Exam 1 Adult 1 questions
The nurse is caring for a patient with an abnormally low blood glucose concentration. Which glucose level will the nurse observe when assessing lab results? A. Lower than 50 to 60 B. between 60 and 80 C. between 75 and 90 D. 95
A. Lower than 50 to 60
A nurse notes that a patient's urine osmolality is 980. Which will the nurse assess as a possible cause of this finding? A. acidosis B. Fluid volume excess C. Diabetes D. hyponatremia
A. acidosis
An older adult client has been prescribed metformin for the treatment of type 2 diabetes for several years. Which change in the client's laboratory values may demonstrate a need to discontinue the medication?
An increase in serum lactate Explanation: It is essential to discontinue metformin if renal impairment occurs or if serum lactate increases. The other listed changes in laboratory values do not necessarily indicate that metformin should be discontinued.
The nurse is caring for a patient with diabetes type 1 who is having severe vomiting and diarrhea. Which condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis
C. metabolic acidosis
Which medications is associated with intermediate acting insulin?
Isophane NPH (Humulin N) is considered intermediate acting because onset of action is delayed and duration is longer. Therefore, this insulin type cannot be administered at mealtime to control postprandial hyperglycemia, but instead is used to provide glycemic control between meals and during the night.
A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes?
It is a complicated disorder that alters the metabolism of glucose. Explanation: Diabetes is a complicated disorder that alters the metabolism of glucose, fats, and proteins affecting many end organs and causing numerous clinical complications. It is part of the metabolic syndrome, a collection of conditions that predispose to cardiovascular disease.
Which would be appropriate to include in teaching a client with type 2 diabetes?
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Explanation: Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.
What is the expected action of sitagliptin on type 2 diabetes?
It slows the rate of inactivation of the incretin hormones. Explanation: Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt nor does it inhibit hydrogen, potassium, and ATPase.
Which of the following is the most appropriate statement regarding the control of pH?
Kidney Excretion of H+ Increases pH Explanation The kidney can excrete excess hydrogen ions into the urine, which can directly increase the blood's pH.
Detemir Insulin is most likely characterized as which of the following types?
Long Acting Explanation Long acting insulin covers insulin needs for about one full day. This type is often combined, when needed, with rapid or short acting insulin. Onset is typically within 1 hour, with no peak time as the insulin is delivered at a steady level.
Which would be least appropriate when administering insulin by subcutaneous injection?
Massaging the site after removing the needle Explanation: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.
A client, who experienced hypoglycemia twice in the past week, eats one meal per day and snacks the rest of the day. What client education will the nurse provide for a client who reports regularly experiencing hypoglycemic symptoms?
Meals should be eaten at regular times. Explanation: A regular dietary intake associated with the administration of insulin or oral hypoglycemic will prevent episodes of hypoglycemia. The client should limit alcohol consumption, but alcohol consumption does not contribute to hypoglycemia. The client should not increase caloric or protein intake. The client should coordinate exercise with her dietary intake, but dietary intake is not the cause of the hypoglycemia.
What is true about the body's control over compensatory changes in response to acid/base status?
Medullary Chemoreceptors Control Ventilation Rate Explanation The medulla has chemoreceptors which measure the pH of the blood. They respond to decreased blood pH by increasing the ventilation rate of the lungs through nervous system innervation of the diaphragm and external intercostal muscles. This increased exhalation of CO2 will cause a compensatory increase in pH.
After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?
Metformin Explanation: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.
The nurse monitoring a client receiving insulin glulisine notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode?
Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV.
Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?
liver enzymes Explanation: Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. Platelets, d-dimer, and tests of renal function are less significant to the safety and efficacy of treatment.
Which of the following medications is considered a glitazone?
pioglitazone Explanation: Pioglitazone and rosiglitazone are classified as a glitazone or thiazolidinedione. Metformin and metformin with glyburide are classified as biguanides. Dapagliflozin is classified as a sodium-glucose co-transporter 2 (SGL-2) inhibitor.
A patient's serum sodium concentration is within the normal range. Which will be the nurse estimate the serum osmolality to be? A. less than 136 B. 275 to 300 C. greater then 408 D. 350 to 544
B 275 to 300
A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?
Client's average blood glucose is above normal. Explanation: The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.
Which clinical indication of a hypophosphatemia does the nurse assess in a patient? A. bone pain B. paresthesia C. seizures D. tetany
D. tetany
The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate?
"Give it by subcutaneous injection immediately before your major meals." Explanation: Pramlintide is administered subcutaneously immediately before major meals. Numerous antidiabetic drugs are taken orally, often once a day in the morning. Exenatide is given subcutaneously within 1 hour before the morning and evening meals. Miglitol should be taken orally with the first bite of each meal.
Which statement best indicates that a client understands how to administer his own insulin injections?
"I wrote down the steps in case I forget what to do." Explanation: The fact that the client has written down each step of insulin administration provides the best assurance that he'll follow through with all the proper steps. Awareness of air bubbles and hand washing indicate that the client understands certain aspects of giving an injection, but doesn't confirm he understands all of the steps. Saying that he can ask a friend or neighbor for help indicates a need for further instruction.
A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching?
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." Explanation: Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs.
The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction?
"If I forget to take my insulin pen, I will be able to use the one that my wife uses." Explanation: Insulin pens are client-specific because the needle may be used multiple times and may be contaminated with blood. Also, the pen is prefilled with a specific type of insulin. The client selects the desired units by turning a dial and listening for a locking ring. The insulin dose is determined by the number of clicks heard. It is a useful method for clients who have poor eyesight.
The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease?
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues." Explanation: Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, promotes protein synthesis, and helps the body store fat by preventing its breakdown for energy.
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice?
"You should take your insulin after you eat breakfast and dinner." Explanation: NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours.
A patient with abnormal sodium losses is receiving a regular diet. How will the nurse supplement the patient's diet to provide 1600 mg of sodium daily? A. one beef cube and 8 oz of tomato juice B. four beef cubes and 8 oz of tomato juice C. one beef cube and 16 oz tomato juice D. one beef cube and 12 oz of tomato juice
A. one beef cube and 8 oz of tomato juice
The nurse is reviewing the laboratory studies for a group of patients. Which patient is most likely to experience a decrease in serum osmolality? A. A patient with diabetes insipidus B. A patient with a glucose level of 360 mg/dL C. A patient with kidney failure D. A patient with uremia
C. A patient with kidney failure
A female patient with diabetes who weighs 150 pounds has an ideal body weight of 118 pounds. She can lose 1 pound per week and drop her extra 32 pounds in approximately 8 months. To meet this goal, the nurse advises the patient to decrease her calories by:
3,500 per week. Explanation: A person needs to decrease caloric intake by 3,500 for each lb of weight that is lost. To lose 1 lb per week, a person would decrease his or her daily caloric intake by 500 calories (500 calories × 7 days = 3,500 calories = 1 lb).
The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively?
50% to 60% Explanation: One half to two thirds of the patient's usual morning dose of insulin (either intermediate-acting insulin alone or both short- and intermediate-acting insulins) is administered subcutaneously in the morning before surgery. The remainder is then administered after surgery.
A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client:
9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). Explanation: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 units of NPH and 9 units of regular insulin. The other choices are incorrect dosages for the ordered insulin.
The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what will the nurse expect to assess? Select all that apply A. Leakage of fluid of serum (exudates) B. microaneurysms C. Focal capillary single closure D. detachment E. blurred optic discs
A. Leakage of fluid of serum (exudates) B. microaneurysms C. Focal capillary single closure
The nurse is preparing to administer intermediate acting insulin to a patient with diabetes. Which insulin will the nurse administer> A. NPH B. Iletin II C. Humalog D. Glargine
A. NPH
A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. Which potential complication from rehydration will the nurse monitor for? A. hypokalemia B. hyperkalemia C. hyperglycemia D. hyponatremia
A. hypokalemia
The health care provider has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? A. 0.45 % sodium chloride B. 0.9 % sodium chloride C. 5% dextrose in water D. 5% dextrose in normal saline solution
A. 0.45 % sodium chloride
A female patient with diabetes who weighs 130 lbs has an ideal body weight of 116. for weight reduction of 2 lb per week, approximately what will be her caloric intake? A. 1000 cal B. 1200 cal C. 1500 cal D. 1800 cal
A. 1000 cal
The nurse will assess the patient for signs of lethargy, increasing intracranial pressure, and seizures when the serum sodium reaches which level? A. 115 mEq/L B. 130 mEq/L C. 145 mEq/L D. 160 mEq/L
A. 115 mEq/L
The nurse is caring for a patient with diabetes who has a diagnosis of nephropathy. What will the nurse expect the urinalysis report to indicate? A. Albumin B. bacteria C. red blood cells D. while blood cells
A. Albumin
The nurse is caring for a patient with a diagnosis of hyponatremia. Which nursing intervention(s) is/are appropriate to include in the plan of care for this patient? (select all that apply) A. Assess for symptoms of nausea and malaise B. encourage the intake of low sodium liquids C. monitor neurologic status D. Restrict tap water intake E. encourage the use of salt substitute instead of salt.
A. Assess for symptoms of nausea and malaise C. monitor neurologic status E. encourage the use of salt substitute instead of salt.
What foods can the nurse recommend for the patient with hypokalemia? A. Fruits such as bananas and apricots B. Green, leafy veggies C. milk and yogurt D. nuts and legumes
A. Fruits such as bananas and apricots
Which laboratory findings does the nurse determine are consistent with hypovolemia in a female patient? Select all that apply. A. Hematocrit level of >47% B. BUN: serum creatinine ratio of >12.1 C. Urine specific gravity of 1.027 D. Urine osmolality of >450 E. Urine positive for blood
A. Hematocrit level of >47% C. Urine specific gravity of 1.027 D. Urine osmolality of >450
When the nurse is caring for a patient with type 1 diabetes, which clinical manifestation would be priority to closely monitor? A. Hypoglycemia B. hyponatremia C. ketonuria D. polyphagia
A. Hypoglycemia
A patient is diagnosed with type 1 diabetes. Which clinical characteristics does the nurse determine will likely be associated with this oatient? select all that apply A. Ketosis prone B. Little endogenous insulin C. obesity at diagnosis D. younger than 30 years of age E. older than 65 years of age
A. Ketosis prone B. Little endogenous insulin D. younger than 30 years of age
A patient reports tingling in the fingers as well as feeling depressed. The nurse assesses positive trousseau and chvostek signs. Which decreased lab result does the nurse observe when the patient's lab work has returned? A. Potassium B. Phosphorus C. Calcium D. Magnesium
C. Calcium
The nurse is caring for a patient with hypernatremia. Which complication of hypernatremia should the nurse continuously monitor for? A. Red blood cell crenation B. red blood cell hydolysis C. cerebral edema D. kidney injury
C. cerebral edema
A patient with mild fluid volume excess is prescribed a diuretic that blocks sodium reabsorption in the distal tubule. Which diuretic does the nurse anticipate administering to the patient? A. Bumetanide B. torasemide C. hydrochlorothiazide D. Furosemide
C. hydrochlorothiazide
Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome?
Administer 2 to 3 L of IV fluid rapidly. Explanation: Regardless of the client's medical history, rapid fluid resuscitation is critical for maintaining cardiovascular integrity. Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia. Commonly ordered fluids include dextran (in cases of hypovolemic shock), isotonic normal saline solution and, when the client is stabilized, hypotonic half-normal saline solution.
Which of the following is an age-related change that may affect diabetes?
Age-related changes include decreased renal function, taste changes, decreased vision, decreased bowel motility, and decreased proprioception.
Which strategy will NOT increase the therapeutic effect of insulin?
All insulin should be stored in a refrigerator but never frozen. Explanation: Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control.
The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use?
Allergy to sulfonamides Explanation: Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glyburide.
A nurse has been caring for a client newly diagnosed with diabetes mellitus. The client is overwhelmed by what he's facing and not sure he can handle giving himself insulin. This client has been discharged and the charge nurse is insisting the nurse hurry because she needs the space for clients being admitted. How should the nurse handle the situation?
Ask the physician to delay the discharge because the client requires further teaching. Explanation: The nurse's primary concern should be the safety of the client after discharge. She should provide succinct information to the physician concerning the client's needs, express her concern about ensuring the client's safety, and ask the physician to delay the client's discharge. The nurse shouldn't suggest that the client rely on a friend or family member because she doesn't know if a friend or family member will be available to help. Refusing to rush and telling the charge nurse she isn't sure the client will be safe demonstrate appropriate intentions, but these actions don't alleviate the pressure to discharge the client. Asking a physician to refer the client to a diabetic nurse-educator addresses the client's needs, but isn't the best response because there's no guarantee a diabetic nurse-educator will be available on such short notice.
A patient is admitted with a diagnosis of kidney injury. The patient reports "stomach distress" and describes ingesting several antacid tablets over two days. BP is 110/70, face flushed, generalized weakness. Which is the most likely magnesium level associated with the symptoms the patient is having? A. 11 B. 5 C. 2 D. 1
B. 5
A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The nurse expects that the compensatory mechanisms associated with hypovolemia would cause which clinical manifestation? Select all that apply. A. Hypertension B. Oliguria C. Tachycardia D. Bradycardia E. tachypnea
B. Oliguria C. Tachycardia E. tachypnea
A nurse is reviewing the laboratory studies for a patient suspected of acute kidney injury. Which test would be the best indicator of the patients renal function? A. Blood urea nitrogen B. Serum creatinine C. Specific gravity D. urine osmolality
B. Serum creatinine
An older adult patient is in the hospital with urosepsis. The patient begins to experience an altered level of consciousness, profound dehydration, and hypotension. Which condition does the nurse suspect the patient is experiencing? A. systemic inflammatory response syndrome B. hyperglycemic hyperosmolar syndrome C. multiple-organ dysfunction D. diabetic ketoacidosis
B. hyperglycemic hyperosmolar syndrome
Which medication does the nurse administer as prescribed to antagonize the effects of potassium on the heart of a patient in severe metabolic acidosis? A. sodium bicarbonate B. magnesium sulfate C. furosemide D. calcium gluconate
B. magnesium sulfate
A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?
Below-normal serum potassium level Explanation: A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.
another appropriate statement regarding the control of pH?
Bicarbonate Reabsorption from the Kidney Increases pH Explanation Another method of increasing blood pH is by increasing the bicarbonate reabsorption from the kidney. As bicarbonate levels in the blood increase, the blood pH increases as well.
The nurse is preparing to administer insulin to a patient with type 1 diabetes in the morning prior to a surgical procedure. What percentage of the usual morning insulin will the nurse administer preoperatively? A. 10- 20 % B. 25- 40 % C. 50- 60 % D. 85- 90 %
C. 50- 60 %
In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many mL in 24 hours? A. 400 B. 600 C. 800 D. 1200
C. 800
The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. Which prescription for fluids will the nurse infuse for this patient? A. D5W B. 0.9 % ns C. 0.45 % ns D. dex 5 ns
C. 0.45 % ns
A patient who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue and a body temperature of 99.3. The urine specific gravity is 1.020. Which is the most likely serum sodium value for this patient? A. 110 mEq/L B. 140 mEq/L C. 155 mEq/L D. 165 mEq/L
C. 155 mEq/L
A patient is admitted with severe vomiting for 24 hours as well as weakness and "feeling exhausted". The nurse observes flat T waves and ST-segment depression on the electrocardiogram. What potassium level does the nurse observe when the laboratory studies are complete? A. 4.0 B. 8.0 C. 2.0 D. 2.6
C. 2.0
An older adult patient with diabetes type 2 comes to the ER with second degree burns to the bottom of their feet. "I didn't feel too hot but my feet must have been too close to the heater? Which does the nurse know most likely was the reason for decreased temp sensation? A. A faulty heater B. Autonomic neuropathy C. peripheral neuropathy D. sudomotor neuropothy
C. peripheral neuropathy
A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered?
Glucagon Explanation: The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia.
Which would a nurse identify as an example of a sulfonylurea?
Glyburide Explanation: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.
Insulin Lispro is most likely which of the following types?
Rapid Acting Explanation Rapid acting insulin covers insulin needs for meals eaten at the same time of injection. This type is often combined with longer-acting insulin. Onset of action is 10-30 minutes, peak action of 1-3 hours, and duration lasting 3-6 hours. Rapid onset, quick peak, and short duration.
Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable?
Entry of glucose into the cells Explanation: After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.
The nurse is providing education to the parents of a child newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching?
Exogenous insulin is required for life. Explanation: Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. Therefore, the client will require insulin supplementation (exogneous insulin) for life. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed in ages 4 through 20 years, not only in childhood.
The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?
Explanation: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.
statement regarding the control of pH?
Expulsion of CO2 through Lungs Increases pH Explanation By increasing the ventilation rate, the medulla forces the expulsion of carbon dioxide through the lungs. This shifts the buffer system away from producing protons, due to LeChatlier's principle. Thus, as CO2 levels decrease, pH
The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?
Garlic Explanation: Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.
Which of the following medications is associated with long acting insulin?
Glargine (Lantus) Explanation Insulin glargine (Lantus) is usually given once per day to mimic the basal rate of insulin normally in the body as a long acting insulin. Insulin glargine is indicated only as a subcutaneous injection and should not be mixed with other insulins in the same injection. Do not administer insulin glargine IV or IM. Glargine insulin is a clear solution and should not be given if viscous or cloudy.
Which is the best indicator of overall diabetic control?
Glycosylated hemoglobin levels Explanation: The glycosylated hemoglobin indicates glucose bound to hemoglobin in red blood cells (RBCs) when RBCs are exposed to hyperglycemia. The binding is irreversible and lasts for the lifespan of RBCs (approximately 120 days). The test reflects the average blood sugar level during the previous 2 to 3 months. The goal is usually less than 7% (blood level 0.07). The range for people without diabetes is approximately 4% to 6% (blood level 0.04 to 0.06).
An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing?
Hyperglycemic hyperosmolar syndrome Explanation: Hyperglycemic hyperosmolar syndrome (HHS) occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes (Reynolds, 2012). The clinical picture of HHS is one of hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis).
The nurse should include what information when educating a client prescribed insulin regarding the characteristics of hypoglycemia?
Hypoglycemia, or a blood glucose concentration lower than 60 mg/dL, is associated with an increase in serum insulin levels. It is triggered by a lack of food, an increase in stress, either emotional or physical or a variety of other factors. This physiological state brings about a the sudden feeling of anxiety and the activity associated with the fight or flight reaction.
When there is a high concentration of hydrogen in the blood or lack of bicarbonate, which of the following is most likely to be true regarding the body?
In a State of Acidemia Explanation When the body detects that there are high levels of protons in blood (causing blood to be excessively acidic), it reacts through multiple organ systems to restore blood back to its neutral or slightly alkaline state.
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?
Increases insulin release Explanation: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.
A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose?
Inspect the previous injection site for inflammation. Explanation: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.
Which medication is associated with rapid acting insulin?
Insulin aspart (Novolog) is an analog of human insulin with a rapid onset (10-20 minutes) and short duration (3-5 hours). Due to its rapid onset of action, injections should be made 5-10 minutes before meals.
Which of the following medications is associated with rapid acting insulin?
Insulin lispro (Humalog) is a rapid-acting (15-30 minutes) analog of regular insulin with a short duration (3-6 hours). Because of its rapid onset, it can be administered immediately before eating, or even after eating.
Which term refers to the progressive increase in blood glucose from bedtime to morning?
Insulin waning Explanation: Insulin waning is a progressive rise in blood glucose from bedtime to morning. The dawn phenomenon occurs when blood glucose is relatively normal until about 3 a.m., when the level begins to rise. The Somogyi effect occurs when blood glucose is normal or elevated at bedtime, decreases at 2 to 3 a.m. to hypoglycemia levels, and subsequently increases as a result of the production of counter-regulatory hormones. DKA is caused by an absence or markedly inadequate amount of insulin. This insulin deficit results in disorders in the metabolism of carbohydrates, proteins, and fats. The primary clinical features of DKA are hyperglycemia, ketosis, dehydration, electrolyte loss, and acidosis.
NPH Insulin is most likely characterized as which of the following types?
Intermediate Acting Explanation Intermediate acting insulin covers insulin needs for about half the day or overnight. It is often combined with rapid or short acting insulin. Onset of action is 1-2 hours, peak within 4-12 hours, and duration lasting 16-24 hours.
Which of the following medications is associated with short acting insulin?
Regular Insulin (Humulin R) Explanation Regular insulin (Humulin R) is unmodified human insulin. For routine treatment of diabetes, it can be administered before meals to control postprandial hyperglycemia or infused subQ to provide basal glycemic control. It is supplied as a clear solution.
A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder?
Serum osmolarity Explanation: Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.
Regular Insulin is most likely which of the following types?
Short Acting Explanation Short acting insulin covers insulin needs for meals eaten within 30-60 minutes as the onset of action is 30-60 minutes, peak action within 2-4 hours, and duration lasting 6-10 hours.
A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin?
Subcutaneous injection Explanation: Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system.
After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?
Subcutaneous injection Explanation: Subcutaneous injection currently is the most common method for administering insulin.
Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin?
Sulfonylureas Explanation: A functioning pancreas is necessary for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate the action of insulin on peripheral receptor sites. Alpha-glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?
Switch the client to a different oral antidiabetic agent. Explanation: The nurse should anticipate that the physician will order a different oral antidiabetic agent. Many clients (25% to 60%) who take glipizide respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent. Restricting carbohydrate intake isn't necessary.
A client has been diagnosed with diabetes and discusses treatment strategies with the nurse. What consequences of untreated diabetes should the nurse include with client teaching?
The nurse should include blindness, limb amputation, cardiovascular disease, and kidney disease in the teaching of the consequences of untreated diabetes. Liver failure is not a known consequence of diabetes.
A client with type 1 diabetes reports waking up in the middle of the night feeling nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood glucose readings have been 110 to 140 mg/dL. The client admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse plans to instruct the client to
check blood glucose at 3:00 a.m. Explanation: In the Somogyi effect, the client has a normal or elevated blood glucose concentration at bedtime, which decreases to hypoglycemic levels at 2 to 3 a.m., and subsequently increases as a result of the production of counter-regulatory hormones. It is important to check blood glucose in the early morning hours to detect the initial hypoglycemia.
After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?
insulin glargine Explanation: Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.
A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?
insulin lispro Explanation: Insulin lispro has a 15-minute onset of action. NPH, 70/30, and regular insulin have longer onsets of action, a later peak, and a longer duration of action.
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy via an insulin pump. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:
rapid-acting insulin only. Explanation: A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
regular Explanation: Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.
The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?
weakness, sweating, and decreased mentation. Explanation: Symptoms of hypoglycemia include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger. The other signs are more consistent with hyperglycemia.
