Exam 2 - Endocrine
How would you treat a diabetic with mild hypoglycemia (i. e. blood sugar 58mg/dl and is weak and shaky)?
15-15
Why is it not typical for Type II diabetics to go into DKA?
Because in Type 2 DM there is still enough endogenous insulin being produced to prevent the break down of fats (ketones) for energy unlike in DKA
Why are Type 2 DM only impacted by HHS?
Because they have enough circulating insulin to prevent the need to break down ketones for energy/prevent ketoacidosis
Macrovascular disease of large and medium-sized blood vessels.
CAD, Stroke, PVD
What can occur as a result of uncontrolled DM?
Damage to blood vessels leading to microvascular and macrovascular problems which increases risk for injury and infection
How do BG levels respond to illness or surgery (increase/decrease/no change)?
Increase
_____________________________________ are deep and fast respirations in an attempt to blow off excess acid from CO2.
Kussmaul respirations
_______________________ is the most widely used oral diabetes agent.
Metformin
Why is foot care important for patients with peripheral neuropathy?
Prevent injuries d/t loss of sensation that could lead to wound infections
What is the primary action of metformin?
Reduce glucose production by the liver and enhance insulin sensitivity for improving glucose transport into cells
A patient is diagnosed with rapid onset diabetic ketoacidosis. Which type of diabetes would the patient most likely have? a. diabetes type 1 b. type 2 diabetes c. gestational diabetes d. diabetes mellitus
a
An adult client who has type 2 diabetes and requires insulin tells the nurse about feeling weak and shaky before supper. The nurse should perform which intervention? a. Have the client drink a glass of milk or orange juice b. Tell the client to lie down for 30 minutes c. Contact the client's physician to decrease the insulin dose d. Administer the next dose of insulin
a
Autoimmune illness, body attacks beta cells within pancreas resulting in altered function of pancreas, unable to produce insulin. This statement is true about which type of diabetes? a. Type 1 b. Type 2 c. Gestational d. Type 1 & 2 e. All of the above
a
Before replacing this potassium intravenously in a DKA or HHS patient, make sure the patient is producing at least _____ ml/hr of urine? a. 30 b. 40 c. 50 d. 60
a
How many grams of Carbohydrates should Diabetes have per day? a. 130 g/day < b. 130 g/day > c. 180 g/day < d. 180 g/day >
a
This type of DM is an autoimmune disorder that destroys the Beta cells in the pancreas resulting in an absence of endogenous insulin production. a. diabetes type 1 b. type 2 diabetes c. gestational diabetes d. diabetes mellitus
a
Which of these medication is rapid-acting insulin? a. Humalog (Lispro) b. Regular (Humulin R or Novolin R) c. NPH (Humulin N) d. Glargine (Lantus)
a
Why would a client have an elevated BG in the morning even after taking evening insulin? a. Somogyi effect b. DKA c. HHS d. Dawn phenomenon
a
_________________________________ is when the insulin causes a decrease in blood glucose and the release of hormones causes a rebound increase to attempt homeostasis. a. Somogyi effect b. DKA c. HHS d. Dawn phenomenon
a
What are the drugs of choice for renal protection? a. ARB's b. ACE inhibitors c. Diuretics d. Anti-hypertensives e. Oral anti-diabetics
a,b
The Type 1 patient is at home ill with a viral infection. What 3 pieces of nursing education might the clinic nurse provide? a. Check blood glucose every 2-4 hours b. Consume fluids w/o added sugar c. Administer insulin as ordered d. Avoid exercise totally e. Monitor for HHS
a,b,c
What patient teachings for diabetic patients needing to maintain foot care? Select all that apply a. wear proper footwear b. avoid bare feet c. avoid cold water d. skin and nail care e. inspect feet weekly f. diligent wound care
a,b,d,f
It is important for the nurse to know what the classic symptoms of type 1 diabetes is. Please identify three of them. a. polyphagia b. increased thirst c. increased sweating d. polyclampsia e. increased urination
a,b,e
What happens with Type II DM? More than one may be correct a. insufficient production of insulin b. no production of insulin c. poor utilization of insulin d. too much production of insulin
a,c
What interventions are important for patients who are experiencing DKA or HHS? a. insulin bolus b. insulin shot c. IV fluids d. potassium replacement e. insulin drip f. electrolyte labs g. cardiac monitoring
a,c,d,e,f,g
Which of these insulins are long acting insulins? a. Glargine (Lantus) b. NPH (Humulin N) c. Regular (Humulin R) d. Glargine (Toujeo)
a,d
Match the medication to its definition a. glipizide b. metformin 1. Stimulates beta-cell release of insulin 2. Reduces production of glucose from liver and increases muscle use of glucose
a1, b2
Match the cell to the hormone it produces: a. Alpha b. Beta c. Delta 1. Glucagon 2. Somatostatin 3. Insulin
a1, b3, c2
Match the lab to its normal values: a. HDL b. LDL c. Cholesterol d. A1C 1. 4-6% 2. <200 3. >45 4. <130
a3, b4, c2, d1
An adult client with type 1 diabetes is scheduled for cataract surgery in the Same Day Surgery Department. On arrival, the client's fingerstick blood glucose was 210 mg/dL. The nurse should should do what next? a. Instruct the client to ambulate b. Contact the client's primary provider c. Reschedule the surgery to another date d. None of the above
b
Before an insulin drip is initiated for DKA or HHS, what is administered? a. insulin shot b. insulin bolus c. IV fluids d. nothing only an insulin drip is given
b
Diagnosing diabetes can be done by assessing blood glucose levels. Which of the following laboratory values is not indicative of diabetes diagnosis? a. HgbA1C 8.1mg/dL b. 2 hour postprandial blood glucose 150mg/dL c. Fasting blood glucose 128mg/dL d. 2 hour postprandial blood glucose 201mg/dL
b
If a patient is to receive lispro (Humalog) and glargine (Lantus), how many injections will they need? a. one b. two c. three d. four
b
Is it appropriate to use an isotonic solution initially with a DKA patient, then change to hypotonic when BG <300mg/dl. a. no b. yes
b
The nurse is educating a client with diabetes about microvascular complications associated with diabetes. The nurse instructs the patient to schedule yearly exams with which of the following specialties? a. Hematology b. Ophthalmology c. Oncology d. Cardiology
b
Type 2 diabetes eventually leads to _________ cell failure. a. delta b. beta c. alpha d. somatostatin
b
What blood glucose level indicates Hyperosmolar Hyperglycemic Syndrome (HHS) in a Type 2 DM? a. <600 b. >600 c. >800 d. <800
b
What can happen if a patient who injects insulin does not rotate injection sites? a. Dawn phenomenon b. Insulin lipodystrophy c. Allergic reactions d. Insulin resistance
b
What electrolyte imbalance is a patient at risk for when taking insulin? a. hypomagnesia b. hypokalemia c. hypercalcemia d. hypernatremia
b
What is essential for preventing microvascular and macrovascular complications from diabetes? a. injecting insulin at the same time of the day b. maintaining normal BS levels c. getting normal check ups d
b
What is the life-threatening complication in Type 1 DM? a. lactic acidosis b. diabetic ketoacidosis c. hyperosmolar hyperglycemic state d. rhabdomyolysis
b
What is the onset, peak, and duration of Humalog (Lispro) - rapid-acting insulin? a. 1-3 hrs, 3-5 hrs, 7-8 hrs b. 15-30 min, 1-3 hrs, 3-5 hrs c. 45-90 min, 2-4 hrs, 4-6 hrs d. 30 min, 3 hrs, 8 hrs
b
What is the onset, peak, and duration of NPH (Humulin N) - intermediate-acting insulin? a. 1-3 hrs, 3-5 hrs, 10-12 hrs b. 1-2 hrs, 6 hrs, 18-24 hrs c. 45-90 min, 2-4 hrs, 4-6 hrs d. 1 hr, 3 hrs, 8 hrs
b
What is the priority intervention for a client with HHS? a. electrolyte replacement b. fluid replacement c. glucose administration d. insulin administration
b
Which complication is associated with kussmaul respirations? a. lactic acidosis b. diabetic ketoacidosis c. hyperosmolar hyperglycemic state d. rhabdomyolysis
b
Which goal is a priority for the diabetic client who is taking insulin and who is experiencing nausea and vomiting from a viral illness or influenza? a. Managing own health b. Obtaining adequate food intake c. Increasing activity d. Relieving pain
b
Which of these statements relates to the etiology of diabetes type I? a. insufficient production of insulin b. no production of insulin c. poor utilization of insulin d. too much production of insulin
b
Which of these would you expect to see in a diabetic ketoacidosis patient? a. respiratory acidosis b. metabolic acidosis c. respiratory alkalosis d. metabolic alkalosis
b
___________________________ is microvascular damage that reduces nerve conduction, loss of sensation and demyelination. a. nephropathy b. neuropathy c. dermopathy d. retinopathy
b
What body systems are priority while treating a patient in DKA or HHS? More than one may be correct a. integumentary b. cardiovascular c. GI/GU d. neuromuscular
b,c,d
What can a nurse teach to a diabetic client about ways to reduce insulin resistance and have a direct effect on lowering blood glucose levels? Select all that apply a. Rotating insulin injection sites b. Getting an appropriate amount of exercise c. Eating less than 130 g of carbs per day d. Safe weight loss e. Track ketone levels
b,d
A nurse is doing teaching to a pre-diabetic patient. Which of these factors increase their risk for diabetes? a. heart disease b. overweight c. lung disease d. obesity e. family history f. advanced age
b,d,e,f
A Type 2 DM patient is preparing for surgery. What education will be needed? a. Do not eat for 2 hours prior to surgery b. Take insulin as scheduled c. Do not take oral anti-diabetic medications d. Exercise prior to surgery
c
A diabetic patient is teaching back what they just learned about diet and exercise. Which of the statements needs to be corrected? a. " I should exercise so I can lose weight and decrease my insulin resistance." b. "I know that I should not exercise if there are ketones in my urine." c. "If my blood sugar is over 200 I should not exercise." d. "I should consume over 130 grams of carbs per day."
c
A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestation should the nurse monitor the client? a. Bradycardia b. Dependent pulmonary crackles c. Deep and fast respirations d. Hypertension
c
A patient has come in for her yearly labs. Her hemoglobin A1C comes back at 8.3%. What does this result mean? a. This patient has normal labs and can come back for a check up in 2 years. b. This patient is now classified as pre-diabetic and will need a check up in 1 year. c. This patient's A1C is very high and they are now classified as diabetic.
c
Dehydration, illness, infection, inadequate insulin dosage, undiagnosed Type 1 DM, and/or poor self-management are all precipitating factors of which complication of diabetes? a. HHS b. Hypoglycemia c. DKA d. Hyperglycemia
c
The client with type 1 diabetes is taught to take isophane insulin suspension NPH at 1700 each day. The client should be instructed the greatest risk of hypoglycemia will occur at about what time? a. 1800, shortly after dinner b. 1300, shortly after lunch c. 0100, while sleeping d. 1100, shortly before lunch
c
What is a common complication with the treatment of HHS? a. potassium depletement b. hypoglycemia c. fluid overload d. DKA
c
What is the best way to prevent diabetes associated complications? a. stop smoking b. stop drinking alcohol c. manage BG levels d. maintain proper hydration
c
What is the life-threatening complication in Type 2 DM? a. lactic acidosis b. diabetic ketoacidosis c. hyperosmolar hyperglycemic state d. rhabdomyolysis
c
What is the onset, peak, and duration of Glargine (Lantus) and Toujeo - long-acting insulin? a. 1-3 hrs, 3-5 hrs, 10-12 hrs b. 1-2 hrs, 6 hrs, 18-24 hrs c. 3-4 hrs, NO PEAK, 24 hrs + d. 1 hr, 3 hrs, 8 hrs
c
What level of a 2-hour plasma glucose level during OGTT (oral glucose tolerance test) would diagnose diabetes? (with a glucose load of 75) a. 100 b. 150 c. 200 d. 250
c
What level of fasting plasma glucose would dx diabetes? a. lower than 109 X2 b. higher than 203 X1 c. higher than 126 X2 d. higher than 147 X2
c
What type of insulin is Regular (Humulin R or Novolin R)? a. Rapid acting b. Long acting c. Short acting d. Intermediate acting
c
_______________ is an important teaching topic for diabetic patients. a. skin care b. mouth care c. foot care d. back care
c
What is the most common reason people go into DKA or HHS? More than one may be correct a. low blood sugars b. illness c. high blood sugars d. infection e. trauma
c,d
Why should metformin be held at least 48 hrs. before contrast medium dye is used during a procedure? Select all that apply a. prevention of ketoacidosis b. prevention of HHS c. prevention of AKI d. prevention lactic acidosis e. prevention of MI
c,d
A client is brought to the emergency room in an unresponsive state with a diagnosis of hyperglycemic hyperosmolar syndrome (HHS). The client has a patent airway. The nurse would immediately prepare to initiate which of the following physician's orders? a. Intravenous infusion of sodium bicarbonate b. 100 units of Intravenous NPH insulin c. Endotracheal intubation d. Intravenous infusion of normal saline
d
A patient comes into the ER who has altered level of consciousness, tachycardia, cool clammy skin, and is diabetic. What do you think is going on? a. DKA b. HHA c. Hyperglycemia d. Hypoglycemia
d
In terms of eating, when should a DM patient administer lispro (Humalog)? a. within 30 minutes b. within 5 minutes c. within 60 minutes d. within 15 minutes
d
Polydipsia, polyphagia, and polyuria are indicative of which type of diabetes? a. Type 1 b. Type 2 c. Gestational d. Type 1 & 2 e. All of the above
d
This is released from pancreatic alpha cells and gut in response to low glucose level. It has the opposite function to maintain normal blood glucose levels. a. somatostatin b. insulin c. amylin d. glucagon
d
What is the onset, peak, and duration of Regular (Humulin R or Novolin R) - short-acting insulin? a. 1-3 hrs, 3-5 hrs, 7-8 hrs b. 15-30 min, 1-3 hrs, 3-5 hrs c. 45-90 min, 2-4 hrs, 4-6 hrs d. 30 min, 3 hrs, 8 hrs
d
What type of insulin is NPH (Humulin N)? a. Rapid acting b. Long acting c. Short acting d. Intermediate acting
d
When administering IV insulin for DKA which electrolyte is at risk for being depleting? a. sodium b. magnesium c. calcium d. potassium
d
When teaching the diabetic client about foot care, the nurse should instruct the client to perform which of the following? a. Cut toenails at angles b. Use hot water when washing feet c. Buy shoes a half size larger d. Avoid going barefoot outside
d
True or false Diabetes patients should see an ophthalmologist once every five years.
false
True or false hypoglycemia is a side effect of Metformin.
false
True or false Thiazide diuretics can cause HHS in type 2 diabetics.
true
True or false hypoglycemia is a side effect of Glipizide.
true
