DM

3. Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 mmHg c. FBG 130 mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L)

A

4. Which statement by the patient with type 2 diabetes is accurate? a. "I will limit my alcohol intake to 1 drink each day." b. "I am not allowed to eat any sweets because of my diabetes." c. "I cannot exercise because I take a blood glucose-lowering medication." d. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

A

1. The nurse is assessing a patient newly diagnosed with type 1 diabetes. Which symptom reported by the patient correlates with the diagnosis? a. Excessive thirst b. Gradual weight gain c. Overwhelming fatigue d. Recurrent blurred vision

A

a-Administer regular insulin intravenously Explanation: lack (absolute or relative) of insulin is the primary cause of DK1. Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority action.

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

8. Which are appropriate therapies for patients with diabetes? (select all that apply) a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of serotonin agonists to decrease appetite e. Use of laser photocoagulation to treat retinopathy

A, C, E

5. You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (select all that apply) a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

A, D, E

8. Which are appropriate therapies for patients with diabetes? (Select all that apply.) a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of β-blockers to treat retinopathy d. Use of serotonin agonists to decrease appetite e. Use of ACE or ARB inhibitors to treat nephropathy

A, E

10. Which patient statement to the nurse indicates a need for additional instruction in administering insulin? a. "I should inject the insulin into a muscle that I plan to exercise vigorously." b. "I can buy the 0.5-mL syringes because the line markings are easier to see." c. "I do not need to aspirate the plunger to check for blood before injecting insulin." d. "I should draw up the regular insulin first, after injecting air into the NPH bottle."

ANS: A Caution the patient about injecting into a site that will be exercised. For example, injecting into the thigh and then going jogging could increase circulation and increase the rate of insulin absorption, causing hypoglycemia. Patient statements about low-vision syringes, avoiding aspiration, and the correct process for combining insulins are accurate and indicate that no additional instruction is needed.

1. Which instructions would the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic? (Select all that apply.) a. "You will need to avoid smoking before the test." b. "Exercise should be avoided until the testing is complete." c. "Several blood samples will be obtained during the testing." d. "You should follow a low-calorie diet the day before the test." e. "The test requires that you fast for at least 8 hours before testing."

ANS: A, C, E Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for accurate test results.

17. Which information about a patient who is scheduled for an oral glucose tolerance test would the nurse consider in interpreting the test results? a. The patient reports having occasional orthostatic dizziness. b. The patient takes oral corticosteroids for rheumatoid arthritis. c. The patient has had a 10 pound weight gain in the last month. d. The patient drank several glasses of water an hour previously.

ANS: B Corticosteroids can affect blood glucose results. The other information will not affect the glucose test results.

11. A patient has been newly diagnosed with type 2 diabetes. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease? a. Ideal weight b. Value system c. Activity level d. Visual changes

ANS: B When dealing with a patient with a chronic condition such as diabetes, identification of the patient's values and beliefs can assist the interprofessional team in choosing strategies for successful lifestyle change. The other information also will be useful but is not as important in developing an individualized plan for the necessary lifestyle changes.

9. Which information will a patient's glycosylated hemoglobin (A1C) result provide to the nurse? a. Fasting preprandial glucose levels b. Glucose levels 2 hours after a meal c. Glucose control over the past 90 days d. Hypoglycemic episodes in the past 3 months

ANS: C Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

1. Polydipsia and polyuria related to diabetes are primarily due to a. the release of ketones from cells during fat metabolism. b. fluid shifts resulting from the osmotic effect of hyperglycemia. c. damage to the kidneys from exposure to high levels of glucose. d. changes in RBCs resulting from attachment of excess glucose to hemoglobin.

B

3. Goals of managing the patient with diabetes include (select all that apply) a. keeping the target A1C greater than 9%. b. teaching self-monitoring of glucose levels. c. preventing complications of hypoglycemia. d. monitoring for ophthalmologic complications. e. maintaining the LDL cholesterol greater than 100 mg/dL (2.6 mmol/L).

B, C, D

d-potassium Explanation: 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. Calcium, magnesium, and phosphorus aren't affected by insulin.

Insulin forces which of the following electrolytes out of the plasma and into the cells? a-Calcium b-Magnesium c-Phosphorus d-Potassium

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

When a client is first admitted with Hyperosmolar hyperglycemia syndrome (HHS), the nurse's priority is to provide: a-Oxygen b-Carbohydrates c-Fluid replacement d-Dietary instruction

b-Human regular insulin Explanation: Regular insulin (Humulin R) is a short-acting insulin and is administered via IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood glucose becomes <13.9 mmol/L (<250 mg/dL). At this point, insulin dose should be decreased by half, to 0.1 units/kg every 2 hours, until the resolution of DKA.

When a client is in 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

d-Undiagnosed, untreated diabetes mellitus Explanation: Undiagnosed, untreated DM is one of the most common causes of HHNS.

Which of the following causes of Hyperosmolar hyperglycemia syndrome (HHS) is most common? a-Insulin overdose b-Removal of the adrenal gland c-Undiagnosed, untreated hyperpituitarism d-Undiagnosed, untreated diabetes mellitus

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

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

2. When distinguishing between persons with type 1 diabetes from type 2 diabetes, the nurse is aware that a. persons with type 1 diabetes require insulin therapy. b. autoantibodies to pancreatic β-cells are found in type 2 diabetes. c. persons with type 1 diabetes may be managed with metformin alone. d. hyperosmolar hyperglycemia syndrome is more common in type 1 diabetes.

A

6. What is the priority action for the nurse to take if the patient with type 2 diabetes reports headache, nervousness, and dizziness? a. Administer glucagon. b. Give insulin as ordered. c. Check the patient's glucose level. d. Assess for other signs of neurologic stroke.

C

7. A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.

C

5. You are caring for a patient with newly diagnosed type 2 diabetes who was started on metformin. What information should you include in discharge teaching? (Select all that apply.) a. Need to reduce physical activity b. Eliminate all forms of sugar from diet c. Use of a portable blood glucose meter d. Hypoglycemia prevention, symptoms, and treatment e. Procedures that require IV contrast media are contraindicated

C, E

2. Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. The patient must receive insulin therapy to prevent ketoacidosis. b. The patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin. c. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.

D

4. Which patient statement demonstrates an understanding of the role of exercise in managing diabetes? a. "I cannot exercise if I am taking insulin and metformin." b. "Exercise increases insulin resistance, so I will need a higher dose of insulin." c. "It is better to exercise before a meal if I take medication that causes hypoglycemia." d. "My insulin dose may need to be changed if I have low glucose levels after exercising."

D

6. What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability? a. Call the provider. b. Give insulin as ordered. c. Assess for other neurologic symptoms. d. Check the patient's blood glucose level.

D