NSG 170 exam 1 (glucose regulation)

insulin deficiency; autoimmune in nature; destruction of beta cells

Type 1 diabetes mellitus

hyperglycemia

100 mg/dL --->

Which fasting plasma (FPG) level would indicate a client has prediabetes? 70mg/dL 100mg/dl 130mg/dL 160mg/dL

100mg/dl

Fasting plasma glucose is being tested. The nurse identifies that the client is considered to be diabetic if the results are within which range? 40-60 mg/dL 80-99 mg/dL 100-125 mg/dL 126-140 mg/dL

126-140 mg/dL

Clinical manifestation of diabetes (all 3 types)

3 aunt ploys, blurred vision, fatigue, slow wound healing, yeast infections, uti, mood changes

Treatment of DKA/HHS

8-10 L fluid replacement, regular insulin infusion by IV, monitor K+ and cardiac function for complications

Hypoglycemia

<70 mg/dL

how many times should a diabetic monitor their glucose?

Blood glucose should be monitored 3-4 times a day; before meals; AM/PM

Treatment for hypoglycemia (T1D/T2D)

Check glucose, assess LOC (if conscious/alert give 25-50% glucose solution), 15/15 rule, if altered (parenteral D50/D10/D5 via IV or glucagon via IM), hospitalized if BG < 50 mg/dL, coma, seizures, altered behavior

diabetes only during pregnancy; caused by an alteration in placental hormones

gestational diabetes

a hospitalized child with T1D has become pale, diaphoretic, and shaky 2 hours after eating breakfast. Which action should the nurse take? notify HCP administer supplemental insulin obtain current blood glucose level give orange juice with slice of bread

obtain current blood glucose level

Which result would the nurse expect to see on the ECG traging monitor when. a client had DKA and a K+ of 5.4 mEq/L? abnormal P waves and depressed T waves peaked T waves and widened QRS complexes abnormal Q waves and prolonged ST segments peaked P waves and an inc number of T waves

peaked T waves and widened QRS complexes

Which clinical findings are commonly associated with hyperglycemia? polyuria polydipsia polyphagia polyphrasia polydysplasia

polyuria polydipsia polyphagia

Complications of gestational diabetes

preeclampsia, hydraminos, congenital defects, LGA, neonatal hypoglycemia

Which common cause of DKA would consider when caring for a postoperative client with diabetes? emotional stress presence of infection inc insulin dose inadequate food intake

presence of infection

Which are risk factors of diabetes in pregnancy? preterm birth hypertension cesarean birth placenta previa placental abruption

preterm birth hypertension cesarean birth

Which eye problem is the leading cause of blindness in clients with diabetes? cataracts glaucoma retinopathy astigmatism

retinopathy

An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus? Ketones glucose lactic acid glutamic acid

ketones

Sick Day Rules (Diabetes)

- Never stop taking insulin or oral antidiabetic agents - Measure blood glucose more frequently - Test urine for ketones and glucose (type 1 >250) - Alternatives to solid foods (milk, soup, cereal, ice cream, pudding, fruit juice, or fizzy drinks) and drink plenty of liquids!

Hyperosmolar Hyperglycemic Syndrome (HHS)

A metabolic complication of uncontrolled type 2 diabetes, similar in severity to diabetic ketoacidosis but without ketosis and acidosis.

Diabetic Ketoacidosis (DKA)

Shortage of insulin resulting in hyperglycemia and production of ketones; only occurs in T1D

Which assessment finding is most significant in an infant of a diabetic mother who is large for gestational age? temp less than 98oF HR of 110 BPM blood glucose < 40 mg/dL increasing bilirubin during first 24hrs

blood glucose < 40 mg/dL

Which common complaints of diabetes would the nurse assess for in a client with a long hx of the disease? leg ulcer loss of visual acuity increased creatinine clearance prolonged capillary refill in toes dec sensation in the lower extremities

leg ulcer loss of visual acuity prolonged capillary refill in toes dec sensation in the lower extremities

Target HbA1c

less than 7%; 6.5% or less

T1D prevention

no prevention

Dawn Syndrome

rise in blood glucose levels between 4am and 8am in response to hypoglycemia during the night

prevention for gestational diabetes

screening is standard from 24-28 weeks of pregnancy, pre-pregnancy consultation, diet, exercise, eye exams

Which outcome is the best indication that a client with T1D is successfully managing the disease? reduction in excess body weight stabilization of serum glucose demonstrated knowledge of the diease adherence to the prescription for insulin

stabilization of serum glucose

Acanthosis nigricans

thickening and darkening of skin near axillary region in patients with Diabetes Type II; also a sign of prediabetes

Which is an appropriate teaching goal for a client who is newly dx as T2D? to perform foot care weekly to administer insulin as prescribed to test urine for both sugar and acetone to identify symptoms of hypoglycemia or hyperglycemia

to identify symptoms of hypoglycemia or hyperglycemia

insulin resistance; defect in insulin secretion; obesity/physical inactivity

type 2 diabetes

Which factor may have precipitated ketoacidosis in a client with T1D who has been adhering to a prescribed insulin regimen? increase exercise dec food intake working night shift upper respiratory infection

upper respiratory infection

Which results would be expected when assessing the lab values of a client with T2D? ketones in blood but not in urine glucose in urine but not in blood urine and blood positive for glucose and ketones urine negative for ketones and positive glucose in blood

urine negative for ketones and positive glucose in blood

Which statement is accurate when teaching a client with diabetes about foot care? remove any corns on your feet wear shoes that are a size larger than your feet examine your feet weekly for potential sores wear synthetic fiber socks when exercising

wear synthetic fiber socks when exercising

A T1D receives humulin R insulin in the AM. Shortly before lunch the nurse identifies the client is diaphoretic and trembling. Which intervention is appropriate? administer insulin give the client lunch immediately encourage the client to drink fluids assess the blood glucose level

assess the blood glucose level

Complication of T1D/T2D

diabetic retinopathy, periodontal disease, neuropathy, nephropathy, CV disease, PVD, CAD, inc risk for infections

T2D Prevention

dietary management, medications for people at risk for prediabetes, exercise, monitor BGL, screen for A1C

A client newly diagnosed with T1D asks why it is necessary to exercise on a regular basis. Which response is accurate? exercise dec insulin sensitivity it stimulates glucagon production exercise improves the cellular uptake of glucose it reduces metabolic requirements for glucose

exercise improves the cellular uptake of glucose

Which intervention would the nurse implement for a client who has T1D and has elevated blood glucose? administer oral hypoglycemic institute urine glucose monitoring give supplemental doses of regular insulin dec rate of IV infusion

give supplemental doses of regular insulin

Which hormone causes the blood glucose level to rise? insulin glucagon epinephrine ACTH

glucagon

Which symptoms would be seen in a client with T1D who is experiencing hypoglycemia? vomiting headache tachycardia cool, clammy skin inc respirations

headache tachycardia cool, clammy skin

Which lab value supports the presence of diabetic ketoacidosis in a client with T1D? dec serum glucose dec serum calcium levels inc BUN levels inc serum bicarbonate levels

inc BUN levels (bc of dehydration)

What will happen to insulin needs during pregnancy for a mother with gestational diabetes?

insulin needs my double or quadruple by the end of pregnancy

Somogyi phenomenon

A rebound phenomenon that occurs in clients with type 1 diabetes mellitus. Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at about 2 to 3 am. Counterregulatory hormones, produced to prevent further hypoglycemia, result in hyperglycemia (evident in the prebreakfast blood glucose level).

Which initial intervention would the nurse expect the primary HCP to order for a client admitted to the hospital with a dx of DKA? IV fluids potassium NPH insulin sodium polystyrene sulfonate (kayexalate)

IV fluids

Which nursing intervention is appropriate when a client is FIRST admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? providing oxygen encouraging carbs administering fluid replacement teaching facts about dietary principles

administering fluid replacement

An obese client with T2D asks about the intake of alcohol or special 'dietetic' food in the diet. Which instruction would be included in the teaching plan? alcohol can be consumed, with its calories counted in the diet unlimited amounts of sugar substitutes can be used as desired alcohol should not be used in cooking because it adds too many calories special dietetic foods are needed because many regular foods cannot be used

alcohol can be consumed, with its calories counted in the diet

What physiological changes would the nurse expect to find in a client with a 20-year hx of T2D? blurry, spotty, hazy vision arthritic changes in hands hyperactive knee and ankle jerk reflexes dependent pallor of the feet and lower legs

blurry, spotty, hazy vision

Which is the primary fluid shift that occurs with diabetes mellitus? intravascular to interstitial because of glycosuria interstitial to extrecellular because of hypoproteinemia intracellular to intravascular because of hyperosmolarity intracellular to intravascular because of inc hydrostatic pressure

intracellular to intravascular because of hyperosmolarity

A client with T1D has hot dry flushed skin; fruity odor to breath; and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? ketoacidosis somogyi phenomenon hypersomolar nonketotic coma hypoglycemic reaction

ketoacidosis