Chapter 48: Complications of DM

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? Answer: D

Administering intravenous (IV) fluids containing glucose

A nurse is caring for a 62-year-old man with a history of hypertension and type 2 diabetes who has been admitted to the inpatient unit for pneumonia. The nurse enters the patient's room to complete an admission assessment and notices that the patient has slurred speech and right-sided weakness. After calling the rapid response team, what is the nurse's next action? Answer: c

Check blood glucose

After giving 6 oz. of orange juice to a patient with hypoglycemia, the nurse finds that the patient's blood glucose level is 65 mg/dL. What would be the most appropriate nursing action in this situation? Answer: A

Give 15g of a carbohydrate

What are the possible patient-specific reasons for selecting the intramuscular route for administering glucagon for treating hypoglycemia? Select all that apply. Answers: 1,2,3

Intravenous access is unavailable. The patient is not alert enough to swallow through oral route. Injecting in the deltoid muscle would result in quicker response.

A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? Answer: C

Kussmauls Respirations

Which drug does the nurse expect to be beneficial in a patient with type 2 diabetes who has the presence of albumin in the urine? Answer: A

Lisinopril

The nurse is instructing a diabetic patient who has infrequent voiding, difficulty voiding, and a weak stream of urine. Which action indicates the need for additional teaching? Answer: C

Loosening the abdominal muscles during voiding

Which drug may result in weight gain as a side effect? Answer: B

Meglitinides

Which process is related to nonproliferative retinopathy? Answer: B

Microaneurysm

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include? Answer: B

Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.

Which population experiences the most disparity related to the amount of complications from diabetes Answer: B

Native Americans

The nurse is teaching the caregiver about the manifestations of hypoglycemia in the diabetic patient. What should the caregiver identify as a manifestation of hypoglycemia? Answer: C

Nervousness and Tremors

What is a risk factor associated with macrovascular complications of diabetes mellitus? Answer: A

Obesity

A patient with diabetes mellitus needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? Answer: B

Obtain comprehensive dental care

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? Answer: B

"I should look at the condition of my feet everyday"

Which statement by the patient shows effective learning about insulin therapy? Answer: C

"I will not use the insulin if any particles appear in the solution."

Which symptoms may be observed in patients with diabetic ketoacidosis? Select all that apply. Answers: 1,4,5

Hypovolemia Soft and sunken eyes sweet fruity odor of breath

A patient with a history of type 2 diabetes is diagnosed with heart failure. Which medication would be a poor choice for controlling the patient's diabetes? Answer: D

Pioglitazone

A patient whose laboratory report shows a blood glucose level of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 is on therapeutic management. At a follow-up visit, the patient has severe hypokalemia (2 mEq/L). Which therapeutic intervention might have caused severe hypokalemia in this patient? Answer: D

Administration of 0.1 U/kg/hr of insulin

The laboratory reports of a patient brought to the emergency department with the symptoms of dehydration show high glucose levels in the blood, large ketone bodies in the urine, decreased serum bicarbonate levels, and acidic pH of the blood. What nursing interventions would help stabilize the patient? Select all that apply. Answers: 4,5

Administration of short-acting insulin intravenously Administration of fluids and electrolytes intravenously

While caring for a patient with diabetic ketoacidosis, the nurse finds that the patient is experiencing rapid, deep breathing due to dyspnea. Which physiologic cause does the nurse suspect? Answer: A

Altered pH balance

Which drug is used for treating neurogenic bladder? Answer: C

Bethanechol

Which intervention may help prevent further complications in an unconscious patient with a history of diabetes whose blood sugar level is found to be 65 mg/dL? Answer: C

Administering 25 to 50 mL of 50 percent glucose intravenously

A nurse is caring for a patient with diabetic ketoacidosis (DKA). The patient is on a continuous short-acting insulin infusion and receiving a continuous infusion of normal saline solution. The nurse understands that insulin causes an intracellular shift of potassium, water, and glucose to move into the intracellular space. The nurse has several things to observe, but what is the highest priority? Answer: D

Cardiac monitoring

Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis? Answer: C

Cerebral Edema

A patient on an inpatient unit pushes the call button for the nurse. The nurse notices upon entering the patient's room that the patient is sweating profusely, pale, and anxious. The patient states, "I feel really dizzy and my vision is blurred." What intervention is the highest priority? Answer: D

Check the patients blood glucose

A nurse is caring for a 24-year-old woman with no available medical history. The patient states that she has been vomiting for two days and feels weak. She states that she cannot seem to drink enough water at home and urinates more than usual throughout the day. The laboratory results reveal an arterial blood pH of 7.28, sodium level of 155 mEq/L, potassium level of 3.5 mEq/L, serum glucose level of 550 mg/dL, sodium bicarbonate level of 10 mEq/L, and a high level of ketones in the urine. What will the nurse include in this patient's plan of care? Select all that apply Answers: 1,2,4,5

Potassium replacement Assessment of mental status Assessment of blood glucose levels Administration of intravenous (IV) fluids

A nurse teaches a student nurse about pancreas transplantation. While caring for a patient whose pancreas has been transplanted, which instruction given by the student nurse strongly suggests ineffective learning? Answer: D

Regular monitoring of glucose is required

Which complication of diabetes mellitus can be monitored by fundus photography? Answer: B

Retinopathy

Which manifestation might the nurse suspect in a patient with diabetes whose serum osmolality is increased and blood glucose level is 610 mg/dL? Answer: B

Seizures

The nurse is providing discharge instructions to a patient who has a neurogenic bladder. Which self-care activities would the patient identify to facilitate bladder emptying to help prevent urinary stasis and infection? Select all that apply. Answers: 1,2,4

Sitting to void Using the Credé maneuver when voiding Tightening the abdominal muscles when voiding

Which statement of the patient with diabetes indicates ineffective learning about management of hypoglycemia? Answer: B

"I will recheck my glucose level 30 minutes after eating 15 g of carbohydrate"

The nurse advises a diabetic patient on insulin therapy who reports headaches on waking and night sweats to reduce the dose of insulin and have a bedtime snack. Which finding supports the nurse's instructions? Answer: A

Blood glucose levels; 60 mg/dL between 2 AM and 4 AM

What are the symptoms of peripheral arterial disease? Select all that apply. Answers: 1,2,3

Cold feet loss of hair dependent rubor

The nurse is conducting a teaching session about nephropathy as a complication of diabetes. Which information would be appropriate for the nurse to include in the session? Answer: B

Controlling blood sugar and blood pressure will reduce the risk of kidney injury.

The nurse would encourage a patient with diabetes mellitus and coronary artery disease to limit intake of which of the following foods to help reduce the percentage of saturated fat in the diet? Answer: D

Dairy products

While caring for a patient showing signs of dawn phenomenon, the student nurse teaches the patient ways to avoid an increased level of blood glucose in the morning. Which instruction strongly suggests a need for further learning? Answer: A

Decrease your insulin intake

Which conditions may lead to a coma in patients with diabetic ketoacidosis if left untreated? Select all that apply. Answers: 1,4,5

Dehydration Metabolic acidosis Electrolyte imbalances

Which complication can be monitored by annual screening using a monofilament Answer: A

Diabetic Neuropathy

Which complication of diabetes can cause hypoglycemic unawareness? Answer: A

Diabetic Neuropathy

Which complication of diabetes can be treated with hyperbaric oxygen? Answer: A

Diabetic foot ulcers

Which medications does the nurse expect to be beneficial in a patient with diabetes mellitus who complains of numbness and a tingling sensation in the lower extremities? Select all that apply. Answers: 2,3,5

Duloxetine Gabapentin Amitriptyline

A patient with diabetes experiences hypoglycemia. What does the nurse educate the patient that a cause of this condition may be? Answer: D

Exercise without a carbohydrate based snack

Which is a symptom of autonomic neuropathy Answer: D

Gastroparesis

Which statement by a patient shows ineffective learning about diabetes management Answer: B

I will drink fruit juices daily

Which statement of the diabetic patient suggests the need for additional learning about foot care? Answer: D

I will give a hot water bottle treatment to my feet daily

Laboratory results have been obtained for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes Answer: A

Increased Triglyceride levels

The nurse is reviewing laboratory results for the patient with diabetes and coronary artery disease. Which laboratory result would help predict possible macrovascular disease as a complication of diabetes? Answer: A

Increased low-density lipoproteins

The urinalysis of a patient with diabetes mellitus that has a blood glucose level of 680 mg/dL reveals a minimal ketone level. Which other finding can the nurse observe in the reports? Answer: C

Increased serum osmolality

What should be the initial treatment for a patient with diabetic ketoacidosis who arrived at the hospital with clinical symptoms of dry mucous membranes, tachycardia, and orthostatic hypotension? Answer: C

Infusion of 0.45 percent or 0.9 percent sodium chloride (NaCl)

Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis? Answer: B

Insulin Therapy

A patient with type 1 diabetes mellitus has received a prescription for propranolol. What does the nurse recognize as the major concern for this patient? Answer: B

Lessened ability to sense hypoglycemia

What is the cause of microaneurysms in nonproliferative retinopathy? Answer: c

Partial blood vessels occlusion

Which patient will not respond to glucagon? Answer: B

Patients with alcoholic liver disease

Which complication of diabetes can be diagnosed by the ankle-brachial index? Answer: C

Peripheral Artery Disease

The nurse is caring for a patient with newly diagnosed type 2 diabetes mellitus. Which symptoms indicate that the patient is experiencing hyperglycemia? Answer: A

Polyuria, Polydipsia, Polyphagia

Which other symptoms should be assessed in a hospitalized patient whose blood and urine tests indicate diabetic ketoacidosis (DKA)? Select all that apply. Answers: 1,2,3,4

Tachycardia Kussmaul respirations Orthostatic hypotension Hypovolemic shock state