Med/Surg Chapter 67
A patient with diabetic ketoacidosis is on an insulin drip of 50 units of regular insulin in 250 ml of normal saline. The current blood glucose level is 549 mg/dl. According to insulin protocol, the insulin drip needs to be changed to 8 units per hour. At what rate does the nurse set the pump? _____ml/hr
40
what is the recommended calorie reduction for a patient with diabetes who must lose weight? a 500 calories/week b 1500 calories/week c 2500 calories/week d 3500 calories/week
a 500 calories/week
Which cultures tend to have a higher incidence of diabetes mellitus (DM)? (select all that apply) a Mexican American b African American c Caucasian d American indian e eastern european
a Mexican american b african American d American indian
Match each diabetic complication with its corresponding pathophysiology. Answers may be used more than once. Proteinuria a Nephropathy b Neuropathy c Retinopathy
a Nephropathy
Self monitoring of blood glucose levels is most important in which patients? (select all that apply) a patients taking multiple daily insulin injections b patients with mild type 2 diabetes c patients with hypoglycemic unawareness d patients using a portable infusion device for insulin administration e ill patients f pregnant patients
a Patients taking multiple daily insulin injections c patients with hypoglycemic unawareness d patients using a portable infusion device for insulin administration e ill patients f pregnant patients
A patient with diabetes who swims for exercise is taught to administer insulin in which area of the body? a abdomen b thighs c arms d hips
a abdomen
Which class of antidiabetic medication should be taken with the first bite of a meal to be fully effective? a alpha-glucosidase inhibitors, which include miglitol (glyset) b biguanides, which include metoformin (Glucophage) c meglitinides, which include nateglinide (starlix) d sulfonylureas, which include chlorpromadine (diabinese)
a alpha-glucosidase inhibitors, which include miglitol (glyset)
A diabetic patient has just returned from surgery with stable blood glucose levels between 120 and 180 mg/dl. Which IV solution will promote adequate hydration and stable blood glucose levels? a d51/2 ns at 125 ml/hr b d5w at 125 ml/hr c 0.45% nss at 100 ml/hr d 0.9% nss at 100 ml/hr
a d5 1/2 ns at 125 ml/hr
Which complications of DM are considered emergencies? (select all that apply) a diabetic ketoacidosis (DKA) b hypoglycemia c diabetic retinopathy d hyperglycemia-hyperosmolar state (HHS) e diabetic neuropathy
a diabetic ketoacidosis (DKA) b hypoglycemia d hyperglycemic-hyperosmolar state (HHS)
a diabetic patient is scheduled to have a blood glucose test the next morning. What does the nurse tell the patient to do before coming in for the test? a eat the usual diet but have nothing after midnight b take the usual oral hypoglycemic tablet in the morning c eat a clear liquid breakfast in the morning d follow the usual diet and medication regimen
a eat the usual diet but have nothing after midnight
Match the definition with its corresponding foot condition. Turning of the great toe a hallux valgus b claw toe deformity c charcot foot
a hallux valgus
Which are signs and symptoms of mild hypoglycemia? (select all that apply) a headache b weakness c gold, clammy skin d irritability e pallor f tachycardia
a headache b weakness d irritability
A patient is admitted with a blood glucose level of 900 mg/dl. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dl. Which complication is the patient most at risk for developing? a hypoglycemia b pulmonary embolus c renal shutdown d pulmonary edema
a hypoglycemia
Match the insulin characteristics with the corresponding types of insulin. Answers may be used more than once. This type of insulin does not have a peak time a insulin glargine (lantus) b regular insulin c NPH insulin
a insulin glargine (lantus)
Match the insulin characteristics with the corresponding types of insulin. Answers may be used more than once. This type of insulin is a long-acting insulin analogue given once daily for basal insulin coverage a insulin glargine (lantus) b regular insulin c NPH insulin
a insulin glargine (lantus)
Match the insulin characteristics with the corresponding types of insulin. Answers may be used more than once. This type of insulin should not be diluted or mixed with any other insulin or solution a insulin glargine (lantus) b regular insulin c NPH insulin
a insulin glargine (lantus)
Which statements about type 1 DM are accurate? (select all that apply) a it is an autoimmune disorder b most people with type 1 DM are obese c age of onset is typically younger than 30 d etiology can be attributed to viral infections e it can be treated with oral antidiabetic medications and insulin
a it is an autoimmune disorder c age of onset is typically younger than 30 d etiology can be attributed to viral infections
Which statements about type 2 DM are accurate? (select all that apply) a it peaks at about the age of 50 b most people with type 2 DM are obese c it typically has an abrupt onset d people with type 2 DM have insulin resistance e it can be treated with oral antidiabetic medications and insulin
a it peaks at about the age of 50 b most people with type 2 DM are obese d people with type 2 DM have insulin resistance e it can be treated with oral antidiabetic medications and insulin
Which factors differentiate DKA from HHS? (select all that apply) a level of hyperglycemia b amount of ketones produced c serum bicarbonate levels d amount of volume depletion e dosage of insulin needed
a level of hyperglycemia b amount of ketones produced
According to the Diabetes Control and Complication Trial (DCCT) study of type 1 DM patients, intensive therapy with good glucose control resulted in delays in which complications? (select all that apply) a macrovascular disease b cardiovascular disease c retinopathy d nephropathy e neuropathy
a macrovascular disease b cardiovascular disease c retinopathy d nephropathy e neuropathy
In developing an individualized meal plan for a patient with diabetes, which goals are the focus of the plan? (select all that apply) a maintaining blood glucose levels at or as close to the normal range as possible b patient food preferences c allowing patients to eat as much as they desire d patient cultural preferences e limiting food choices only when guided by scientific evidence
a maintaining blood glucose levels at or as close to the normal range as possible b patient food preferences d patient cultural preferences e limiting food choices only when guided by scientific evidence
Match each diabetic complication with its corresponding pathophysiology. Answers may be used more than once. End-stage kidney disease a Nephropathy b Neuropathy c Retinopathy
a nephropathy
Match the descriptions with the corresponding type of diabetes. Answers may be used more than once. Autoimmune process is causing beta cell destruction a type 1 b type 2 c gestational
a type 1
Match the descriptions with the corresponding type of diabetes. Answers may be used more than once. Usually abrupt onset of thirst and weight loss a type 1 b type 2 c gestational
a type 1
The nurse is preparing to administer 20 units of N)PH insulin (humulin N) along with 6 units of regular insulin (humulin R) to a patient with diabetes. How does the nurse prepare the injuection? (place the steps in order using the numbers 1 through 7) ___ a gently roll the NPH insulin vial in the hands ___ b wash hands ___ c wipe off the tops of the insulin vials with an alcohol pad ___ d inject 20 units of air into the NPH insulin vial ___ e invert the regular insulin vial and withdraw 8 units of insulin ___ f invert the NPH insulin vial and withdraw 20 units of insulin ___ g inject 8 units of air into the regular insulin vial
a=2 b=1 c=3 d=4 e=6 f=7 g=5
Place the injection sites in order of speed of absorption using the numbers 1 through 4, with 1 having the fastest absorption and 4 having the slowest absorption. ___ a buttocks ___ b abdomen ___ c deltoid ___ d thigh
a=4 b=1 c=2 d=3
Match each diabetic complication with its corresponding pathophysiology. Answers may be used more than once. Muscle weakness a Nephropathy b Neuropathy c Retinopathy
b Neuropathy
A patient has been diagnosed with diabetes. Which aspects does the nurse consider in formulating the teaching plan for this patient? (select all that apply) a covering all needed information in one teaching session b assessing visual impairment regarding insulin labels and markings on syringes c assessing manual dexterity to determine if the patient is able to draw insulin into a syringe d assessing patient motivation to learn and comprehend instructions e assessing the patient's ability to read printed material
b assessing visual impairment regarding insulin labels and markings on syringes c assessing manual dexterity to determine if the patient is able to draw insulin into a syringe d assessing patient motivation to learn and comprehend instructions e assessing the patient's ability to read printed material
Which class of antidiabetic medication must be held for 48 hours if the patient is having an x-ray with iodinated contrast materials? a alpha-glucosidase inhibitors, which include miglitol (glyset) b biguanides, which include metoformin (Glucophage) c meglitinides, which include nateglinide (starlix) d sulfonyfureas, which include chlorpromadine (diabinese)
b biguanides, which include metoformin (Glucophage)
Which statement about dietary concepts for a patient with diabetes is true? a alcoholic beverage consumption is unrestricted b carbohydrate counting is emphasized when adjusting dietary intake of nutrients c sweeteners should be avoided because of the side effects d both soluble and insoluble fiber foods should be limited
b carbohydrate counting is emphasized
A patient with insulin-dependent diabetes is planning to travel by air and asks the nurse about preparations for the trip. What does the nurse tell the patient to do? a pack insulin and syringes in a labeled crushproof kit in the checked luggage. b carry all necessary diabetes supplies in a clearly identified pack aboard the plane c ask the flight attendant to put the insulin in the galley refrigerator once on the plane d take only minimal supplies and get the prescription filled at his or her destination
b carry all necessary diabetes supplies in a clearly identified pack aboard the plan
Match the definition with its corresponding foot condition. Hyperextended toes causing increased pressure on the ball of the foot a hallux valgus b claw toe deformity c charcot foot
b claw toe deformity
A patient with type 2 diabetes often has which laboratory value? a elevated thyroid studies b elevated triglycerides c ketones in the urine d low hemoglobin
b elevated triglycerides
When glucagon is administered, what does it do? a competes for insulin at the receptor sites b frees glucose from hepatic stores of glycogen c supplies glycogen directly to the vital tissues d provides a glucose substitute for rapid replacement
b frees glucose from hepatic stores of glycogen
A patient with diabetes has signs and symptoms of hypoglycemia. he patient is alert and oriented with a blood glucose of 56 mg/dl. What does the nurse do next? a give a glass of orange juice with two packets of sugar and continue to monitor the patient b give 8 oz of skim milk and then a carbohydrate and protein snack c give a complete carbohydrate and continue to monitor the patient d administer d50 iv push and give the patient something to eat
b give 8 oz skim milk then a carbohydrate and protein snack
Which insulins are considered to have a rapid onset of action? (select all that apply) a novolin 70/30 b glulisine c humulin N d aspart c lispro
b glulisine d aspart e lispro
In determining if a patient is hypoglycemic, the nurse looks for which characteristics in addition to checking the patient's blood glucose? (select all that apply) a nausea b hunger c irritability d palpitations e profuse perspiration f rapid, deep respirations
b hunger c irritability d palpitations e profuse perspiration
Which statement about insulin is true? a exogenous insulin is necessary for management of all cases of type 2 DM b insulin's effectiveness depends on the individual patient's absorption of the drug c insulin doses should be regulated according to self-monitoring urine glucose levels d insulin administered in multiple doses per day decreases the flexibility of a patient's lifestyle
b insulin's effectiveness depends on the individual patient's absorption of the drug
Why is glucose vital to the body's cells? a it is used to build cell membranes b it is used by cells to produce energy c it affects the process of protein metabolism d it provides nutrients for genetic material
b it is used by cells to produce energy
Which is considered the earliest sign of diabetic nephropathy? a positive urine RBCs b microalbuminuria c positive urine glucose d positive urine WBCs
b microalbuminuria
Match each diabetic complication with its corresponding pathophysiology. Answers may be used more than once. Pain or numbness a Nephropathy b Neuropathy c Retinopathy
b neuropathy
a patient with diabetes presents to the emergency department with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate "all the time." How does the nurse document this subjective finding? a polydipsia and polyphagia b polydipsia and polyuria c polycoria and polyuria d polyphagia and polyesthesia
b polydipsia and polyuria
Match the insulin characteristics with the corresponding types of insulin. Answers may be used more than once. This type of insulin should be given 30 minutes before meals a insulin glargine (lantus) b regular insulin c NPH insulin
b regular insulin
Match the insulin characteristics with the corresponding types of insulin. Answers may be used more than once. When mixing insulins, this type is always drawn up first a insulin glargine (lantus) b regular insulin c NPH insulin
b regular insulin
A diabetic patient is on a mixed-dose insulin protocol of 8 units regular insulin and 12 units NPH insulin at 7 a.m. At 10:30 a.m. the patient reports feeling uneasy, shaky, and has a headache. which is the probable explanation for this? a the NPH insulin'[s action is peaking and there is an insufficient blood glucose level b the regular insulin's action is peaking, and there is an insufficient blood glucose level c the patient consumed to many calories at breakfast and now has an elevated blood glucose level d the symptoms are unrelated to the insulin administered in the early morning or diet taken in at lunchtime
b the regular insulin's action is peaking, and there is an insufficient blood glucose level
Match the descriptions with the corresponding type of diabetes. Answers may be used more than once. Cells have a reduced ability to respond to insulin a type 1 b type 2 c gestational
b type 2
Match the descriptions with the corresponding type of diabetes. Answers may be used more than once. Most who suffer with this type of diabetes are obese adults a type 1 b type 2 c gestational
b type 2
The nurse is providing discharge teaching to a patient about self-monitoring of blood glucose (SMBG). What information does the nurse include? (select all that apply) a only perform SMBG before breakfast b wash hands before using the meter c do a retest if the results seem unusual d it is ok to reuse lancets in the home setting e do not share the meter
b wash hands before using the meter c do a retest if the results seem unusual e do not share the meter
Which statement by a patient with diabetes indicates an understanding of the principles of self-care? a "I don't like the idea of sticking myself to often to measure my sugar" b "I plan to measure the sugar in my urine at least four times a day." c "I plan to get my spouse to exercise with me to keep me company." d "If I get a cold, I can take my regular cough medication until I feel better."
c "I plan to get my spouse to exercise with me to keep me company."
Which individual is at greatest risk for developing type 2 DM? a 25-year old African-American woman b 36-year old African-American man c 56-year old Hispanic woman d 40-year old Hispanic man
c 56-year old Hispanic woman
Match each diabetic complication with its corresponding pathophysiology. Answers may be used more than once. Hemorrhage into the eye a Nephropathy b Neuropathy c Retinopathy
c Retinopathy
The nurse is teaching a patient with diabetes about proper foot care. Which instructions does the nurse include? (select all that apply) a use rubbing alcohol to toughen the skin on the soles of the feet b wear open-toed shoes or sandals in warm weather to prevent perspiration c apply moisturizing cream to the feet after bathing, but not between the toes d use cold water for bathing the feet to prevent inadvertent thermal injury e do not go barefoot f inspect your feet daily
c apply moisturizing cream to the feet after bathing, but not between the toes e do not go barefoot f inspect your feet daily
Match the definition with its corresponding foot condition. Deformity where the foot is warm, swollen, painful, and walking causes the arch to collapse, giving the foot a "rocker bottom" shape a hallux valgus b claw toe deformity c charcot foot
c charcot foot
Why is glucagon given in a dextrose solution? a dextrose promotes more storage of glucose in the liver b dextrose stimulates the pancreas to produce more insulin c dextrose increases blood sugar levels at a controlled rate d dextrose inhibits glycogenesis, gluconeogenesis, and lipolysis
c dextrose increases blood sugar levels at a controlled rate
Match the descriptions with the corresponding type of diabetes. Answers may be used more than once. Carbohydrate intolerance is first recognized during pregnancy a type 1 b type 2 c gestational
c gestational
Match the descriptions with the corresponding type of diabetes. Answers may be used more than once. Diagnosis based on results of 100 g glucose tolerance test a type 1 b type 2 c gestational
c gestational
After a 2-hour glucose challenge, which result demonstrates impaired glucose tolerance? a less than 100 mg/dl b less than 140 mg/dl c greater than 140 mg/dl d greater than 250 mg/dl
c greater than 140 mg/dl
Which statement about sexual intercourse for patients with diabetes is true? a the incidence of sexual dysfunction is lower in men than women b retrograde ejaculation does not interfere with male fertility c impotence is associated with DM in male patients d sexual dysfunction in female patients includes inability to achieve pregnancy
c impotence is associated with DM in male patients
A 47 year old patient with a history of type 2 DM and emphysema that reports smoking three packs of cigarettes per day is admitted to the hospital with a diagnosis of acute pneumonia. The patient is placed on the regular oral antidiabetic agents, sliding scale insulin, and antibiotic medications. On day 2 of hospitalization, the health care provider orders prednisone therapy. What does the nurse expect the blood glucose to do? a decrease b stay the same c increase d return to normal
c increase
Which statement s true about insulin? a it is secreted by alpha cells in the islets of Langerhans b it is a catabolic hormone that builds up glucagon reserves c it is necessary for glucose transport across cell membranes d it is stored in muscles and converted to fat for storage
c it is necessary for glucose transport across cell membranes
In a patient with hyperglycemia, the respiratory center is triggered in an attempt to excrete more carbon dioxide and acid, thus causing a rapid and deep respiratory pattern. What is the term for this respiratory pattern? a tachypnea b cheyne-stokes respiration c kussmaul respiration d biot respiration
c kussmaul respiration
Which statements about sensory alteration in patients with diabetes are accurate? (select all that apply) a healing of foot wounds is reduced because of impaired sensation b very few patients with diabetic foot ulcers have peripheral sensory neuropathy c loss of pain, pressure, and temperature sensation in the foot increases the risk for injury d sensory neuropathy causes loss of normal sweating and skin temperature regulation e it can be delayed by keeping the blood glucose level as close to normal as possible
c loss of pain, pressure, and temperature sensation in the foot increases the risk for injury d sensory neuropathy causes loss of normal sweating and skin temperature regulation e it can be delayed by keeping the blood glucose level as close to normal as possible
Which class of antidiabetic medication should be given 1-30 minutes before meals? a alpha-glucosidase inhibitors, which include miglitol (glyset) b biguanides, which include metoformin (Glucophage) c meglitinides, which include nateglinide (starlix) d sulfonylureas, which include chlorpromadine (diabinese)
c meglitinides, which include nateglinide (starlix)
Which oral agent may cause lactic acidosis? a nateglinide b repaglinide c metformin d miglitol
c metaformin
Which electrolyte is most affected by hyperglycemia? a sodium b chloride c potassium d magnesium
c potassium
what is the recommended protocol for patients with type 2 DM who must lose weight? a participate in an aerobic program twice a week for 20 minutes each session b slowly increase insulin dosage until mild hypoglycemia occurs c reduce calorie intake moderately and increase exercise d reduce daily calorie intake to 1000 calories and monitor urine for ketones
c reduce calorie intake moderately and increase exercise
What type of insulin is used in the emergency treatment of DKA and hyperglycemic-hyperosmolar nonketotic syndrome (HHNS)? a NPH b lente c regular d protamine zinc
c regular
Match each diabetic complication with its corresponding pathophysiology. Answers may be used more than once. Hard exudate deposits a Nephropathy b Neuropathy c Retinopathy
c retinopathy
Match each diabetic complication with its corresponding pathophysiology. Answers may be used more than once. Neovascularization a Nephropathy b Neuropathy c Retinopathy
c retinopathy
Match each diabetic complication with its corresponding pathophysiology. Answers may be used more than once. Permanent blindness a Nephropathy b Neuropathy c Retinopathy
c retinopathy
Which statement about insulin administration is correct? a insulin may be given orally, intravenously, or subcutaneously b insulin injections should be spaced on closer than one-half inch apart c rotating injection sites improves absorption and prevents lipohypertrophy d in a mixed dose protocol, the longer acting insulin should be withdrawn first
c rotating injection sites improves absorption and prevents lipohypertrophy
glucagon is used primarily to treat the patient with which disorder? a DKA b idiosyncratic reaction to insulin c severe hypoglycemia d HHNS
c severe hypoglycemia
A 50-year old patient seen in the emergency department (ED) reported nausea, vomiting and dehydration. When admitted to the hospital, the patient's fasting blood glucose was over 500 mg/dl, and a blood gas showed a ph of 7.38. The patient was diagnosed with diabetes and treated with insulin and fluids. What do these events tell the nurse about the patient? a the diabetes is temporary b the patient will only require insulin when stressed or ill: the diabetes is temporary c the pancreas is producing enough insulin to prevent ketoacidosis d the pancreas is not producing enough insulin to prevent ketoacidosis
c the pancreas is producing enough insulin to prevent ketoacidosis
A 25-year-old female patient with type 1 diabetes tells the nurse, "I have two kidne's and I'm still young. I expect to be around for a long time, so why should I worry about my blood sugar?" What is the nurse's best response? a "you have little to worry about as long as your kidneys keep making urine." b "you should discuss this with your physician because you are being unrealistic." c "you would be right if your diabetes was managed with insulin." d "keeping your blood sugar under control now can help to prevent damage to both kidneys."
d "keeping your blood sugar under control now can help to prevent damage to both kidneys."
According to the American diabetes association (ADA), which laboratory finding is most indicative of DM? a fasting blood glucose = 80 mg/dl b 2-hr postprandial blood glucose = 100 mg/dl c 1-hr glucose tolerance blood glucose = 110 mg/dl d 2-hr glucose tolerance blood glucose = 210 mg/dl
d 2-hr glucose tolerance blood glucose = 210 mg/dl
A patient has been receiving insulin in the abdomen for 3 days. On day 4 where does the nurse give the insulin injection? a deltoid b thigh c abdomen, near the navel d abdomen, but in an area different from the previous day's injection e abdomen, in the same area as the previous day's injection
d abdomen, but in an area different from the previous day's injection
A patient with diabetes has signs and symptoms of hypoglycemia. The patient has a blood glucose of 56 mg/dl, is not alert but responds to voice, and is confused and is unable to swallow fluids. What does the nurse do next? a give a glass of orange juice with two packets of sugar and continue to monitor the patient b give a glass of orange or other type of juice and continue to monitor the patient. c give a complex carbohydrate and continue to monitor the patient d administer d50 iv push
d administer d50 iv push
What is the basic principle of meal planning for a patient with type 1 DM? a five small meals per day plus a bedtime snack b taking extra insulin when planning to eat sweet foods c high-protein, low-carbohydrate, and low fiber foods d considering the effects and peak action times of the patient's insulin
d considering the effects and peak action times of the patient's insulin
A patient with type 1 diabetes is taking a mixture of NPH and regular insulin at home. The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patient's norming dose of insulin? a administer the dose that is routinely prescribed at home because the patient has type 1 diabetes and needs the insulin b administer half the dose because the patient is NPO c hold the insulin with all the other medications because the patient is NPO and there is no need for insulin d contact the health care provider for an order regarding the insulin
d contact the health care provider for an order regarding the insulin
Which laboratory test is the best indicator of a patient's average blood glucose level and/or compliance with the DM regimen over the last 3 months? a postpradial blood glucose test b oral glucose tolerance test (OGTT) c casual blood glucose test d glycosylated hemoglobin (HbA1c)
d glycosylated hemoglobin (HbA1c)
Which are modifiable risk factors for type 2 diabetes mellitus? (select all that apply) a age b family history c working in a low-stress environment d maintaining ideal body weight e maintaining adequate physical activity
d maintaining ideal body weight e maintaining adequate physical acitvity
Untreated hyperglycemia results in which condition? a respiratory acidosis b metabolic alkalosis c respiratory alkalosis d metabolic acidosis
d metabolic acidosis
Early treatment of DKA and HHNS includes IV administration of which fluid? a glucagon b potassium c bicarbonate d normal saline
d normal saline
Which class of antidiabetic medication is most likely to cause a hypoglycemic episode because of the long duration of action? a alpha-glucosidase inhibitors, which include miglitol (glyset) b biguanides, which include metoformin (Glucophage) c meglitinides, which include nateglinide (starlix) d sulfonylureas, which include chlorpromadine (diabinese)
d sulfonylureas, which include chlorpromadine (diabinese)
A patient with type 2 DM, usually controlled with a sulfonylurea, develops a urinary tract infection. Due to the stress of the infection, the patient must be treated with insulin. What additional information about this treatment does the nurse relay to the patient? a the sulfonylurea must be discontinued and insulin taken until the infection clears b insulin will now be necessary to control the patient's diabetes for life c the sulfonylurea dose must be reduced until the infection clears d the insulin is necessary to supplement the sulfonylurea until the infection clears
d the insulin is necessary to supplement the sulfonylurea until the infection clears
A patient will be using an external insulin pump. What does the nurse tell the patient about the pump. a self-monitoring of blood glucose levels can be done only twice a day b the insulin supply must be replaced every 2 to 4 weeks c the pump's battery should be checked on a regular weekly schedule d the needle site must be changed every 1 to 3 days
d the needle site must be changed every 1 to 3 days
