4106 Week 5 Diabetes Mellitus

Which clinical manifestations are associated with diabetes mellitus type 2? Select all that apply. 1 Ketoacidosis 2 Candida infection 3 Recurrent infections 4 Abdominal cramping 5 Recurrent vaginal yeast 6 Prolonged wound healing

2, 3, 5, 6 Candida infection, recurrent infections, recurrent vaginal yeast, and prolonged wound healing are clinical manifestations of diabetes mellitus type 2. Recurrent infection involves the symptomatic reactivation of the latent infection. Wound healing is prolonged for patients with diabetes mellitus due to an impaired immune system. Ketoacidosis and abdominal cramping are key symptoms of diabetes mellitus type 1.

Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis? Electrolytes Insulin therapy Sodium bicarbonate IV fluids

Insulin therapy When the body cannot utilize glucose for energy, it burns fat for energy, resulting in the production of ketones. Insulin therapy is useful for reducing the serum ketone levels. Electrolytes are given to correct the electrolyte imbalance. Sodium bicarbonate is given to treat metabolic acidosis. IV fluids are indicated for correction of dehydration.

Which question would the nurse ask a patient admitted to the hospital with frequent urination and excessive thirst to support the diagnosis of diabetes? "What is your name?" "What is your height?" "What is your weight?" "Do you have a family history of diabetes?"

"Do you have a family history of diabetes?" The patient's family history is needed to know if there is any family history of diabetes. The patient's name is necessary to identify the patient but not the clinical condition. Parameters such as height and weight of the patient are required to calculate the body mass index (BMI). However, the nurse does not ask the patient his or her height and weight; rather, height and weight are measured.

Which laboratory parameter assesses the function of pancreatic β-cells? C-peptide level Hemoglobin level Urine-specific gravity Serum creatinine level

C-peptide level Proinsulin is the precursor of insulin. Enzymatic activity helps to split proinsulin into insulin and C-peptide. Therefore the function of pancreatic beta cells can be assessed by measuring C-peptide levels. Hemoglobin levels indicate the oxygen-carrying capacity of the blood. Urine-specific gravity indicates fluid and electrolyte balance. Serum creatinine levels indicate renal function.

A nurse is providing discharge teaching to a patient with a new diagnosis of type 1 diabetes mellitus who will need to give self-injections of insulin at home. Which statement by the patient indicates to the nurse that the discharge teaching was effective? "I can use my lower forearm for insulin injections." "If my intermediate-acting insulin looks cloudy, I should discard the bottle." "I need to rotate sites of injection to allow for better absorption of the insulin." "I should push the plunger all the way down and then remove the needle as soon as possible."

"I need to rotate sites of injection to allow for better absorption of the insulin." Teaching the patient to rotate the injection within and between sites is important to allow for better insulin absorption. The lower forearm is not an injection site for subcutaneous insulin administration. The abdomen, arm, thigh, and buttock are the preferred sites. Intermediate-acting insulin is normally cloudy, and the patient should gently roll the bottle between the palms of hands to mix the insulin. The patient should push the plunger all the way down and leave the needle in place for 5 seconds to ensure that all of the insulin has been injected before removing the needle.

Which statement made by the patient indicates correct knowledge of the onset of action of the mealtime insulin aspart? "I will administer my aspart 30 minutes before mealtime." "I will administer my aspart 60 minutes before mealtime." "I will administer my aspart within 15 minutes of eating my meal." "I will administer my aspart 30 minutes after the conclusion of my meal."

"I will administer my aspart within 15 minutes of eating my meal." Aspart is rapid-acting insulin, onsets within five minutes, and peaks within an hour. The patient is instructed to administer it when food is in front of him or her, making the option "I will administer aspart within 15 minutes of eating" correct. If the patient administers the aspart 30 or 60 minutes before the food arriving, then the patient may experience hypoglycemia. The patient may have hyperglycemia if he or she waits 30 minutes until after eating to administer the insulin.

Which statement made by a patient demonstrates the need for further teaching about diabetes management? "I will exercise daily." "I will drink fruit juices daily." "I will walk wearing shoes daily." "I will have a yearly influenza vaccination."

"I will drink fruit juices daily." Having fruit juices daily does not help in diabetes management because it contains sugars that are easily absorbed. Exercising daily helps to maintain good health. Wearing shoes daily will help to avoid injuries to feet, which is important because wound healing is delayed in diabetic patients. Diabetic patients have weakened immune systems and are more prone to flu. Therefore annual vaccination against influenza is required.

Which statement made by a patient with diabetes indicates the need for additional learning about foot care? "I will wear only padded socks." "I will wash my feet daily with gentle soap." "I will check my feet for swelling and cuts every day." "I will sleep with a hot water bottle to warm my feet."

"I will sleep with a hot water bottle to warm my feet." A patient suffering from severe diabetes may have sensory neuropathy. Hot water is not recommended because the patient will not be able to sense the degree of warmth of the water and may get burns. Using padded socks will protect the patient from cuts. Washing the feet daily with gentle soap will reduce the risk of infection. By checking for swelling and cuts every day, the patient can get timely treatment if needed.

Which statement made by the patient with type 1 diabetes indicates a need for further instruction? "I'll have a snack available when I exercise." "I'll check my blood sugar level after every meal." "I'll eat my meals and snacks at regular times every day." "I'll start learning how to make high-fiber, low-fat foods."

"I'll check my blood sugar level after every meal." Finger-stick blood glucose testing should be performed before meals. Checking the blood glucose after meals will yield inaccurate results. This is of essential concern if the patient is basing insulin dosage on finger-stick blood glucose results. Having a snack nearby during exercise, eating meals and snacks at regular times, and eating high-fiber, low-fat foods are all correct in regard to diabetes management.

Which statements made by the nurse to a patient newly diagnosed with type 1 diabetes would be included in a teaching plan? Select all that apply. 1 "You should decrease your dietary sugar intake." 2 "I will teach you how to self-administer your insulin." 3 "It is important to consume a diet that is high in fats." 4 "It is important for you to reduce your physical activity." 5 "You should monitor your blood sugar as prescribed."

1, 2, 5 The nurse should teach the patient to decrease dietary sugar intake, self-administer insulin, and regularly monitor blood glucose levels as prescribed. A high-fat diet increases the patient's cholesterol levels and may increase the blood sugar levels. Reduction of physical exercise can also lead to an increase in blood glucose level.

Which statement made by the patient with diabetes mellitus indicates that further education regarding exercise is required? "I should exercise about 30 minutes five days a week." "Because I take insulin daily, I should exercise about one hour after eating a meal." "Exercise will help me to lose weight, which will help my body to better use insulin." "It is especially important that I exercise if my blood sugar is above 250 mg/dL and my urine is positive for ketones."

"It is especially important that I exercise if my blood sugar is above 250 mg/dL and my urine is positive for ketones." Strenuous activity can be perceived by the body as a stress and cause an increase in blood sugar by the release of counterregulatory hormones when the blood sugar is elevated and ketosis is present. The American Diabetes Association recommends that people with diabetes exercise 30 minutes per day, five days per week. To prevent hypoglycemia, it is important to exercise about an hour after consuming a meal or eat small carbohydrate snacks every 30 minutes during exercise. Weight loss decreases insulin resistance, which can lower blood glucose.

After discussing prevention of type 1 diabetes complications with the nurse, the patient is correct when making which statement? "I must limit fats in my diet to help prevent neuropathy." "I should use a hot water bottle on my feet when they feel cold." "I should have an eye examination at least once every two years for glaucoma screening." "It is important that I take my blood pressure medication to help prevent kidney damage."

"It is important that I take my blood pressure medication to help prevent kidney damage." Patients with diabetes who have albumin in their urine should receive angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists to treat hypertension, which would also delay the progression of nephropathy. Dietary fat intake will not affect kidney function. Hot water bottle use increases the risk of tissue damage because of the diabetic's neuropathy and delayed healing. Diabetics should have an eye examination once a year to screen for retinopathy.

A nurse is evaluating an overweight patient in the adult ambulatory clinic for a yearly physical. The patient has a family history of type 2 diabetes and is afraid of developing this disease. How would the nurse respond? "There is only a genetic link in type 1 diabetes." "Weight plays no role in the development of type 2 diabetes." "In type 2 diabetes, the pancreas is unable to produce insulin, so symptoms would already be noticeable." "Metabolic abnormalities, such as insulin resistance and being overweight, play a role in developing type 2 diabetes."

"Metabolic abnormalities, such as insulin resistance and being overweight, play a role in developing type 2 diabetes." Patients with metabolic abnormalities, such as being overweight, increase the risk of insulin resistance and inappropriate insulin secretion, which can lead to type 2 diabetes. There is a genetic link associated with type 2 diabetes, although the link is not fully understood at this time. People with first-degree relatives suffering from this disease are 10 times more likely to be diagnosed as well. Overweight patients have increased adipocytes, which secrete hormones (adipokines) that play a role in glucose and fat metabolism and likely contribute to the development of this disease. Type 1 diabetes is characterized by the autoimmune destruction of insulin-producing β-cells in the pancreas, which causes the downstream effects of the disease.

Which instruction would the nurse give a patient who is prescribed metformin and complains of an "upset stomach" after ingestion of the medication? "Stop taking the medication immediately and notify the prescriber." "Take metformin with food to decrease gastrointestinal (GI) side effects." "Get your blood glucose checked because it sounds like hypoglycemia." "Take diphenhydramine 25 mg before taking metformin to prevent nausea."

"Take metformin with food to decrease gastrointestinal (GI) side effects." The nurse should suggest that the patient take metformin with food to decrease GI side effects. It is not within the nurse's scope of practice to prescribe medications such as diphenhydramine for nausea. Advising the patient to stop the medication immediately may result in a hyperglycemic response and should not be done without medication prescriber guidance. Getting the patient's blood glucose checked will not address the complaints of GI distress.

A patient, admitted with type 1 diabetes, asks the nurse what "type 1" means. Which response by the nurse is accurate? "There is decreased insulin secretion, cellular resistance to insulin that is produced, or both." "An increased amount of adipose tissue has led to an insufficient amount of insulin being produced." "The body produces autoantibodies that destroy beta cells in the pancreas." "The insulin being made is not used by the tissues properly, leading to high blood sugar.

"The body produces autoantibodies that destroy beta cells in the pancreas." In type 1 diabetes mellitus, the body produces autoantibodies and the pancreas is unable to make any insulin. The patient will require life-long exogenous insulin to control blood sugars. There is no cellular resistance, and insulin secretion is absent, not decreased. Patients with type 1 diabetes are typically very thin; adipose tissue does not result in a decreased insulin production. It cannot be used by the tissues and cells because none is being produced.

Which statement made by a patient newly diagnosed with diabetes indicates an understanding of a teaching session focused on hypoglycemia? "When my blood sugar is less than 70 mg/dL, I will take 15 grams of a fast-acting carbohydrate, such as orange juice, and recheck in 15 minutes." "When my blood sugar is less than 70 mg/dL, I will drink 8 ounces of milk and recheck in 15 minutes." "I will eat a few hard candies when my blood sugar is less than 70 mg/dL and recheck in 15 minutes." "When my blood sugar is less than 70 mg/dL, I will take three to four sugar tablets and recheck in 30 minutes."

"When my blood sugar is less than 70 mg/dL, I will take 15 grams of a fast-acting carbohydrate, such as orange juice, and recheck in 15 minutes." The patient understands the need for a fast-acting sugar and the need to recheck in 15 minutes. Milk is not a fast-acting carbohydrate, so it will take longer for the low blood sugar to stabilize. The patient's statement about the hard candies does not indicate that the patient understands the need for 15 to 20 grams of carbohydrates. Rechecking blood sugar in 30 minutes is waiting too long to check blood sugar.

The patient states, "I want my partner to be able to make medical decisions in the event that I cannot." How would the nurse respond? "A living will is your best option." "How long have you been together?" "The Patient Self-Determination Act will uphold your decision." "You need to have a written durable power of attorney for health care."

"You need to have a written durable power of attorney for health care." The patient requesting that his or her partner make medical decisions in the event that he or she cannot should have a durable power of attorney written. This is one type of advanced directive in which people, when they are competent, identify someone else to make decisions for them, should they lose their decision-making ability in the future. The Patient Self-Determination Act requires all health care facilities receiving Medicare and Medicaid to make available advanced directives allowing individuals to state their preferences or refusals of health care in the event that they are incapable of consenting for themselves. Responding to the patient with the statement of "How long have you been together?" is poor therapeutic communication. A living will allows an individual to state his or her preferences and refusals for end-of-life medical care.

A patient with a 15-year history of diabetes has been complaining of intermittent pain in the legs. Which other symptoms would the nurse assess if the patient has the complication of peripheral arterial disease? Select all that apply. 1 Cold feet 2 Loss of hair 3 Dependent rubor 4 Urinary retention 5 Bowel incontinence

1, 2, 3 Peripheral arterial disease causes decreased blood flow to the lower extremities. Cold feet, loss of hair, and dependent rubor are the signs of peripheral arterial disease. Urinary retention and bowel incontinence are symptoms of autonomic neuropathy.

Which statements are accurate when describing glargine? Select all that apply. 1 There is no pronounced peak action time. 2 It should be administered subcutaneously. 3 It should be administered orally with food and water each morning. 4 It should be diluted or mixed with other insulin or solutions in the same syringe. 5 If it does not achieve glycemic goals, the administration of a mealtime insulin may be required.

1, 2, 5 Glargine is a long-acting (background) insulin that lacks a peak action time. Glargine is often administered once a day via subcutaneous injection. Mealtime insulin may also be added if glargine is not adequate to achieve glycemic goals. The medication is not administered orally with food and water. Glargine must not be diluted or mixed with other insulin or solution in the same syringe.

Which defining characteristics are associated with the Somogyi effect? Select all that apply. 1 Documented morning hyperglycemia 2 Caused by not rotating insulin injection sites 3 Avoided by consuming a bedtime snack 4 Treated with a lower dose of insulin in the evening 5 Documented hypoglycemia between 2:00 AM and 4:00 AM 6 Required adjustment of administration time of evening insulin

1, 3, 4, 5 Hyperglycemia in the morning can be caused by the Somogyi effect, which can be stimulated by too much insulin in the evening. During the night, typically between 2:00 AM and 4:00 AM, hypoglycemia occurs, which stimulates a release in counterregulatory hormones in an attempt to raise the blood sugar. What results is rebound hyperglycemia resulting in higher blood sugar readings upon awakening. The Somogyi effect must be differentiated from dawn phenomenon, which also results in higher morning blood sugar readings. The treatment for Somogyi effect includes consuming a bedtime snack or reducing the evening insulin dose, whereas the treatment for dawn phenomenon is an increase in the evening insulin dose or an adjustment in the timing of the evening insulin dose. Not rotating insulin injection sites does not result in either the Somogyi effect or dawn phenomenon. In fact, current recommendations are to use the same anatomic injection site (e.g., the abdomen) for one week before moving to another anatomic injection site.

The nurse is teaching a patient with insulin-dependent diabetes about the effects of exercise on blood glucose level. When collaborating with the patient to develop a self-management plan, which examples of moderate activity would the nurse suggest? Select all that apply. 1 Fishing 2 Bowling 3 Dancing 4 Walking briskly 5 Aerobic exercises

2, 3, 4 Examples of moderate activity include bowling, walking briskly, and dancing. The American Diabetes Association (ADA) recommends at least 150 minutes per week of moderate activity, which expends 200-350 kcal/hr. Fishing is considered a light activity in which approximately 100-200 kcal/hr are expended. Aerobic exercises are considered vigorous activity expending approximately 400-900 kcal/hr.

Which blood glucose level indicates hyperglycemia? 60 to 70 mg/dL 80 to 110 mg/dL 100 to 125 mg/dL 200 to 250 mg/dL

200 to 250 mg/dL Hyperglycemia is a condition in which the blood glucose level is greater than 200 mg/dL. If the blood glucose level ranges from 60 to 70 mg/dL, then it indicates hypoglycemia. The blood glucose level is considered normal if it ranges from 80 to 110 mg/dL. The blood glucose level ranges from 100 to 125 mg/dL in prediabetes.

Administration of which prescribed intervention may help to prevent further complications in an unconscious patient with a history of diabetes whose blood sugar level is found to be 65 mg/dL? 100 mL of whole milk orally 15 g of fast-acting carbohydrate orally 25 to 50 mL of 50% glucose IV 20 to 40 U of 30/70 insulin subcutaneously

25 to 50 mL of 50% glucose IV The patient should be immediately administered 25 to 50 mL of 50% glucose IV, which would rapidly raise the glucose concentration in the bloodstream. An oral route of administration of fast-acting carbohydrate is not appropriate in an unconscious patient. Treatment with carbohydrate that contains fats, such as whole milk, should be avoided because the fat will decrease the absorption of glucose and delay the response. Insulin is to be administered in patients with hyperglycemia.

Which conditions may cause a patient to develop diabetes mellitus? Select all that apply. 1. Glaucoma 2. Astigmatism 3. Cystic fibrosis 4. Hyperthyroidism 5. Hemochromatosis 6. Recurrent pancreatitis

3, 4, 5, 6 Diabetes may occur due to some other medical conditions. Cystic fibrosis, hyperthyroidism, hemochromatosis, and recurrent pancreatitis result from destruction, damage, interference, or injury to pancreatic cell function and can result in diabetes. Glaucoma and astigmatism are not related to pancreatic cell dysfunction.

Which components may result in metabolic syndrome? Select all that apply. 1. Low body weight 2. Low glucose levels 3. Low levels of triglycerides 4. Elevated BP 5. Decreased levels of high-density lipoproteins (HDL)

4, 5 If an individual has elevated BP, he or she is at a greater risk of developing type 2 diabetes as a result of having metabolic syndrome. A decreased level of HDL is also a risk factor for metabolic syndrome, which may lead to type 2 diabetes mellitus. Low body weight, low glucose levels, and low levels of triglycerides are not associated with the development of metabolic syndrome; therefore these are not risk factors for the onset of type 2 diabetes.

Which intervention will be beneficial for a patient with a blood glucose level of 250 mg/dL who is receiving treatment for hyperosmolar hyperglycemic syndrome?

Administering IV fluids containing glucose A patient with hyperosmolar hyperglycemic syndrome whose blood glucose level approaches 250 mg/dL should receive IV fluids containing glucose to prevent hypoglycemia. NaCl 0.9% is administered in patients with diabetic ketoacidosis. Administering 0.1 unit/kg/hr of insulin is indicated to correct hyperglycemia and hyperketonemia. IM glucagon is administered in hypoglycemic patients who are unconscious.

Which pathophysiologic cause of type 1 diabetes mellitus is correct? Insulin resistance of the body tissues Decreased mass count of pancreatic β-cells Autoimmune destruction of pancreatic β-cells Fatigued pancreatic β-cells due to overproduction of insulin

Autoimmune destruction of pancreatic β-cells Pancreatic β-cells are the main source of insulin production in the body. Autoimmune destruction of pancreatic β-cells results in minimal or no production of insulin. Absence of insulin is the factor associated with type 1 diabetes mellitus. Insulin resistance is the condition where insulin is produced by the pancreas, but its uptake is resisted by the tissues. This factor is associated with type 2 diabetes mellitus. A decreased mass count of pancreatic β-cells and fatigued pancreatic β-cells produce insufficient insulin for the normal metabolism, so these factors are associated with type 2 diabetes.

A patient hospitalized with diabetes has become shaky, anxious, and diaphoretic. Which action would the nurse implement first? Administer a 15-g snack. Notify the health care provider. Check the blood glucose level. Administer crackers with peanut butter.

Check the blood glucose level. The blood glucose level should be checked with the first signs of hypoglycemia because it can be reversed easily, but can be life threatening if not treated. In the hospital setting, it is convenient to check the blood glucose. A 15 g snack should be provided after the blood glucose has been determined to be low. The health care provider should be notified after the blood glucose level is known. The patient is exhibiting signs of decreased blood glucose. Administration of insulin will lower further the blood glucose.

A patient diagnosed with type 1 diabetes has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse would be performed initially? Check the patient's blood sugar at 3:00 AM. Provide the patient with an evening snack. Rotate insulin injection sites between the abdomen, thigh, and arm. Contact the health care provider to increase the evening insulin dose.

Check the patient's blood sugar at 3:00 AM. Hyperglycemia in the morning may be caused by the Somogyi effect. If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 and 4:00 AM for hypoglycemia will help determine whether the cause is the Somogyi effect. Diabetics should be given evening snacks to prevent hypoglycemia during the night, but glucose assessment is a priority to rule out the Somogyi effect. Injection sites are rotated to prevent lipodystrophy. An increased dose of evening insulin may cause further decrease in early morning glucose and increased rebound hyperglycemia.

he nurse would encourage a patient newly diagnosed with type 2 diabetes to limit intake of which foods to help reduce the percent of fat in the diet? Cheese Broccoli Chicken Oranges

Cheese Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help to avoid macrovascular changes.

Which foods would the nurse encourage a patient with diabetes mellitus and coronary artery disease to limit intake of to help reduce the percentage of saturated fat in their diet? Chicken and turkey Frozen and canned vegetables Enriched flour products Dairy products

Cheese and dairy products are higher in fat and calories than vegetables, fruit, enriched flour products, or poultry and should be limited.

Which foods would the nurse encourage a patient with diabetes mellitus and coronary artery disease to limit intake of to help reduce the percentage of saturated fat in their diet? Chicken and turkey Frozen and canned vegetables Enriched flour products Dairy products

Dairy products Cheese and dairy products are higher in fat and calories than vegetables, fruit, enriched flour products, or poultry and should be limited.

Which signs/symptoms would the nurse expect to find upon physical examination in a patient admitted with diabetic ketoacidosis? Blood sugar 200 mg/dL and bradypnea Hypotension and blood sugar 68 mg/dL Diaphoresis and extreme hunger Dry skin and Kussmaul respirations

Dry skin and Kussmaul respirations In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. The patient also will present with dry, loose skin. Blood glucose will be elevated, not decreased or normal. BP will not be low (hypotension), and respiratory rate will be increased, not decreased (bradypnea).

After admitting a patient with diabetic ketoacidosis (DKA) to the emergency department, which nursing intervention is a priority? Administer IV insulin Administer oxygen Insert a Foley catheter Establish IV access

Establish IV access Because fluid imbalance in a patient with DKA is potentially life threatening, the initial goal of therapy is to establish IV access and begin fluid and electrolyte replacement. Insulin is administered IV only after a potassium level is determined, because insulin administration may cause hypokalemia. Administration of oxygen and insertion of a Foley catheter may be necessary in the initial emergency management of DKA, but obtaining IV access is a priority.

Which factor would the nurse explain to a diabetic patient might be the cause of the hypoglycemia he or she is experiencing? Mild illness with fever Insufficient injection of insulin Overeating at a family holiday dinner Exercising without a carbohydrate-based snack

Exercising without a carbohydrate-based snack Exercising without a carbohydrate-based snack could result in hypoglycemia. Mild illness, insufficient insulin dosage, and overeating are situations that would cause hyperglycemia, or an increased blood glucose level.

When teaching the patient with diabetes about repaglinide, which instruction regarding the timing of the medication would the nurse teach the patient? Immediately before meals When blood sugar levels are greater than 250 mg/dL Two hours after meals At bedtime

Immediately before meals Repaglinide is an oral antidiabetic agent that should be given any time from 30 minutes to just before meals. It is given on a fixed schedule rather than only when blood sugars are elevated. The medication will not be effective if administered after meals or at bedtime.

Which statement is characteristic of metformin? It causes weight gain. It decreases hepatic glucose production. It should not be given with sulfonylureas. It is inappropriate for initial management of type 2 diabetes

It decreases hepatic glucose production. The primary action of metformin is to reduce glucose production by the liver. Metformin often causes weight loss instead of weight gain. Metformin can be administered in conjunction with sulfonylureas. Metformin is preferred for the initial management of type 2 diabetes.

Which is an insulin-dependent diabetes? Prediabetes Gestational diabetes Adult-onset diabetes Juvenile-onset diabetes

Juvenile-onset diabetes Juvenile-onset diabetes is also known as type 1 diabetes. Type 1 diabetes is an insulin-dependent diabetes because there is lack of insulin due to breakdown of islet cells. Prediabetes is a condition in which the blood glucose levels are above normal but not enough to be diagnosed as diabetes. Gestational diabetes is seen during pregnancy; it may be insulin-dependent or non-insulin-dependent diabetes. Adult-onset diabetes is also known as type 2 diabetes. Type 2 diabetes is non-insulin-dependent diabetes because some insulin is produced by the pancreas, but it is either insufficient for the needs of the body, poorly used by the tissues, or both.

When assessing for signs of ketoacidosis in a patient with diabetes, which respiratory pattern would the nurse expect to find? Central apnea Hypoventilation Kussmaul respirations Cheyne-Stokes respirations

Kussmaul respirations In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and unlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

Which symptom would the nurse teach the caregiver of a patient with diabetes to identify as a manifestation of hypoglycemia? Increase in urination Abdominal cramps Nervousness and tremors Nausea and vomiting

Nervousness and tremors Nervousness and tremors; cold, clammy skin; and numbness of the fingers and toes are some of the manifestations of hypoglycemia that the caregiver should watch for out in the patient. An increase in urination, abdominal cramps, and nausea and vomiting are manifestations of hyperglycemia.

Which complication of diabetes mellitus can be monitored by fundus photography? Neuropathy Retinopathy Nephropathy Dermatopathy

Retinopathy Fundus photography helps to examine the interior surface of the eye (fundus). Therefore fundus photography helps to detect the microvascular damage caused by chronic hyperglycemia to the retina, known as retinopathy. Neuropathy can be monitored by a comprehensive foot examination. Diabetic nephropathy can be monitored by checking for microalbuminuria and serum creatinine. Dermatopathy can be monitored by frequent skin examinations.

Which is an insulin-dependent tissue? Brain Kidney Skeletal muscle Red blood cells

Skeletal muscle Skeletal muscles have specific receptors that are activated by insulin that permit the transportation of glucose into the cells. The brain, kidney, and red blood cells do not have receptors; instead, they require only a specific amount of glucose for normal functioning.

Which instruction, in relation to mealtimes, would the nurse give to a patient who is prescribed lispro? Take on an empty stomach between meals. Take it simultaneously with a meal. Take it within 15 minutes of mealtime. Take it 30 to 45 minutes before a meal

Take it within 15 minutes of mealtime. Rapid-acting synthetic insulin analogs, which include lispro (Humalog), aspart (NovoLog), and glulisine (Apidra), have an onset of action of approximately 15 minutes and should be injected within 15 minutes of mealtime. The rapid-acting analogs most closely mimic natural insulin secretion in response to a meal. Lispro is not administered on an empty stomach or simultaneously with a meal. Short-acting regular insulin, not rapid-acting synthetic insulin, is administered 30 to 45 minutes before a meal to ensure the onset of action coincides with meal absorption.

Which effect do counter regulatory hormones have on insulin? They inhibit glucose production in the body. They maintain the blood glucose level in the body. They help insulin to decrease the level of glucose in the body. They increase the movement of glucose into the cells of the body.

They maintain the blood glucose level in the body. Counter regulatory hormones are antagonist to insulin. They help to maintain the blood glucose level by increasing the blood glucose level and decreasing the movement of glucose into the cells. Counter regulatory hormones key up the glucose production. Their function is contradictory to insulin because they increase the level of glucose in the body. They decrease the movement of glucose in the cells of the body.