DM Drugs

The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b. Cranial nerve testing for peripheral neuropathy c. Pedal pulse palpation for arterial insufficiency d. Auscultation of the carotids for bruits associated with atherosclerosis

ANS: A High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes. Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications of diabetes.

An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."

ANS: A If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes on two separate days to be diagnosed with diabetes. This patient does not need to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would require further work-up. No conclusive evidence indicates that this patient has diabetes, because the random sample value is so low, and the patient has not had two separate tests on different days. However, this also is not conclusive evidence that the patient does not have diabetes.

A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? a. This is an acceptable practice. b. These two forms of insulin are not compatible and cannot be mixed. c. Mixing these two forms of insulin may increase the overall potency of the products. d. NPH insulin should only be mixed with insulin glargine.

ANS: A NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with any other insulin for administration.

The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats per minute who is about to receive digoxin [Lanoxin] c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin]

ANS: A The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because this patient needs to consume a good source of glucose immediately or perhaps the NPO status will be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58 beats per minute, but this is not a priority action. The patient with a headache needs to be followed up, but because the blood pressure is 136/92 mm Hg, the headache is probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin.

Which statement is correct about the contrast between acarbose and miglitol? a. Miglitol has not been associated with hepatic dysfunction. b. With miglitol, sucrose can be used to treat hypoglycemia. c. Miglitol is less effective in African Americans. d. Miglitol has no gastrointestinal side effects.

ANS: A Unlike acarbose, miglitol has not been associated with hepatic dysfunction. Sucrose should not be used to treat hypoglycemia with miglitol. Miglitol is more effective in African American patients. Miglitol has gastrointestinal side effects.

A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer? a. Blood glucose level of 600 mg/dL testbanks_and_xanax b. Blood glucose level of 60 mg/dL c. Acidosis d. Ketones in the urine

ANS: B A patient with diabetic ketoacidosis (DKA) has a high glucose level (at least 500 mg/dL or higher); therefore, a glucose level of 60 mg/dL would not be consistent with DKA. A blood glucose level of 600 mg/dL, acidosis, and ketones in the urine are consistent with DKA.

A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) a. Initiation of reliable contraception to prevent pregnancy b. Ways to reduce hyperglycemic episodes c. Use of a prokinetic drug (eg, metoclopramide) d. Smoking cessation e. Emphasis on the importance of taking antihypertensive drugs consistently

ANS: B,D,E Tighter glycemic control and fewer hyperglycemic episodes have been correlated with fewer complications. Smoking cessation and strict compliance with any drugs prescribed for hypertension also help reduce the risk of complications. The use of contraception or a prokinetic drug is not related to a reduced risk of vision loss in patients with diabetes.

A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a. Hypoglycemia b. Flatulence c. Elevated iron levels in the blood d. Fluid retention e. Diarrhea

ANS: B,E Acarbose and miglitol frequently cause flatulence, cramps, abdominal distention, borborygmus (rumbling bowel sounds), and diarrhea. Acarbose also can cause liver damage. Neither acarbose nor miglitol causes hypoglycemia, elevated iron levels, or fluid retention.

A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a. Before each meal and before bed b. In the morning for a fasting level and at 4:00 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing

ANS: C A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (eg, six or seven times a day) to manage both the patient and the fetus so that no teratogenic effects occur. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three times a day is not enough.

An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct? a. Between 6.5 and 7.0 b. Below 7.0 c. Below 8.0 d. Between 7.0 and 8.5

ANS: C For patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications, the target A1c level should be below 8.0. For most other patients with diabetes, the target is 7.0 and below.

Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime

ANS: C Glargine insulin is indicated for once daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage.

A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more."

ANS: C Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to monitor their blood glucose.

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.

ANS: D Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (eg, tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor blocking by propranolol

Which statement is accurate about the long-term complications of diabetes? a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

ANS: D In both types of diabetes, optimal control of the disease slows the development of microvascular complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis. Patients with type 2 diabetes have fewer complications if their blood sugar level is optimally controlled. Hypoglycemia does not occur more frequently in patients with optimally controlled type 1 diabetes.

A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "You should use a carbohydrate counting approach to maintain glycemic control."

ANS: D Patients with diabetes should be given intensive insulin therapy education using either a carbohydrate counting or experience-based estimation approach in achieving glycemic control. A patient with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually to determine the number of total calories the person should have daily. The total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.

A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro [Humalog]

ANS: D Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage.

What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a. Self-monitoring blood glucose (SMBG) graph report b. Patient's report c. Fasting blood glucose level d. Glycosylated hemoglobin level

ANS: D The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been, on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient and indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the glycosylated hemoglobin level, because the equipment used might not be accurate and the testing may not reflect actual measurements 100% of the time. The patient's report of blood sugar levels is not considered as accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting blood glucose level indicates the patient's blood sugar level for that one time when it was obtained.

The nurse is conducting an educational session with a patient who is newly diagnosed with diabetes. The nurse knows further education is needed when the patient states, "In the U.S.: 1. 6 million people are diagnosed with diabetes per year." 2. 25.8 million people have diabetes." 3. 18.8 million people have been diagnosed with diabetes." 4. 7 million people have diabetes but have not been diagnosed."

Correct Answer: 1 Rationale 1: Approximately 1.9 million new cases of DM are diagnosed each year in the United States. Rationale 2: This chronic illness affects an estimated 25.8 million people. Rationale 3: This chronic illness affects an estimated 25.8 million people, of that number, 18.8 million have been diagnosed. Rationale 4: An estimated 7 million are undiagnosed. Global Rationale: Approximately 1.9 million new cases of DM are diagnosed each year in the United States. This chronic illness affects an estimated 25.8 million people, of that number, 18.8 million have been diagnosed and an estimated 7 million are undiagnosed.

A patient with diabetes asks what can be done to prevent the development of corns on the feet. How should the nurse respond to this patient? 1. "Make sure that you select shoes that are appropriately fitted." 2. "Use corn pads to gradually remove the growths." 3. "Corns are best treated by shaving them off." 4. "A mild abrasive soap can be used to scrub the area to remove them."

Correct Answer: 1 Rationale 1: Corns can be prevented by wearing correctly fitting shoes. Rationale 2: Corn pads are not an option for the diabetic patient. Rationale 3: Shaving treatments to remove the corns and are not an option for the diabetic patient. Rationale 4: Scrubs to remove the corns are not option for the diabetic patient. Global Rationale: Corns can be prevented by wearing correctly fitting shoes. Corn pads, scrubs, and shaving treatments to remove the corns and are not options for the diabetic patient.

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 pounds and 12 ounces 4. a fasting blood glucose level of 89 mg/dL

Correct Answer: 1 Rationale 1: Many drugs, including thyroid hormone, impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Rationale 2: This is a desired finding. Rationale 3: This is an acceptable birth weight for a patient with diabetes. Rationale 4: This is a desirable level for a patient with diabetes. Global Rationale: Many drugs, including thyroid hormone, impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Decreasing the waist-to-hip ration, delivering a baby that weighted 8 lbs. and 12 ounces, and having a fasting blood glucose level of 89 are all desirable findings for the patient with a family history of type 2 diabetes mellitus.

A patient with type 1 diabetes mellitus has a serum hematocrit level of 24%. What additional finding should the nurse report to the health care 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

Correct Answer: 1 Rationale 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 health care provider must be notified of this finding. Rationale 2: This glycosylated level does not require immediate notification of the primary health care provider. Rationale 3: The presence of albumin in the urine does not require immediate notification of the primary health care provider. Rationale 4: The presence of glucose in the urine does not require immediate notification of the primary health care provider.

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."

Correct Answer: 1 Rationale 1: Studies of patients with DM who have gastrointestinal surgery for morbid obesity show complete remission of type 2 DM in over three-quarters of cases.

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 exam 4. knowing symptoms of urinary tract infections

Correct Answer: 1 Rationale 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.

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?"

Correct Answer: 1 Rationale 1: Urine glucose testing is no longer recommended for the patient with diabetes who is self-managing the condition. The blood glucose level is likely to be drastically different than a urine level because urine may sit in the bladder for several hours. If the result is negative, the blood glucose could be normal, hyperglycemic (up to 180 mg/dL), or hypoglycemic (less than 70 mg/dL). Rationale 2: Advising the patient the method of testing is not reliable is not entirely correct and does not provide needed information to the patient. Rationale 3: Telling the patient he is correct does not provide adequate information. Rationale 4: It is inappropriate for the nurse to make such a suggestion about the method of testing to be utilized by the patient. Global Rationale: Urine glucose testing is no longer recommended for the patient with diabetes who is self-managing the condition. The blood glucose level is likely to be drastically different than a urine level because urine may sit in the bladder for several hours. If the result is negative, the blood glucose could be normal, hyperglycemic (up to 180 mg/dL), or hypoglycemic (less than 70 mg/dL). Advising the patient the method of testing is not reliable is not entirely correct and does not provide needed information to the patient. Telling the patient he is correct does not provide adequate information. It is inappropriate for the nurse to make such a suggestion about the method of testing to be utilized to the patient.

The nurse is caring for a healthy patient who has a serum glucose level of 60 mg/dL. The nurse anticipates which counterregulatory serum hormonal changes to occur in this patient? Standard Text: 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

Correct Answer: 1, 2 Rationale 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. Rationale 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. Rationale 3: Insulin is not released as a counterregulatory hormone. Rationale 4: Thyroxine level would increase with hypoglycemia. Rationale 5: Glucocorticoids levels would increase with hypoglycemia. Global Rationale: If blood glucose falls, glucagon is released to raise hepatic glucose output, raising glucose levels. Epinephrine, growth hormone, thyroxine, and glucocorticoids (often referred to as glucose counterregulatory hormones) also stimulate an increase in glucose in times of hypoglycemia, stress, growth, or increased metabolic demand. Insulin is not released as a counterregulatory hormone. Thyroxine and glucocorticoids levels would increase with hypoglycemia.

The nurse instructs a patient with type 2 diabetes mellitus on the use of a glucometer for self-monitoring. Which patient statements about glucometer performance indicate that teaching has been effective? Standard Text: 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

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

The nurse is teaching a patient with diabetes about the illness. The nurse knows the teaching has been effective when the patient identifies which statements as being true of pancreatic cells? Standard Text: 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.

Correct Answer: 1, 2, 4 Rationale 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. Rationale 2: Beta cells secrete the hormone insulin, which facilitates the movement of glucose across cell membranes into cells, decreasing blood glucose levels. Rationale 3: Cephalon cells are not pancreatic cells. Rationale 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. Rationale 5: Epsilon cells are not pancreatic cells. Global Rationale: 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. Beta cells secrete the hormone insulin, which facilitates the movement of glucose across cell membranes into cells, decreasing blood glucose levels. Insulin prevents the excessive breakdown of glycogen in the liver and in muscle, facilitates lipid formation while inhibiting the breakdown of stored fats, and helps move amino acids into cells for protein synthesis. 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. Cephalon cells are not pancreatic cells. Epsilon cells are not pancreatic cells.

The nurse is teaching a patient with type 2 diabetes mellitus about glyburide (DiaBeta). The nurse knows teaching has been effective when the patient states, "I need to monitor for dizziness, lightheadedness, and sweating if I take: Standard Text: Select all that apply. 1. ibuprofen (Motrin) for pain." 2. ranitidine (Zantac) for heartburn." 3. cetirizine (Zyrtec) for allergies." 4. metoprolol (Lopressor) for hypertension." 5. docusate sodium (Colace) for constipation."

Correct Answer: 1, 2, 4 Rationale 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 (Motrin). Rationale 2: Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is taking ranitidine (Zantac). Rationale 3: Zyrtec does not interact with glyburide. Rationale 4: Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is also taking a beta blocker such as metoprolol (Lopressor). Rationale 5: Colace does not interact with glyburide. Global Rationale: Dizziness, lightheadedness, and sweating are symptoms of hypoglycemia. Monitor for hypoglycemia if the patient is also taking nonsteroidal anti-inflammatory agents (NSAIDs), ranitidine, or beta blockers. Zyrtec and Colace do not interact with glyburide.

The nurse is preparing to administer insulin to an underweight patient. Which actions should the nurse take when providing this injection? Standard Text: 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.

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

The nurse is reviewing data collected from a patient with a predisposition to developing insulin resistance. Which medications should the nurse identify as potentially causing this patient to develop diabetes? Standard Text: Select all that apply. 1. nicotinic acid (Niacor) 2. acetaminophen (Tylenol) 3. levothyroxine (Synthroid) 4. furosemide (Lasix) 5. phenytoin (Dilantin)

Correct Answer: 1, 3, 4, 5 Rationale 1: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include nicotinic acid (Niacor). Rationale 2: Acetaminophen (Tylenol) is not a medication that impairs insulin secretion, precipitating DM in people with predisposing insulin resistance. Rationale 3: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include levothyroxine (Synthroid), which is a thyroid hormone. Rationale 4: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include furosemide (Lasix), which is a thiazide diuretic. Rationale 5: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples include phenytoin (Dilantin). Global Rationale: Many drugs impair insulin secretion, precipitating DM in people with predisposing insulin resistance. Examples are nicotinic acid, thyroid hormone, thiazides, and phenytoin. Acetaminophen (Tylenol) does not impair insulin secretion and precipitate diabetes mellitus in people with predisposing insulin resistance.

The nurse is caring for a patient experiencing diabetic ketoacidosis. What actions should the nurse take when preparing this patient's insulin infusion? Standard Text: 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.

Correct Answer: 1, 3, 5 Rationale 1: Insulin infusions are always administered using an intravenous pump. Rationale 2: Dextrose 50 should be kept at the bedside in the event of a hypoglycemic reaction. Rationale 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. Rationale 4: Insulin infusions are diluted in 0.9% or 0.45% saline. Rationale 5: Do not discontinue the intravenous infusion until subcutaneous administration of insulin is resumed.

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? Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 17 Rationale: 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.

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.

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

The community nurse is teaching a group of members with type 1 or 2 diabetes mellitus who are planning to participate in an athletic triathlon. On which potential complication from this event should the nurse focus when teaching? 1. diabetic ketoacidosis 2. hypoglycemia 3. hyperosmolar hyperglycemic state 4. impaired glucose tolerance

Correct Answer: 2 Rationale 1: Diabetic ketoacidosis is not associated with exercise. Rationale 2: One reason for the development of severe hypoglycemia is too much exercise. Rationale 3: Hyperosmolar hyperglycemic state is not associated with exercise. Rationale 4: Exercise does not impact glucose tolerance. Global Rationale: One reason for the development of severe hypoglycemia is too much exercise. Diabetic ketoacidosis and hyperosmolar hyperglycemic state are not associated with exercise. Exercise does not impact glucose tolerance.

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

Correct Answer: 2 Rationale 1: Difficulty swallowing and nausea are not specifically attributed to aging. Rationale 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. Rationale 3: Peripheral neuropathies affect the sensory and motor function of the extremities. Rationale 4: Swallowing, nausea, and constipation are not adverse effects of insulin. Global Rationale: 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 hypo-motility of the bowel. Difficulty swallowing and nausea are not specifically attributed to aging. Peripheral neuropathies affect the sensory and motor function of the extremities. Swallowing, nausea, and constipation are not adverse effects of insulin.

The manager observes a graduate nurse teaching a 5-year-old patient with diabetes mellitus. The manager determines that content being instructed is appropriate when the nurse states, "Insulin acts like: 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."

Correct Answer: 2 Rationale 1: Insulin does not make protein into muscle. Rationale 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. Rationale 3: Insulin does not make blood vessels thick and sticky. Rationale 4: A scarcity of insulin may lead to polydipsia. Global Rationale: 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. Insulin does not make protein into muscle or make blood vessels thick and sticky. A scarcity of insulin may lead to polydipsia.

A patient with no previous history of diabetes mellitus has ketones in the urine. Which question should the nurse ask this patient? 1. "What did you eat for breakfast and lunch today?" 2. "Can you please describe any weight loss strategies you've been using?" 3. "Have you donated blood recently?" 4. "Have you ever been told you have albumin in your urine?"

Correct Answer: 2 Rationale 1: The patient's food choices for breakfast and lunch will not address the problem of ketonuria. Rationale 2: The cellular use of fats for fuel results in ketosis.

A patient at risk for the development of type 2 diabetes mellitus asks why weight loss will reduce risk of the condition. 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."

Correct Answer: 2 Rationale 1: This is not a true statement. Rationale 2: Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. Rationale 3: While obesity is a risk factor for the development of diabetes, this does not answer the patient's question. Rationale 4: Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin. Global Rationale: Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. The amount of food ingested does not mean that diabetes will develop because more insulin is needed to process the food eaten. While obesity is a risk factor for the development of diabetes, this does not answer the patient's question. Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin.

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? Standard Text: 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

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

The nurse is identifying patients at risk for needing insulin. Which patients should the nurse identify as potentially needing insulin to maintain a normal blood glucose level? Standard Text: 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

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

The nurse is assessing a patient with type 2 diabetes mellitus. What questions should the nurse ask to determine the patient's risk for a lower extremity amputation? Standard Text: 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?"

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

Type: MCMA 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? Standard Text: Select all that apply. 1. Test blood glucose 30 minutes after reaching 70 mg/dL. 2. Ingest 4 ounces of fruit juice when blood glucose is below 70 mg/dL. 3. Measure blood glucose 15 minutes after ingesting a carbohydrate source. 4. Add table sugar to 8 ounces of fruit juice when blood glucose is below 70 mg/dL. 5. Ingest additional 15 grams of carbohydrate if blood glucose remains low after 15 minutes.

Correct Answer: 2, 3, 5 Rationale 1: Blood glucose should be tested 1 hour after the blood glucose has reached ≥ 70 mg/dL because blood glucose levels may start to fall again after 1 hour. Rationale 2: When mild hypoglycemia occurs, immediate treatment is necessary. People experiencing hypoglycemia should take about 15 g of a rapid-acting sugar. This amount of sugar is found in 1/2 cup (4 ounces) of fruit juice. Rationale 3: After eating a carbohydrate source, the patient should wait 15 minutes and then monitor blood glucose level. Rationale 4: Adding sugar to the fruit sugar already in the juice could cause a rapid rise in blood glucose, with persistent hyperglycemia. Rationale 5: If the blood glucose remains low after 15 minutes, eat another 15 grams of carbohydrate. Global Rationale: When mild hypoglycemia occurs, immediate treatment is necessary. People experiencing hypoglycemia should take about 15 g of a rapid-acting sugar. This amount of sugar is found in 1/2 cup (4 ounces) of fruit juice. After eating a carbohydrate source the patient should wait 15 minutes and then monitor blood glucose level. If the blood glucose remains low after 15 minutes, eat another 15 grams of carbohydrate. Blood glucose should be tested 1 hour after the blood glucose has reached ≥ 70 mg/dL because blood glucose levels may start to fall again after 1 hour. Adding sugar to the fruit sugar already in the juice could cause a rapid rise in blood glucose, with persistent hyperglycemia.

The nurse is caring for a patient who is prescribed 120 units of U-100 regular insulin to be administered at 0700 and 1600 hours. The physician has written an order for an equivalent dose of U-500 insulin to be provided. The nurse reviews the order with the primary health care provider and states, "120 units of U-100 insulin is equivalent to _______ units of U-500 insulin." : Record your answer rounding to the nearest whole number.

Correct Answer: 24 Rationale: 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.

A nurse is conducting an educational session for a group of patients regarding the incidence and prevalence of diabetes. The nurse explains that approximately 25.8 million people have been diagnosed with the disorder, but 7 million people have not. Statistically, what is the percentage of people who have undiagnosed diabetes?

Correct Answer: 27 Rationale: To calculate this percentage the nurse should divide the number who are not diagnosed by the total number of people with the disorder or 7/25.8 = 0.27. Then multiply this value by 100 or 0.27 × 100 = 27%. Global Rationale:

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 hungrier than in the past?" 4. "Have you noticed any changes in your vision?"

Correct Answer: 3 Global Rationale: Type 1 and type 2 diabetes have similar manifestations, especially polyuria and polydipsia. Polyphagia is not often seen, and weight loss is uncommon. Vision changes are seen in both type 1 and type 2 diabetes mellitus.

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."

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

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

Correct Answer: 3 Rationale 1: Anxiety is a symptom of hypoglycemia. Rationale 2: Pale, cool skin is a symptom of hypoglycemia. Rationale 3: In diabetic ketoacidosis, the blood glucose level is above 250 mg/dL. Rationale 4: An ulcer is not a symptom of diabetic ketoacidosis. Global Rationale: Anxiety and pale, cool skin are symptoms of hypoglycemia. In diabetic ketoacidosis, the blood glucose level is above 250 mg/dL. An ulcer is not a symptom of diabetic ketoacidosis.

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.

Correct Answer: 3 Rationale 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 of diabetes has on the patient. Rationale 2: Storing health-related items away from common family areas in the home strengthens denial of the health problem. Rationale 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.

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

Correct Answer: 3 Rationale 1: Management of diabetic nephropathy includes control of hypertension with exercise. Rationale 2: Management of diabetic nephropathy includes control of hypertension with reduced salt intake. Rationale 3: Management of diabetic nephropathy includes control of hypertension with weight loss.

A nurse is teaching a group of patients about the prevalence of type 2 diabetes in older adults. The nurse knows teaching has been effective when a patient states, "Statistically, in a group of 100 older adults in the United States, approximately: 1. 10 will have type 2 diabetes." 2. 17 will have type 2 diabetes." 3. 27 will have type 2 diabetes." 4. 33 will have type 2 diabetes."

Correct Answer: 3 Rationale 1: More than 10 will have type 2 diabetes. Rationale 2: More than 17 will have type 2 diabetes. Rationale 3: The National Institute of Diabetes and Digestive and Kidney Diseases estimates that 26.9% of the U.S. population over the age of 65 have DM.

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 3. physical inactivity 4. low waist-to-hip ratio

Correct Answer: 3 Rationale 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 the patient most at risk for type 2 DM. Rationale 2: A blood pressure of 120/70 is normal and carries no increased risk for type 2 DM. Rationale 3: Physical inactivity is a major risk factor for type 2 DM. Rationale 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. Global Rationale: Physical inactivity is a major risk factor for type 2 DM. 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 blood pressure of 120/70 is normal and carries no increased risk for type 2 DM. 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.

A patient with diabetes mellitus and poor circulation has thick and ingrown toenails. What should the nurse instruct the patient to do? 1. Soak feet in Epsom salts daily. 2. Use a clean sharp razor blade to trim nails. 3. Make an appointment with a podiatrist. 4. Cut toenails immediately prior to bathing.

Correct Answer: 3 Rationale 1: There is no indication for this patient to soak feet daily in Epsom salts. Rationale 2: The use of a clean sharp razor could cause an injury. Rationale 3: The toenails of the patient with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Rationale 4: Cutting the nails before a bath would be difficult because the nails are thick and ingrown. Global Rationale: The toenails of the patient with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Cutting the nails before a bath would be difficult because the nails are thick and ingrown. There is no indication of a need for soaking feet daily in Epsom salts.

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."

Correct Answer: 3 Rationale 1: While the statement about diabetics being thin is correct, it does not answer the patient's question. Rationale 2: It is not impossible for diabetics to gain weight. Rationale 3: The diabetic patient 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. Rationale 4: Although the laboratory tests might indicate the presence of diabetes, it does not meet the patient's needs for teaching. Global Rationale: The diabetic patient 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. While the statement about diabetics being thin is correct, it does not answer the patient. It is not impossible for diabetics to gain weight. Although the laboratory tests might indicate the presence of diabetes, it does not meet the patient's needs for teaching.

A 78-year-old 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.

Correct Answer: 4 Rationale 1: A slight elevation in serum glucose level warrants further investigation. Rationale 2: There is no reason to question the laboratory results at this time. Rationale 3: There is inadequate information to make a diagnosis of type 1 diabetes mellitus. Rationale 4: Older adults 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. Global Rationale: Older adults 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. In an adequately functioning endocrine system, dietary intake is managed by the needed amounts of insulin produced by the pancreas. There is no reason to question the laboratory results at this time. There is inadequate information to make a diagnosis of type 1 diabetes mellitus.

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."

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

The nurse notes that a 41-year-old patient's fasting blood glucose level is 125 mg/dL. What should the nurse suspect is occurring with the patient? 1. severe hyperglycemia 2. consistent with diabetes 3. normal results 4. consistent with prediabetes

Correct Answer: 4 Rationale 1: This is not severe hyperglycemia. If it were, the nurse would immediately notify the health care provider. Rationale 2: Diabetes is fasting blood glucose level of 126 mg/dL or greater. Rationale 3: A normal fasting blood glucose level is less than or equal to 100 mg/dL. Rationale 4: Prediabetes is a fasting blood glucose level greater than 100 mg/dL and under 126 mg/dL. Global Rationale: Fasting blood glucose of 125 mg/dL is not severe hyperglycemia. If it were, the nurse would immediately notify the health care provider. This is not an indication of diabetes. A normal fasting blood glucose level is less than or equal to 100 mg/dL. Prediabetes is a fasting blood glucose level greater than 100 mg/dL and under 126 mg/dL.

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

Correct Answer: 4 Rationale 1: Type 1 diabetes mellitus is not treated with oral medications. Rationale 2: Patients with diabetes do not progress from type 1 to type 2. Rationale 3: People with type 1 must have insulin. Rationale 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.

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.

Correct Answer: 4 Rationale 1: While the patient is demonstrating manifestations consistent with hypoglycemia, providing a snack is not the first action the nurse should take. Rationale 2: The patient is hypoglycemic, so insulin administration would be incorrect, as it would only add to the problem. Rationale 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. Rationale 4: The first action would be to verify the patient's blood glucose level. Global Rationale: The first action would be to verify the patient's blood glucose level. 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. While the patient is demonstrating manifestations consistent with hypoglycemia, obtaining the glucose levels first would be most beneficial. The patient is hypoglycemic, so insulin administration would be incorrect, as it would only add to the problem.

The nurse is reviewing instruction provided to a graduate nurse regarding insulin therapy. Which statement made by the graduate indicates that further instruction is needed? Standard Text: 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.

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

A patient with type 1 diabetes mellitus voided 4,000 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

Correct Answer: D Rationale 1: A blood glucose level of 60 mg/dL is hypoglycemia. Polyuria is not a manifestation of hypoglycemia. Rationale 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. Rationale 3: A blood glucose level of 125 mg/dL is consistent with prediabetes. Polyuria is not a manifestation of prediabetes. Rationale 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).