Patho/Pharm Exam #2 Final Review

What are the treatment goals for the ABCs of diabetes?

1. HgbA 2. BP 3. Cholesterol: Lipid Profile

What are 8 manifestations of DM?

1. Hyperglycemia 2. glucosuria 3. Polyuria 4. Polydispsia 5. Polyphagia 6. Weight loss 7. Blurred vision 8. Fatigue

What 5 symptoms from dehydration and acidosis may occur while in a hyperglycemic episode

1. Nausea 2. Vomiting 3. Abdominal cramps 4. Fatigue 5. Polyphagia 6. Polydipsia

What are 9 consequences of Hypoglycemia?

1. Nervousness 2. Irritability 3. Diaphoresis 4. Anxiety 5. Palpitations 6. Neurological changes 7. Seizures 8. Unconsciousness 9. Death

Which hormone would the nurse identify as inhibiting insulin and glucagon secretion? A. Amylin B. Somatostatin C. Triiodothyronine D. Pancreatic polypeptide

B. Somatostatin

islets of langerhans are situated among the many small ________

acini

what are cell clusters that produce digestive enzymes

acini

in prediabetes, Cells are insulin-resistant, potentially due to ________________ secreted by adipose cells

adipokines

_______________ ___________ secrete glucagon when serum glucose levels fall

alpha cells

Insulin lispro is an __________ of human insulin

analog

Both hormones cortisol and glucagon are insulin-______________

antagonistic

In prediabetes, glucose levels in the blood increase as a result of insulin resistance, this causes the ____________ to increase insulin production to compensate

pancreas

_________________ _______________ _____________ is the growth of new retinal blood vessels, also known as "neovascularization"

proliferative diabetic retinopathy

Insulin glargine and insulin degludec have a ___________ duration of action

prolonged

Insulin lispro has a _______ onset in approximately _______ minutes

rapid; 15 minutes

Unopened insulin vials should be stored under ____________ until needed

refrigeration

NPH insulins can be mixed with _______-________ insulins

short-acting

An example of a DPP-4 inhibitors

sitagliptin

_______________ regulates insulin and glucagon

somatostatin

Insulin should be kept out of __________ and _____________

sunlight and extreme heat

Regular insulin is _____________ human insulin

unmodified

Glucagon is released from _______ -_____________ ___________ in the pancreas during the acute stage of of hypoglycemia

α-Langerhans cells

List 9 signs and symptoms of hyperglycemia

1. Polyuria 2. Polydipsia 3. Dehydration 4. Fatigue 5. Fruity odor to breath 6. Kussmaul breathing 7. Weight loss 8. Hunger 9. poor wound healing

What are 3 possible drug interactions that can be involved with complications of insulin treatment?

1. Hypoglycemic agents 2. Hyperglycemic agents 3. Beta-adrenergic blocking agents (medicines that lower blood pressure)

How does DPP-4 inhibitors (Sitagliptin) work?

1. Promotes glycemic control by enhancing the actions of incretin hormones 2. Stimulates glucose-dependent release of insulin 3. Suppress postprandial release of glucagon

How does Thiazolidinediones (Pioglitazone) work?

1. Improves sensitivity to insulin be acting as an agonist at receptor sites and also glucose production and use 2. Requires presence of insulin for activity 3. Decreases insulin resistance without hypoglycemia

What are the SE/AE of sodium-glucose co-transporter 2 (SGLT-2) inhibitors (Empagliflozin)

1. Ketoacidosis!!! 2. Necrotizing fasciitis of perineum!!! 3. Urosepsis!!! 4. Genital fungal infections in females 5. UTI 6. Polyuria

What 3 cardio/pulmonary findings would the nurse expect to find in a patient experiencing DKA?

1. Kussmaul Respirations 2. Acetone Breath 3. Tachycardia (if dehydrated)

What are the 2 SE/AE of Metformin?

1. Lactic Acidosis!!! 2. GI upset

What are 4 complications of insulin treatment?

1. Lipohypertrophy (a lump of fatty tissue under your skin caused by repeated injections in the same place) 2. Allergic reactions 3. Hypokalemia (Low blood potassium levels) 4. Drug interactions

How does Alpha-glucosidase inhibitors (Acarbose) work?

1. Lower blood sugar by inhibiting the enzyme alpha-glucosidase in the GI tract 2. Delays and reduced glucose absorption 3. Especially helpful in postprandial hyperglycemia

How does Sulfonylureas (Glyburide) work?

1. Lowers BS by stimulating insulin to be secreted by pancreas 2. Increases sensitivity to insulin at receptor sites 3. May decrease hepatic glucose production

What is Biguanides (metformin) used for?

1. Management of Type 2 Diabetes 2. May be used in combination with good diet, insulin, or sulfonylurea oral hypoglycemics

What are Alpha-glucosidase inhibitors (Acarbose) for?

1. Management of blood sugar in T2DM 2. May use with insulin or other hypoglycemic agents

What do you educate a patient taking DPP-4 inhibitors (Sitagliptin)

1. Monitor for signs of pancreatitis 2. Assess for SJS rashes 3. Monitor renal function 4. Given with or w/out food 5. Follow diet/exercise plan 6. Monitor BS

After opening, insulin can be kept up to ______ month(s) without significant loss of activity

1

Insulin mixtures in prefilled syringes should be stored in a refrigerator for at least _______ _________ with the needle pointing up

1 week

How does sodium-glucose co-transporter 2 (SGLT-2) inhibitors (Empagliflozin) work?

1. Blocks reabsorption of filtered glucose in the kidney, leading to glucosuria 2. Increases excretion of glucose in urine

What are 6 different diagnostic test that can be performed to assess a patient with diabetes

1. Blood glucose testing 2. Antibody testing 3. Lipid analysis 4. Renal function tests 5. C-reactive protein 6. HgA1c testing

What do you educate to a patient taking Alpha-glucosidase inhibitors (Acarbose)

1. Check blood sugar regularly 2. Monitor liver enzymes 3. Give with first bite of each meal 3/day 4. Give at the same time daily 5. Follow diet/exercise plan

What do you educate to a patient taking Meglitinides (Repaglinide)

1. Check blood sugar regularly 2. Proper diet and exercise plans 3. Give before meals 4. Usually well tolerated

Which findings would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? (SATA) 1. Confusion 2. Drowsiness 3. Diaphoresis 4. Nervousness 5. Heart rate 110 beats/min

1. Confusion 2. Drowsiness 3. Diaphoresis 4. Nervousness 5. Heart rate 110 beats/min

What are Meglitinides (Repaglinide) for?

1. Control blood sugar in T2DM 2. May be used with metformin, rosiglitazone, or pioglitazone

What is Thiazolidinediones (Pioglitazone) for?

1. Control blood sugar in T2DM 2. May use with metformin, sulfonylureas, or insulin

What is Sulfonylureas (Glyburide) used for?

1. Control blood sugar in T2DM when diet therapy is not working 2. First antidiabetic medication available

What is the peak duration of regular insulin if given SQ

1-5 hours

___-___________ regulates other glucose-regulatory hormones including glucagon and epinephrine synthesis

1-cortisol

How does Biguanides (metformin) work? (3)

1. Decreases hepatic glucose production 2. Decreases intestinal glucose absorption 3. Increases sensitivity to insulin

What are 3 findings the nurse would find during a skin assessment of a hypoglycemic patient?

1. Diaphoresis 2. Cool 3. Clammy

What do you educate to a patient who is taking metformin?

1. Do not consume alcohol 2. Diet and exercise is important 3. Renal function tests during long term use 4. Take at the same time daily

What do you educate to a patient taking Sulfonylureas (Glyburide)?

1. Do not consume alcohol 2. Monitor weight & CBC w/ long term use 3. Take at the same time daily, check BS 4. Follow diet and exercise plan 5. Avoid aspirin 6. Use sunscreen

what are the SE/AE for Sulfonylureas (Glyburide)

1. Erythema multiforme!!! 2. Photosensitivity 3. Aplastic anemia 4. Weight gain 5. Hypoglycemia 6. Cardiotoxicity

An example(s) of GLP-1 receptor agonists

1. Exenatide [Byetta] 2. Semaglutide [Ozempic]

What are the SE/AE associated with the use of Alpha-glucosidase inhibitors (Acarbose)

1. GI Upset 2. Liver dysfunction 3. Hypoglycemia

What are the 2 Counterregulatory hormones to raise glucose

1. Glucagon 2. Cortisol

What are long-term consequences of hyperglycemia due to macrovascular damage

1. HTN 2. Cardiovascular and Peripheral vascular disease

What are the SE/AE associated with Thiazolidinediones (Pioglitazone)?

1. Heart failure!!! 2. Liver failure!!! 3. Bladder cancer!!! 4. Rhabdomyolysis!!! 5. URI, sinusitis 6. Headache 7. Myalgia

What secondary prevention education would the nurse provide for a patient with diabetes (3)

1. A1C measurements twice a year 2. Annual renal function and lipid tests 3. Dental, foot, and eye examinations

What are sodium-glucose co-transporter 2 (SGLT-2) inhibitors (Empagliflozin) for?

1. Adjunct to diet and exercise in T2DM 2. Reduce risk of CV death in T2DM with CV disease 3. Reduce risk of CV death and hospitalizations for HF in patient with HF

What is GLP-1 receptor agonists (Semaglutide [Ozempic]) used for?

1. Adjunct to diet and exercise in T2DM 2. Reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes mellitus and established cardiovascular disease

What are 7 risk factors for impaired glucose regulation?

1. Age 2. Pregnancy 3. Racial and ethnic groups 4. Genetics 5. Lifestyle 6. Family Hx 7. Selected medications

what are the SE/AE associated with Meglitinides (Repaglinide)

1. Angina 2. Hypoglycemia

What are 6 findings the nurse would find during a neuro assessment of a hypoglycemic patient?

1. Anxiety 2. Irritability 3. Confusion 4. Seizeres 5. Unconsciousness 6. Coma

What do you educate to a patient taking SE/AE of GLP-1 receptor agonists (Semaglutide [Ozempic])?

1. Assess for s/sx of pancreatitis 2. Monitor A1C 3. Monitor HR 4. Proper injection techniques 5. Follow diet/exercise plans

What do you educate for a patient taking SE/AE for GLP-1 receptor agonists (Exenatide)?

1. Assess for s/sx of pancreatitis 2. Monitor renal function 3. Take 60 min. before meals 4. Proper injection techniques 5. Follow diet/exercise plans

What do you educate to a patient taking a sodium-glucose co-transporter 2 (SGLT-2) inhibitor (Empagliflozin)

1. Assess signs of dehydration 2. Monitor UOP 3. Give at the same time daily with or w/out food 4. Follow diet/exercise plans 5. Assess skin for ulcers and sores 6. Assess for yeast in females

List 8 signs and symptoms of hypoglycemia

1. Reduced Cognition 2. Tremors 3. Diaphoresis 4. Weakness 5. Hunger 6. Headache 7. Irritability 8. Seizure

What are the 3 major microvascular complications of diabetes

1. Retinopathy 2. Nephropathy 3. Neuropathy

What are long-term consequences of hyperglycemia due to microvascular damage

1. Retinopathy 2. Nephropathy 3. Preipheral Neuropathy

What are the 4 approved routes for regular insulin?

1. SUBQ 2. IV infusion 3. IM 4. Oral inhalation

How is GLP-1 receptor agonists (Semaglutide [Ozempic]) taken?

1. SUBQ injection 2. PO form available

What do you educate for a patient taking Thiazolidinediones (Pioglitazone)?

1. Signs of HF 2. Monitor CBC & liver enzymes with long term use 3. Take at the same time daily 4. Follow diet and exercise plans 5. Give with or without food

How does GLP-1 receptor agonists (Exenatide)

1. Slows gastric emptying 2. Stimulates glucose-dependent release of insulin 3. Inhibits postprandial release of glucagon and suppresses appetite

How does GLP-1 receptor agonists (Semaglutide [Ozempic]) work?

1. Slows gastric emptying 2. Stimulates glucose-dependent release of insulin 3. Inhibits postprandial release of glucagon and suppresses appetite

What are the SE/AE associated with DPP-4 inhibitors (Sitagliptin)

1. Stevens Johnson Syndrome!!! 2. Pancreatitis!!! 3. Rhabdomyolysis!!! 4. GI upset 5. Heart failure

How does Meglitinides (Repaglinide) work?

1. Stimulates insulin to release by closing the potassium channels 2. Opens calcium channels in beta cells to release insulin

What cardio/pulmonary changes occur during a patient experiencing hypoglycemia?

1. Tachycardia 2. No respiratory changes

What are the SE/AE of GLP-1 receptor agonists (Semaglutide [Ozempic])

1. Thyroid C-cell tumors!!! 2. Pancreatitis!!! 3. Abdominal pain, constipation, diarrhea, nausea, vomiting 4. Decreased appetite 5. Weight loss 6. Tachycardia

What are the SE/AE for GLP-1 receptor agonists (Exenatide)?

1. Thyroid C-cell tumors!!! 2. Pancreatitis!!! 3.Thrombocytopenia!!! 4. Decreased appetite 5. Weight loss 6. CNS changes

What are the 3 dosing schedules of Insulin?

1. Twice daily premixed insulin regimen 2. Intensive basal/bolus strategy 3. Continuous subcutaneous insulin

What 2 skin assessment findings would the nurse expect to find in a patient experiencing a hyperglycemic episode?

1. Warm 2. Moist

In what order will the nurse perform the actions associated with insulin administration?

1. Wash hands with soap and water 2. Rotate the vial of insulin between the palms of the hands 3. Wipe the top of the insulin vial with alcohol swab 4. Instill air into the vial of insulin equal to the desired dose 5. Withdraw the correct amount of insulin from the inverted vial

Symptoms related to degree of hypoglycemia and can include what 8 symptoms

1. Weakness 2. Dizziness 3. Headache 4. Hunger 5. Blurred vision 6. Difficulty concentrating 7. feeling shaky 8. Palpitations

High blood glucose and HTN can damage eye blood vessels, causing what 3 disorders?

1. retinopathy 2. Cataracts 3. Glaucoma

it is suggested that the caloric intake of a diabetic person's diet should be limited to _______% Saturated fats

10%

NPH insulin has a duration of ______-______ hours

10-16 hours

How quick do the effects of regular insulin begin if given IV

10-30 minutes

What is the peak duration of regular insulin if given IV

15-30 minutes

Mixtures of insulin in vials are stable for _______ month(s) at room temperature and for __________ month(s) under refrigeration

1; 3

NPH insulin is injected ______ or ______ times daily to provide glycemic control between meals and during the night

2-3 times daily

NPH insulin has an onset of ______-______ hours

2-4 hours

Which information would the nurse include in the teaching plan of an adolescent who is found to have T1DM (SATA) A. Insulin therapy B. Prophylactic antibiotics C. Blood glucose monitoring D. Oral hypoglycemic agents E. Adherence to the treatment regimen

A. Insulin therapy C. Blood glucose monitoring E. Adherence to the treatment regimen

Which complication associated with T1DM should the nurse include in the teaching plan for the parent of a newly diagnosed child? A. Obesity 2. Ketoacidosis 3. Resistance to treatment 4. Hypersensitivity to other medications

2. Ketoacidosis

it is suggested that the caloric intake of a diabetic person's diet should be _______% Protein

20%

S/S of DKA can often develop as quickly as ______ hours

24

Insulin glargine and insulin degludec have an onset of _____-_____ hours

3-4 hours

Insulin lispro has a short duration of _______-_______ hours

3-5 hours

An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus? A. Ketones B. Glucose C. Lactic acid D. Glutamic acid

A. Ketones

Which is an appropriate teaching goal for a client who is newly diagnosed as having T2DM? A. To perform foot care weekly B. To administer insulin as prescribed C. To test urine for both sugar and acetone D. To identify symptoms of hypoglycemia or hyperglycemia

D. To identify symptoms of hypoglycemia or hyperglycemia

S/S of _______ include confusion, excessive thirst, fruity-scented breath, frequent urination, N/V, Abd pain, weakness of fatigue, and Kussmaul respirations

DKA

Which factors can predispose a client with T1DM to a DKA coma? (SATA) 1. Taking too much insulin 2. Getting too much exercise 3. Excessive emotional stress 4. Running a fever with the flu 5. eating fewer calories than prescribed

3. Excessive emotional stress 4. Running a fever with the flu

it is suggested that the caloric intake of a diabetic person's diet should be _______% Fat

30%

How quick do the effects of regular insulin begin if given SQ

30-60 minutes

What is the duration of regular insulin if given IV?

30-60 minutes

Insulin Lispro has a peak of _____-_______ minutes

30-90 minutes

NPH insulin has a peak of _____-______ hours

4-10 hours

Insulin lispro should be injected ____-____ minutes before meals

5-10 minutes

What is the duration of regular insulin if given SQ?

5-7 hours (up to 10 hours)

What is the HgA1C value that would place a client as prediabetic?

5.7 to less than 6.5%

it is suggested that the caloric intake of a diabetic person's diet should be _______% carbohydrates

50%

The nurse is assessing a client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? A. "I will stop taking my insulin when I am ill because I am not eating B. "I will check my urine for ketones when my blood sugar is over 250" C. "I will alternate drinking gatorade and water throughout the day while ill" D. "I will continue all my insulin including my glargine when I am sick"

A. "I will stop taking my insulin when I am ill because I am not eating

An obese client with type 2 diabetes asks about the intake of alcohol or special "dietetic" food in the diet. Which instruction would be included in the teaching plan? A. Alcohol can be consumed, with its calories counted in the diet B. Unlimited amounts of sugar substitutes can be used as desired C. Alcohol should not be used in cooking because it adds too many calories D. Special "dietetic" foods are needed because many regular food cannot be used

A. Alcohol can be consumed, with its calories counted in the diet

Which physiological changes would the nurse expect to find in a client with a 20-year Hx of T2DM? A. Blurry, spotty, or hazy vision B. Arthritic changes in the hands C. Hyperactive knee and ankle jerk reflexes D. Dependent pallor of the feet and lower legs

A. Blurry, spotty, or hazy vision

Which child would the nurse recommend screeming for type 2 diabetes mellitus (T2DM) during a local health screening (SATA) A. Child who recently turned 10 years old, has not yet entered puberty, and has no other risk factors B. 7-year-old child, BMI in the 80th percentile, no other risk factors C. African-American child, BMI in the 87th percentile, family history of diabetes D. 9-year-old Hispanic child, BMI in the 90th percentile, no other risk factors E. Caucasian child, BMI in the 96th percentile, signs of insulin resistance

A. Child who recently turned 10 years old, has not yet entered puberty, and has no other risk factors C. African-American child, BMI in the 87th percentile, family history of diabetes E. Caucasian child, BMI in the 96th percentile, signs of insulin resistance

Which factors contribute to a client's slow rate of healing? (SATA) A. Diabetes B. Cataract C. Smoking D. Dermatitis E. Alcohol abuse

A. Diabetes C. Smoking E. Alcohol abuse

The nurse is formulating a teaching plan for a client recently diagnosed with T2DM. Which interventions would the nurse include to decrease the risk of complications? (SATA) A. Examine feet daily B. Wear well-fitting shoes C. Perform regular exercise D. Powder the feet after showering E. Visit the PHCP weekly F. Test bathwater with the toes before bathing

A. Examine feet daily B. Wear well-fitting shoes C. Perform regular exercise

A client is taught how to recognize signs of a hypoglycemic reaction. Which symptoms identified by the client indicate to the nurse that the teaching was effective? A. Fatigue B. Nausea C. Weakness D. Nervousness E. Increased Thirst F. Increased perspiration

A. Fatigue C. Weakness D. Nervousness F. Increased perspiration

Which manifestation would lead a nurse to suspect that a client with uncontrolled diabetes is experiencing hypoglycemia in response to insulin administration? (SATA) A. Headache B. Confusion C. Extreme thirst D. Profuse sweating E. Increased urination

A. Headache B. Confusion D. Profuse sweating

The nurse is monitoring the newborn of a diabetic mother for tremors, periods of apnea, cyanosis, and poor suckling ability. With which complication are these manifestations associated? A. Hypoglycemia B. Hypercalcemia C. CNS edema D. Congenital depression of the islets of Langerhans

A. Hypoglycemia

An adolescent with type 1 diabetes mellitus is admitted to the intensive care unit in ketoacidosis with a blood glucose level of 170 mg/dL. A continuous insulin infusion is started. Which adverse reaction to the infusion is most important for the nurse to monitor? A. Hypokalemia B. Hypovolemia C. Hypernatremia D> Hypercalcemia

A. Hypokalemia

Which nursing intervention is appropriate to include in the plan of care for a client with DKA? A. IV administration of regular insulin B. Administer insulin glargine SUBQ at hour of sleep C. Maintain nothing NPO status D. Iv administration of 10% dextrose

A. IV administration of regular insulin

Which laboratory value supports the presence of DKA? A. Increased serum lipids B. Decreased hematocrit level C. Increased serum calcium levels D. Decreased blood urea nitrogen levels

A. Increased serum lipids

An adolescent with a Hx of T1DM is admitted in ketoacidosis. Which cause would the nurse suspect as precipitating this episode of ketoacidosis? A. Infection B. Increased exercise C. Recent weight loss D. Overdose of insulin

A. Infection

A client who is 60 pounds (27.2kg) more than the ideal body weight is admitted to the hospital with a diagnosis of T1DM. Which concept would the nurse include in teaching about diabetes when discussing strategies to lose weight? A. Obesity leads to insulin resistance B. Surplus fat causes excretion of insulin C. Fat cells absorb insulin and prevent its circulation to other cells D. Lipids accumulate in the pancreas and interfere with insulin production

A. Obesity leads to insulin resistance

Which statement would a nurse make about older adults and T2DM? A. Older adults seldom develop ketoacidosis B. Older adults secrete no endogenous insulin C. Older adults have a lower risk of complications D. Older adults develop a sudden onset of symptoms

A. Older adults seldom develop ketoacidosis

Which mechanism of action explains how glyburide decreases serum glucose levels? A. Stimulates the pancreas to produce insulin B. Accelerates the liver's release of stored glycogen C. Increases glucose transport across the cell membrane D. Decreases absorption of glucose from the gastrointestinal system

A. Stimulates the pancreas to produce insulin

What is the HgA1C value that would place a client as diabetic?

Above 6.5%

An example of an alpha-glucosidase inhibitor

Acarbose

___________ cells also secrete immune/inflammatory substances that impair insulin sensitivity and glucose metabolism

Adipose

What are GLP-1 receptor agonists (Exenatide) used for?

Adjunct to diet and exercise in T2DM

Death may occur from ________ crisis if Addison disease is left untreated

Adrenal

______________ can potentiate the effect of oral hypoglycemics

Allopurinol

a peptide hormone released from the beta cells along with insulin and has a synergistic relationship with insulin in controlling glucose

Amylin

What are the DPP-4 inhibitors (Sitagliptin) for?

As an adjunct to diet and exercise in T2DB blood sugar management

Peripheral vascular disease results from ______________

Atherosclerosis

Which fasting plasma glucose value (mg/dL) is diagnostic for prediabetes? A. 70 mg/dL B. 100 mg/dL C. 130 mg/dL D. 160 mg/dL

B. 100 mg/dL

The primary health care provider prescribes daily fasting blood glucose level for a client with diabetes mellitus. Which is the goal of fasting glucose levels for a client with diabetes mellitus? A. 40 to 65 mg/dL of blood B. 70 to 105 mg/dL of blood C. 110 to 145 mg/dL of blood D. 150 to 175 mg/dL of blood

B. 70 to 105 mg/dL of blood

When will the nurse monitor for a potential hypoglycemic reaction after administering daily regular insulin to a client with type 1 diabetes at 8 am? A. At breakfast B. Before lunch C. Before dinner D. In the early afternoon

B. Before lunch

A student with T1DM asks the nurse which primary hormone causes the blood glucose level to rise. Which hormone would the nurse report? A. Insulin B. Glucagon C. Epinephrine D. ACTH

B. Glucagon

A child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 am each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur? A. Before noon B. In the afternoon C. Within 30 minutes D. During the evening

B. In the afternoon

Which molecule excessively accumulates in the blood to precipitate the signs and symptoms associated with a diabetic coma? A. Sodium bicarbonate, causing alkalosis B. Ketones as a result of rapid fat breakdown, causing acidosis C. Nitrogen from protein catabolism, causing ammonia intoxication D. Glucose from rapid carbohydrate metabolism, causing drowsiness

B. Ketones as a result of rapid fat breakdown, causing acidosis

Which responses would the nurse expect a client experiencing hypoglycemia to exhibit? (SATA) A. Nausea B. Palpitation C. Tachycardia D. Nervousness E. Warm, dry skin F. Increased respirations

B. Palpitation C. Tachycardia D. Nervousness

A diabetes mellitus complains of difficulty seeing. Which factor would the nurse suspect as being the cause? A. Lack of glucose in the retina B. The growth of new retina blood vessels or "neovascularization" C. Inadequate glucose supply to rods and cones D. Destructive effect of ketones on retinal metabolism

B. The growth of new retina blood vessels or "neovascularization"

A child receiving 45 unites of intermediate-acting insulin at 7:00 am and 7:00 pm. Which statement by the nurse is most appropriate when discussing bedtime snacks with the parent? A. "offer a snack at bedtime if there are signs of hyperglycemia B."Provide a bedtime snack to prevent hypoglycemia during the night" C. "Withhold the snack after dinner to prevent hyperglycemia during sleep" D. "Leave a snack at the bedside in case the child become hungry during the night"

B."Provide a bedtime snack to prevent hypoglycemia during the night"

What value is defined as sever Hypoglycemia?

BG < 50 mg/dL

What value is defined as Hypoglycemia

BG < 70 mg/dL

What BG value is defined as hyperglycemia post-prandial

BG >140 mg/dL

What BG value is defined as severe hyperglycemia post-prandial

BG>180 mg/dL

What is a normal HgA1c value for a person without diabetes?

Below 5.7%

Hyperglycemia may destroy/desensitize _________ cells (glucose toxicity

Beta

_________ ____________ secrete insulin when serum glucose levels increase and amylin to enhance insulin

Beta Cells

Which response would be given by the nurse of an adolescent who has just been found to have T1DM and asks about exercise? A. "exercise should be restricted" B. "Exercise will increase blood glucose" C. "Extra snacks are needed before exercise" D. "Extra insulin is required during exercise"

C. "Extra snacks are needed before exercise"

______________ is steroid hormone. It crosses cell membranes and binds to its nuclear receptor

Cortisol

Between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage? A. 10th and 12th weeks of gestation B. 18th and 22nd weeks of gestation C. 24th and 28th weeks of gestation D. 36th and 40th weeks of gestation

C. 24th and 28th weeks of gestation

Which assessment finding would the nurse associate with a client with diabetic ketoacidosis? (SATA) A. Diaphoresis B. Retinopathy C. Acetone Breath D. Increased arterial bicarbonate level E. Decreased arterial carbon dioxide level

C. Acetone Breath E. Decreased arterial carbon dioxide level

Which nursing intervention is appropriate when a client is first admitted with HHNKS? A. Providing O2 B. Encouraging carbohydrates C. Administering fluid replacement D. Teaching facts about dietary principles

C. Administering fluid replacement

Which assessment findings would the nurse identify as a significant in an infant of a diabetic birth parent who is large for gestational age (LGA) A. Temperature less than 98 F B. Heart rate of 110 beats/min C. Blood glucose level less than 40 mg/dL D. Increasing bilirubin during the first 24 hours

C. Blood glucose level less than 40 mg/dL

Which cellular process associated with type 1 diabetes mellitus results in increased client fatigue? A. Increased metabolism at the cellular level B. Increased glucose absorption from the intestine C. Decreased production of insulin by the pancreas D. Decreased glucose secretion into the renal tubes

C. Decreased production of insulin by the pancreas

The nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those born to women who do not have diabetes. On which information about pregnancy and diabetes would the nurse base the response? A. Taking exogenous insulin stimulates fetal growth B. Consuming more calories covers the insulin secreted by the fetus C. Extra circulating glucose causes the fetus to acquire fatty deposits D. Fetal weight gain increases from an excessive response of the pancreatic enzymes

C. Extra circulating glucose causes the fetus to acquire fatty deposits

Which laboratory value supports the presence of DKA in a client with T1DM? A. Decreased serum glucose levels B. Decreased serum calcium levels C. Increased blood urea nitrogen levels D. Increased serum bicarbonate levels

C. Increased blood urea nitrogen levels

Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? A. Glargine B. NPH insulin C. Insulin aspart D. Insulin detemir

C. Insulin aspart

Which complication of diabetes would the nurse suspect when a health care provider prescribes one tube of glucose gel for a client with T1DM? A. DKA B. Hyperinsulin secretion C. Insulin-induced hypoglycemia D. Idiosyncratic reaction to insulin

C. Insulin-induced hypoglycemia

Which fluid shift will the nurse take into consideration when assessing a client with type 1 diabetes who is experiencing a fluid imbalance? A. Intravascular to interstitial as a result of glycosuria B. Extracellular to interstitial as a result of hypoproteinemia C. Intracellular to intravascular as a result of hyperosmolarity D. Intercellular to intravascular as a result of increased hydrostatic pressure

C. Intracellular to intravascular as a result of hyperosmolarity

the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues - curbs functions that would be nonessential or harmful in a fight-or-flight situation

Cortisol

Which time range would a nurse teach as the highest risk for hypoglycemia to a client with T1DM who self-administers neutral protamine Hagedorn (NPH) insulin every morning at 8:00 am? A. 9:00 am to 10:00 am B. 10:00 am to 11:00 am C. Noon to 8:00 pm D. 8:00 pm to midnight

C. Noon to 8:00 pm

Which eye problem is the leading cause of blindness in clients with diabetes? A. Cataracts B. Glaucoma C. Retinopathy D. Astigmatism

C. Retinopathy

When palnning care for a client with type 1 diabetes, which change in insulin requirements would the nurse anticipate on the first postpartum day? A. Slow decrease B. Rapid Increase C. Sudden decrease D. Gradual increase

C. Sudden decrease

A teaching plan was developed for a 12-year-old child who has been hospitalized for treatment of newly diagnosed type 1 diabetes. Which would cause the nurse to be concerned about the effectiveness of the program? A. The child is being taught by different nurses B. The nurse's instruction is limited to short periods C. The parent is having difficulty accepting the diagnosis D. The child is not at the appropriate developmental level for the teaching

C. The parent is having difficulty accepting the diagnosis

The nurse is teaching a school-age child how to use an insulin pump. Which instruction by the nurse is most important for the child to understand? A. The needle must be changed every day B. A blood glucose check is necessary once a day C. The pump is an attempt to mimic the way a healthy pancreas works D. Subcutaneous pockets near the abdomen are used to implant the pump

C. The pump is an attempt to mimic the way a healthy pancreas works

Which medication is responsible for neonatal hypoglycemia? A. Warfarin B. Simvastatin C. Tolbutamide D. Methimazole

C. Tolbutamide

Pregnancy induces progressive changes in maternal _________________ metabolism

Carbohydrate

What is the ultimate end result of glucose metabolism?

Cellular use of glucose for energy

Which period of time would a nurse recognize as the greatest risk of hypoglycemia when caring for a client who receives regular insulin daily at 8:00 am? A. 8:30 am to 9:30 am B. 8:00 pm to 12:00 am C. 1:00 pm to 8:00 pm D. 10:00 am to 1:00 PM

D. 10:00 am to 1:00 PM

A client's fasting plasma glucose levels are being evaluated. The nurse identifies that the client is considered to be diabetic if the results are within which range? A. 40 to 60 mg/dL B. 80 to 99 mg/dL C. 100 to 125 mg/dL D. 126 to 140 mg/dL

D. 126 to 140 mg/dL

The nurse teaches an adolescent with type 1 diabetes about peak action of NPH insulin and the risk for hypoglycemia. The nurse determines teaching has been effective when the adolescent identifies insulin peak action within which time frame? A. 1 to 2 hours B. 2 to 4 hours C. 5 to 10 hours D. 4 to 12 hours

D. 4 to 12 hours

Which laboratory results support the nurse's suspicion that a client diagnosed with type 1 diabetes is experiencing ketoacidosis? A. Blood glucose of 40 mg/ 100 mL, blood pH of 7.37 B. Blood glucose of 130 mg/ 100 mL, blood pH of 7.35 C. Blood glucose of 650 mg/ 100 mL, blood pH of 7.42 D. Blood glucose of 300 mg/ 100 mL, blood pH of 7.20

D. Blood glucose of 300 mg/ 100 mL, blood pH of 7.20

Which clinical finding supports the diagnosis of DKA? A. Nervousness and tachycardia B. Erythema toxicum rash and pruritus C. Diaphoresis and AMS D. Deep respirations and fruity odor to the breath

D. Deep respirations and fruity odor to the breath

With which response would the nurse associate the response of diaphoresis, weakness, and palor at 3:30 pm in a client with type 1 diabetes who receives 30 units of NPH inuslin at 7:00 AM? A. Diabetic coma B. HHNKS C. DKA D. Hypoglycemic reaction

D. Hypoglycemic reaction

A 15-year-old adolescent is found to have T1DM. Which would the nurse include when teaching the adolescent about T1DM? A. it does not always require insulin B. It involves early vascular changes C. It occurs more often in obese adolescents D. It has a more rapid onset than does T2DM

D. It has a more rapid onset than does T2DM

Which purpose of insulin would a nurse identify when caring for a client prescribed insulin added to a solution of 10% dextrose in water after an intravenous solution containing potassium inadvertently was infused too rapidly? A. Glucose with insulin increases metabolism, which accelerates potassium excretion B. Increased potassium causes a temporary slowing of the pancreatic production of insulin C. Increased insulin accelerates the excretion of glucose and potassium, therby decreasing the serum potassium levels D. Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level

D. Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level

For which condition is an oral hypoglycemic agent indicated? A. Ketoacidosis B. Obesity C. Pancreatitis D. Reduced insulin production

D. Reduced insulin production

Which rationale explains why IV potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? A. Potassium loss occurs rapidly from diaphoresis present during coma B. Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts C. Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose D. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment

D. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment

When teaching a client with diabetes about monitoring for episodes of hypoglycemia, which symptom would the nurse include in the teaching plan? A. Thirst B. Nausea C. Anorexia D. Sweating

D. Sweating

An adolescent with diabetes had a 6:30 am fasting blood glucose level of 180 mg/dL. Which nursing action is a priority A. Encourage the adolescent to start exercising B. Ask the adolescent to obtain an immediate glucometer reading C. Inform the adolescent that a complex carbohydrate such as cheese should be eaten D. Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered

D. Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered

What is a short term consequence of Hyperglycemia

Dehydration

________ ___________ secrete somatostatin

Delta Cells

2-hour plasma glucose >_______ mg/dL post 75 g glucose is criteria for for diagnosis of _______________

Diabetes

An example of a Sodium-glucose co-transporter 2 (SGLT-2) inhibitors

Empagliflozin

___________ cells secrete ghrelin

Epsilon

What can be used for severe hyperglycemia if IV glucose is not available?

Glucagon

_____________ may be used by type 1 diabetics to treat insulin shock/coma

Glucagon

_______________ counters insulin directly by reversing/suppressing glycogen synthesis and converting to glycogenolysis

Glucagon

a hormone that your pancreas makes to help regulate your blood glucose (sugar) levels - increases your blood sugar level and prevents it from dropping too low

Glucagon

the main sugar found in your blood - it comes from the food you eat, and is your body's main source of energy - your blood carries glucose to all of your body's cells to use for energy

Glucose

What is the preferred treatment for severe hypoglycemia with conscious patients?

Glucose oral gel

a stored form of glucose, a main source of energy that your body stores primarily in your liver and muscles

Glycogen

process of storing excess glucose for use by the body at a later time - conversion to glycogen

Glycogenesis

process by which glycogen, the primary carbohydrate stored in the liver and muscle cells of animals, is broken down into glucose to provide immediate energy and to maintain blood glucose levels during fasting

Glycogenolysis

What laboratory test would the nurse expect to be prescribed that will reveal the effectiveness of a diabetic regimen for a child with T1DM?

Glycosylated hemoglobin

Insulin glargine and insulin degludec are modified _________ insulin

Human

Identical to insulin produced by the human pancreas

Human insulin

Modified forms of human insulin that have the same pharmacologic actions as human insulin but different time courses

Human insulin analogs

Dehydration, polyuria, and ketones are assessment findings the nurse would expect to find in a patient experiencing what?

Hyperglycemia

________________ a state of elevated blood glucose levels, defined as more than 100 mg/dL in a fasting state or 140 mg/dL when not fasting

Hyperglycemia

________________ can cause a patients mental status to range from alert to confused and coma, particularly if in untreated DKA

Hyperglycemia

Muscle tremors, NML hydration, and no ketones are all assessment findings the nurse would expect to find with a patient experiencing what?

Hypoglycemia

State of insuffcient or low blood glucose levels, defined as less than 70 mg/dL

Hypoglycemia

Insulin glargine and insulin degludec should not be given via _______

IV

Insulin should be given via ______ for DKA

IV

What is the preferred treatment for severe hyperglycemia?

IV Glucose

For an unconscious patient with a hypoglycemic insulin complication, they should be given what?

IV glucose or parenteral glucagon is the preferred treatment

DKA develops when the body is unable to produce enough ___________

Insulin

a hormone created by your pancreas that controls the amount of glucose in your bloodstream at any given moment - helps store glucose in your liver, fat, and muscles - regulates your body's metabolism of carbohydrates, fats, and proteins

Insulin

NPH insulin is what type of insulin

Intermediate duration

How does glucagon differ from cortisol?

It is a polypeptide hormone and cannot cross the cell membrane

_____________ acts faster than regular insulin but has a shorter duration of action

Lispro

Insulin glargine and insulin degludec are what types of insulin?

Long duration

An increased risk for stroke, CVA, TIA, and cognitive impairment is a _______________ complication of diabetes

Macrovascular

HTN and insulin resistance increasing the risk for CAD is a _______________ complication of diabetes

Macrovascular

An example of Biguanide

Metformin

__________ insulin is the only one suitable for mixing with short-acting insulins

NPH

__________ insulins are cloudy suspensions that must be agitated before administration

NPH

HTN damages small blood vessels and excess blood glucose overworks the kidneys resulting in ______________

Nephropathy

Hyperglycemia damages the nerves in the PNS. This may result in pain and/or numbness. Feet wounds may go undetected, get infected, and lead to gangrene. This condition is defined as?

Neuropathy

_________ cells secrete a pancreatic polypeptide, which regulates some of the other pancreatic activities

PP

An example of a thiazolidinediones

Pioglitazone

An example of a meglitinides?

Repaglinide

NPH insulins are administered by ____________ injection only

SUBQ

How is GLP-1 receptor agonists (Exenatide) administered?

SUBQ injection

What is the usual route for Insulin lispro?

SUBQ or use of an insulin pump

Insulin lispro is what type of insulin?

Short duration: rapid acting

Regular insulin is what type of insulin

Short duration: slower acting

a peptide hormone that regulates insulin and glucagon

Somatostatin

Insulin glargine and insulin degludec have what peak time

They have no peak

There are no specific symptoms for an elevated _________ ___________ level

blood glucose

which cause of tremors, pallor, and diaphoresis would be suspected in a client with type 1 diabetes? a. overeating b. viral infection c. aerobic exercise d. missed insulin dose

c. aerobic exercise

Insulin glargine and insulin degludec are in a ________ solution

clear

Lispro is found in a _____ solution

clear

Regular insulin is given in a _________ solution

clear

For a conscious patient with a hypoglycemic insulin complication, what should be given?

fast acting oral sugar

in DKA, without enough insulin, the body begins to breakdown ________ as alternative fuel, resulting in the production of ketones (blood acids)

fats

Short-acting insulins should be drawn _________ when mixing with NPH insulins

first

Cortisol is involved in __________, The synthesis of glucose from muscle protein and other non-carbohydrates in order to sustain the brain during fasting and starvation

gluconeogenesis

refers to synthesis of new glucose from noncarbohydrate precursors, provides glucose when dietary intake is insufficient or absent. It also is essential in the regulation of acid-base balance, amino acid metabolism, and synthesis of carbohydrate derived structural components

gluconeogenesis

The neurologic system is dependent upon _________ for energy needs

glucose

An example of a sulfonylurea

glyburide

________ cannot correct hypoglycemia resulting from starvation

glycogen

ghrelin stimulates __________

hunger

Insulin lispro has extreme risk for ________________

hypoglycemia

in T2DM, the pancreas gradually loses its ability to produce _________

insulin

Endocrine functions are carried out by approximately 1 million __________ ____ _________________

islets of langerhans

Insulin glargine and insulin degludec should be given ______-daily subQ dosing to treat adults and children with T1DM and adults with T2DM

once

T2DM is usually managed initially with ________ ______________ medications

oral antidiabetics