Lewis CHapter 49

4. What characterizes type 2 diabetes (select all that apply)? a. β-Cell exhaustion d. Altered production of adipokines b. Insulin resistance e. Inherited defect in insulin receptors c. Genetic predisposition f. Inappropriate glucose production by the liver

A, B, C, D, E, F

36. Priority Decision: Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse? a. "That is a good range for your glucose levels." b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia and you should increase your food intake." d. "You should take only half your insulin dosage for the next few days to get your glucose level back to normal."

a. "That is a good range for your glucose levels."

10. During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results (select all that apply)? a. A1C of 7.5% b. Glycosuria of 3+ c. FPG >126 mg/dL (7.0 mmol/L). d. Random blood glucose of 126 mg/dL (7.0 mmol/L) e. A 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)

a. A1C of 7.5% c. FPG >126 mg/dL (7.0 mmol/L).

9. Priority Decision: When caring for a patient with metabolic syndrome, what should the nurse give the highest priority to teaching the patient about? a. Achieving a normal weight b. Performing daily aerobic exercise c. Eliminating red meat from the diet d. Monitoring the blood glucose periodically

a. Achieving a normal weight

28. Priority Decision: A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. Administer the usual insulin dosage. b. Hold fluid intake until the nausea subsides. c. Come to the clinic immediately for evaluation and treatment. d. Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L).

a. Administer the usual insulin dosage.

41. A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? a. It is more difficult to achieve strict glucose control than in younger patients. b. It usually is not treated unless the patient becomes severely hyperglycemic. c. It does not include treatment with insulin because of limited dexterity and vision. d. It usually requires that a younger family member be responsible for care of the patient.

a. It is more difficult to achieve strict glucose control than in younger patients.

15. A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. Withdraws the NPH dose into the syringe first b. Injects air equal to the NPH dose into the NPH vial first c. Removes any air bubbles after withdrawing the first insulin d. Adds air equal to the insulin dose into the regular vial and withdraws the dose

a. Withdraws the NPH dose into the syringe first

18. When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. Tight glycemic control can be maintained. b. Errors in insulin dosing are less likely to occur. c. Complications of insulin therapy are prevented. d. Frequent blood glucose monitoring is unnecessary.

a. Tight glycemic control can be maintained.

20. Which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. Insulin c. Meglitinide b. Biguanide d. Sulfonylurea

b. Biguanide

16. Delegation Decision: The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP)? a. Discuss complications of diabetes. b. Check that the bath water is not too hot. c. Check the patient's technique for drawing up insulin. d. Teach the patient to use a meter for self-monitoring of blood glucose.

b. Check that the bath water is not too hot.

37. Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. It can be prevented by tight glucose control. b. It occurs with a higher frequency and earlier onset than in the nondiabetic population. c. It is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake.

b. It occurs with a higher frequency and earlier onset than in the nondiabetic population.

3. Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. Decrease glucose production b. Stimulate glucose output by the liver c. Increase glucose transport into the cells d. Independently regulate glucose level in the blood

b. Stimulate glucose output by the liver

26. The nurse assesses the diabetic patient's technique of self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. Doing the SMBG before and after exercising b. Puncturing the finger on the side of the finger pad c. Cleaning the puncture site with alcohol before the puncture d. Holding the hand down for a few minutes before the puncture

c. Cleaning the puncture site with alcohol before the puncture

31. What describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? a. DKA requires administration of bicarbonate to correct acidosis. b. Potassium replacement is not necessary in management of HHS. c. HHS requires greater fluid replacement to correct the dehydration. d. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level.

c. HHS requires greater fluid replacement to correct the dehydration.

32. The patient with newly diagnosed diabetes is displaying shakiness, confusion, irritability, and slurred speech. What should the nurse suspect is happening? a. DKA c. Hypoglycemia b. HHS d. Hyperglycemia

c. Hypoglycemia

19. Priority Decision: A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first? a. Increase the evening insulin dose to prevent the dawn phenomenon. b. Use a single-dose insulin regimen with an intermediate-acting insulin. c. Monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising. d. Decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect.

c. Monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising

22. Priority Decision: The nurse is assessing a newly admitted diabetic patient. Which observation should be addressed as the priority by the nurse? a. Bilateral numbness of both hands b. Stage II pressure ulcer on the right heel c. Rapid respirations with deep inspiration d. Areas of lumps and dents on the abdomen

c. Rapid respirations with deep inspiration

8. Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. An obese 50-year-old Hispanic woman b. A child whose father has type 1 diabetes c. A 34-year-old woman whose parents both have type 2 diabetes d. A 12-year-old boy whose father has maturity onset diabetes of the young (MODY)

c. A 34-year-old woman whose parents both have type 2 diabetes

5. Which laboratory results would indicate that the patient has prediabetes? a. Glucose tolerance result of 132 mg/dL b. Glucose tolerance result of 240 mg/dL c. Fasting blood glucose result of 80 mg/dL d. Fasting blood glucose result of 120 mg/dL

d. Fasting blood glucose result of 120 mg/dL

17. The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration. b. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c. placing the insulin bottle currently in use in a small container on the bathroom countertop. d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.

d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.

29. The nurse should observe the patient for symptoms of ketoacidosis when a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.

c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy.

40. Following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful."

d. "I'll know if I have sores or lesions on my feet because they will be painful."

14. Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. Only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. At mealtime or within 15 minutes of meals

d. At mealtime or within 15 minutes of meals

6. The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)? a. Maintain a healthy weight. b. Exercise for 60 minutes each day. c. Have blood pressure checked regularly. d. Assess for visual changes on monthly basis. e. Monitor for polyuria, polyphagia, and polydipsia.

a. Maintain a healthy weight. e. Monitor for polyuria, polyphagia, and polydipsia.

21. The patient with type 2 diabetes is being put on acarbose (Precose) and wants to know why she is taking it. What should the nurse include in this patient's teaching (select all that apply)? a. Take it with the first bite of each meal. b. It is not used in patients with heart failure. c. Endogenous glucose production is decreased. d. Effectiveness is measured by 2-hour postprandial glucose. e. It delays glucose absorption from the gastrointestinal (GI) tract

a. Take it with the first bite of each meal. d. Effectiveness is measured by 2-hour postprandial glucose. e. It delays glucose absorption from the gastrointestinal (GI) tract

12. When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. Pull back on the plunger after inserting the needle to check for blood. b. Consistently use the same size of insulin syringe to avoid dosing errors. c. Clean the skin at the injection site with an alcohol swab before each injection. d. Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies

b. Consistently use the same size of insulin syringe to avoid dosing errors.

13. A patient with type 1 diabetes uses 20 U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6:00 pm. When teaching the patient about this regimen, what should the nurse emphasize? a. Hypoglycemia is most likely to occur before the noon meal. b. Flexibility in food intake is possible because insulin is available 24 hours a day. c. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. d. Premeal glucose checks are required to determine needed changes in daily dosing.

c. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia.

34. A diabetic patient is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. Have the patient drink some orange juice. b. Administer 10 U of regular insulin subcutaneously. c. Call for an ambulance to transport the patient to a medical facility. d. Administer glucagon 1 mg intramuscularly (IM) or subcutaneously.

d. Administer glucagon 1 mg intramuscularly (IM) or subcutaneously.

11. The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has a. diabetes. c. impaired fasting glucose. b. elevated A1C. d. impaired glucose tolerance.

d. impaired glucose tolerance.

30. What are manifestations of diabetic ketoacidosis (DKA) (select all that apply)? a. Thirst d. Metabolic acidosis b. Ketonuria e. Kussmaul respirations c. Dehydration f. Sweet, fruity breath odor

30. a, b, c, d, e, f.

33. The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level (select all that apply)? a. Headache d. Emotional changes b. Unsteady gait e. Increase in urination c. Abdominal cramps f. Weakness and fatigue

33. a, c, e, f.

38. What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)? a. Chronic kidney disease b. Coronary artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremities e. Capillary and arteriole membrane thickening specific to diabetes

38. b, d.

39. The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient (select all that apply)? a. Painless foot ulcers b. Erectile dysfunction c. Burning foot pain at night d. Loss of fine motor control e. Vomiting undigested food f. Painless myocardial infarction

39. b, e, f.

2. Which tissues require insulin to enable movement of glucose into the tissue cells (select all that apply)? a. Liver b. Brain c. Adipose d. Blood cells e. Skeletal muscle

2. c, e. Adipose, Skeletal Muscle

23. Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times. b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars from the diet. d. limit saturated fat intake to 30% of dietary calorie intake.

a. eat regular meals at regular times.

25. To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? a. Only after a 15-g carbohydrate snack is eaten b. About 1 hour after eating when blood glucose levels are rising c. When glucose monitoring reveals that the blood glucose is in the normal range d. When blood glucose levels are high, because exercise always has a hypoglycemic effect

b. About 1 hour after eating when blood glucose levels are rising

27. A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for all minority populations every year b. FPG for all individuals at age 45 and then every 3 years c. Testing people under the age of 21 for islet cell antibodies d. Testing for type 2 diabetes in all overweight or obese individuals

b. FPG for all individuals at age 45 and then every 3 years

24. What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. Ideal body weight b. Normal serum glucose and lipid levels c. A special diabetic diet using dietetic foods d. Five small meals per day with a bedtime snack

b. Normal serum glucose and lipid levels

7. In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. Fatigue c. Polyphagia b. Polydipsia d. Recurrent infections

b. Polydipsia

1. In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. Enhances the breakdown of adipose tissue for energy b. Stimulates hepatic glycogenolysis and gluconeogenesis c. Prevents the transport of triglycerides into adipose tissue d. Accelerates the transport of amino acids into cells and their synthesis into protein

d. Accelerates the transport of amino acids into cells and their synthesis into protein