Diabetes EAQ pt.2
A patient presents to the emergency department with vomiting, abdominal pain, and rapid, deep respirations. The patient's blood glucose is 480 mg/dL. What nursing action should be taken?
Check urine for ketones
Which oral medication lowers blood glucose levels by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine, allowing for the filtered glucose to be excreted in the urine rather than moved back into the blood?
Dapagliflozin (Farxiga)
The nurse provides education about metformin to a patient with diabetes. What is a symptom of lactic acidosis, a common side effect of this medication?
Diarrhea
What method must the patient with diabetes use with regard to insulin safety?
Discard any unused insulin after 28 days.
A patient has 0700 fingerstick blood glucose readings of 353-286 for 3 mornings in a row, and the nurse is concerned the patient may have dawn phenomenon. Which finding is consistent with this phenomenon?
Early morning glucose elevations
The nurse is treating a patient with diabetes. Which are risk factors for development of vision loss in patients with diabetes? Select all that apply.
Proteinuria Poor glucose regulation
The nurse is providing education regarding sick day rules to a patient with diabetes. What information does the nurse include in the teaching plan? Select all that apply.
Check urine for ketones. Monitor blood glucose at least every 4 hours. Drink 8 to 12 ounces of sugar-free liquid every hour while awake.
What symptoms should be assessed for in a patient diagnosed with hypoglycemia? Select all that apply.
Confusion Weakness Cool, clammy skin
A patient has been newly diagnosed with diabetes mellitus. Which factors does the nurse emphasize should be monitored regularly by the patient to prevent and detect complications of the disease? Select all that apply.
Feet Urine Vision Kidney function Hemoglobin A 1c
The nurse is providing discharge teaching to a patient with newly diagnosed diabetes. Which statement by the patient indicates a correct understanding about the need to wear a MedicAlert bracelet?
"If I become hypoglycemic, I could become unconscious."
The nurse is reviewing the implications of culture on the development of diabetes. Which patient will the nurse determine has the greatest risk for developing type 2 diabetes mellitus?
44-year-old healthy American Indian patient with a family history of type 2 diabetes
The nurse is providing education to a patient with a new diagnosis of type 1 diabetes. What action by the patient indicates a need for further teaching?
Aspirating for blood return before administering the medication
The nurse is caring for a group of patients with acidosis. The nurse recognizes that Kussmaul respirations are consistent with which situation?
Aspirin overdose
Which symptoms indicate autonomic neuropathy? Select all that apply.
Atonic bladder Dried, cracked skin Orthostatic hypotension
What best describes the etiology of type 1 diabetes mellitus?
Autoimmune disorder
What are the distinguishing characteristics of type 1 diabetes mellitus (DM) that the nurse should remember? Select all that apply.
Autoimmune disorder Beta cells are destroyed Triggered by viral infections
What techniques should a patient with diabetes use to administer insulin injections? Select all that apply.
Avoid injecting insulin on scarred sites. Avoid injecting within a 2-inch radius around the navel. Grasp a fold of the skin and inject insulin subcutaneously.
Which conditions place a patient at risk for developing metabolic alkalosis? Select all that apply.
Blood transfusion Nasogastric suctioning Total parenteral nutrition
Which procedure describes a tube inserted into the airway in order to view airway structures and obtain tissue samples for a biopsy?
Bronchoscopy
The nurse relates continuous, adventitious breath sounds to which conditions? Select all that apply.
Bronchospasm Pulmonary vessel engorgement
The nurse is providing teaching about weight gain secondary to insulin resistance to a patient with type 1 diabetes. What actions by the patient can minimize this complication?
Calorie restriction
Which manifestation is associated with hyperglycemia in a patient with diabetes mellitus?
Excessive urination
What information about exercise should the nurse include for patients diagnosed with diabetes? Select all that apply.
Exercise increases insulin sensitivity. Hypoglycemia can occur from increased muscle glucose uptake. Exercise can lead to hyperglycemia and ketones if diabetes is not controlled.
The nurse is providing health screening. The nurse determines that the patient with which lab value should receive teaching related to diabetes?
Fasting blood glucose of 127 mg/dL
The patient with diabetes is at risk for eye and vision complications. What is the distinguishing characteristic of proliferative diabetic retinopathy?
Formation of new retinal blood vessels
The nurse is providing education for a patient newly diagnosed with diabetes. The patient is discussing healthy sources of carbohydrates. What sources should be included? Select all that apply.
Fruits Legumes Low-fat milk products
Which hormone is responsible for maintaining blood glucose levels during periods of fasting from food?
Glucagon
The nurse is providing teaching to a patient at risk for the development of type 2 diabetes. The nurse explains which benefits of exercise for this patient? Select all that apply.
Glucose tolerance Reduced body weight
A patient diagnosed with type 2 diabetes is being seen for routine health screening. The patient has received nutritional education and begun regular exercise. What lab value indicates the patient may need to begin medication therapy?
Glycosylated hemoglobin (A1C) 7.0%
A patient with diabetes mellitus reports a burning or tingling sensation in the toes. A primary health care provider suspects distal symmetric neuropathy. The nurse recognizes that which findings indicate motor alterations in the intrinsic muscles of the foot associated with this condition? Select all that apply.
Hammertoes High arch Claw toes
The nurse is teaching patients with diabetes about the need for annual eye care. Which groups of patients are statistically at risk of foregoing annual eye care because of the cost involved or the lack of insurance? Select all that apply.
Hispanics African Americans Those with less formal education
The home health care nurse is providing teaching to an insulin-dependent patient regarding infection. What symptom is priority for the patient to report to the health care provider?
Hyperglycemia
Which conditions are typical features of metabolic syndrome? Select all that apply.
Hypertension Hyperglycemia Hyperlipidemia Abdominal obesity
What information does the nurse include when planning teaching for a patient with diabetes? Select all that apply.
Importance of foot care Correct storage for insulin Understanding of why the insulin is being prescribed
What is the role of incretin hormones in glucose regulation? Select all that apply.
Increase insulin secretion Slow rate of gastric emptying Prevent hyperglycemia after meals
The nurse is providing screening for patients about diabetes mellitus. What diagnoses does the nurse recognize as triggers for development of type 1 diabetes mellitus? Select all that apply.
Mumps Coxsackievirus
Which finding is seen in a patient with type 2 diabetes mellitus?
Obesity
A patient diagnosed with diabetes plans to engage in strenuous exercise. The patient has a blood sugar level of 285 mg/dL. What action by the patient demonstrates an understanding of the teaching about diabetes?
Patient checks urine for ketone bodies.
Which patient taking metformin does the nurse consider at highest risk for lactic acidosis?
Patient who is receiving dialysis
A patient with type 2 diabetes experiences a stroke and the nurse is caring for the patient in the intensive care unit (ICU). What factor puts this patient at greater risk for a poor clinical outcome?
Patients with diabetes experience brain damage that would normally not cause damage in a patient without diabetes.
The nurse is caring for a patient with diabetes who has autonomic neuropathy of the feet. What is the effect of this condition?
Skin cracks and fissures
The nurse is providing teaching on meal planning to an older adult patient who reports three episodes of hypoglycemia in the past several months. What action by the nurse is most appropriate?
Suggest a referral for home health care.
The nurse is providing preoperative instructions to a patient with diabetes. What instructions should the nurse include?
Sulfonylureas should be discontinued one day before surgery.
A patient with type 2 diabetes, retinopathy, and complaints of painful "pins and needles" sensations in the feet presents to the primary care clinic. The nurse notes the patient's low-density lipoprotein cholesterol (LDL) level is at 75 mg/dL. What can the nurse determine regarding the patient's LDL level?
The level is higher than the recommended level and should be addressed by the health care provider.
What role does the liver play in the production, conversion, and release of insulin?
The liver converts a prohormone into insulin before releasing it into the bloodstream.
Which explanation best assists a patient in differentiating type 1 diabetes from type 2 diabetes?
Those with type 2 diabetes make insulin, but in inadequate amounts.
What intervention is most important to prevent complications for the patient diagnosed with diabetes?
Tight glucose control
What is the purpose of bronchoscopy?
To obtain tissue sample for culture and biopsy
The nurse is assessing a patient for diabetic foot problems. What should the nurse include in this assessment? Select all that apply.
Toenails Tinea pedis History of previous ulcer
The nurse is caring for a patient with diabetes mellitus who is being screened for nephropathy. What laboratory test will the nurse reference as the test used to screen for early nephropathy?
Urine for albumin
A patient with type 1 diabetes has had multiple episodes of hypoglycemia. What teaching by the nurse may be indicated?
Use the fingertip only for blood glucose checks.
Which assessment finding is identified as a risk for type 2 diabetes mellitus (DM) and cardiovascular disease (CVD)?
Waist circumference of 40 inches or more
The nurse is teaching a patient about the movement of glucose in the body. Arrange the sequence of events that take place when blood glucose levels drop in the correct order.
When blood glucose levels fall, insulin secretion stops and glucagon is released. Glucagon prevents hypoglycemia by triggering the release of glucose from cell storage sites. Glucagon causes the release of glucose from the liver. Glycogen is broken down to glucose in the liver during the process of glycogenolysis; similarly, amino acids are broken down to glucose in the process of gluconeogenesis. When liver glucose is unavailable, first lipolysis and then proteolysis provide alternate fuel for energy.
A patient recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the patient the proper use of the machine?
While performing the test in the hospital
A 5'8", 225-pound patient with metabolic syndrome has a blood pressure of 158/96 mm Hg, a high-density lipoprotein cholesterol level of 39 mg/dL, and a waist size of 44 inches. Which recommendation does the nurse make to this patient?
"Consume fewer calories to reduce your weight."
The nurse is providing discharge teaching to a patient with diabetes about injury prevention for peripheral neuropathy. Which statement by the patient indicates a need for further teaching?
"I can break in my shoes by wearing them all day."
The nurse is instructing a patient with diabetes about exenatide. Which patient statement indicates a correct understanding of the teaching?
"I'll need to learn how to administer injections to myself."
The nurse is providing instructions to a patient scheduled for a fasting plasma glucose (FPG) test for diabetes screening. What statement by the patient reflects a need for further teaching?
"It is important not to eat 12 hours before the labs are drawn."
The nurse is providing teaching for a patient newly diagnosed with type 1 diabetes. Which statements by the patient indicate an understanding of the teaching provided about continuous glucose monitoring? Select all that apply.
"It is important to check fingersticks with continuous glucose monitoring." "I should purchase disposable sensors for the continuous glucose monitor system."
A patient expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response?
"Let's tackle it piece by piece. What is most scary to you?"
A patient is scheduled for a glycosylated hemoglobin (A1C) test. The patient calls to request the day be changed because he has a family function the weekend before the test and is concerned about following the nutritional plan. What statement by the nurse is most appropriate?
"The A1C test will not be affected by what you eat in the days before it."
A diabetic patient has a glycosylated hemoglobin (A1C) level of 9.4%. What does the nurse say to the patient regarding this finding?
"What are you doing differently?"
The nurse is providing discharge instructions for a patient who was admitted with diabetic ketoacidosis. What information does the nurse include when teaching the patient about the pathophysiology of the condition?
"When insulin is deficient, fats break down, causing acidosis."
The nurse is caring for a patient who has type 2 diabetes with poorly controlled blood glucose levels. The patient asks the nurse, "When my blood sugar is high, why am I always hungry, even when I constantly eat?" What is the nurse's best response? Select all that apply.
"When insulin is not present, increased hunger persists." "Despite eating, glucose is not being used at the cellular level." "When cellular glucose is low, cell starvation triggers excessive hunger."
Consuming which item is appropriate for the patient who becomes hypoglycemic at home?
1 tbsp of honey
The nurse is providing teaching to a patient prescribed insulin lispro. How long before a meal is the patient required to inject the insulin lispro?
10 minutes
Which blood glucose level does the operating room nurse recognize as optimal during surgery to prevent hypoglycemia?
150 mg/dL
The nurse is providing nutritional recommendations for a patient who has been diagnosed with diabetes. What statement by the patient indicates a need for further teaching?
1800 calories
A registered nurse is teaching a group of nursing students about the recommendation of the American Diabetes Association (ADA) regarding indications for testing an individual with type 2 diabetes. Which individual suggested by a nursing student for testing indicates a need for further education?
An individual who is 45 years old with a body mass index (BMI) less than 25 kg/m2
What macrovascular complications may occur as a result of diabetes mellitus? Select all that apply.
Cardiovascular disease Cerebrovascular disease
Which are priority interventions for a diabetic patient to reduce modifiable risk factors associated with cardiovascular disease? Select all that apply.
Ceasing smoking Controlling hypertension Controlling hyperglycemia Controlling high triglycerides
What information should be included when teaching a patient with diabetes about foot care?
Check bath water temperature before stepping in the water.
What action is important for a patient with diabetes to take on sick days?
Check urine for ketones.
The nurse has provided teaching about exercise to a patient diagnosed with type 1 diabetes. What action by the patient demonstrates effective teaching?
Eat a carbohydrate snack if participating in unplanned exercise.
When providing teaching about nutrition to a patient diagnosed with diabetes, what instruction should the nurse include?
Eat consistent amounts of food at consistent times.
The nurse has provided education about factors responsible for increased rates of diabetes among minority groups. Which factor identified by the patient indicates a need for further teaching?
Increased financial resources
The nurse is teaching a patient about insulin administration. Which actions by the patient demonstrate an accurate understanding of the teaching provided? Select all that apply.
Inserting needle at 90-degree angle Turning bottle upside down to withdraw insulin
A patient with type 2 diabetes mellitus is experiencing cardiovascular autonomic neuropathy (CAN). What should the nurse include on this patient's care plan to address safety?
Instruct to change positions slowly.
A patient newly diagnosed with type 1 diabetes is receiving education about the types of premeal insulin. What selection by the patient indicates the teaching was effective?
Insulin aspart
The nurse is providing education to a patient about the prevention of hypoglycemia. What signs and symptoms of this complication should be included in the teaching?
Irritability
The nurse is providing nutritional education to a patient newly diagnosed with diabetes. What should be considered for optimal adherence to the plan? Select all that apply.
Lifestyle Financial status Cultural background
The nurse is caring for a patient who has been on a hunger strike for 30 days and has no body fat and poor muscle definition. What mechanisms have been providing this patient with energy? Select all that apply.
Lipolysis Proteolysis
The nurse is admitting a patient with diabetic ketoacidosis to the intensive care unit (ICU). What arterial blood gas (ABG) result will the nurse likely find when reviewing the patient's laboratory results?
Low pH, low CO 2, low HCO 3
To decrease the risk of acid-base imbalance, what goal must the patient with diabetes mellitus strive for?
Maintaining blood glucose level within normal limits.
The nurse is screening patients in a clinic. What groups have a higher risk of developing type 2 diabetes? Select all that apply.
Mexican Americans Patients with glucose intolerance during pregnancy
Which information should be included when providing education to a patient about sick day rules? Select all that apply.
Notify the healthcare provider if ill. Drink 8 to 12 ounces of sugar-free liquid each hour while awake. If unable to eat, consume liquids equal to the carbohydrate content normally eaten.
What mechanism causes electrolyte imbalances in the patient with diabetes who is experiencing extremely elevated blood glucose levels?
Osmotic diuresis
The nurse is providing teaching to a patient diagnosed with peripheral neuropathy secondary to diabetes. Which instructions regarding footwear should be included for the patient?
Socks or stockings should be fitted properly.
What area of the patient's feet would the nurse identify as correct for assessing for plantar ulcers?
Sole of the foot
The nurse is teaching a patient with diabetes about proper foot care. Which statement by the patient indicates that teaching was effective?
"I must inspect my shoes for foreign objects before putting them on."
The nurse is teaching a patient with type 2 diabetes about the importance of weight control. Which comment by the patient indicates a need for further teaching?
"I should begin exercising for at least an hour every day."
The nurse is teaching a patient about the manifestations and emergency treatment of hypoglycemia. In assessing the patient's knowledge, the nurse asks the patient what he or she should do if feeling hungry and shaky. Which response by the patient indicates a correct understanding of hypoglycemia management?
"I should eat three graham crackers."
The nurse is assessing an older adult patient with type 2 diabetes and notes that the patient has optic nerve atrophy. What statement will the nurse include when teaching the patient about this condition?
"This results from lack of oxygen vessel swelling."
The nurse is caring for a patient who is receiving sitagliptin. Which finding requires immediate attention?
Amylase 546 mg/dL
A patient with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The patient's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38/min, BP 91/54 mm Hg, and O 2 saturation 99% on room air. Which action does the nurse take first?
Check the blood glucose.
Which is a side effect of angiotensin-converting enzyme (ACE) inhibiting drugs on the respiratory system?
Cough
Which assessment findings are considered normal for a 79-year-old patient?
Effectiveness of the cilia decreases and risk of hypoxia increases
The nurse is planning nutritional education for a patient newly diagnosed with diabetes. Who should be included as part of the treatment team? Select all that apply.
Nurse Patient's family Registered dietician
Which statement about blood pressure, as it relates to diabetes mellitus, is correct?
Patients with diabetes should keep their blood pressure below 130/80 mm Hg.
The nurse is determining the learning needs of a patient diagnosed with diabetes. What items should the nurse include in this assessment? Select all that apply.
Psychosocial concerns Current mental health status Nutrition history and practices
Which action is correct when drawing up a single dose of insulin?
Pull back plunger to draw air into the syringe equal to the insulin dose.