Diabetes Mellitus Study Guide

Glucagon may be given in the treatment of hypoglycemia because it: A. Inhibits gluconeogenesis B. Stimulates the release of insulin C. Increases blood glucose levels D. Provides more storage of glucose.

C. Increases blood glucose levels Glucagon, an insulin antagonist produced by the alpha cells in the islets of Langerhans, leads to the conversion of glycogen to glucose in the liver.

A client's blood gases reflect diabetic acidosis. The nurse should expect: A. Increased pH B. Decreased PO2 C. Increased PCO2 D. Decreased HCO3

D. Decreased HCO3 The bicarbonate-carbonic acid buffer system helps maintain the pH of the body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids.

Knowing that gluconeogenesis helps to maintain blood glucose levels, a nurse should: A. Document weight changes because of fatty acid mobilization. B. Evaluate the patient's sensitivity to low room temperatures because of decreased adipose tissue insulation. C. Protect the patient from sources of infection because of decreased cellular protein deposits. D. Do all of the above.

D. Do all of the above All measures ensure gluconeogenesis in maintaining glucose homeostasis.

A nurse performs a physical assessment on a client with T2DM. Findings include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse? A. Pulse B. Blood pressure C. Respiration D. Temperature

D. Temperature An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration

6-14 hours after administration The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.

According to the National Diabetes Statistics Report, diabetes remains one of the leading causes of death in the United States since 2010. Which of the following factors are risks for the development of DM? Select all that apply. A. Age over 45 years B. Overweight with a waist/hip ratio >1 C. Having a consistent HDL level above 40 mg/dl D. Maintaining a sedentary lifestyle E. Polycystic ovary syndrome

A, B, D, and E. Options A, B, D, and E: Aging results in a reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to metabolic syndrome and a sedentary lifestyle. For women, having PCOS increases the risk of diabetes.

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: A. Administer regular insulin intravenously B. Administer 5% dextrose intravenously C. Correct the acidosis D. Apply an electrocardiogram monitor

A. Administer regular insulin intravenously Option A: Lack (absolute or relative) of insulin is the primary cause of DK1. Options B and C: Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Option D: Applying an EKG is not a priority action.

A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse's primary responsibility to: A. Check the client's serum glucose level B. Assist the client out of bed to the chair C. Place the client in a High-Fowler's position D. Ensure that the client's residual limb is elevated

A. Check the client's serum glucose level Because the client has diabetes, it is essential that the blood glucose level is determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage.

A client with DM states, "I cannot eat big meals; I prefer to snack throughout the day." The nurse should carefully explain that: A. Regulated food intake is basic to control B. Salt and sugar restriction is the main concern C. Small, frequent meals are better for digestion D. Large meals can contribute to a weight problem

A. Regulated food intake is basic to control An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two between meals snacks need to be tailored to the client's specific needs, with due regard for activity, diet, and therapy.

Dr. Wijangco orders insulin lispro (Humalog) 10 units for a client with DM. When will the nurse administer this medication? A. When the client is eating B. Thirty minutes before meals C. Fifteen minutes before meals D. When the meal trays arrive on the floor

A. When the client is eating (no rationale provided)

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalanced nutrition: less than body requirements D. Disabled family coping: compromised

A: Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options B, C, and D are not related specifically to the issue of the question.

Rotating injection sites when administering insulin prevents which of the following complications? A. Insulin edema B. Insulin lipodystrophy C. Insulin resistance D. Systemic allergic reactions

B. Insulin lipodystrophy Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites.

Which adaptations should the nurse caring for a client with DKA expect the client to exhibit? SATA A. Sweating B. Low PCO2 C. Retinopathy D. Acetone breath E. Elevated serum bicarbonate

B. Low PCO2 C. Retinopathy Options B and C: Metabolic acidosis initiates respiratory compensation in the form of Kussmaul's respirations to counteract the effects of ketone buildup, resulting in a lowered PCO2. Option D: A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis.

During a visit to the hospital, the student nurses are asked which of the following persons would most likely be diagnosed with DM. They are correct if they answered a 44-year-old: A. Caucasian woman. B. Asian woman. C. African-American woman. D. Hispanic male.

C. African-American woman. Age-specific prevalence of diagnosed DM is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.

A clinical manifestation that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A. Blurred vision B. Diaphoresis C. Nausea D. Weakness

Correct answer: B. Diaphoresis A hypoglycemic reaction activates a fight-or-flight response in the body which then triggers the release of epinephrine and norepinephrine resulting in diaphoresis.

Genevieve has T1D and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include? A. The alcohol could cause pancreatic disease. B. The alcohol could cause serious liver disease. C. The alcohol could predispose you to hypoglycemia. D. The alcohol could predispose you to hyperglycemia.

C. Alcohol could predispose you to hypoglycemia. Option C: Alcohol can potentiate hypoglycemic effects (not hyperglycemic) Option A: Alcohol can cause pancreatic disease, but the client's pancreas is not producing any insulin currently. Option B: Alcohol can cause liver disease, but the more immediate concern is hypoglycemia.

When a client is first admitted with HHNS, the nurse's priority is to provide: A. Oxygen B. Carbohydrates C. Fluid replacement D. Dietary instruction

C. Fluid replacement As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin.

A male nurse is providing a bedtime snack for his patient. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: A. 6-8 hours B. 10-14 hours C. 14-18 hours D. 24-28 hours

Correct answer: C. 14-18 hours Option C: Intermediate-acting insulins include Humulin N and Novolin N. They have an onset of two to four hours, peak of 4 to 12 hours, and a duration of 14 to 18 hours. Option A: Regular or short-acting insulins include Humulin R and Novolin R. They have an onset of half an hour, a peak of two to three hours, and a duration of six to eight hours. Option D: Long-acting insulins include Levemir and Lantus. They have an onset of several hours, minimal or no peak, and a duration of 24 hours or more.

Your patient has had the following intake: 8 oz glasses of iced tea, 4 oz cartons of grape juice, ¾ pt of ice cream, 32 oz of juice, 1 ½ L of D5W IV and 6 oz of cottage cheese. What will you record as the total intake in mL for this patient?

Correct answer: 3,195 ml 1 pt = 500 ml 1 oz = 30 ml 240 ml + 120 ml + 375 ml + 960 ml + 1,500 ml = 3,195 ml (Cottage cheese is not liquid at room temperature, so it is not included when calculating intake.)

Give Regular insulin by continuous I.V. infusion at 20 units/hr. The solution is 250 ml NS with 100 units of Regular insulin. What rate on the infusion pump will deliver the correct dose?

Correct answer: 50 ml/hr

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to: A. Administer a sedative B. Make sure the client knows all the correct medical terms to understand what is happening C. Ignore the signs and symptoms of anxiety so that they will soon disappear D. Convey empathy, trust, and respect toward the client

The most appropriate intervention is to address the client's feelings related to anxiety. Option A: Administering a sedative is not the most appropriate intervention. Option B: A client will not relate to medical terms, particularly when anxiety exists. Option C: The nurse should not ignore the client's anxious feelings.

Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal? A. The client will be very thirsty. B. The client will complain of nausea. C. The client will need to urinate. D. The client will have moist clammy skin.

D. The client will have moist clammy skin. Option D: Moist skin is the sign of hypoglycemia, which the client would experience if he injected himself with insulin and did not eat. Options A, B, and C: Thirst, nausea and increased urination are signs of hyperglycemia

Which of the following causes of HHNS is most common? A. Insulin overdose B. Removal of the adrenal gland C. Undiagnosed, untreated hyperpituitarism D. Undiagnosed, untreated diabetes mellitus

D. Undiagnosed, untreated diabetes mellitus Undiagnosed, untreated diabetes mellitus is one of the most common causes of HHNS.

Your patient has had the following intake: 2 ½ cups of coffee (240 mL/cup) 11.5 oz of grape juice ¾ qt of milk 320 mL of diet coke 1 ¼ L of D5W IV 2 oz of grits. What will you record as the total intake in mL for this patient?

Correct answer: 3,265 ml 1 qt = 1,000 ml 1 oz = 30 ml 600 ml + 345 ml + 750 ml + 320 ml + 1,250 ml = 3,265 ml (Grits is not liquid at room temperature, so it is not included when calculating intake.)

Jansen is receiving metformin (Glucophage). What will be the best plan of the nurse with regard to patient education with this drug? Select all that apply. A. It stimulates the pancreas to produce more insulin. B. It must be taken with meals. C. It decreases sugar production in the liver. D. It inhibits the absorption of carbohydrates. E. It reduces insulin resistance.

B, C, and E. Options B, C, and E: Metformin (Glucophage) reduces insulin resistance, decreases sugar production in the liver, and should be taken with meals for the best absorption and effect. Options A and D: It does not stimulate the pancreas to produce more insulin and does not inhibit the absorption of carbohydrates.

A client with T1 has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should: A. Call the physician B. Encourage the intake of fluids C. Administer the insulin as ordered D. Give the client 1/2 c. of orange juice

C. Administer the insulin as ordered A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered.

Insulin forces which of the following electrolytes out of the plasma and into the cells? A. Calcium B. Magnesium C. Phosphorus D. Potassium

D. Potassium Option D: Insulin forces potassium out of the plasma, back into the cells, causing hypokalemia. Potassium is needed to help transport glucose and insulin into the cells. Options A, B, and C: Calcium, magnesium, and phosphorus aren't affected by insulin.

An older woman with DM visits the clinic concerning her condition. Which of the following symptoms might an older woman with DM complain? A. Anorexia B. Pain intolerance C. Weight loss D. Perineal itching

D. Perineal itching Older women might complain of perineal itching due to vaginal candidiasis.

When a client is experiencing diabetic ketoacidosis, the insulin that would be administered is: A. Human NPH insulin B. Human regular insulin C. Insulin lispro injection D. Insulin glargine injection

B. Human regular insulin Regular insulin (Humulin R) is short-acting insulin and is administered via IV - initial dose of 0.3 units/kg - 0.2 units/kg 1 hour later - 0.2 units/kg every 2 hours until blood glucose becomes <13.9 mmol/L At this point, the dose should be decreased by half, to 0.1 units/kg every 2 hours, until DKA is resolved

Billy is being asked concerning his health in the emergency department. When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about the history of: A. Alcohol use B. Cigarette smoking C. Diabetes mellitus D. High-protein diet

Correct answer: A. Alcohol use. Alcohol use is one of the most common risk factors for pancreatitis in the United States.

Joko has recently been diagnosed with T1DM and asks nurse Jessica for help formulating a nutrition plan. Which of the following recommendations would the nurse make to help the client increase calorie consumption to offset absorption problems? A. Eat small meals with two or three snacks throughout the day to keep blood glucose levels steady B. Increase the consumption of simple carbohydrates C. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals. D. Skip meals to help lose weight

Correct answer: C. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals.

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B. It is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

A client is in DKA secondary to infection. As the condition progresses, which of the following symptoms might the nurse see? A. Kussmaul's respirations and a fruity odor on the breath B. Shallow respirations and severe abdominal pain C. Decreased respiration and increased urine output D. Cheyne-stokes respirations and foul-smelling urine

A. Kussmaul's respirations and a fruity odor on the breath Coma and severe acidosis are ushered in with Kussmaul's respirations (very deep but not labored respirations) and a fruity odor on the breath (academia).

Which of the following is accurate pertaining to physical exercise & T2DM? A. Physical exercise can slow the progression of T2DM. B. Strenuous exercise is beneficial when blood glucose is high. C. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia. D. Adjusting insulin regimen allows for safe participation in all forms of exercise.

A. Physical exercise can slow the progression of T2DM. Option A: Physical exercise slows the progression of T2DM because exercise has beneficial effects on carbohydrate metabolism & insulin sensitivity. Options B, C, and D: Strenuous exercise can cause retinal damage and can cause hypoglycemia. Insulin and foods both must be adjusted to allow safe participation in exercise.

A patient was recently diagnosed with T1D and received insulin. Which laboratory test will the nurse assess? A. Potassium B. AST (aspartate aminotransferase) C. Serum amylase D. Sodium

A. Potassium Option A: Insulin causes potassium to move into the cell and may cause hypokalemia. Options B, C, and D: There is no need to monitor the sodium, serum amylase, and AST levels.

Dr. Shrunk orders IV insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) IV. What does the best evaluation of the nurse reveal? Select all that apply. A. The nurse could have given the insulin subcutaneously. B. The nurse should have contacted the physician. C. The nurse should have used regular insulin (Humulin R). D. The nurse used the correct insulin. E. The nurse could have given the insulin intramuscularly.

B and C. Options B and C: Regular insulin is the only insulin that can be given intravenously (IV). The nurse did not use correct insulin as it was not regular insulin. Contact the provider to clarify the order, regular insulin is the only insulin that can be given intravenously (IV). Option A: The nurse cannot give the insulin subcutaneously when it is ordered to be given intravenously (IV).

The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says: A. "I need to rub my forearm vigorously until warm before testing at this site." B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." C. "I have to make sure that my current glucose monitor can be used at an alternate site." D. "Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels."

B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected.

The nurse is admitting a client with newly diagnosed DM and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client complains of headache and nausea. Based on the serum laboratory results below, how would the nurse interpret the client's acid-base balance? Lab Results: pH: 7.34 HCO3-: 19 mEq/L PaCO2: 35 mm Hg PaO2: 88 mm Hg Potassium: 5.3 mEq/L Chloride: 102 mEq/L Calcium: 10.4 mg/dl Anion gap: 30 mEq//L A. Metabolic alkalosis. B. Metabolic acidosis. C. Respiratory acidosis. D. Respiratory alkalosis.

B. metabolic acidosis Metabolic acidosis typically manifests with: low pH low bicarbonate level, normal to low PaCO2 normal PaO2. The client's serum electrolyte levels also support metabolic acidosis, which includes an elevated potassium level, normal to elevated chloride level, and normal calcium level. The client's anion gap of 30 mEq/L is high, also indicative of metabolic acidosis. This kind of metabolic acidosis occurs with diabetic ketoacidosis and other disorders.

Marlisa has been diagnosed with T1D. She asks Nurse Errol what this means. What is the best response by the nurse? Select all that apply. A. "Your alpha cells should be able to secrete insulin, but cannot." B. "The exocrine function of your pancreas is to secrete insulin." C. "Without insulin, you will develop ketoacidosis (DKA)." D. "The endocrine function of your pancreas is to secrete insulin." E. "It means your pancreas cannot secrete insulin."

C, D, and E Options C, D, and E: One function of your pancreas is to secrete insulin. The endocrine function of the pancreas is to secrete insulin. A consequence of T1DM is that without insulin, severe metabolic disturbances, such as DKA will result. Option A: Insulin is secreted by the beta, not the alpha, cells of the pancreas. Option B: The endocrine, not the exocrine, function of the pancreas is to secrete insulin.

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: A. Third day B. Every other day C. 1-2 weeks D. 2-4 weeks

C. 1-2 weeks Rotation of sites for insulin injection should be done every week or two. Overuse of the same spot cause fat cells to break down or build up (lipodystrophy) causing lumps under the skin and may interfere with insulin absorption.

The nurse is admitting a patient diagnosed with T2DM. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth

Correct answer: A. Hypoglycemia Option A: Hypoglycemia does not occur in T2DM unless the patient is on insulin therapy or taking other diabetes medication. Option B: T2DM can affect blood circulation which makes it easier for the skin to bruise. Option C: The presence of ketones in the urine happens due to a lack of available insulin. Option D: Losing a lot of fluids caused by frequent urination can lead to dehydration hence patients can develop dry mouth.

Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. >5.6%

Correct answer: B. 5.7-6.4% Option B: Glycosylated hemoglobin levels between 5.7%-6.4% is considered as pre-diabetes. Option A: Glycosylated hemoglobin levels over 6.5 % are considered diagnostic of diabetes. Options C and D: Glycosylated hemoglobin levels less than 5.6 % are normal.

A health care provider prescribed ondansetron (Zofran) 8 mg p.o. T.i.d to a patient with T1D with complaints of vomiting.; Available stock of Zofran in a 100 ml bottle labeled 4 mg/tsp.; How many ml will the nurse administer for each dose?

Correct answer: 10 ml

After suffering an acute MI, a client with a history of T1D is prescribed metoprolol (Lopressor) I.V. Which nursing interventions are associated with I.V. administration of metoprolol? Select all that apply. A. Monitor glucose levels closely. B. Monitor for heart block and bradycardia. C. Monitor blood pressure closely. D. Mix the drug in 50 ml of dextrose 5% in water and infuse over 30 minutes. E. Be aware that the drug is not compatible with morphine.

___ Correct Answer: A, B, and C. Options A, B, and C: Metoprolol masks the common signs of hypoglycemia; therefore, glucose levels should be monitored closely in diabetic clients. When used to treat an MI, metoprolol is contraindicated in clients with heart rates less than 45 beats/minute and any degree of heart block, so the nurse should monitor the client for bradycardia and heart block. Metoprolol masks common signs and symptoms of shock, such as decreased blood pressure, so blood pressure should also be monitored closely. Option D: The nurse should give the drug undiluted by direct injection. Option E: Although metoprolol should not be mixed with other drugs, studies have shown that it is compatible when mixed with morphine sulfate or when administered with alteplase infusion at a Y-site connection.

Gregory is a 52-year-old man identified as high-risk for DM. Which laboratory test should a nurse anticipate a physician would order for him? Select all that apply. A. Fasting Plasma Glucose (FPG) B. Two-hour Oral Glucose Tolerance Test (OGTT) C. Glycosylated hemoglobin (HbA1C) D. Fingerstick glucose three times daily E. Urinalysis and urine culture

A and B. Options A and B: When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. An FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. Option C: HbA1C evaluates long-term glucose control. Option D: A fingerstick glucose three times daily spot-checks blood glucose levels. Option E: Urinalysis and urine cultures, in which bacteria from a urine sample are grown in a laboratory, are done to diagnose a urinary tract infection.

When reviewing the urinalysis report of a client with newly diagnosed DM, the nurse would expect which urine characteristics to be abnormal? SATA A. Amount. B. Odor. C. pH. D. Specific gravity. E. Glucose level. F. Ketone bodies.

A, B, E, and F. DM is associated with increased amounts of urine, a sweet or fruity odor, and glucose and ketone bodies in the urine. It does not affect the urine's pH or specific gravity.

A client with T1DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? A. "The best time for me to exercise is every afternoon." B. "The best time for me to exercise is right after I eat." C. "The best time for me to exercise is after breakfast." D. "The best time for me to exercise is after my morning snack."

A. "The best time for me to exercise is every afternoon." Option A: A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication. Options B, C, and D do not address peak action times.

A client with a diagnosis of DKA is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? A. Elevated blood glucose level and a low plasma bicarbonate B. Decreased urine output C. Increased respiration and an increase in pH D. Comatose state

A. Elevated blood glucose level and a low plasma bicarbonate Option A: In diabetic acidosis, the arterial pH is less than 7.35. plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. Options B and C: The client would be experiencing polyuria, and Kussmaul's respirations would be present. Option D: A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis

Glucose is an important molecule in a cell because this molecule is primarily used for: A. Extraction of energy B. Synthesis of protein C. Building of genetic material D. Formation of cell membranes

A. Extraction of energy Glucose catabolism is the main pathway for cellular energy production.

A client with DM visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently, the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? A. prednisone (Deltasone) B. atenolol (Tenormin) C. phenelzine (Nardil) D. allopurinol (Zyloprim)

A. prednisone (Deltasone) Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

A client diagnosed with T1D receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse? A. "Insulin must be injected because it needs to work quickly." B. "Insulin can't be in a pill because it is destroyed in stomach acid." C. "Have you talked to your doctor about taking pills instead?" D. "I know it is tough, but you will get used to the shots soon."

B. "Insulin can't be in a pill because it is destroyed in stomach acid." Option B: Insulin must be injected because it is destroyed in the stomach acid if taken orally. Option A: The onset of insulin action is not the issue here. Option C: The nurse should answer the client's question, not refer him back to the physician. Option D: Telling he will get used to shots does not answer his question and is condescending.

Albert, a 35-year-old insulin-dependent diabetic, is given NPH insulin at 0730 every morning. The nurse expects that the NPH insulin will reach its maximum effect between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330

B. 1330 and 1930 The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH (intermediate-acting insulin) - onset 1-3 hours post injection - peak 4-12 hours later - effective for 12-16 total hours

The nurse is teaching a client regarding the administration of insulin as part of the discharge plan. Which of the following insulin has the most rapid onset of action? A. insulin regular (Humulin R) B. lispro (Admelog) C. glargine (Toujeo) D. insulin NPH (Humulin N)

B. Lispro (Admelog) Option B: Lispro is a rapid-acting insulin that works within 15 minutes after injection, a peak of 30-90 minutes, and a duration of 2-4 hours. Option A: Human regular (Humulin R) is a regular or short-acting insulin that usually reaches the bloodstream in 30 minutes, a peak of 2-3 hours, and a duration of 3 to 6 hours. Option C: Glargine (Toujeo) is ultra-long-acting insulin that reaches the bloodstream within 6 hours, has no peak, and duration 36 hours or longer. Option D: Insulin NPH (Humulin N) is an intermediate-acting insulin that reaches the bloodstream about 2 to 4 hours after injection, a peak of 4-12 hours, and duration of 12-18 hours.

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. A. Thirst B. Palpitations C. Diaphoresis D. Slurred speech E. Hyperventilation

B. Palpitations C. Diaphoresis D. Slurred speech Palpitations, an adrenergic symptom, occur as the glucose levels fall; the sympathetic nervous system is activated and epinephrine and norepinephrine are secreted causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.

Rosemary has been taking glargine (Lantus) to treat her condition. One of the benefits of glargine (Lantus) insulin is its ability to: A. Release insulin rapidly throughout the day to help control basal glucose. B. Release insulin evenly throughout the day and control basal glucose levels. C. Simplify the dosing and better control blood glucose levels during the day. D. Cause hypoglycemia with other manifestations of other adverse reactions.

B. Release insulin evenly throughout the day and control basal glucose levels. Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.

Which of the following chronic complications is associated with diabetes? A. Dizziness, dyspnea on exertion, and coronary artery disease B. Retinopathy, neuropathy, and coronary artery disease C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts D. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias

B. Retinopathy, neuropathy, and coronary artery disease Option B: These are all chronic complications of diabetes. Option A: Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. Option C: Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia. Option D: Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism.

A nurse found out that the patient's bedtime snack was not eaten. This should alert the nurse to check and assess for: A. Elevated serum bicarbonate and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Symptoms of hyperglycemia during the peak time of NPH insulin D. Sugar in the urine

B. Signs of hypoglycemia earlier than expected. Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m.

Harry is a diabetic patient who is experiencing a reaction to alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following? A. Uncontrolled diabetes B. Somogyi phenomenon C. Brittle diabetes D. Diabetes insipidus

B. Somogyi phenomenon Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and an increase in ketones.

The nurse expects that a T1 diabetic may receive how much of his or her morning dose of insulin preoperatively? A. 10-20% B. 25-40% C. 50-60% D. 85-90%

C. 50-60% Surgical procedures may result in a number of metabolic perturbations that can alter normal glucose homeostasis. Patients with T1DM who are using long-acting insulins, such as glargine, should continue these as normal when fasting. If the patient is prone to morning hypoglycemia, the dose can be reduced by 20%. Thus, the diabetic patient may receive 80% of his or her morning dose of insulin preoperatively. Patients taking premixed insulins or fixed-combination insulins are more of a challenge. It may not be feasible or economical to change the patient's premixed insulin just before surgery. In these situations, the patient can take ½ - ¾ of the morning dose, followed by administration of a dextrose-containing intravenous fluid and frequent blood glucose checks.

Nurse Matt makes a home visit to the client with dDM. During the visit, Nurse Matt notes the client's additional insulin vials are not refrigerated. What is the best action by the nurse at this time? A. Instruct the client to label each vial with the date when opened. B. Tell the client there is no need to keep additional vials. C. Have the client place the insulin vials in the refrigerator. D. Have the client discard the vials.

C. Have the client place the insulin vials in the refrigerator. Option C: Vials not in use should be refrigerated to preserve drug potency. Option A: Writing the date of opening on the vial is good practice, but does not address the need to refrigerate additional vials. Option B: The client should always have additional vials of insulin available. Option D: There is no need to discard the vials.

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? A. Give glyburide again B. Give subcutaneous insulin and monitor blood glucose C. Monitor blood glucose closely, and look for signs of hypoglycemia D. Monitor blood glucose, and assess for signs of hyperglycemia

C. Monitor blood glucose closely, and look for signs of hypoglycemia. Option C: When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemia. Option A: Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Option B: Giving insulin would also lower the glucose levels, causing hypoglycemic. Option D: The client wouldn't have hyperglycemia if the glyburide was absorbed.

Clients with T1D may require which of the following changes to their daily routine during periods of infection? A. No changes B. Less insulin C. More insulin D. Oral antidiabetic agents

C. More insulin During periods of infection or illness, diabetics may need even more insulin to compensate for increased BG levels.

Serge who has DM is taking oral agents and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the client his oral medications? A. Administer the oral agents immediately after the test. B. Notify the diagnostic department and request orders. C. Notify the physician and request orders. D. Administer the oral agents with a sip of water before the test.

C. Notify the physician and request orders. Option C: It is best to notify the client's physician and request orders. Option A: The medications should not be given upon return unless the physician orders this; the client may still need to be NPO. Option B: The radiologist in the diagnostic department might give orders, but it would be best to check with the client's physician first. Option D: The client should not receive the medication during NPO status unless directed by the physician.

Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of T2DM. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase), is to: A. Induce hypoglycemia by decreasing insulin sensitivity. B. Improve insulin sensitivity and decrease hyperglycemia. C. Stimulate the beta cells of the pancreas to secrete insulin. D. Decrease insulin sensitivity by enhancing glucose uptake.

C. Stimulate the beta cells of the pancreas to secrete insulin. Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin.

A clinical instructor teaches a class for the public about DM. Which individual does the nurse assess as being at the highest risk for developing diabetes? A. The 50-year-old client who does not get any physical exercise B. The 56-year-old client who drinks three glasses of wine each evening C. The 42-year-old client who is 50 pounds overweight D. The 38-year-old client who smokes one pack of cigarettes per day

C. The 42-year-old client who is 50 pounds overweight Option C: Obesity increases the likelihood of developing diabetes mellitus due to the overstimulation of the endocrine system. Option A: Exercise is important, but lack of exercise is not as big a risk factor as obesity. Option C: Consuming alcohol is associated with liver disease but is not as high a risk factor for diabetes as obesity. Option D: Smoking is a serious health concern but is not a specific risk factor for diabetes.

The goal of preprandial blood glucose for those with T1D is: A. <80 mg/dl B. <130 mg/dl C. <180 mg/dl D. >8%

Correct answer: B. <130 mg/dl Option B: According to the American Diabetes Association, the recommended preprandial glucose target for an adult with diabetes is between 80-130 mg/dl Option C: This is the recommended postprandial (1-2 hours after eating) glucose target for an adult with diabetes. Option D: An A1c value of >8 signifies that diabetes is not well controlled and a high risk for diabetes complications is possible.

A patient was recently discharged after being hospitalized due to T1D and was given ergocalciferol (Vitamin D) 225,000 units PO daily. The patient have on hand ergocalciferol in 50,000 unit tablets. How many tablet(s) should the patient take?

Correct answer: 4.5 tablets

Nurse Shey is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply. A. Cakes, candies, cookies, and regular soft drinks should be avoided. B. Gestational diabetes increases the risk that the mother will develop diabetes later in life. C. Gestational diabetes usually resolves after the baby is born. D. Insulin injections may be necessary. E. The mother should strive to gain no more weight during pregnancy. F. The baby will likely be born with diabetes

Correct answer: A, B, C, and D. Options A, B, C, and D: Gestational diabetes can occur between the 16th and 28th week of pregnancy. If not responsive to diet and exercise, insulin injections may be necessary. Concentrated sugars should be avoided. Option E: Weight gain should continue, but not in excessive amounts. Option F: Usually, gestational diabetes disappears after the infant is born. However, diabetes can develop 5 to 10 years after pregnancy.

During a visit to a community, the nurse will recommend routine screening for diabetes when the person has one or more of seven risk criteria. Which of the following persons that the nurse comes in contact with most needs to be screened for diabetes based on the seven risk criteria? A. A client with an HDL cholesterol level of 40 mgdl and a triglyceride level of 300 mg/dl B. A woman who is at 90% of standard body weight after delivering an eight-pound baby C. A middle-aged Caucasian male D. An older client who is hypotensive

Correct answer: A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl The seven risk criteria include: greater than 120% of standard body weight, Certain races but not including Caucasian, delivery of a baby weighing more than 9 pounds or a diagnosis of gestational diabetes, hypertensive, HDL greater than 35 mg/dl or triglyceride level greater than 250 or a triglyceride level of greater than 250 mg/dl, and, lastly, impaired glucose tolerance or impaired fasting glucose on prior testing.

Mr. Wesley is newly diagnosed with TRD and is being seen by the home health nurse. The doctor's orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar QID. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg dL. The nurse would expect the patient to be: A. Anxiety, paleness, and pulse of 110 bpm B. Lethargic with hot dry skin and rapid deep respirations C. Alert and cooperative with BP of 130 80 mm Hg and respirations of 12 breaths per minute D. Short of breath, with distended neck veins and bounding pulse of 96 bpm

Correct answer: A. Anxiety, paleness, and pulse of 110 bpm Hypoglycemia triggers the release of epinephrine (adrenaline), the "fight-or-flight" hormone which can cause symptoms such as confusion, paleness, and tachycardia.

Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites. Blood sugar is well controlled when Hemoglobin A1C is: A. Below 5.7% B. Between 12%-15% C. Less than 180 mg dL D. Between 90 and 130 mg dL

Correct answer: A. Below 5.7% HbA1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

Nurse Robedee is teaching an underweight and emaciated client about the proper methods/techniques when giving insulin. Which one of the following shows a proper technique? A. Pinch the skin up and use a 90-degree angle B. Use a 45-degree angle with the skin pinched up C. Massage the area of injection after injecting the insulin D. Warm the skin with a warmed towel or washcloth prior to the injection

Correct answer: A. Pinch the skin up and use a 90-degree angle The best angle for a thin person is 90 degrees with the skin pinched up. The area is not massaged and it is not necessary to warm it.

During the lecture, the clinical instructor tells the students that 50% to 60% of daily calories should come from carbohydrates. What should the nurse say about the types of carbohydrates that can be eaten? A. Try to limit simple sugars to between 10% and 20% of daily calories. B. Simple carbohydrates are absorbed more rapidly than complex carbohydrates. C. Simple sugars cause a rapid spike in glucose levels and should be avoided. D. Simple sugars should never be consumed by someone with diabetes.

Correct answer: A. Try to limit simple sugars to between 10% and 20% of daily calories. Option A: It is recommended that carbohydrates provide 50% to 60% of the daily calories. Approximately 40% to 50% should be from complex carbohydrates. The remaining 10% to 20 % of carbohydrates could be from simple sugars. Options B and C: Studies give no evidence that carbohydrates from simple sugars are digested and absorbed more rapidly than complex carbohydrates, and they do not appear to affect blood sugar control.

A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology? A. The client with diabetes mellitus. B. The client with diabetes insipidus. C. The client with diabetic ketoacidosis. D. The client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion.

Correct answer: B Option B: Maintaining adequate fluid, replacing vasopressin, and correcting underlying intracranial problems (typically lesions, tumors, or trauma affecting the hypothalamus or pituitary gland) are the main objectives in treating diabetes insipidus. Option A: Diabetes mellitus does not involve vasopressin deficiencies or an intracranial disorder, but rather a disturbance in the production or use of insulin. Option C: Diabetic ketoacidosis results from severe insulin insufficiency. Option D: An excess of vasopressin leads to SIADH, causing the client to retain fluid.

Which of the following, if stated by the nurse, is correct about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)? A. "This syndrome occurs mainly in people with T1D." B. "It has a higher mortality rate than diabetic ketoacidosis." C. "The client with HHNS is in a state of overhydration." D. "This condition develops very rapidly."

Correct answer: B. "It has a higher mortality rate than diabetic ketoacidosis." Option B: It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. Option A: Hyperglycemic Hyperosmolar Nonketotic Syndrome occurs only in people with T2DM. Option D: This condition develops very slowly over hours or days.

A client was brought to the emergency room with complaints of slurring of speech, vomiting, dry mucosa, and dry skin turgor. Lab tests showing serum sodium 125 mEq/L and serum blood glucose of 350 mg/dL. Nurse Sophie will anticipate the physician to initially order which of the following intravenous solutions? A. 10% dextrose in water (D10W) B. 0.9% normal saline solution C. 5% dextrose in water (D5W) D. 0.45% normal saline solution

Correct answer: B. 0.9% normal saline solution Option B: The client is experiencing diabetic ketoacidosis. Initial priority in the treatment is to restore the extracellular fluid volume through the intravenous administration of 0.9% normal saline at 15-20 ml/kg/h. Options A and C: Intravenous solutions containing dextrose will be given once serum glucose reaches 250 mg dL. Option D: 0.45% normal saline will be given once serum sodium stabilizes.

When taking a health history, the nurse screens for manifestations suggestive of T1D. Which of the following manifestations are considered the primary manifestations of T1D and would be most suggestive and require follow-up investigation? A. Excessive intake of calories, rapid weight gain, and difficulty losing weight B. An increase in three areas: thirst, intake of fluids, and hunger C. Poor circulation, wound healing, and leg ulcers D. Lack of energy, weight gain, and depression

Correct answer: B. An increase in three areas: thirst, intake of fluids, and hunger The primary manifestations of T1D are polyuria (increased urine output), polydipsia (increased thirst), polyphagia (increased hunger).

Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? A. Alpha-glucosidase inhibitors B. Biguanides C. Meglitinides D. Sulfonylureas

Correct answer: B. Biguanides Option B: Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Option A: Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels Options C and D: Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin.

The nurse working in the physician's office is reviewing lab results on the clients seen that day. One of the clients who has classic diabetic symptoms had an eight-hour fasting plasma glucose (FPG) test done. The nurse realizes that diagnostic criteria developed by the American Diabetes Association for diabetes include classic diabetic symptoms plus which of the following fasting plasma glucose levels? A. Higher than 106 mg/dl B. Higher than 126 mg/dl C. Higher than 140 mg/dl D. Higher than 160 mg/dl

Correct answer: B. Higher than 126 mg/dl Diabetes is diagnosed at a fasting blood glucose of greater than or equal to 126 mg/dl

The guidelines for carbohydrate counting as medical nutrition therapy for DM includes all of the following, except: A. Flexibility in types and amounts of foods consumed B. Unlimited intake of total fat, saturated fat, and cholesterol C. Including adequate servings of fruits, vegetables, and the dairy group D. Applicable to with either T1 or T2 DM

Correct answer: B. Unlimited intake of total fat, saturated fat and cholesterol The guidelines for Carbohydrate Counting as medical nutrition therapy for DM include all of the following except unlimited intake of total fat, saturated fat and cholesterol.

A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has T1D. Which of the following actions should the nurse do first? A. Inject 1 mg of glucagon subcutaneously B. Administer 50 mL of 50% glucose I.V C. Give 4 to 6 oz (118 to 177 mL) of orange juice D. Give the client four to six glucose tablets

Correct answer: C. Give 4 to 6 oz (118 to 177 mL) of orange juice. Option C: Because the client is awake and complaining of symptoms, the nurse should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4 to 6 oz of fruit juice, five to six hard candies, or 1 tablespoon of sugar. Options A, B, and D: When a client has worsening symptoms of hypoglycemia or is unconscious, treatment includes 1 mg of glucagon subcutaneously or intramuscularly, or 50 mL of 50% glucose I.V. The nurse may also give two to three glucose tablets for a hypoglycemic reaction.

The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of T2DM and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents? A. Comply with medication regimen 100% for 6 months B. Quit the use of any tobacco products by the end of three months C. Lose a pound a week until the weight is within the normal range for height and exercise 30 minutes daily D. Practice relaxation techniques for at least five minutes five times a day for at least five months

Correct answer: C. Lose a pound a week until the weight is within the normal range for height and exercise 30 minutes daily When T2DM lose weight through diet and exercise they sometimes have an improvement in insulin efficiency sufficient to the degree they no longer require oral hypoglycemic agents.

You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent. The client mentions that he usually has a couple of beers each night and takes an aspirin each day to prevent heart attack and or strokes. Which of the following responses would be best on the part of the nurse? A. As long as you only drink two beers and take one aspirin, this should not be a problem B. The aspirin is alright but you need to give up drinking any alcoholic beverages C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of hypoglycemia D. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug

Correct answer: C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of hypoglycemia Alcohol lowers blood glucose levels and disrupts the production of glucose in the liver. Sulfonylureas, when taken with alcohol, may produce a disulfiram-like reaction which may lead to flushing, hypotension, nausea, tachycardia, vertigo, and blurred vision. Metformin should be avoided in patients with a history of chronic alcohol use because they may be more predisposed to lactic acidosis.

A medication nurse is about to give insulin to a patient with DM. Upon reviewing the medications of the patient, which of the following would cause a further decrease in the blood glucose level of the patient? A. hydrochlorothiazide (Microzide) B. levothyroxine (Synthroid) C. carvedilol (Coreg) D. hydrocortisone (SoluCortef)

Correct answer: C. carvedilol (Coreg) Option C: Carvedilol (Coreg) is a beta-blocker when given together with insulin would cause an increased hypoglycemic effect of insulin, resulting in a further decrease in the serum blood glucose level. Option A, B, and D: Hydrochlorothiazide (a thiazide diuretic), levothyroxine (a thyroid agent), and hydrocortisone (a glucocorticoid) are medications that can increase the blood glucose level.

A patient received 6 units of regular insulin three (3) hours ago. The nurse would be MOST concerned if which of the following was observed? A. Kussmaul respirations and diaphoresis B. Anorexia and lethargy C. Diaphoresis and trembling D. Headache and polyuria

Correct answer: C. diaphoresis and trembling Diaphoresis and trembling indicate hypoglycemia and should be treated immediately.

At the time Cherrie Ann found out that the symptoms of diabetes were caused by high levels of blood glucose, she decided to break the habit of eating carbohydrates. With this, the nurse would be aware that the client might develop which of the following complications? A. Retinopathy B. Atherosclerosis C. Glycosuria D. Acidosis

Correct answer: D. Acidosis When a client's carbohydrate consumption is inadequate, ketones are produced from the breakdown of fat. These ketones lower the pH of the blood, potentially causing acidosis that can lead to a diabetic coma.

A nurse is caring for a client admitted with diabetic retinopathy. Which of the following would the nurse expect to note on the assessment of this client: A. Blurred or distorted vision B. Flashes of lights or floaters C. Sudden loss of vision D. All of the above

Correct answer: D. All of the above Diabetic retinopathy is a complication of diabetes that is characterized by chronic and progressive damage to the retina. Symptoms include blurring of vision (due to macular edema), flashes of lights, and sudden loss of vision (due to retinal detachment).

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following, except: A. Integumentary inspection for the presence of brown spots on the lower extremities B. Observation for paleness of the lower extremities C. Observation for blanching of the feet after the legs are elevated for 60 seconds D. Palpation for increased pulse volume in the arteries of the lower extremities

Correct answer: D. Palpation for increased pulse volume in the arteries of the lower extremities Option D: One of the signs and symptoms of impaired peripheral arterial circulation is the absence of a pulse or a weak pulse in the legs or feet. Option A: This happens when high pressure in the veins pushes blood into the skin tissue causing reddish-brown staining in the skin tissue. When skin is stained like this, it is very fragile and may break down or, if knocked, fail to heal as usual. Options B and C: When a person develops impaired peripheral arterial circulation, the extremities — usually the legs — don't receive enough blood flow and oxygen to keep up with demand leading to a change in the color of the legs.

Nurse Pira is explaining to the client about T2DM. Risk factors of such condition include all of the following, except: A. Advanced age B. Physical inactivity C. Obesity D. Smoking

Correct answer: D. Smoking Additional risk factors for T2DM are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race / ethnicity. African-Americans, Hispanics

Tony is a night shift nurse who is assigned to a patient whose glucose levels remain normal at bedtime but experiences hypoglycemia at 3 am and hyperglycemia at 7 am. The patient is likely experiencing what kind of complication of insulin therapy? A. Insulin resistance B. Dawn phenomenon C. Insulin lipohypertrophy D. Somogyi phenomenon

Correct answer: D. Somogyi phenomenon Option D: Somogyi phenomenon ( post-hypoglycemic hyperglycemia) is characterized by a rebound high blood glucose level in the morning in response to low blood glucose that occurs at about 2-3 am in the morning. Option A: Insulin resistance happens when a person receiving insulin develops immune antibodies that bind the insulin, hence decreasing the insulin available for use in the body. Option B: Dawn phenomenon is characterized by a morning increase of blood sugar which happens as a response to declining levels of insulin and a nocturnal release of hormones (growth hormone, catecholamines, and cortisol). Option C: Insulin lipohypertrophy is the development of fatty lumps on the surface of the skin and is a common side effect of repeated use of an injection site.

Which insulin can be administered through continuous intravenous infusion? A. insulin glargine (Lantus) B. insulin aspart (Novolog) C. insulin detemir (Levemir) D. insulin degludec (Tresiba) E. regular insulin (Novolin R)

Correct answer: E. regular insulin (Novolin R) Option E: Regular insulin is a short-acting insulin that can be given intravenously in a continuous manner. Options A, B, C, and D: These are long-acting insulin that are not easily absorbed by the body hence there is a risk for severe prolonged hypoglycemia.

Nurse Andy has finished teaching a client with DM how to administer insulin. He evaluates the learning has occurred when the client makes which statement? A. "I should check my blood sugar immediately prior to the administration." B. "I should provide direct pressure over the site following the injection." C. "I should use the abdominal area only for insulin injections." D. "I should only use a calibrated insulin syringe for the injections."

D. "I should only use a calibrated insulin syringe for the injections." Option D: To ensure the correct insulin dose, a calibrated insulin syringe must be used. Option A: There is no need to check blood glucose immediately prior to the injection. Option B: There is no need to apply direct pressure over the site following an insulin injection. Option C: Insulin injections should be rotated to the arm and thigh, not just the abdominal area.

Gary has T2DM. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement? A. "My cells have increased their receptors, but there is enough insulin." B. "My peripheral cells have increased sensitivity to insulin." C. "My beta cells cannot produce enough insulin for my cells." D. "My cells cannot use the insulin my pancreas makes."

D. "My cells cannot use the insulin my pancreas makes." Option D: With T2DM, the pancreas produces insulin, but the cells cannot use it. Option A: There is a decrease, not an increase, in receptor sites with T2DM. Option B: Peripheral cells have a decreased, (not increased) sensitivity to insulin. The beta cells continue to produce insulin with T2DM

The principal goals of therapy for older patients who have poor glycemic control are: A. Enhancing the quality of life. B. Decreasing the chance of complications. C. Improving self-care through education. D. All of the above.

D. All of the above. One of the principal goals of therapy for older persons with DM and poor glycemic control is enhancing the quality of life due to the decline in physical performance and an increased risk of poor health outcomes due to physiologic vulnerability to clinical, functional, or psychosocial stressors. Decreasing the chance of complications is another goal of therapy for older persons with diabetes because diabetes complications can lead to serious illness and even death, which is why prevention is so important. As with all patients with diabetes, diabetes self-management education and ongoing diabetes self-management support are vital components of diabetes care for older adults and their caregivers. Through good self-management, people with diabetes can better their quality of life and diminish the risk of developing complications. It can also help lower the number of hospital admissions, or make those times when they do need to go into hospital, for whatever reason, a better experience, with a reduced length of stay.

An ailing 70y.o woman with a diagnosis of T2DM has been ill with pneumonia. The client's intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient? A. Insulin resistance has developed. B. Diabetic ketoacidosis is occurring. C. Hypoglycemia unawareness is developing. D. Hyperglycemic hyperosmolar nonketotic syndrome.

D. Hyperglycemic hyperosmolar non-ketotic coma. Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units or more. DKA, an acute metabolic condition, usually is caused by absent or markedly decreased amounts of insulin.

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis? A. Subcutaneous B. Intramuscular C. IV bolus only D. IV bolus, followed by continuous infusion

D. IV bolus, followed by continuous infusion. Option D: An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose. Option A: After the client is stabilized, subcutaneous insulin is given. Option B: Insulin is never given intramuscularly.

During the morning rounds, Nurse AJ accompanied the physician in every patient's room. The physician writes orders for the client with DM. Which order would the nurse validate with the physician? A. Use Humalog insulin for sliding scale coverage. B. Metformin (Glucophage) 1000 mg per day in divided doses. C. Administer regular insulin 30 minutes prior to meals. D. Lantus insulin 20U BID.

D. Lantus insulin 20U BID. Option D: Lantus insulin is usually prescribed once-a-day so an order for BID dosing should be validated with the physician. Option A: Humalog insulin can be prescribed for sliding scale coverage. Option B: Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day. Option C: Regular insulin is administered 30 minutes before meals.

A 50-year-old widower is admitted to the hospital with a diagnosis of DM and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia. The gerontology nurse should anticipate which of the following secondary medical diagnoses? A. Impaired glucose tolerance B. Gestational diabetes mellitus C. Pituitary tumor D. Pancreatic tumor

D. Pancreatic tumor The onset of hyperglycemia in older adults can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumors

The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs using one (1) syringe. Inject air equal to NPH dose into NPH vial Inject air equal to regular dose into regular dose Invert regular insulin bottle and withdraw regular insulin dose Invert NPH vial and withdraw NPH dose

D: 1, 3, 2, 4 (correct order) Inject air equal to NPH dose into NPH vial Invert regular insulin bottle and withdraw regular insulin dose Inject air equal to regular dose into regular dose Invert NPH vial and withdraw NPH dose A short-acting (regular insulin) and intermediate-acting insulin (NPH) are compatible. They can be mixed by drawing the regular insulin first followed by the NPH. _________________________ Air should be injected into the NPH insulin vile first, which allows withdrawal of the NPH insulin at a later step in the procedure without having to instill air into the vial from a syringe that contains regular insulin. Instilling air into the regular insulin vial increases the pressure in the vile, facilitating removal of the required dose. Removing the desired dose of insulin while the needle is still in the vile reduces the risk of contamination by repeated punctures, and maintains the sharpness of the needle. Having the syringe contain regular insulin first prevents the need to withdraw the regular insulin into a syringe that contains NPH insulin and inadvertently contaminating the regular insulin vial with the longer-acting NPH insulin; contaminating regular insulin with NPH insulin will reduce the speed at which the regular insulin functions, which in turn will delay treatment of a hyperglycemic event. Finally, the required dose of NPH insulin can be removed from the NPH insulin vile.

A pt with T1D is found unresponsive in the clinic. Which nursing action is a priority? TIP: To arrange all answers in the correct order, simply drag and drop the choices below. Treat the client for hypoglycemia. Call the physician STAT. Assess the vital signs. Call a code.

The correct order of answers is shown above. When a T1D pt is unresponsive, the nurse should focus on the treatment of hypoglycemia, as this is more likely than hyperglycemia. This is an emergency situation where the nurse must act before calling the physician. Vital signs should be taken after the client is treated for hypoglycemia. Assessment for Airway, Breathing, and Circulation (ABC) should precede calling a code; there is no information that the client is not breathing.