition therapy for diabetes mellitus includes all of the following, except: A. Flexibility in types and amounts of foods consumed B. Unlimited intake of total fat, saturated fat, and cholesterol C. Including adequate servings of fruits, vegetables, and the dairy group D. Applicable to with either Type 1 or Type 2 diabetes mellitus

Correct Answer: B. Unlimited intake of total fat, saturated fat and cholesterol The guidelines for Carbohydrate Counting as medical nutrition therapy for diabetes mellitus include all of the following except unlimited intake of total fat, saturated fat, and cholesterol. Carb counting at its most basic level involves counting the number of grams of carbohydrate in a meal and matching that to the dose of insulin.

The nurse is conducting a teaching session for a 25-year-old underweight and emaciated client with newly diagnosed type 1 diabetes mellitus. The client lives alone and is anxious about managing their condition, particularly self-administering insulin injections. Considering the client's physical condition and concerns, which is the most appropriate technique for self-administering insulin injections from the following options: A. Instruct the client to pinch the skin up and use a 90-degree angle for insulin injection. B. Advise the client to use a 45-degree angle with the skin pinched up during insulin injection. C. Teach the client to massage the area of injection after injecting the insulin to promote absorption. D. Recommend warming the skin with a warm towel or washcloth prior to the injection to improve circulation.

Correct Answer: B. Use a 45-degree angle with the skin pinched up For an underweight and emaciated client, using a 45-degree angle with the skin pinched up helps to ensure the insulin is injected into the subcutaneous tissue rather than the muscle. This method promotes proper absorption of insulin and reduces the risk of injection site complications.

Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol what this means. What is the best response by the nurse? Select all that apply. A. "Your alpha cells should be able to secrete insulin, but cannot." B. "The exocrine function of your pancreas is to secrete insulin." C. "Without insulin, you will develop ketoacidosis (DKA)." D. "The endocrine function of your pancreas is to secrete insulin." E. "It means your pancreas cannot secrete insulin."

Correct Answer: C, D, & E One function of your pancreas is to secrete insulin. The endocrine function of the pancreas is to secrete insulin. A consequence of diabetes mellitus type 1 is that without insulin, severe metabolic disturbances, such as ketoacidosis (DKA) will result.

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: A. Third day B. Every other day C. 1-2 weeks D. 2-4 weeks

Correct Answer: C. 1-2 weeks Rotation of sites for insulin injection should be done every week or two. Frequently using the same spot over time can cause fat cells to break down or build up (lipodystrophy) causing lumps under the skin and may interfere with insulin absorption.

A male nurse is providing a bedtime snack for his patient. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: A. 6-8 hours B. 10-14 hours C. 14-18 hours D. 24-28 hours

Correct Answer: C. 14-18 hours Intermediate-acting insulins include Humulin N and Novolin N. They have an onset of two to four hours, a peak of 4 to 12 hours, and a duration of 14 to 18 hours. They are absorbed more slowly, and last longer. They are also used to control the blood sugar overnight while fasting and between meals.

The nurse expects that a type 1 diabetic may receive how much of his or her morning dose of insulin preoperatively? A. 10-20% B. 25-40% C. 50-60% D. 85-90%

Correct Answer: C. 50-60% Surgical procedures may result in a number of metabolic perturbations that can alter normal glucose homeostasis. Patients with type 1 diabetes mellitus who are using long-acting insulins, such as glargine, should continue these as normal when fasting. Patients taking premixed insulins or fixed-combination insulins are more of a challenge. It may not be feasible or economical to change the patient's premixed insulin just before surgery. In these situations, the patient can take ½ - ¾ of the morning dose, followed by administration of a dextrose-containing intravenous fluid and frequent blood glucose checks.

A client with type 1 diabetes mellitus has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should: A. Call the physician B. Encourage the intake of fluids C. Administer the insulin as ordered D. Give the client 1/2 c. of orange juice

Correct Answer: C. Administer the insulin as ordered A value of 258 mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered. Sliding scale regimens may include a bedtime high blood sugar correction. As the nighttime scale only considers the amount of insulin required to drop the blood sugar level back into the target range, it should not be used to cover a bedtime snack.

During a visit to the hospital, the student nurses are asked which of the following persons would most likely be diagnosed with diabetes mellitus. They are correct if they answered a 44-year-old: A. Caucasian woman. B. Asian woman. C. African-American woman. D. Hispanic male.

Correct Answer: C. African-American woman. Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence. T2DM varies among ethnic groups and is 2 to 6 times more prevalent in Blacks, Native Americans, Pima Indians, and Hispanic Americans compared to Whites in the United States.

A patient received 6 units of regular insulin three (3) hours ago. The nurse would be most concerned if which of the following was observed? A. Kussmaul respirations and diaphoresis B. Anorexia and lethargy C. Diaphoresis and trembling D. Headache and polyuria

Correct Answer: C. Diaphoresis and trembling Diaphoresis and trembling indicate hypoglycemia and should be treated immediately. Neurogenic signs and symptoms can either be adrenergic (tremor, palpitations, anxiety) or cholinergic (hunger, diaphoresis, paresthesias). Identification of a hypoglycemic patient is critical due to potential adverse effects, including coma and/or death.

Joko has recently been diagnosed with type 1 Diabetes Mellitus and asks nurse Jessica for help formulating a nutrition plan. Which of the following recommendations would the nurse make to help the client increase calorie consumption to offset absorption problems? A. Eat small meals with two or three snacks throughout the day to keep blood glucose levels steady B. Increase the consumption of simple carbohydrates C. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals. D. Skip meals to help lose weight

Correct Answer: C. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals. Complex carbohydrates (apples, broccoli, peas, dried beans, carrots, peas, oats) decrease glucose levels/insulin needs, reduce serum cholesterol levels, and promote satiation. Food intake is scheduled according to specific insulin characteristics and individual patient responses.

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide: A. Oxygen B. Carbohydrates C. Fluid replacement D. Dietary instruction

Correct Answer: C. Fluid replacement As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin. Aggressive hydration with isotonic fluid with electrolyte replacement is the standard practice in the management of HHS. An initial fluid bolus of 15 to 20 ml/kg followed by an infusion rate of 200 to 250ml/hour is the recommended rate for adults.

A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has type 1 diabetes mellitus. Which of the following actions should the nurse do first? A. Inject 1 mg of glucagon subcutaneously B. Administer 50 mL of 50% glucose I.V C. Give 4 to 6 oz (118 to 177 mL) of orange juice D. Give the client four to six glucose tablets

Correct Answer: C. Give 4 to 6 oz (118 to 177 mL) of orange juice. Because the client is awake and complaining of symptoms, the nurse should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4 to 6 oz of fruit juice, five to six hard candies, or 1 tablespoon of sugar.

Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse Matt notes the client's additional insulin vials are not refrigerated. What is the best action by the nurse at this time? A. Instruct the client to label each vial with the date when opened. B. Tell the client there is no need to keep additional vials. C. Have the client place the insulin vials in the refrigerator. D. Have the client discard the vials.

Correct Answer: C. Have the client place the insulin vials in the refrigerator. Vials not in use should be refrigerated to preserve drug potency. Vials of insulin not in use should be refrigerated. Extreme temperatures (<36 or >86°F, <2 or >30°C) and excess agitation should be avoided to prevent loss of potency, clumping, frosting, or precipitation.

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it: A. Inhibits gluconeogenesis B. Stimulates the release of insulin C. Increases blood glucose levels D. Provides more storage of glucose.

Correct Answer: C. Increases blood glucose levels Glucagon, an insulin antagonist produced by the alpha cells in the islets of Langerhans, leads to the conversion of glycogen to glucose in the liver. Glucagon is a polypeptide hormone commonly used in the treatment of severe hypoglycemia with FDA approval for the treatment of severe hypoglycemia and as a diagnostic aid in imaging of the GI tract.

The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of type 2 diabetes mellitus and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents? A. Comply with medication regimen 100% for 6 months B. Quit the use of any tobacco products by the end of three months C. Lose a pound a week until the weight is within the normal range for height and exercise 30 minutes daily D. Practice relaxation techniques for at least five minutes five times a day for at least five months

Correct Answer: C. Lose a pound a week until the weight is within the normal range for height and exercise 30 minutes daily When Type II diabetics lose weight through diet and exercise they sometimes have an improvement in insulin efficiency sufficient to the degree they no longer require oral hypoglycemic agents. A diet low in saturated fat, refined carbohydrates, high fructose corn syrup, and high in fiber and monounsaturated fats needs to be encouraged. Aerobic exercise for a duration of 90 to 150 minutes per week is also beneficial. The major target in T2DM patients, who are obese, is weight loss.

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? A. Give glyburide again B. Give subcutaneous insulin and monitor blood glucose C. Monitor blood glucose closely, and look for signs of hypoglycemia D. Monitor blood glucose, and assess for signs of hyperglycemia

Correct Answer: C. Monitor blood glucose closely, and look for signs of hypoglycemia. When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemia. As rates for hypoglycemia can be higher with glyburide than other oral antidiabetic agents, close monitoring for signs and symptoms of declining blood glucose levels is required.

Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection? A. No changes B. Less insulin C. More insulin D. Oral antidiabetic agents

Correct Answer: C. More insulin During periods of infection or illness, diabetics may need even more insulin to compensate for increased blood glucose levels. During illness, it is important that insulin be continued even if the patient is unable to eat or is vomiting.

Serge who has diabetes mellitus is taking oral agents and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the client his oral medications? A. Administer the oral agents immediately after the test. B. Notify the diagnostic department and request orders. C. Notify the physician and request orders. D. Administer the oral agents with a sip of water before the test.

Correct Answer: C. Notify the physician and request orders. It is best to notify the client's physician and request orders. After a period of fasting ("nil per os," NPO), oral antidiabetic drugs should be resumed only when the patient eats the first normal-sized meal. Special recommendations are in effect for metformin and sulfonylureas.

Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus type 2. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase), is to: A. Induce hypoglycemia by decreasing insulin sensitivity. B. Improve insulin sensitivity and decrease hyperglycemia. C. Stimulate the beta cells of the pancreas to secrete insulin. D. Decrease insulin sensitivity by enhancing glucose uptake.

Correct Answer: C. Stimulate the beta cells of the pancreas to secrete insulin. Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin.

You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent. The client mentions that he usually has a couple of beers each night and takes an aspirin each day to prevent heart attacks and/or strokes. Which of the following responses would be best on the part of the nurse? A. As long as you only drink two beers and take one aspirin, this should not be a problem B. The aspirin is alright but you need to give up drinking any alcoholic beverages C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of hypoglycemia D. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug

Correct Answer: C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of hypoglycemia Alcohol lowers blood glucose levels and disrupts the production of glucose in the liver. Sulfonylureas, when taken with alcohol, may produce a disulfiram-like reaction which may lead to flushing, hypotension, nausea, tachycardia, vertigo, and blurred vision. Metformin should be avoided in patients with a history of chronic alcohol use because they may be more predisposed to lactic acidosis.

A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at the highest risk for developing diabetes? A. The 50-year-old client who does not get any physical exercise B. The 56-year-old client who drinks three glasses of wine each evening C. The 42-year-old client who is 50 pounds overweight D. The 38-year-old client who smokes one pack of cigarettes per day

Correct Answer: C. The 42-year-old client who is 50 pounds overweight Obesity increases the likelihood of developing diabetes mellitus due to the overstimulation of the endocrine system. Obesity is believed to account for 80-85% of the risk of developing type 2 diabetes, while recent research suggests that obese people are up to 80 times more likely to develop type 2 diabetes than those with a BMI of less than 22.

Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include? A. The alcohol could cause pancreatic disease. B. The alcohol could cause serious liver disease. C. The alcohol could predispose you to hypoglycemia. D. The alcohol could predispose you to hyperglycemia.

Correct Answer: C. The alcohol could predispose you to hypoglycemia. Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client. When the client drinks alcohol, the alcohol can inhibit the liver's ability to release glucose into the blood. This can be particularly significant for people on stronger medication such as insulin because it can mean that the liver is not able to release enough glycogen to keep the blood glucose levels from going too low under the influence of insulin in the body.

A medication nurse is about to give insulin to a patient with diabetes mellitus. Upon reviewing the medications of the patient, which of the following would cause a further decrease in the blood glucose level of the patient? A. hydrochlorothiazide (Microzide) B. levothyroxine (Synthroid) C. carvedilol (Coreg) D. hydrocortisone (SoluCortef)

Correct Answer: C. carvedilol (Coreg) Carvedilol (Coreg) is a beta-blocker when given together with insulin would cause an increased hypoglycemic effect of insulin, resulting in a further decrease in the serum blood glucose level. Carvedilol has hyperglycemic potential when given orally for 5 days in normal albino rats. Though it may be beneficial in diabetics for various comorbid conditions, the glycemic control may worsen during its use in subjects with prediabetes, diabetes, high risk diabetes.

Nurse Andy has finished teaching a client with diabetes mellitus how to administer insulin. He evaluates the learning has occurred when the client makes which statement? A. "I should check my blood sugar immediately prior to the administration." B. "I should provide direct pressure over the site following the injection." C. "I should use the abdominal area only for insulin injections." D. "I should only use a calibrated insulin syringe for the injections."

Correct Answer: D. "I should only use a calibrated insulin syringe for the injections." To ensure the correct insulin dose, a calibrated insulin syringe must be used. Insulin syringes are used only to deliver units of insulin. To decrease dosage error, insulin syringes are calibrated in units and not milliliters. Insulin syringes are available in three sizes: 100 unit (1 mL), 50 unit (0.5 mL), and 30 unit (0.3 mL)

Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement? A. "My cells have increased their receptors, but there is enough insulin." B. "My peripheral cells have increased sensitivity to insulin." C. "My beta cells cannot produce enough insulin for my cells." D. "My cells cannot use the insulin my pancreas makes."

Correct Answer: D. "My cells cannot use the insulin my pancreas makes." With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. T2DM is an insulin-resistance condition with associated beta-cell dysfunction. Initially, there is a compensatory increase in insulin secretion, which maintains glucose levels in the normal range. As the disease progresses, beta cells change, and insulin secretion is unable to maintain glucose homeostasis, producing hyperglycemia.

At the time Cherrie Ann found out that the symptoms of diabetes were caused by high levels of blood glucose, she decided to break the habit of eating carbohydrates. With this, the nurse would be aware that the client might develop which of the following complications? A. Retinopathy B. Atherosclerosis C. Glycosuria D. Acidosis

Correct Answer: D. Acidosis When a client's carbohydrate consumption is inadequate, ketones are produced from the breakdown of fat. These ketones lower the pH of the blood, potentially causing acidosis that can lead to a diabetic coma. Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, acidosis, and ketonemia. It is a life-threatening complication of diabetes and typically seen in patients with type-1 diabetes mellitus, though it may also occur in patients with type-2 diabetes mellitus.

A nurse is caring for a client admitted with diabetic retinopathy. Which of the following would the nurse expect to note on the assessment of this client: A. Blurred or distorted vision B. Flashes of lights or floaters C. Sudden loss of vision D. All of the above

Correct Answer: D. All of the above Diabetic retinopathy is a complication of diabetes that is characterized by chronic and progressive damage to the retina. Symptoms include blurring of vision (due to macular edema), flashes of lights, and sudden loss of vision (due to retinal detachment).

The principal goals of therapy for older patients who have poor glycemic control are: A. Enhancing the quality of life. B. Decreasing the chance of complications. C. Improving self-care through education. D. All of the above.

Correct Answer: D. All of the above. Older adults with diabetes are at substantial risk for both acute and chronic microvascular and cardiovascular complications of the disease. More than 25% of the U.S. population aged ?65 years has diabetes, and the aging of the overall population is a significant driver of the diabetes epidemic.

A client's blood gases reflect diabetic acidosis. The nurse should expect: A. Increased pH B. Decreased PO2 C. Increased PCO2 D. Decreased HCO3

Correct Answer: D. Decreased HCO3 The bicarbonate-carbonic acid buffer system helps maintain the pH of the body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids. Acidosis in DKA is due to the overproduction of ?-hydroxybutyric acid and acetoacetic acid. At physiological pH, these 2 keto acids dissociate completely, and the excess hydrogen ions bind the bicarbonate, resulting in decreased serum bicarbonate levels.

An ailing 70-year-old woman with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client's intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient? A. Insulin resistance has developed. B. Diabetic ketoacidosis is occurring. C. Hypoglycemia unawareness is developing. D. Hyperglycemic hyperosmolar nonketotic syndrome.

Correct Answer: D. Hyperglycemic hyperosmolar nonketotic syndrome. Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNS. The most frequent reason for this complication is infection. The infectious process in the respiratory, gastrointestinal, and genitourinary systems can act as the causative factor. The reason for this is the insensible water loss and the release of endogenous catecholamines. Approximately 50% to 60% of HHS is attributable to infectious etiology.

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis? A. Subcutaneous B. Intramuscular C. IV bolus only D. IV bolus, followed by continuous infusion

Correct Answer: D. IV bolus, followed by continuous infusion. An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose. Previous treatment protocols have recommended the administration of an initial bolus of 0.1 U/kg, followed by the infusion of 0.1 U/kg/h. A more recent prospective randomized trial demonstrated that a bolus is not necessary if patients are given hourly insulin infusion at 0.14 U/kg/hr.

During the morning rounds, Nurse AJ accompanied the physician in every patient's room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician? A. Use Humalog insulin for sliding scale coverage. B. Metformin (Glucophage) 1000 mg per day in divided doses. C. Administer regular insulin 30 minutes prior to meals. D. Lantus insulin 20U BID.

Correct Answer: D. Lantus insulin 20U BID. Lantus insulin is usually prescribed once a day so an order for BID dosing should be validated with the physician. Lantus is designed to give a steady level of insulin over 24 hours, even when you are not eating such as between meals and overnight. This helps keep blood glucose levels consistent during the day and at night.

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following, except: A. Integumentary inspection for the presence of brown spots on the lower extremities B. Observation for paleness of the lower extremities C. Observation for blanching of the feet after the legs are elevated for 60 seconds D. Palpation for increased pulse volume in the arteries of the lower extremities

Correct Answer: D. Palpation for increased pulse volume in the arteries of the lower extremities One of the signs and symptoms of impaired peripheral arterial circulation is the absence of a pulse or a weak pulse in the legs or feet. A general concept to bear in mind is that anything impinging the vessel can decrease peripheral pulses.

A 50-year-old widower is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia. The gerontology nurse should anticipate which of the following secondary medical diagnoses? A. Impaired glucose tolerance B. Gestational diabetes mellitus C. Pituitary tumor D. Pancreatic tumor

Correct Answer: D. Pancreatic tumor The onset of hyperglycemia in older adults can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumors. Weight loss occurs in about 90% of patients. Approximately 90% of all cases of pancreatic cancer are among people over 55 years of age.

An older woman with diabetes mellitus visits the clinic concerning her condition. Which of the following symptoms might an older woman with diabetes mellitus complain? A. Anorexia B. Pain intolerance C. Weight loss D. Perineal itching

Correct Answer: D. Perineal itching Older women might complain of perineal itching due to vaginal candidiasis. In diabetes, blood glucose levels can go abnormally high, which can therefore provide ideal conditions for naturally present yeast to grow and also diminishes the body's ability to fight infection.

Insulin forces which of the following electrolytes out of the plasma and into the cells? A. Calcium B. Magnesium C. Phosphorus D. Potassium

Correct Answer: D. Potassium Insulin forces potassium out of the plasma, back into the cells, causing hypokalemia. Potassium is needed to help transport glucose and insulin into the cells. Insulin shifts potassium into cells by stimulating the activity of Na+-H+ antiporter on cell membrane, promoting the entry of sodium into cells, which leads to activation of the Na+-K+ ATPase, causing an electrogenic influx of potassium. IV insulin leads to a dose-dependent decline in serum potassium levels

Nurse Pira is explaining to the client about type 2 diabetes mellitus. Risk factors of such condition include all of the following, except: A. Advanced age B. Physical inactivity C. Obesity D. Smoking

Correct Answer: D. Smoking Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.

Tony is a night shift nurse who is assigned to a patient whose glucose levels remain normal at bedtime but experiences hypoglycemia at 3 am and hyperglycemia at 7 am. The patient is likely experiencing what kind of complication of insulin therapy? A. Insulin resistance B. Dawn phenomenon C. Insulin lipohypertrophy D. Somogyi phenomenon

Correct Answer: D. Somogyi phenomenon The Somogyi phenomenon ( post-hypoglycemic hyperglycemia) is characterized by a rebound high blood glucose level in the morning in response to low blood glucose that occurs at about 2-3 am in the morning. The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia.

A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse? A. Pulse B. Blood pressure C. Respiration D. Temperature

Correct Answer: D. Temperature An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis. Due to the possibility of an infectious trigger for DKA, the patient may be febrile or hypothermic. If there is a superimposed infection that triggered the episode of DKA, the patient may have other infectious symptoms like fever, cough, or other urinary symptoms.

Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal? A. The client will be very thirsty. B. The client will complain of nausea. C. The client will need to urinate. D. The client will have moist clammy skin.

Correct Answer: D. The client will have moist clammy skin. Moist skin is the sign of hypoglycemia, which the client would experience if he injected himself with insulin and did not eat. "Insulin shock" is a common term for low blood sugar, or hypoglycemia. It may also be called an insulin reaction.

Which of the following causes of Hyperglycaemic Hyperosmolar Non-Ketotic Syndrome (HHNS) is most common? A. Insulin overdose B. Removal of the adrenal gland C. Undiagnosed, untreated hyperpituitarism D. Undiagnosed, untreated diabetes mellitus

Correct Answer: D. Undiagnosed, untreated diabetes mellitus Undiagnosed, untreated diabetes mellitus is one of the most common causes of HHNS. Hyperosmolar hyperglycemic syndrome (HHS) is a clinical condition that arises from a complication of diabetes mellitus. Type 2 diabetes accounts for about 90% to 95% of diabetes cases. It is most commonly seen in patients with obesity. If diabetes mellitus is well controlled, the chance of developing HHS is minimal.

Which insulin can be administered through continuous intravenous infusion? A. insulin glargine (Lantus) B. insulin aspart (Novolog) C. insulin detemir (Levemir) D. insulin Afrezza E. regular insulin (Novolin R)

Correct Answer: E. regular insulin (Novolin R) Regular insulin is a short-acting insulin that can be given intravenously in a continuous manner. For intravenous infusions, to minimize insulin adsorption to plastic IV tubing, flush the intravenous tube with a priming infusion of 20 mL from a 100 mL-polyvinyl chloride bag insulin every time a new intravenous tubing is added to the insulin infusion container.

A 44-year-old woman with type 1 diabetes comes to the emergency department due to abdominal pain accompanied by nausea and vomiting. The patient had a history of chronic back pain due to a motor accident 20 years ago. Her situation renders her unable to work and pay for the increasing price of insulin, which has doubled during the last five years. The patient doesn't have medical coverage or insurance; therefore, she rations her insulin intake, making her unable to follow her prescribed therapeutic regimen for her diabetes. Because of her situation, the client is at high risk of developing diabetic ketoacidosis. As her nurse, which of the following symptoms would you anticipate the client to exhibit? Select all that apply. A. Fruity odor breath B. Deep and labored respirations C. Blurred vision D. Increased urination E. Increased thirst F. Fatigue G. Blood glucose level of 60 mg/dL H. Dehydration I. Respiratory rate of 8 bpm J. Hypernatremia K. Metabolic alkalosis

Correct Answers: A, B, C, D, E, F, & H. Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration. It is a life-threatening complication of diabetes and is usually seen in patients with type-1 diabetes mellitus.

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. A. Thirst B. Palpitations C. Diaphoresis D. Slurred speech E. Hyperventilation

Correct Answers: B, C, & D. Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs and symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL. The clinical manifestations of hypoglycemia can be classified as either neuroglycopenic or neurogenic.

The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth

Correct answer: A. Hypoglycemia Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM.

A nurse went to a patient's room to do routine vital signs monitoring and found out that the patient's bedtime snack was not eaten. This should alert the nurse to check and assess for: A. Elevated serum bicarbonate and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Symptoms of hyperglycemia during the peak time of NPH insulin D. Sugar in the urine

Correct answer: B. Signs of hypoglycemia earlier than expected. Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m. The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic patients. The thinking is that these patients should monitor their blood glucose levels and adjust insulin dosages as necessary to prevent hypo- or hyperglycemic episodes.

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to: A. Administer a sedative B. Make sure the client knows all the correct medical terms to understand what is happening C. Ignore the signs and symptoms of anxiety so that they will soon disappear D. Convey empathy, trust, and respect toward the client

Correct answer: D. Convey empathy, trust, and respect toward the client. The most appropriate intervention is to address the client's feelings related to anxiety. Establish and maintain a trusting relationship by listening to the client; displaying warmth, answering questions directly, offering unconditional acceptance; being available, and respecting the client's use of personal space.

Knowing that gluconeogenesis helps to maintain blood glucose levels, a nurse should: A. Document weight changes because of fatty acid mobilization. B. Evaluate the patient's sensitivity to low room temperatures because of decreased adipose tissue insulation. C. Protect the patient from sources of infection because of decreased cellular protein deposits. D. Do all of the above.

Correct answer: D. Do all of the above All measures ensure gluconeogenesis in maintaining glucose homeostasis. The purpose of gluconeogenesis is to maintain blood glucose levels during a fast. In the human body, some tissues rely almost exclusively on glucose as a metabolic fuel source.