Exam 2 Questions - Diabetes

Which patient statement indicated to the nurse the need for further teaching regarding the new diagnosis of type 1 diabetes? A. "I will need to take medication by mouth until my blood sugar is within normal limits again." B. "The things that I eat may impact the dose of my medication used to control my blood glucose." C. "If I get the flu, the dose of my insulin may need to be altered to control my blood glucose." D. "I will monitor my blood glucose to help determine whether my medication is working as anticipated."

A. "I will need to take medication by mouth until my blood sugar is within normal limits again." This statement indicates the need for further education because lifelong insulin administration is required for cellular metabolism in patients with type 1 diabetes

A client was diagnosed with type 2 diabetes 5 years ago, and had now started insulin therapy. What is the most important information to teach this client? A. "Your diabetes was not controlled with several drugs, so insulin therapy is the next step." B. "This therapy is not usually warranted." C. "All clients with type 2 diabetes need insulin therapy." D. "This therapy is only temporary."

A. "Your diabetes was not controlled with several drugs, so insulin therapy is the next step."

A patient is diagnosed with hypoglycemia. What glucose level should the nurse expect when monitoring the capillary blood glucose? A. 65 mg/dL B. 100 mg/dL C. 138 mg/dL D. 200 mg/dL

A. 65 mg/dL Hypoglycemia is usually defined as a blood glucose level below 70 mg/dL

A client present with diaphoresis, palpitations and tachycardia approximately 2 hours after receiving 20 units of regular insulin. What is the nurses most appropriate intervention? A. Administer 15 grams of a simple carbohydrate. B. Administer additional insulin based on a sliding scale C. Administer lorazepam per PRN order D. Draw blood for a glucose level

A. Administer 15 grams of a simple carbohydrate.

The nurse is reviewing type 1 diabetes with a group of patients newly diagnosed with the disorder. What should the nurse explain as the major cause for the disorder A. Autoimmune Process B. Cancer of the pancreas C. Alteration in lipid and protein utilization D. Malfunction of carbohydrates metabolism

A. Autoimmune Process Type 1 Diabetes is typically triggered by an autoimmune process in which the insulin producing beta cells of the pancreas are destroyed, resulting in an absolute lack of insulin

The nurse answers the call light of a patient with diabetes. The patient has a mild tremor, slight diaphoresis, and is fully oriented. What should the nurse do? A. Check the patients blood glucose level B. Call the lab for a STAT glucose level C. Administer dextrose 50% IV D. Administer 4 oz of OJ with one packet of sugar

A. Check the patients blood glucose level

The nurse is assessing a client diagnosed with type 1 diabetes for symptoms associated with diabetic katoacidosis. Which of the following will the nurse most likely assess in this client. Select all that apply. A. Dehydration B. Fruity odor to breath C. Hypertension D. Kussmaul Respiration

A. Dehydration B. Fruity odor to breath D. Kussmaul Respiration The client diagnosed with diabetic ketoacidosis will experience dehydration, fruity breath odor, Kussmaul respirations and abdominal pain. The client will also have hypotension and not hypertension. The clients HR will be tachycardia and not bradycardia.

A patient is having testing to diagnose type 1 diabetes. Which diagnostic tests might be prescribed for this patient? Select all that apply A. Hemoglobin A1c B. 2 hour post-prandial C. Serum triglycerides D. Fasting blood glucose

A. Hemoglobin A1c B. 2 hour post-prandial D. Fasting blood glucose HgbA1c gives an accurate indication of long term, time averaged glucose levels over the 6 to 8 weeks before the HgbA1c blood draw 2-hour postprandial or oral glucose tolerance test measures blood glucose levels 1-2 hours after consuming a high glucose beverage. The diagnostic value is based on the blood glucose level 2 hours after consumption Fasting blood glucose measures the glucose level after no caloric intake for at least 8 hours. Normally, insulin is released, moving that glucose into the cells, preventing hyperglycemia. Without adequate insulin, hyperglycemia results

The nurse is preparing to administer IV insulin to a client diagnose with DKA. What will the nurse monitor while the client is receiving this intervention? A. Hypokalemia and hypoglycemia B. Hypocalcemia and hyperkalemia C. Hyperkalemia and hyperglycemia D. Hypernatremia and hypercalcemia

A. Hypokalemia and hypoglycemia

A client with type 1 diabetes often skips his ordered insulin dose. What priority teaching should the nurse include? A. May lead to ketoacidosis B. May cause hypoglycemic coma C. May lead to pancreatitis D. May cause diabetes insipidus

A. May lead to ketoacidosis

The nurse admits a client diagnosed with a new onset of type 1 diabetes. Which symptoms should the nurse expect to find during his initial physical assessment? A. Polydipsia, polyuria and weight loss B. Weight gain, tiredness and bradycardia C. Irritability, diaphoresis and tachycardia D. Diarrhea, abdominal pain and weight loss

A. Polydipsia, polyuria and weight loss

A patient with type 2 diabetes experiences a hypoglycemic reactions. The capillary blood glucose level is 60 mg/dL and the patient is given 4 oz of apple juice. What should the nurse do next? A. Recheck the patients blood glucose in 15 minutes B. Mark the medication administration record to hold the next scheduled dose for insulin C. Recheck the blood glucose before the next meal. D. Give the patient another 4 oz of OJ in 30 minutes

A. Recheck the patients blood glucose in 15 minutes

The nurse is caring for a client with DKA. The client is receiving insulin and IV fluids. Which lab test would be a priority for the nurse to monitor. A. Serum potassium B. Hemoglobin A1c C. Serum Calcium D. Serum nitrogen

A. Serum potassium

The nurse teaches a client diagnosed with hyperglycemic hyperosmolar state (HHS) how to monitor his condition. What is a potential warning sign of this condition? A. Symptoms of hyperglycemia B. Symptoms of hypoglycemia C. Ketones in the urine D. Rapid and deep respirations

A. Symptoms of hyperglycemia

A patient with diabetes has peripheral neuropathy. What should the nurse do to prevent related complications? A. Wash, dry and inspect feet daily B. Use a lubricating lotion on feet daily C. Avoid wearing shoes as much as possible D. Soak feet in soap and warm water for 20 mins daily

A. Wash, dry and inspect feet daily

A patient is newly diagnosed with type 1 diabetes. How should the nurse respond when the patient asks how long insulin injections will be necessary A. You will need insulin injections for the rest of your life B. Once your pancreas recovers, you may be able to discontinue the injections C. If you follow your diet closely, your blood sugar may be controlled by just taking insulin pills D. You may be able to stop the injections if you exercise and regularly adhere to the prescribed diet

A. You will need insulin injections for the rest of your life

The nurse monitors for which clinical manifestations in the patient diagnosed with type 2 diabetes. Select all that apply. A. Muscle Cramps B. Fatigue C. Poor wound healing D. Recurrent infections

B. Fatigue C. Poor wound healing D. Recurrent infections In addition to the 3 types of Ps of type 1 diabetes, other common clinical manifestations include fatigue, poor wound healing and recurrent infections

The home health nurse is visiting a client newly diagnosed with type 1 diabetes. The client reports nausea and abdominal pain. The nurse observes dehydration and dry skin. What question should the nurse ask the client? A. "What did you drink today?" B. "Are you taking your insulin daily?" C. "When is the last time you had a checkup?" D. "Did you weigh yourself today?"

B. "Are you taking your insulin daily?"

Which statement by the patient indicates a need for additional instruction in administering insulin? A. "I need to rotate injection sites among my arms, legs, and abdomen each day." B. "I can buy the 0.5-mL syringes because the line markings will be easier to see." C. I do not need to aspirate the plunger to check for blood before injecting insulin." D. "I should draw up the regular insulin first, after injecting air into the NPH bottle."

B. "I can buy the 0.5-mL syringes because the line markings will be easier to see." To administer insulin, an insulin syringe should be used. Insulin is measured in units and mL syringes do not measure units

The nurse is instructing a client diagnosed with type 2 diabetes on daily foot care. Which of the following statements indicate the clients needs further instruction? A. "I will check my feet everyday." B. "I will cut my toenails with scissors." C. "I will keep my appointments with my podiatrist." D. "I will wear properly fitted shoes."

B. "I will cut my toenails with scissors."

A client with type 1 diabetes is exhibiting Kussmaul's respirations, abdominal discomfort and lethargy. What intervention should he nurse perform? A. Assess CBC B. Administer insulin as ordered C. Start an IV infusion of dextrose D. Assess neurological status

B. Administer insulin as ordered Clients with Kussmaul's respirations, abdominal discomfort and lethargy are symptomatic of DKA. The nurse should administer insulin to decrease blood glucose levels

A patient asks what can be done to prevent long-term complications of diabetes. What should the nurse respond to this patients question? A. Regularly inspect feet B. Carefully control blood glucose C. Limit fluids to prevent stress to kidneys D. Keep OJ with sugar available at all times

B. Carefully control blood glucose

A client with type 1 diabetes presents with polyphagia, polydipsia and polyuria. Further assessment shows signs of dehydration. The nurse determines that this client may be experiencing A. Diabetes insipidus B. Diabetic Ketoacidosis C. Hypoglycemia D. Syndrome of inappropriate antidiuretic hormone (SIADH)

B. Diabetic Ketoacidosis

The nurse is providing education to a group of clients newly diagnosed with type 1 diabetes. One client asks why the gycosylated hemoglobin blood test (HbA1c) is done. What is the nurses best response? A. HbA1c measures hemoglobin in addition to blood glucose level B. HbA1c is used to assess long-term glycemic control C. HbA1c provides information about conditions that effect a RBC's life span D. HbA1c provides information about serum protein and albumin

B. HbA1c is used to assess long-term glycemic control

The nurse monitors for which clinical manifestations in the patient diagnoses with type 1 diabetes? Select all that apply A. Weight gain B. Large volume of urine output C. Extreme hunger D. Extreme thirst

B. Large volume of urine output C. Extreme hunger D. Extreme thirst Polyphagia, polydipsia, polyuria are manifestations of type 1 diabetes

Which of these lab values, noted by the nurse when reviewing the chart of a hospitalized diabetic patient, indicates the need for rapid assessment of the patient? A. Hb A1c of 5.8% b. Noon blood glucose of 52 mg/dL C. Hb A1c of 6.9% D. Fasting blood glucose of 130 mg/dL

B. Noon blood glucose of 52 mg/dL The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms of hypoglycemia, and give the patient some carb containing beverage such as OJ. The other values are within an acceptable range for a diabetic patient

When the nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis, the patient reports feeling anxious, nervous, and sweaty. Which action should the nurse take first? A. Administer 1 mg glucagon SQ B. Obtain a glucose reading using a finger stick C. Have the patient drink 4 oz of OJ D. Give the scheduled dose of lispro (Humalog) insulin

B. Obtain a glucose reading using a finger stick The clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient glucose with a finger stick or order a stat blood glucose

A nurse is teaching a client recently diagnosed with type 1 diabetes about the chronic complications associates with the disease. What information should the nurse include? A. Buy shoes that are 1/2 a size larger B. Schedule yearly eye exams C. Exercise will increase insulin resistance D. Podiatry visits are necessary every 5 years

B. Schedule yearly eye exams

The hallmark of hyperglycemic hyperosmolar syndrome (HHS) is A. Hyperglycemia with low serum osmolarity B. Severe hyperglycemia with minimal or absent ketosis C. little or not ketosis in serum with rapidly escalating ketouria D. hyperglycemia and ketosis

B. Severe hyperglycemia with minimal or absent ketosis The hallmarks of HHS are extremely high levels of plasma glucose with resulting elevations in serum elevations in serum hyperosmolarity and osmotic diuresis. The disorder occurs mainly in patients with type 2 diabetes

Which statement best describes the pathophysiology of type 2 diabetes? A. There is an absolute lack of insulin B. The cells resist glucose from entering C. Pancreatic cells stop producing insulin D. An autoimmune disorder damages pancreatic cells

B. The cells resist glucose from entering Type 2 diabetes involves defects at the cell membrane that prevent the normal action of insulin is present, the cell "resists" its effect in transporting glucose into the cell

The nurse is administering an insulin infusion for a client diagnosed with DKA. Which outcome indicates that treatment has been effective? A. Lowered blood glucose level to normal limits within an hour B. The replacement of fluids during the first 24 hours C. An increase in anion gap within 24 hours D. An increase in blood glucose levels within the first 3 hours

B. The replacement of fluids during the first 24 hours

A client is being screened for diabetes and has two recent fasting blood glucose results of 132 mg/dL and 146 mg/dL. How should these results be interpreted? A. These are normal results. No further action is needed B. These results indicate diabetes. Follow-up is required C. The fasting blood glucose test should be repeated two more times D. The client should be scheduled for a hemoglobin A1c test

B. These results indicate diabetes. Follow-up is required

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

B. Unlimited intake of total fat, saturated fat and cholesterol

During a home visit by the nurse with a type 2 diabetes, which observation of the patient indicates the need for further teaching A. Exercising with a treadmill B. Walking barefoot in the backyard C. Eating one-half apple and cheese for a snack D. Stated a weight loss of 2 lbs. over the last month

B. Walking barefoot in the backyard The patient with type 2 diabetes should never walk barefoot

The nurse is assessing a 22 year old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response? A. "Are you anorexic?" B. "Is your urine dark colored?" C. "Have you lost weight lately?" C. "Do you crave sugary drinks?"

C. "Have you lost weight lately?"

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is most at risk for the development of: A. Infection B. Confusion C. Dehydration D. Skin breakdown

C. Dehydration

A client is instructed to rotate the sites of insulin injections because it will help prevent: A. A decrease in absorption B. An allergic reaction C. Lipodystrophy D. Skin Breakdown

C. Lipodystrophy The rotation of sites is used to prevent lipodystrophy, a localized complication of insulin administration characterized by changes in the SQ fat at the site of the injection

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? A. Infuse dextrose 50% by slow IV push. B. Administer 1 mg glucagon subcutaneously. C. Obtain a glucose reading using a finger stick. D. Have the patient drink 4 ounces of orange juice.

C. Obtain a glucose reading using a finger stick.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may A. need a diet higher in calories while receiving prednisone. B. develop acute hypoglycemia while taking the prednisone. C. require administration of insulin while taking prednisone. D. have rashes caused by metformin-prednisone interactions.

C. require administration of insulin while taking prednisone.

The nurse is preparing to discuss long term complications of diabetes with a patient newly diagnosed with the disorder. Which structure should the nurse identify as causing complications because of underlying damage. A. Heart B. Liver C. Brain D. Blood Vessels

D. Blood Vessels Most of the complications of diabetes involve either the large blood vessels in the body (macro-vascular complications) or the tiny blood vessels, such as those in the eyes or kidneys (microvascular complications)

The nurse is caring for a client with type 1 diabetes. At 3:00 AM, the nurse finds the client disoriented to time and place, diaphoretic and complaining fo palpitations. What is the nurse's priority intervention? A. Give 10 to 15 grams of carbohydrate orally B. Call the healthcare provider for additional insulin order C. Administer 1 mg of glucagon SQ D. Check blood glucose level

D. Check blood glucose level

The nurse correlates which assessment findings to a patient experiencing diabetic ketoacidosis? A. Slow HR B. Deep Rapid Respirations C. Decreased Urine Output D. Increased BP

D. Deep Rapid Respirations The patient develops Kussmal's respirations, which are rapid, deep respirations

Which test provides a way to monitor fluctuations of blood glucose levels over the previous 6-12 weeks? A. Glucose tolerance testing B. Fasting blood glucose C. Capillary blood glucose D. HgbA1c

D. HgbA1c

The nurse is admitting a client diagnosed with DKA. What is the nurses priority intervention? A. SQ glucagon administration B. Transfusion of whole blood C. Glucocorticoid administration D. IV insulin

D. IV insulin

A patient with type 1 diabetes asks what caused the fruity odor that was present at diagnosis. How should the nurse respond? A. Excess sugar is excreted in the urine, which causes the fruity odor B. The proteins in the blood are metabolized to a substance that has a fruity odor C. The excess sugar in the blood is metabolized to fructose and excreted via the lungs D. In the absence of available sugar, the body breaks down fat into ketones, which have a fruity odor

D. In the absence of available sugar, the body breaks down fat into ketones, which have a fruity odor

A patient has a 10- year history of diabetes. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum lab values validate the diagnosis of diabetic ketoacidosis. Which of the following statements best describes the rationale for administering potassium supplements with the patients insulin therapy? A. Potassium replaces losses incurred with diuresis B. The patient has been in a long-term malnourished state C. IV potassium renders the infused solution isotonic D. Insulin drives potassium back into the cells

D. Insulin drives potassium back into the cells

A patient tells the nurse that there is a history of diabetes in the family and even though she has always tried to keep her blood glucose level on the low side she still developed diabetes. What information should the nurse provide? A. Body weight is a big contributor to the development of all types of diabetes B. There is no way to stop the development of diabetes C. Diabetes can be caused by taking some medications D. It is thought that genetics is involved with the development of both type 1 and 2 diabetes

D. It is thought that genetics is involved with the development of both type 1 and 2 diabetes

A patient diagnosed with DKA is receiving normal saline infusion and intravenous insulin. What additional medication does the nurse expect to be prescribed for this patient? A. Diuretic B. Calcium C. Antibiotic D. Potassium

D. Potassium Care must be taken to monitor potassium levels before treating the hyperglycemia with insulin. As insulin is administered to decrease hyperglycemia, potassium will also move back into the cell, worsening hypokalemia. If hypokalemia is present, potassium replacement is a priority

A client is prescribed to be given insulin an intravenous access line. The nurse realizes that which of the following insulins can be administered intravenously. A. Glargine B. Lispro C. NPH D. Regular

D. Regular Regular insulin may be given IV or SQ. All other insulins are given SQ

Which of the following should the nurse instruct a client when teaching how to self-administer insulin? A. The insulin bottle must be shaken B. The long-acting insulin is clear C. Refrigerated insulin is best for injection D. The blood glucose level should be checked prior to administration

D. The blood glucose level should be checked prior to administration