AH1 Exam 1

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the infection

10 to 15 minutes

Once digested, what percentage of carbohydrates is converted to glucose?

100

fasting blood glucose for diabetes

126 mg/dL

The herpes simplex virus 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of

2 to 12 days

Glycosylated hemoglobin reflects blood glucose concentrations over

3 months

A nurse is caring for a patient with type 1 DM who reports feeling anxious and having palpitations. The glucometer reads 50 mg/dl. The nurse should give the patient

6 oz of apple juice

Which statement is true regarding gestational diabetes?

A glucose challenge test should be performed between 24 to 28 weeks

Which would be included in the teaching plan for a client dx with DM?

An elevated BG concentration contributes to complications of diabetes, such as diminished vision

Which clinical characteristic is associated with type 2 DM (previously referred to as non-insulin-dependent DM)?

BG can be controlled through diet and exercise

Metformin (Glucophage)

Biguanide. Decreases gluconeogenesis. Increases glucose uptake. First line DM tx b/c it does Not cause hypoglycemia. SEs: diarrhea, and lactic acidosis (secondary to renal and hepatic insufficiency)., take with food, do not crush or chew

Which information should be included in the teaching plan for a client receiving glargine, a peakless basal insulin?

Do not mix with other insulins

A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The nurse is teaching the client about meal planning using exchange lists. The teaching is effective based on which statement by the client

For dinner I ate 3 oz hamburger on a bun with ketchup, pickle and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon and a diet soda

Somogyi effect

G is normal or elevated at bedtime and decreases at 2 or 3 AM to hypoglycemic levels and subsequently increases as a result of the production of counter-regulatory hormones

A client with type 2 DM has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on the statement

I will take this medication in the morning with the first bite of breakfast

A client is admitted with DKA. Which order from the physician should the nurse implement first?

Infuse 0.9% normal saline solution 1L/hr for 2 hours

A nurse is documenting the plan of care for a patient who has type 1 DM that has remained unstable despite conventional insulin therapy. The provider has explained to the patient that the new plan will incorporate the use of a long-acting insulin preparation. The nurse anticipates seeing a prescription for

Insulin glargine (Lantus)

A nurse is teaching a client recovering from DKA about "sick days" The client asks the nurse why its important to monitor the urine for ketones

Ketones accumulate in blood and urine when fat breaks down in absence of insulin, signaling an insulin deficiency that will cause the body to start breaking down stored fat for energy

Which type of insulin acts most quickly?

Lispro (rapid-acting, onset w/in 10-15 minutes)

A nurse is teaching a patient with type 1 DM who is beginning a complex regimen of glycemic control about the properties and actions of the various types of insulin. The nurse should explain that the type of insulin that has an onset of 60-120 minutes, peaks in 6-14 hrs, and duration of 24 hours is

Neutral protamine hagedorn (NPH)

short acting insulin

Onset 30-60 minutes Peak 2-4 hours Duration 5-8 hours administer 30-60 minutes before meals i.e. regular insulin

rapid acting insulin

Onset: 10-30 min Peak: 30 min-3 hr Duration: 3-5 hr administer before meals i.e. lispro, aspart, glulisine, human insulin

A client who has an altered level of consciousness is receiving a tube feeding. Clients receiving tube feeding should be placed in which position

Semi-fowlers or higher

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus?

The client has not eaten but continues to take insulin or oral antidiabetic medications

Which intervention regarding nutrition is implemented for client who have undergone laryngectomy

Use enteral feeding after the procedure

A 16 y/o client with newly dx type 1 DM has very low body weight despite regular meals. The client is upset because friends frequently state "You look anorexic" When statement is the best response

Your body is using protein and fat for energy instead of glucose

Alpha glucosidease inhibitors

acarbose and miglitol, delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation

A client newly dx with type 1 DM has an unusual increase in BG from bedrime to morning. The physician suspects insulin waning. Based on this dx, the nurse expects which change to the client's medication

administer a dose of intermediate-acting insulin before the evening meal

A first-line antibiotic used to treat acute rhinosinusitis is

amicillin

A client is admitted with abdominal pain, nausea and vomiting. H/o type 1 DM. Nurse suspects DKA. Which action will help the nurse confirm

assess the client's breath odor

Type 1 DM

autoimmune dysfunction involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas. Immune system cells and antibodies are present in circulation and also can be triggered by certain genetic tissue types of viral infections. Usually occurs at a young age w/ no successful interventions to prevent.

Which clinical manifestation of type 2 DM occurs if glucose levels are very high?

blurred vision

Good nutrition to prevent and control DM

carbohyrates 45% of intake protein 15-20% of intake unsaturated and polyunsaturated fats 20-35% add omega-3 fatty acids and fiber reduce saturated fats and LDLs

When a client has undergone a laryngectomy and there is evidence of wound breakdown, the nurse monitors the client very carefully because of high risk for

cartoid artery hemorrhage

A client with type 1 DM reports waking up in the middle of the night feeling confused with tremors and feeling of hunger. Morning fasting BG have been between 110 and 140. Client admits to exercising excessively and skipping meals over the past several weeks. Nurse should instruct the client to

check BG at 3 AM

The nurse knows that there are three types of chronic pharyngitis. Which of the following is characterized by numerous swollen lymph follicles on the pharyngeal wall?

chronic granular

Another term for clergyman's sore throat is

chronic granular pharyngitis

Which age-related change may affect diabetes and its management?

decreased renal function

Which is a priority nursing intervention that the nurse should perform for a client who has undergone surgery for a nasal obstruction?

ensure mouth breathing

The nurse assesses a client who is bleeding profusely from the nose. The nurse documents this finding as which condition

epistaxis

A nurse is reviewing the results of routine lab tests performed as part of a 50 y/o woman's annual physical examination. The nurse notes a BG level of 120 mg/dl. The nurse should interpret this as an abnormal result for a

fasting BG measurement

During a f/u visit 3 mo after newly dx type 2 DM, a client reports exercising and following a reduced calorie diet. Assessment reveals that the client has only lost 1 lb and did not bring the glucose-monitoring record. Which value should the nurse measure?

glycosylated hemoglobin

2 hour glucose test for diabetes

greater than 200 mg/dL

causal blood glucose for diabetes

greater than 200 mg/dl

A client is being assessed for acute laryngitis. The nurse knows that clinical manifestation of acute laryngitiss include

hoarseness

A nurse is teaching a patient newly dx with type 1 DM how to check BG levels. Which of the following is the appropirate instruction for transferring the patient's blood to the reagent portion of the test strip/monitor in most siutations?

hold the test strip next to the blood on the patients fingertip

A nurse is preparing fo discharge a client with coronary artery disease and hypertension who is at risk for type 2 DM. Which information is important to include in the discharge teaching

how to control BG through lifestyle modification with diet and exercise

A client with DM is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for the client

hypoglycemia

A 60 yo client comes to the ED reporting weakness, vision problems, increased thirst, increased urination and frequent infections that do not seem to heel easily. The physician suspects DM. Which classic symptom should the nurse watch for

increased hunger

Which clinical manifestation of hemorrhage is r/t carotid artery rupture?

increased pulse rate

Which is the priority nursing dx for a client undergoing a laryngectomy?

ineffective airway clearance

Dawn phenomenon

insulin is relatively normal until about 3AM when levels begin to rise

Which term refers to the progressive increase in BG from bedtime to morning

insulin waning

NPH is an example of

intermediate acting insulin

Which statement is correct regarding glargine insulin

it cannot be mixed with any other type of insulin

A nurse is reviewing self-administration of insulin using a pre-filled pen administration system with a patient who started using the pen system the previous week. The patient asks what he can do to help reduce injection pain. The nurse should suggest

keep the pens at room temperature for a few minutes

Which by-product of fat breakdown in the absence of insulin accumulates in the blood and urine

ketones

A late complication of radiation therapy is

laryngeal necrosis

The nurse is assessing a client for obstructive sleep apnea (OSA) S/S?

loud snoring, insomnia, polycythemia

A client with DM is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor for

low BG concentrations

A client with type 1 DM is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation associated with this classic symptom

muscle wasting and tissue loss

Stiffness of the neck or inability to bend the neck is referred to as which of the following?

nuchal rigidity

Which type of sleep apnea is characterized by lack of airflow due to pharyngeal occlusion

obstructive

intermediate acting insulin

onset: 2 - 4 hours peak: 4 - 12 hours duration: 12 - 18 hours *often used in combination with short acting insulin administer between meals or at night i.e. NPH

long acting insulin

onset: 6 - 10 hours peak: none duration: 18 - 24 hours * do not mix with other insulins * take at same time every day i.e. glargine (Lantus)

Which medication is used to treat bacterial pharyngitis?

penicillin

The nurse is assessing a client in the clinic and upon physical assessment the client demonstrates displacement of the sternum. this would be documented as

pigeon chest

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes

presence of autoantibodies against islet cells

Which clinical characteristic is associated with type 1 DM (previously referred to as insulin-dependent DM)?

presence of islet cell antibodies

Type 2 DM

progressive condition due to inability of cells to respond to insulin (insulin resistance) and decreased production of insulin by the beta cells. most often occurs later in life due to obesity, inactivity, and heredity.

A nurse is teaching a patient newly dx with type 2 DM about biguanide she has been rx, which is metformin (Glucophage). The nurse should explain that this type of medication acts by

reducing hepatic glucose production

The nurse is teaching a client about self-injection of insulin and about mixing regular and NPH. Which information is important to include in the teachng

regular is drawn up into the syringe first

glycosylated hemaglobin (HbA1C)

should be between 4 and 6% greater than 6.5% means diabetes

Which dx test is used to confirm the dx of maxillary and frontal sinusitis?

sinus aspirates

Which category of oral anti-diabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin?

sulfonylureas

When the nurse gives a client and family instructions after laryngeal surgery, which does the nurse indicate should be avoided?

swimming

A nurse instructing a patient about using an insulin pump should explain that the risk of DKA increases with the pump because

the tubing could become occulded

A client receives a daily injection of glargine insulin at 7 am. When should the nurse monitor for hypoglycemic reaction

this insulin has no peak action and does not cause a hypoglycemic reaction

A client with type 1 DM is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching

use all available injection sites within one area

Which factor is the focus of nutrition interventions for clients with type 2 DM?

weight loss