Nurs 170 Complications of Diabetes Mellitus

Which complications of diabetes can be treated with hyperbaric oxygen? A. Diabetic foot ulcers B. Diabetic nephropathy C. Neuropathic arthropathy D. Peripheral vascular disease

A. Diabetic foot ulcers Hyperbaric oxygen is used for wound healing in diabetic foot ulcers. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used in the treatment of diabetic nephropathy. Neuropathic arthropathy results in ankle and foot changes and increases the chances of developing foot ulcers. Peripheral vascular disease is one of the macrovascular complications of diabetes. Management includes smoking cessation and control of hypertension.

Which complication of diabetes can cause hypoglycemic unawareness? A. Diabetic neuropathy B. Diabetic dermopathy C. Diabetic ketoacidosis D. Diabetic nephropathy

A. Diabetic neuropathy Autonomic neuropathy is a type of diabetic neuropathy. Autonomic neuropathy can affect all the systems in the body leading to hypoglycemic unawareness. Diabetic dermopathy may cause acanthosis nigricans and necrobiosis lipoidica diabeticorum. Diabetic ketoacidosis may cause dehydration, metabolic acidosis, and electrolyte disturbance. Diabetic nephropathy leads to reduction in the glomerular filtration rate of the kidneys.

The nurse advises a diabetic patient on insulin therapy who reports headaches on awakening and a history of night sweats to reduce the dose of insulin and have a bedtime snack. Which finding support the nurse's instructions? A. Blood glucose levels: 60 mg/dL between 2 AM and 4 AM B. Blood glucose levels: 60 mg/dL between 2 PM and 4 AM C. Blood glucose levels: 60 mg/dL between 2 PM and 4 PM D. Blood glucose levels: 60 mg/dL between 2 AM and 4 PM

A. Blood glucose levels: 60 mg/dL between 2 AM and 4 AM Reducing the dose of insulin and having a bedtime snack are the instructions given to a patient who is experiencing morning hyperglycemia. The Somogyi effect is characterized by morning hyperglycemia. If a patient is experiencing morning hyperglycemia, blood glucose levels between 2 AM and 4 AM will be low. The patient may report headaches on awakening and recall having night sweats or nightmares. A bedtime snack, a reduction in the dose of insulin, or both can help to prevent the Somogyi effect. Blood glucose levels of 60 mg/dL between 2 PM and 4 AM, blood glucose levels of 60 mg/dL between 2 AM and 4 PM, and blood glucose levels of 60 mg/dL between 2 PM and 4 PM are not associated with the Somogyi effect.

A patient with a 15-year history of diabetes has been complaining of intermittent pain in the legs. Which other symptoms would the nurse assess if the patient has the complication of peripheral arterial disease? Select all that apply A. Cold feet B. Loss of hair C. Dependent rubor D. Urinary retention E. Bowel incontinence

A. Cold feet B. Loss of hair C. Dependent rubor Peripheral arterial disease causes decreased blood flow to the lower extremities. Cold feet, loss of hair, and dependent rubor are the signs of peripheral arterial disease. Urinary retention and bowel incontinence are symptoms of autonomic neuropathy.

Which complication can be monitored by annual screening using a monofilament? A. Diabetic neuropathy B. Diabetic retinopathy C. Diabetic dermopathy D. Diabetic nephropathy

A. Diabetic neuropathy Sensory neuropathy is a type of diabetic neuropathy in which loss of protective sensation (LOPS) is common. LOPS may lead to lower extremity amputation. Therefore, annual screening using a monofilament is important in monitoring the patient for diabetic neuropathy. Diabetic retinopathy is monitored by annual fundoscopic examination. Examining the skin changes is important in diabetic patients to monitor for diabetic dermopathy. Serum creatinine and urinalysis for microalbuminuria help to monitor for diabetic nephropathy.

Which rationales are correct when giving 1 mg of glucagon to treat hypoglycemia? Select all that apply A. IV access is not available B. The patient is unconscious or unable to swallow C. Deltoid muscle injection gives a faster response D. The patient prefers IM glucagon administration E. IM doses are smaller that IV doses

A. IV access is not available B. The patient is unconscious or unable to swallow C. Deltoid muscle injection gives a faster response In instances in which the patient has no intravenous access or is not alert enough to swallow, the best option is to administer 1 mg of glucagon by intramuscular or subcutaneous injection. Intramuscular injection in the site of the deltoid muscle will result in a quicker response. Glucagon stimulates a strong hepatic response to convert glycogen to glucose and, therefore, makes glucose rapidly available. The patient cannot make the choice for route of administration, because the patient is not alert. The intramuscular and intravenous doses are the same in volume.

Which symptoms may be observed in patients with diabetic ketoacidosis (DKA)? Select all that apply A. Lethargy B. Flushed, moist skin C. Hypoventilation D. Soft and sunken eyes E. Sweet fruity odor of breath

A. Lethargy D. Soft and sunken eyes E. Sweet fruity odor of breath Dehydration in patients with DKA results in lethargy, soft and sunken eyes, and sweet fruity odor of breath. Skin would be flushed and dry, not moist. Patients with DKA typically experience a rapid, deep-breathing pattern known as Kussmaul respirations, not hypoventilation, as a means of correcting the acid-base imbalance caused by the condition.

Which drug would the nurse give to a patient who has type 2 diabetes and the presence of albumin in the urine? A. Lisinopril B. Duloxetine C. Pregabalin D. Bethanechol

A. Lisinopril The presence of albumin in the urine indicates nephropathy in patients with diabetes. Angiotensin converting enzyme inhibitors such as lisinopril may delay the progression of nephropathy in diabetic patients. Duloxetine is a selective serotonin reuptake inhibitor that is used for symptomatic treatment of sensory neuropathy. Pregabalin is an antiseizure medication used for neuropathic pain in diabetic patients. Bethanechol is a cholinergic agonist that is indicated for the treatment of neurogenic bladder.

Which risk factor is associated with macrovascular complications of diabetes mellitus? A. Obesity B. Low-fat diet C. Active lifestyle D. Hypotension

A. Obesity Obesity increases the risk for blood vessel and cardiovascular disease. Hypoglycemia, if untreated, results in seizures and coma. Hypovolemia, due to excessive dehydration, may lead to shock. Patients with adrenal insufficiency may have minimal glycogen stores and may not respond to glucagon therapy.

Which symptom indicates that a patient with newly diagnosed type 2 diabetes mellitus is experiencing hyperglycemia? A. Polydipsia B. Weight gain C. Diaphoresis D. Loss of appetite

A. Polydipsia Symptoms of hyperglycemia, as seen in both forms of diabetes mellitus, include polydipsia, polyuria, polyphagia, and weight loss. Patients with hyperglycemia due to diabetes mellitus do not manifest weight gain, loss of appetite or oliguria, or bradycardia, but they may exhibit fatigue, tachycardia, and abdominal pain. Irritability and diaphoresis are manifestations of hypoglycemia (low blood sugar).

After administering an intramuscular glucagon injection to an unconscious patient, which rationale would explain why the nurse would then turn the patient on their side? A. To prevent aspiration B. To avoid postural hypotension C. To promote the patient's comfort D. To help the patient regain consciousness

A. To prevent aspiration IM glucagon is administered for hypoglycemia. Because nausea is a common reaction after glucagon injection, the patient should be turned to one side until gaining consciousness in order to prevent aspiration if vomiting occurs. Because the patient is unconscious, turning to the side will not promote the patient's comfort. The patient who is unconscious due to severe hypoglycemia will regain consciousness due to administration of the glucagon injection.

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. Which statement made by the patient indicates the patient understands the principles of foot care? A. "I should only walk barefoot in nice dry weather" B. "I should look at the condition of my feet every day" C. "I am lucky my shoes fit so nice and tight because they give me firm support" D. "When I am allowed up out of bed, I should check the shower water with my toes"

B. "I should look at the condition of my feet every day" Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. The patient should not walk barefoot. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.

Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis? A. Electrolytes B. Insulin therapy C. Sodium bicarbonate D. IV fluids

B. Insulin therapy When the body cannot utilize glucose for energy, it burns fat for energy, resulting in the production of ketones. Insulin therapy is useful for reducing the serum ketone levels. Electrolyte are given to correct the electrolyte imbalance. Sodium bicarbonate is given to treat metabolic acidosis. Iv fluids are indicated for correction of dehydration.

Which drug may result in weight gain as a side effect? A. Biguanides B. Meglitinides C. Dopamine agonist D. Dipeptidyl peptidase-4 inhibitors

B. Meglitinides Weight gain is a common side effect seen with meglitinides. Biguanides, dopamine agonists, and dipeptidyl peptidase-4 inhibitors may not result in weight gain.

Which process is related to nonproliferative retinopathy? A. Hemorrhage B. Microaneurysm C. Neovascularization D. Retinal detachment

B. Microaneurysm Partial occlusion of the small blood vessels in the retina causes microaneurysms in nonproliferative retinopathy. Hemorrhage is seen in proliferative retinopathy because of fragile, newly formed blood vessels. In proliferative retinopathy, the retinal capillaries become occluded, resulting in the formation of new vessels. This process is called neovascularization. Partial or complete retinal detachment occurs if the new blood vessels pull the retina while the vitreous contract.

Which information would the nurse include in a teaching plan about vascular complications for a patient with diabetes? A. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin C. Renal damage resulting from changes in large-and medium-sized blood vessels can be prevented by careful glucose control D. Macroangiopathy causes slowed gastric emptying and the sexual impotence experienced by a majority of patients with diabetes.

B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotence and slowed gastric emptying result from microangiopathy and neuropathy.

Which complication of diabetes mellitus can be monitored by fundus photography? A. Neuropathy B. Retinopathy C. Nephropathy D. Dermatopathy

B. Retinopathy Fundus photography helps to examine the interior surface of the eye (fundus). Therefore, fundus photography helps to detect the microvascular damage caused by chronic hyperglycemia to the retina, known as retinopathy. Neuropathy can be monitored by a comprehensive foot examination. Diabetic nephropathy can be monitored by checking for microalbuminuria and serum creatinine. Dermatopathy can be monitored by frequent skin examinations.

Which statement by the patient demonstrates effective learning about insulin therapy? A. "I will remove the needle immediately after injection" B. "I will not push the needle straight into the pinched-up area" C. "I will not use the insulin if any particles appear in the solution" D. "I will not rotate the injection within one anatomic site for at least one week"

C. "I will not use the insulin if any particles appear in the solution" Insulin should be discarded if any particles appear in the solution. The needle should be left in place for 5 seconds to ensure that all of the insulin dose has been injected, then the needle may be removed. The needle should be pushed straight into the pinched-up area. The injection site should be rotated in a single anatomical spot, such as the abdomen, for at least 1 week before using a different site to allow better insulin absorption.

Administration of which prescribed intervention may help to prevent further complications in an unconscious patient with a history of diabetes whose blood sugar level is found to be 65 mg/dL? A. 100 mL of whole milk orally B. 15 g of fast-acting carbohydrate orally C. 25 to 50 mL of 50% glucose IV D. 20 to 40 U of 30/70 insulin subcutaneously

C. 25 to 50 mL of 50% glucose IV The patient should be immediately administered 25 to 50 mL of 50 percent glucose intravenously, which would rapidly raise the glucose concentration in the blood stream. An oral route of administration of fast-acting carbohydrate is not appropriate in an unconscious patient. Treatment with carbohydrate that contains fats, such as whole milk, should be avoided, because the fat will decrease the absorption of glucose and delay the response. Insulin is to be administered in patients with hyperglycemia.

Which drug is used for treating neurogenic bladder? A. Valsartan B. Gabapentin C. Bethanechol D. Amitriptyline

C. Bethanechol Neurogenic bladder may develop as a sensation in the inner bladder wall, causing urinary retention. A cholinergic agonist drug such as bethanechol is used for treating this condition. Valsartan is an angiotensin receptor blocker that is used in patients with diabetes and microalbuminuria. Gabapentin is an antiseizure medication used for treating neuropathic pain. Amitriptyline is a tricyclic antidepressant used in the treatment of neuropathic pain.

Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis? A. Polyuria B. Hypokalemia C. Cerebral edema D. Metabolic acidosis

C. Cerebral edema Incorrect fluid replacement especially with hypotonic fluids may cause a sudden drop in serum sodium resulting in cerebral edema. Polyuria is a manifestation of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Hypokalemia may be seen with severe dehydration. Metabolic acidosis is observed with diabetic ketoacidosis due to fluid losses.

Which treatment would be done initially for a patient with diabetic ketoacidosis who arrived at the hospital with clinical symptoms of dry mucous membranes, tachycardia, and orthostatic hypotension? A. Infusion of 5% to 10% dextrose B. Subcutaneous injection of 1 mg glucagon C. Infusion of 0.45% or 0.9% sodium chloride (NaCl) D. IV administration of 25 to 50 mL of 50% glucose

C. Infusion of 0.45% or 0.9% sodium chloride (NaCl) Dry mucous membranes, tachycardia, and orthostatic hypotension indicate severe dehydration. Infusion of 0.45 percent or 0.9 percent NaCl is given for fluid replacement to prevent dehydration. Infusion of 5 percent to 10 percent dextrose is given to prevent hypoglycemia. If the patient has severe hypoglycemia and is in an unconscious state, a subcutaneous injection of 1 mg glucagon or intravenous administration of 25 to 50 mL of 50 percent glucose is given.

Which symptom would the nurse teach the caregiver of a patient with diabetes to identify as a manifestation of hypoglycemia? A. Increase in urination B. Abdominal cramps C. Nervousness and tremors D. Nausea and vomitting

C. Nervousness and tremors Nervousness and tremors; cold, clammy skin; and numbness of the fingers and toes are some of the manifestations of hypoglycemia which the caregiver should watch for out in the patient. An increase in urination, abdominal cramps, and nausea and vomiting are manifestations of hyperglycemia.

Which complication of diabetes can be diagnosed by the ankle-brachial index? A. Diabetic neuropathy B. Diabetic nephropathy C. Peripheral arterial disease D. Hyperosmolar hyperglycemic syndrome

C. Peripheral arterial disease The ankle-brachial index is used to diagnose peripheral arterial disease. Diabetic neuropathy is diagnosed based on the symptoms and by examining the patient's lower extremities. Increased serum creatinine, decreased glomerular filtration rate, and albuminuria is indicative of diabetic nephropathy. Hyperosmolar hyperglycemic syndrome is suspected if the blood glucose levels are more than 600 mg/dL, with a marked increase in serum osmolality.

Which intervention will be beneficial for a patient with a blood glucose level of 250 mg/dL who is receiving treatment for hyperosmolar hyperglycemic syndrome? A. Administering 0.9% NaCl B. Administering 0.1 unit/kg/hr of insulin C. Administering IM glucagon D. Administering IV fluids containing glucose

D. Administering IV fluids containing glucose A patient with hyperosmolar hyperglycemic syndrome whose blood glucose level approaches 250 mg/dL should receive IV fluids containing glucose to prevent hypoglycemia. NaCl 0.9 percent is administered in patients with diabetic ketoacidosis. Administering 0.1 u/kg/hr of insulin is indicated to correct hyperglycemia and hyperketonemia. IM glucagon is administered in hypoglycemic patients who are unconscious.

Which foods would the nurse encourage a patient with diabetes mellitus and coronary artery disease to limit intake of to help reduce the percentage of saturated fat in their diet? A. Chicken and turkey B. Frozen and canned vegetables C. Enriched flour products D. Dairy products

D. Dairy products Cheese and dairy products are higher in fat and calories than vegetables, fruit, enriched flour products, or poultry and should be limited.

Which is a symptom of autonomic neuropathy? A. Aphasia B. Glaucoma C. Paresthesia D. Gastroparesis

D. Gastroparesis Gastroparesis is delayed gastric emptying, which is one of the complications of autonomic neuropathy. Aphasia is one of the severe neurologic manifestations of hyperosmolar hyperglycemic syndrome. Glaucoma may occur due to diabetic retinopathy. Paresthesias is seen in sensory neuropathy.

The laboratory reports of a patient brought to the emergency department with symptoms of dehydration show high glucose levels in the blood, large ketone bodies in the urine, decrease serum bicarbonate levels, and acidic pH of the blood. Administration of which prescribed interventions would help stabilize this patient? Select all that apply A. Glucagon IM B. 50% glucose IV C. Fast-acting carbohydrates orally D. Short-acting insulin IV E. Fluids and electrolytes IV

D. Short-acting insulin IV E. Fluids and electrolytes IV Intravenous administration of short-acting insulin helps to stabilize the blood glucose levels. Intravenous administration of fluids and electrolytes may help to rectify the fluid electrolyte balance and normalize the blood pH. Administering glucagon, 50 percent glucose, and fast-acting carbohydrates increase the blood sugar level so these interventions are appropriate for hypoglycemia.

Which pathologic change is the cause of microaneurysms in nonproliferative retinopathy? A. Retinal edema B. Neurovascularization C. Partial blood vessels occlusion D. Intraretinal hemorrhages

Partial occlusion of the small blood vessels in the retina causes microaneurysms in the capillary walls in nonproliferative retinopathy. Retinal edema is caused by leakage of the capillary fluids from the walls of microaneurysms. Occlusion of retinal capillaries leads to neurovascularization, which is the formation of new blood vessels to supply the retina with blood. Intraretinal hemorrhages may occur due to leakage of the capillary fluids from microaneurysms. Hemorrhage is seen in proliferative retinopathy because of fragile, newly formed blood vessels. In proliferative retinopathy, the retinal capillaries become occluded, resulting in the formation of new vessels. This process is called neovascularization. Partial or complete retinal detachment occurs if the new blood vessels pull the retina while the vitreous contract.