Chapter 48 Diabetes Mellitus
In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. enhances breakdown of adipose tissue for energy b. stimulates hepatic glycogenolysis and gluconeogenesis c. prevents the transport of triglycerides into adipose tissue d. increases amino acid transport into cells and protein synthesis
d
Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times b. restrict calories to promote moderate weight loss c. eliminate sucrose and other simple sugars from the diet d. limit saturated fat intake to 30% of dietary calorie intake
a
A patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medication. The patient tells the nurse that she would rather control her blood sugar with herbal therapy. Which action should the nurse take? a. teach the patient that herbal therapy is not safe and should not be used b. Advise the patient to discuss using herbal therapy with her HCP before using it c. encourage the patient to give the prescriptive medication time to work before using herbal therapy d. teach the patient that if she takes herbal therapy she will have to monitor blood sugar more often
b
What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. ideal body weight b. normal serum glucose and lipid levels c. a special diabetic diet using diabetic foods d. five small meals per day with a bedtime snack
b
What disorders and diseases are related to macrovascular complications of diabetes? (SATA) a. chronic kidney disease b. coronary artery disease c. micro-aneurysms and destruction of retinal vessels d. ulceration and amputation of the lower extremities e. capillary and arteriole membrane thickening specific to diabetes
b, d
The nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as the priority by the nurse? a. bilateral numbness of both hands b. stage II pressure ulcer on the right heel c. rapid respirations with deep inspiration d. areas of lumps and dents on the abdomen
c
A patient with diabetes is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. have that patient drink some orange juice b. administer 10 U of regular insulin subcutaneously c. call for an ambulance to transport the patient to a medical facility d. administer glucagon 1 mg IM or SQ
d
The nurse determines that a patient with a 2 hour oral glucose tolerant test of 152 mg/dL has a. diabetes b. elevated A1c c. impaired fasting glucose d. impaired glucose tolerance
d
The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level? (SATA) a. heaadache b. unsteady gait c. abdominal cramps d. emotional changes e. increase in urination f. weakness and fatigue
a, c, e, f
The following interventions are planned for a patient with diabetes. Which intervention can the nurse delegate to UAP? a. discuss complications of diabetes b. check that the bath water is not too hot c. check the patient's technique for drawing up insulin d. teach the patient to use a meter for self-monitoring of blood glucose
b
Which statement best describes the atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. it can be prevented by tight glucose control b. it occurs with a higher frequency and earlier onset than in the nondiabetic population c. it is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes d. It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake
b
Which tissues require insulin to enable movement of glucose into the tissue cells? (SATA) a. liver b. brain c. adipose d. blood cells e. skeletal muscle
c, e
Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful."
d
The patient with type 2 diabetes is being put on acarbose (Precose) and wants to know about taking it. What should the nurse include in this patient's teaching? (SATA) a. take it with the first bite of each meal b. it is not used in patients with heart failure c. endogenous glucose production is decreased d. effectiveness is measure by 2 hour postprandial glucose e. it delays glucose absorption from the GI tract
a, d, e
A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. administer the usual insulin dosage b. hold fluid intake until nausea subsides c. come to the clinic immediately for evaluation and treatment d. monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL
a
A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. withdraws NPH dose into the syringe first b. Injects air equal to the NPH dose into the NPH vial first c. Removes any air bubbles after withdrawing the first insulin d. adds air equal to the insulin dose into regular vial and withdraws the dose
a
A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? a. it is more difficult to achieve strict glucose control than in younger patients b. treatment is not warranted unless the patient develops severe hyperglycemia c. it does not include treatment with insulin because of limited dexterity and vision d. it usually requires that a younger family member be responsible for care of the patient
a
To prevent hyperglycemia or hypogylcemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? a. plan activity and food intake related to blood glucose levels b. when blood glucose is greater than 250 mg/dL and ketones are present c. when glucose monitoring reveals that the blood glucose is in the normal range d. when blood glucose levels are high, because exercise always has a hypoglycemic effect
a
Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80-90 mg/dL. Which is the best response by the nurse? a. "This is a good range for your glucose levels"' b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia and you should increase your food intake." d. "You should take only half your insulin dosage for the next few days to get your glucose level back to normal."
a
When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan? a. achieving a normal weight b. performing daily aerobic exercise c. eliminating red meat form the diet d. monitoring the blood glucose periodically
a
When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. tight glycemic control can be maintained b. errors in insulin dosing are less likely to occur c. complications of insulin therapy are prevented d. frequent blood glucose monitoring is unnecessary
a
What characterizes type 2 diabetes? (SATA) a. beta cell exhaustion b. insulin resistence c. genetic predisposition d. altered production of adipokines e. inherited defect in insulin receptors f. inappropriate glucose production by the liver
a, b, c, d, e f
What are manifestations of DKA? (SATA) a. thirst b. ketonuria c. dehydration d. metabolic acidosis e. Kussmaul respirations f. sweet, fruity breath odor
a, b, c, d, e, f
During routine health screening, a patient is found to have fasting plasma glucose of 132 mg/dL. At a follow up visit, a diagnosis of diabetes would be made based on which laboratory results? (SATA) a. A1c pf 7.5% b. Glycosuria of 3+ c. Fasting plasma glucose greater than or equal to 127 mg/dL d. random blood glucose of 126 mg/dL e. a 2 hour oral glucose tolerance test of 190 mg/dL
a,c
The nurse is teaching the patient with prediabetes ways to prevent of delay the development of type 2 diabetes. What information should be included? (SATA) a. maintain a healthy weight b. exercise for 60 mins each day c. have blood pressure checked regularly d. assess fir visual changes on a monthly basis e. monitor for polyuria, polyphagia, polydipsia
a,e
The patient with diabetes is brought to the emergency department by his family members who say that he has had an infection, is not acting like himself, and he is more tired than usual. Number the nursing actions in the order of priority for this patient a. establish IV access b. check blood glucose c. ensure patent airway d. begin continuous regular insulin drip e. administer 0.9% NaCl solution at 1 L/hr f. establish time of last food and medications
a. 3 b. 2 c. 1 d. 5 e. 4 f. 6
A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. oral glucose tolerant test for all minority populations every year b. fasting plasma glucose for all individuals at age 45 and then every 3 years c. testing people under the age of 21 for islet cell antibodies d. testing for type 2 diabetes in all overweight or obese individuals
b
A patient with type 1 diabetes uses 20 U of Novolin 70/30 (NPH/regular) in the morning and at 6:00 PM. When teaching the patient about this regimen, what should the nurse emphasize? a. hypoglycemia is most likely to occur before the noon meal b. a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia c. flexibility in food intake is possible because insulin is available 24 hours a day d. Premeal glucose checks are required to determine needed changes in daily dosing
b
In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. fatigue b. polydypsia c. polyohagia d. recurrent infections
b
When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the pateint? a. pull back on the plunger after inserting the needle to check for blood b. consistently use the same size of insulin syringe to avoid dosing errors c. clean the skin at the injection site with alcohol swab before each injection d. premeal glucose checks are required to determine needed changes in daily doses
b
Which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. insulin b. biguanide c. meglitinide d. sulfonylurea
b
Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. decrease glucose production b. stimulate glucose output by the liver c. increase glucose transport into the cells d. independently regulate glucose level in the blood
b
The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient? (SATA) a. painless foot ulcers b. erectile dysfunction c. burning foot pain at night d. loss of fine motor control e. vomiting undigested food f. painless myocardial infarcation
b, e, f
A patient taking insulin has recorded fasting glucose levels about 200 mg/dL on awakening for the last five mornings. What should the nurse advise the patient to do first? a. increase the evening insulin dose to prevent the dawn phenomenon b. use a single-dose insulin regimen with an intermediate-acting insulin c. monitor the glucose level at bedtime, between 2:00 AM and 4:00 AM and on arising d. decrease the evening insulin dosage to prevent hypoglycemia and the Somogyi effect
c
The nurse assesses the technique pf the patient with diabetes for self-monitoring of blood glucose 3 months after initial instruction. Which error in the performance of self-monitoring blood glucose noted by the nurse requires intervention? a. doing the self-monitoring blood glucose before and after exercising b. puncuturing the finger on the side of the finger pad c. cleaning the puncture site with alcohol before the puncture d. holding the hand down for a few minutes before the puncture
c
The nurse should observe the patient for symptoms of ketoacidosis when a. illnesses causing NV lead to bicarb loss with body fluids b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy d. The patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy
c
What describes the primary difference in treatment for DKA and hyperosmolar hyperglymeic syndrome (HHS)? a. DKA requires administration of bicarb to correct acidosis b. Potassium replacement is not necessary in management of HHS c. HHS requires greater fluid replacement to correct the dehydration d. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level
c
Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. an obese 40 year old hispanic woman b. a child whose father has type 1 diabetes c. a 34-year-old woman whose parents both have type 2 diabetes d. a 12 year old boy whose father has maturity onset diabetes of the young (MODY)
c
Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. at mealtime or within 15 minutes of meals
d
The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration b. storing syringes prefilled with NPH and regular insulin needle-up in refrigerator c. placing the insulin bottle currently in use in a small container on the bathroom countertop d. mixing an evening dose or regular insulin glargine in one syringe for additional administration
d
The patient with type 2 diabetes has trouble controlling his blood glucose with several OAs but wants to avoid the risks of insulin. The HCP told him a medication will be prescribed that will increased insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying. The nurse knows this is which medication that will have to be injected? a. dopamine receptor agonist, bromocriptine (Cycloset) b. Dipeptidyl peptidase-4 (DDP-4) inhibitor, sitagliptin (Januvia) c. sodium-glucose co-transporter 2 (SGLT2) inhibitor, canagliflozin (Invokana) d. Glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)
d
Which laboratory results would indicate that the patient has prediabetes? a. glucose intolerant result of 132 mg/dL b. glucose tolerance result of 240 mg/dL c. Fasting blood glucose result of 80mg/dL d. fasting blood glucose result of 120 mg/dL
d