Ch. 37- Learning: Diabetes Mellitus and Its Complications

A patient is being evaluated for diabetes mellitus (DM). Which finding should the nurse expect to assess in this patient? A. 5 lb weight gain in the last 3 weeks B. Blood pressure 82/58 mmHg and heart rate 124 beats/min C. Blood pressure 180/94 mmHg; respirations 16 breaths/min and shallow; bounding pulses bilaterally D. Anorexia over the last 2 months

B. Blood pressure 82/58 mmHg and heart rate 124 beats/min - Hypotension and tachycardia indicate DM. - Weight loss is more common with new onset of diabetes mellitus. - Polyphagia is a sign of diabetes, not anorexia. - Hypotension, not hypertension, is expected with new onset diabetes mellitus.

The nurse is teaching the parent of a toddler with type 1 diabetes mellitus (T1DM). Which statement by the parent indicates to the nurse that the teaching is effective? A. "My child is a picky eater. My child will be at risk for hypoglycemia if the child refuses to eat after insulin is administered." B. "Insulin should be given prior to each meal." C. "If my child refuses to eat, I can adjust the insulin dose." D. "Because my child's blood sugar is controlled with insulin, I do not need to worry about how much my child eats."

A. "My child is a picky eater. My child will be at risk for hypoglycemia if the child refuses to eat after insulin is administered." Toddlers and young children may be "picky eaters" and struggle with food intake. It is important to note that a child's refusal to eat after administration of insulin places the child at a high risk for hypoglycemia. Insulin should be given after the child eats. Insulin doses should not be adjusted. If a child refuses to eat after administration of insulin, there is a high risk for hypoglycemia.

A patient newly diagnosed with type 1 diabetes mellitus (T1DM) has over 80% loss of pancreatic beta-cell mass. Which statement should the nurse include when teaching the patient about this disease process? A. "You may see insulin production increase slightly, but eventually, it will cease." B. "A decrease in tissue sensitivity to insulin triggers the body to stop producing insulin." C. "You will have relative insulin deficiency for the rest of your life." D. "We will be able to review your history and pinpoint the environmental trigger that caused the damage."

A. "You may see insulin production increase slightly, but eventually, it will cease." Type 1 diabetes mellitus (T1DM) leads to absolute insulin deficiency as the pancreatic beta cells eventually cease to produce insulin. During the honeymoon period, which can last for up to one year, the remaining beta cells work hard to keep up with insulin demand. However, they will eventually be unable to keep up and will cease to produce insulin. T1DM results in absolute insulin deficiency. An environmental trigger may never be determined. Type 2 diabetes mellitus (T2DM) is caused by a decrease in tissue sensitivity to insulin.

Which clinical manifestation should the nurse expect to assess in a patient diagnosed with hyperglycemic hyperosmolar syndrome (HHS)? A. Electrolyte imbalances B. Fluid volume overload C. Ketonuria D. Metabolic acidosis

A. Electrolyte imbalances Clinical manifestations of hyperglycemic hyperosmolar syndrome include fluid volume deficit and electrolyte imbalances. However, clinical signs of metabolic acidosis and ketosis are not present. Metabolic acidosis and ketosis are not clinical manifestation of HHS. Fluid volume deficit, not fluid volume overload, is a clinical manifestation of HHS.

Which clinical manifestation is the first sign of diabetic nephropathy? A. Microalbuminuria B. Glucosuria C. Gastroparesis D. Esophageal disturbances

A. Microalbuminuria - Microalbuminuria is the first sign of diabetic nephropathy. The goal of treatment of hypertension is to preserve renal function. - Glucosuria, gastroparesis, and esophageal disturbances are not clinical manifestations of diabetic nephropathy.

In which state is the primary focus of metabolism on fueling the brain and nervous system with glucose? A. Postabsorptive B. Starvation C. Absorptive D. Puberty

A. Postabsorptive - During the postabsorptive state the ratio of glucagon to insulin increases. - During the absorptive state insulin increases. Puberty is not a metabolic state. - During starvation, insulin levels remain low. The primary source of glucose is gluconeogenesis in the liver. Skeletal muscle uses free fatty acids for fuel, but also ketone bodies produced by the liver. The brain may begin to rely on ketone bodies for fuel.

The nurse is teaching a pregnant patient with gestational diabetes about the need for glucose control. Which statement made by the patient indicates that the teaching has been effective? A. "I should increase my carbohydrate intake to ensure my baby has a higher birth weight." B. "Excellent glucose control will reduce the risk of complications both for myself and my baby." C. "I should monitor my blood sugar once daily in the morning." D. "Because I have gestational diabetes, my baby is at high risk for low birth weight."

B. "Excellent glucose control will reduce the risk of complications both for myself and my baby." - Low birth weight has been associated with insulin resistance. Infants born to mothers with diabetes typically have a high birth weight and also are at risk for developing diabetes. The best way to reduce complications and risks for mother and baby is to tightly control blood glucose during pregnancy. - Gestational diabetes puts the baby at risk for high birth weight. - Carbohydrate intake should be carefully monitored to prevent high blood glucose levels in the mother, which creates hyperinsulinemia in the baby. Hyperinsulinemia can lead to severe hypoglycemia in the baby shortly after birth. - Blood glucose should be monitored more often than once a day.

The nurse prepares teaching for a community group on the increase in the incidence of type 2 diabetes mellitus (T2DM). Which statement should the nurse include when teaching about this disorder? A. "Low socioeconomic status greatly decreases the risk of developing T2DM." B. "Minor modifications such as adding exercise or decreasing daily calorie intake can greatly reduce the risk of developing T2DM." C. "Urbanization is a nonmodifiable risk factor for T2DM." D. "Central body obesity is a major risk factor in the development of type 1 diabetes mellitus (T1DM)."

B. "Minor modifications such as adding exercise or decreasing daily calorie intake can greatly reduce the risk of developing T2DM. - Urbanization is associated with changes in diet, physical activity, obesity, and socioeconomic status. - Low socioeconomic status increases the risk for development of T2DM. - Urbanization is a risk factor for T2DM, but lifestyle modifications can mitigate this risk. - Central body obesity is a risk factor for T2DM, not type 1 diabetes mellitus (T1DM).

The nurse is reviewing type 1 diabetes mellitus with a group of new nurses. Which risk factor should the nurse identify as being associated with type 1 diabetes mellitus (T1DM)? A. Obesity B. Family history C. Hypertension D. Polycystic ovary syndrome

B. Family history - The risk of developing T1DM is approximately 0.4% in the general population; while children with an affected family member have a 5% risk of developing T1DM by age 20. - Obesity, defined as being at least 20% over desired body weight or having a body mass index of 25.1 or greater, is a risk factor associated with type 2 diabetes mellitus (T2DM). - Polycystic ovary syndrome is a risk factor associated with type 2 diabetes mellitus. - A blood pressure of greater or equal than 130/85 mmHg is a risk factor associated with type 2 diabetes mellitus.

Which clinical manifestation should the nurse expect in a patient with stage 3 type 2 diabetes mellitus (T2DM)? A. Postprandial hyperglycemia and normal fasting blood glucose levels B. Fasting and postprandial hyperglycemia C. Hypoglycemia during menses D. Hyperinsulinemia and normal blood glucose levels

B. Fasting and postprandial hyperglycemia Stage 3 type 2 diabetes mellitus (T2DM) occurs as insulin resistance continues to increase so patients exhibit hyperglycemia even when fasting and after lunch and dinner (postprandial). Female patients with type 2 DM actually are hyperglycemic not hypoglycemic. Hyperinsulinemia usually would create normal blood glucose levels, but in stage 3 T2DM, insulin resistance creates hyperglycemia.

The nurse teaches a patient with diabetes mellitus (DM) about ongoing care needs. Which patient statement requires follow-up by the nurse? A. "Routine screening will detect changes that could lead to kidney disease." B. "If I get sick, I should check my blood glucose more often." C. "I should have my eyes checked every 5 years." D. "I should follow up with my healthcare provider regularly for a foot check."

C. "I should have my eyes checked every 5 years." - Routine eye exams are part of the standard of care for patients with diabetes because retinopathy can be treated to prevent blindness, as long as it is caught prior to the onset of symptoms. - It is appropriate for a patient to check blood glucose more often when sick. - It is appropriate for the patient to follow up with the healthcare provider routinely for a foot check. - Routine screening can detect changes that indicate kidney disease.

Which statement explains the genetic cause for the development of type 2 diabetes mellitus (T2DM)? A. The exact mode is unknown. B. An important gene responsible for insulin secretion becomes the target of an autoimmune dysfunction. C. A virus triggers genetic mutation. D. An important gene responsible for glucose transport can become defective, leading to a higher baseline HbA1c.

D. An important gene responsible for glucose transport can become defective, leading to a higher baseline HbA1c. The C allele at rs8192675 has been found to contribute to a defect in glucose metabolism, resulting in a higher baseline HbA1c. A recent study found that treating carriers of this gene with metformin resulted in better glycemic control. Despite the findings of the study, type 2 diabetes mellitus (T2DM) is known to be a polygenetic disorder. Autoimmune dysfunction may lead to type 1 diabetes mellitus (T1DM). Although T2DM is a polygenetic disorder, there is evidence to support the identification of specific genetic defects. - Viral infections have been implicated in the development of T1DM.

Which patient is at the greatest risk of developing type 2 diabetes mellitus (T2DM)? A. A college student whose twin was recently diagnosed with type 1 diabetes mellitus (T1DM) B. A high-profile lawyer who jogs 5 miles every morning C. A construction worker with central obesity, working hard to lose weight D. An office worker with central obesity recently diagnosed with osteoporosis

D. An office worker with central obesity recently diagnosed with osteoporosis A Westernized lifestyle includes a high-calorie diet and decreased physical activity, which leads to obesity. Central obesity, or increased weight around the trunk, is a prominent risk factor for type 2 diabetes mellitus (T2DM). Central obesity is a marker for glucose intolerance, hyperinsulinemia, and hypertriglyceridemia. Metabolic syndrome is also a strong risk factor for T2DM.

The nurse reviews the pathophysiology of diabetes mellitus before assessing a patient with the disorder. Which cells are destroyed and unable to produce insulin in a patient with type 1 diabetes mellitus (T1DM)? A. Delta B. Gamma C. Alpha D. Beta

D. Beta - Beta cells secrete the hormone insulin. These cells are destroyed and are no longer able to produce insulin in a patient with type 1 diabetes mellitus (T1DM). - The alpha, delta, and gamma cells are not destroyed and continue to function in a patient with type 1 diabetes mellitus. - Alpha cells produce the hormone glucagon. - Delta cells produce somatostatin. - Gamma cells secrete pancreatic polypeptide.

The nurse is caring for a patient with a new onset of diabetic nephropathy. Which clinical manifestation should the nurse expect the patient to exhibit? A. Glucosuria B. Gastroparesis C. Esophageal disturbances D. Microalbuminuria

D. Microalbuminuria - Microalbuminuria is the first sign of diabetic nephropathy. The goal of treatment of hypertension is to preserve renal function. - Glucosuria, gastroparesis, and esophageal disturbances are not clinical manifestations of diabetic nephropathy.

The nurse prepares to assess a patient with suspected diabetes mellitus (DM). Which clinical manifestation should the nurse expect to assess in this patient? A. Decreased urination B. Weight gain C. Hypertension D. Tachycardia

D. Tachycardia - Tachycardia is a clinical manifestation of DM. - Hypertension, weight gain, and decreased urination are not clinical manifestations of diabetes mellitus.

Which reason explains polydipsia in the development of diabetes? A. Compensatory mechanism in response to dehydration and fluid volume depletion B. Compensatory mechanism in response to hypoglycemia C. Compensatory mechanism in response to hyperkalemia D. Compensatory mechanism in response to the alkaline state of the blood

A. Compensatory mechanism in response to dehydration and fluid volume depletion - Hyperglycemia increases serum osmolarity. - Extreme thirst is a compensatory mechanism for the high serum osmolarity and resulting fluid loss. - Polydipsia does not occur due to hyperkalemia, hypoglycemia, or the alkaline state of the blood.

A patient with type 2 diabetes mellitus (T2DM) has had an elevated blood glucose after eating and in the mornings before eating. The patient asks why an insulin regimen is now being recommended. Which response should the nurse make to this patient? A. "You are now in stage 2 T2DM, which means your blood glucose levels will increase when fasting." B. "You are now in stage 3 T2DM, which means your blood glucose levels will increase after eating and when fasting." C. "You are now in stage 3 T2DM, which means your blood glucose levels will increase only after eating." D. "You are now in stage 2 T2DM, which means your blood glucose levels will increase after eating."

B. "You are now in stage 3 T2DM, which means your blood glucose levels will increase after eating and when fasting." Stage 3 type 2 diabetes mellitus (T2DM) occurs as insulin resistance continues to increase. Hyperglycemia causes the pancreatic beta cells to become toxic and, eventually, decline in insulin production. Free fatty acids are produced at a greater rate and lead to even more insulin resistance.

The nurse notes that a patient with type 1 diabetes mellitus is prescribed insulin. Which should the nurse realize as the primary function of insulin? A. Production of ketones B. Activation of receptors in the cell wall that facilitate the transport of glucose into the cell C. Assistance in the formation of glucose from noncarbohydrate sources D. Breakdown of carbohydrates

B. Activation of receptors in the cell wall that facilitate the transport of glucose into the cell The primary functions of insulin include the synthesis of glycogen in the liver and muscle, the synthesis of protein in the liver and muscle, and the synthesis of triglycerides in adipose tissue and, to a smaller extent, in muscle. Insulin is necessary for glycolysis and glucose transport into insulin-sensitive tissues, such as muscle. Most important, insulin suppresses gluconeogenesis, glycogenolysis, and lipolysis. Breakdown of carbohydrates, gluconeogenesis, and production of ketones are not functions of insulin.

A patient with diabetes mellitus (DM) is shaking and diaphoretic and has a blood glucose level of 42 mg/dL. Which step should the nurse take first? A. Draw blood for a comprehensive metabolic panel. B. Give the patient a glass of orange juice and then recheck the blood glucose. C. Prepare to administer insulin. D. Check the urine for ketones.

B. Give the patient a glass of orange juice and then recheck the blood glucose. - The patient is displaying signs of hypoglycemia. Increasing blood glucose is the priority. - Obtaining a comprehensive metabolic panel or checking the urine for ketones are not appropriate at this time. - Administering insulin will worsen the hypoglycemia.

The nurse is caring for a patient experiencing polyuria and unexplained weight loss. Which diagnostic test result indicates to the nurse that the patient has diabetes mellitus (DM)? A. Fasting plasma glucose of 112 mg/dL B. Glycosylated hemoglobin (A1C) of 7.2% C. Casual plasma glucose of 150 mg/dL D. Two-hour plasma glucose of 100 mg/dL after oral glucose tolerance test

B. Glycosylated hemoglobin (A1C) of 7.2% - An A1C level of 6.5% or higher indicates diabetes mellitus (DM). - A casual plasma glucose level greater than 200 mg/dL along with symptoms of polyuria, polydipsia, and unexplained weight loss indicate diabetes mellitus. - A fasting plasma glucose level greater than 126 mg/dL indicates diabetes mellitus. - A 2-hour plasma glucose level of greater than 200 mg/dL during an oral glucose tolerance test indicates diabetes mellitus.

The nurse is aware of a group of clinic patients who have a family member with type 1 diabetes mellitus (T1DM). Which patient should the nurse identify as the one with the greatest risk for developing the disorder? A. The patient's sister diagnosed with type 2 diabetes mellitus (T2DM). B. The patient's identical twin diagnosed with type 1 diabetes mellitus (T1DM) C. The patient's mother-in-law diagnosed with type 2 diabetes mellitus (T2DM). D. The patient's aunt diagnosed with type 1 diabetes mellitus (T1DM).

B. The patient's identical twin diagnosed with type 1 diabetes mellitus (T1DM) - A patient with a monozygotic twin diagnosed with type 1 diabetes mellitus (T1DM) has a 50% risk of developing T1DM. - There is no correlation between a sibling with type 2 diabetes mellitus (T2DM) and a patient's risk of developing T1DM. - There is no correlation between a mother-in-law with T2DM and a patient's risk of developing T1DM. - An aunt is not a first-degree relative, so there is no correlation between an aunt with T1DM and the patient's risk of developing T1DM.

The nurse is teaching a patient recently diagnosed with type 1 diabetes mellitus (T1DM). The patient has over 80% loss of pancreatic beta-cell mass. For which patient statement should the nurse follow up? A. "I will need insulin replacement as, eventually, my body will no longer produce insulin." B. "Insulin production may increase slightly in the short term, but eventually, my body will cease to produce insulin." C. "I will have relative insulin deficiency for the rest of my life." D. "My twin is at risk for developing T1DM."

C. "I will have relative insulin deficiency for the rest of my life." - Type 1 diabetes mellitus (T1DM) leads to absolute insulin deficiency as the pancreatic beta cells eventually cease to produce insulin. During the honeymoon period, which can last for up to one year, the remaining beta cells work hard to keep up with insulin demand. However, they will eventually be unable to keep up and will cease to produce insulin. - Insulin production may increase slightly in the short term, but eventually the remaining beta cells will cease to produce insulin. - A patient whose identical twin has been diagnosed with T1DM is at risk of developing T1DM. - In T1DM, the patient's body will eventually cease to produce insulin.

Which condition accurately describes the process that occurs after ingestion of carbohydrates in a healthy adult patient? A. Plasma glucose levels are increased through glycogenolysis. B. Free fatty acids are released from adipose tissue. C. Insulin levels rise to stimulate glucose uptake. D. Sleepiness occurs as a result of a higher ratio of glucagon to insulin.

C. Insulin levels rise to stimulate glucose uptake. The absorptive state occurs after intake of carbohydrates. Insulin levels rise to stimulate glucose uptake. A higher rate of glucagon to insulin, glycogenolysis, and release of free fatty acids occur during the postabsorptive state.

Which statement is accurate for the pathophysiological changes that occur in the development of diabetic ketoacidosis (DKA)? A. Ketone bodies are produced from the excess glucose in the bloodstream and cause metabolic acidosis and electrolyte imbalances. B. Ketone bodies cause osmotic diuresis and loss of potassium. C. Ketone bodies are produced through the breakdown of lipids into energy. Ketones in the bloodstream cause metabolic acidosis and electrolyte imbalances. D. Ketone bodies result from the breakdown of fats into energy. Ketone bodies help transport glucose into the cells.

C. Ketone bodies are produced through the breakdown of lipids into energy. Ketones in the bloodstream cause metabolic acidosis and electrolyte imbalances. - Ketone bodies are produced when fat is broken down. - Ketones in the bloodstream cause metabolic acidosis. - Ketones in the urine cause a loss of sodium.

A patient with diabetes mellitus who is recovering from bronchitis experiences nausea, vomiting, and abdominal pain. Which action should be the primary nursing intervention? A. Drawing blood for a complete blood count (CBC) B. Drawing blood for hemoglobin and hematocrit C. Placing telemetry leads for cardiac monitoring D. Collecting a urine specimen for a urinalysis

C. Placing telemetry leads for cardiac monitoring - Diabetic ketoacidosis (DKA) causes potassium loss. Cardiac dysrhythmias are the result of hypokalemia. - Hemoglobin and hematocrit, urinalysis, and CBC are not priorities at this time.

Which information should the nurse include when teaching a patient about the risk factors for type 2 diabetes mellitus (T2DM)? A. Because changes in urbanization and lifestyle are the greatest risk factors for T2DM, an individual cannot prevent or slow its occurrence. B. Familial disposition is the greatest risk factor for T2DM. C. Individuals in the lowest socioeconomic brackets have the greatest risk of T2DM, making socioeconomic status the greatest risk factor for development of T2DM. D. Decreasing caloric intake and increasing physical exercise may decrease the risk of T2DM.

D. Decreasing caloric intake and increasing physical exercise may decrease the risk of T2DM. - A Westernized lifestyle includes a high-calorie diet and decreased physical activity, which leads to obesity. Central obesity, or increased weight around the trunk, is a prominent risk factor for type 2 diabetes mellitus (T2DM). - Central obesity is a marker for glucose intolerance, hyperinsulinemia, and hypertriglyceridemia. - Metabolic syndrome is also a strong risk factor for T2DM. The development of T2DM can be prevented or slowed through lifestyle modifications. - Lifestyle is the greatest risk factor for T2DM, not socioeconomic status or familial disposition.

The nurse is caring for a patient with diabetes mellitus (DM). Which assessment indicates to the nurse the patient may have developed diabetic neuropathy? A. Macular edema B. Hypertension C. Microalbumuria 45 mg albumin/24 hr D. Numbness and tingling in the lower legs

D. Numbness and tingling in the lower legs - Diabetic neuropathy is nerve damage due to diabetes mellitus (DM). Numbness and tingling in the lower legs is a clinical manifestation of neuropathy. - Microalbuminuria of 45 mg albumin/24 hr, macular edema, and hypertension are not clinical manifestations of diabetic neuropathy.

The nurse is assessing patients with diabetes mellitus (DM) in the clinic. Which patient should the nurse see first? A. The patient whose blood sugar was 75 mg/dL when it was checked 1 hour ago B. The patient who ate lunch 4 hours ago and is complaining of hunger C. The patient who is asking for assistance to the bathroom D. The patient who is sweaty, difficult to arouse, and disoriented to location

D. The patient who is sweaty, difficult to arouse, and disoriented to location - Hypoglycemia has two major categories of symptoms. The autonomic nervous system symptoms are caused by decreased glucose to the brain. The neuroglycopenic symptoms are caused by decreased glucose to the central nervous system. Sweating, drowsiness, and disorientation are physiological responses to hypoglycemia. - Hunger and urination are not physiological responses to hypoglycemia. - There is no information to indicate that a patient whose blood glucose was 75 mg/dL 1 hour ago is displaying signs of hypoglycemia.

The nurse is presenting information on the incidence of diabetes mellitus (DM) at a community health education program. Which statement should the nurse recognize as being incorrect about diabetes mellitus (DM)? A. Prediabetes affects 79 million people. B. Approximately 1 in 400 children and adolescents has diabetes mellitus. C. Type 2 diabetes mellitus is more common in Hispanics and non-Hispanic African Americans than in other ethnic groups. D. Type 2 diabetes mellitus is more common in Asian Americans and non-Hispanic Caucasian Americans than in other ethnic groups.

D. Type 2 diabetes mellitus is more common in Asian Americans and non-Hispanic Caucasian Americans than in other ethnic groups. Diabetes disproportionately affects minority populations; 7.6% of non-Hispanic Caucasian Americans, 9.0% of Asian Americans, 12.8% of Hispanics/Latinos, 13.2% of non-Hispanic African Americans, and 15.9% of American Indians/Alaskan Natives have diagnosed DM. In the general population, the risk of developing T2DM is approximately 3%.