Nurs 309 Exam (Ch 64 - Diabetes)

The male diabetic patient asks the nurse for advice about alcohol consumption. What is the nurse's best response?

"Avoid more than two drinks a day and have them with or shortly after meals."

The nurse is providing discharge teaching to a client with DM about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching?

"I can break in my shoes by wearing them all day."

The nurse is teaching a client with DM about proper foot care. Which statement by the client indicates that teaching was effective?

"I must inspect my shoes for foreign objects before putting them on."

Which statement by a patient with DM indicates an understanding of the principles of self care?

"I plan to get my spouse to exercise with me to keep me company."

The nurse is teaching a client with type 2 DM about the importance of weight control. Which comment by the client indicates a need for further teaching?

"I should begin exercising for at least an hour a day."

The nurse is teaching a client about the manifestations and emergency treatment of hypoglycemia. In assessing the client's knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates a correct understanding of hypoglycemia management?

"I should eat three graham crackers."

The nurse is providing discharge teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet?

"If I become hypoglycemic, I could become unconscious."

Nurse is preparing to teach a diabetic patient how to select appropriate shoes. Which points must be included in the teaching plan?

"It is best to have the shoes fitted by an experienced shoe fitter such as a podiatrist." "the heels of the shoes should be less than 2 inches high." "Avoid tight fitting shoes, which can cause tissue damage to your feet." "You should get at least two pairs of shoes so you can change them midday and in the evening."

Which class of anti diabetic medication must be held after using contrast media until adequate kidney function is established?

Biguanides, includes metformin

A patient with type 1 DM is planning to travel by air and asks the nurse about preparations for the trip. What does the nurse tell the patient to do?

Carry all necessary diabetes supplies in a clearly identified pack aboard the plane.

A client newly diagnosed with DM is not ready/willing to learn diabetes contorl during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family?

Causes and treatment of hypoglycemia

Which descriptors are typical of type 2 DM?

Cells have decreased ability to respond to insulin Most patients diagnosed are obese adults.

The patient with diabetes has a foot that is warm, swollen, and painful. Walking cause the arch of the foot to collapse and gives the foot a "rocker bottom" shape. Which foot deformity does the nurse recognize?

Charcot foot

The nurse has just taken change of shift report on a group of clients on the medical surgical unit. Which client does the nurse assess first?

Client taking glyburide (Diabeta) who is dizzy and sweaty.

The nurse has just received change of shift report on the endocrine unit. Which client does the nurse see first?

Client with type 1 DM whose insulin pump is beeping "occlusion"

What is the basic principle of meal planning for a patient with type 1 DM?

Considering the effects and peak action times of the patient's insulin.

A patient with type 1 DM is taking a mixture of NPH and regular insulin at home. The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patient's morning does of insulin?

Contact the health care provider for an order regarding the insulin

A client expresses fear and anxiety over life changes associated with DM stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the BEST response?

"Let's tackle it piece by piece. What is most scary to you?"

A 25 year old female patient with type 1 DM tells the nurse, "I have 2 kidneys and I'm still young, I expect to be around for a long time, so why should I worry about my blood sugar?" What is the nurse's BEST response?

"keeping your blood sugar under control now can help to prevent damage to both kidneys."

A patient asks the nurse how insulin injection site rotation should be accomplished. What is the nurse's best response?

"rotation within one site is preferred to avoid changes in insulin absorption."

A DM client has a HbA1C of 9.4%. What does the nurse say to the client regarding this finding?

"what are you doing differently?"

The nurse is caring for a patient with DM. The patient's urine is positive for ketones. What does the nurse instruct the patient with regard to exercise?

"when urine ketones are present, you should not exercise."

In reviewing the health care provider admission requests for a client admitted in a HHS, which request is inconsistent with this diagnosis?

1 ampule NaHCO3 IV now

A client with type 1 DM received regular insulin at 7am. The client should be monitored for hypoglycemia at which time?

11am

According to the American Diabetes Association, which lab finding is most indicative of DM?

2 hour glucose tolerance blood glucose - 210 mg/dL

Along with exercise, what is the recommended calorie reduction for a patient with diabetes who must lose weight?

250 - 500 calories a day.

A patient with DKA is on an insulin drip of 50 units of regular insulin in 250 mL of normal saline. The current glucose level is 549 mg/dL. According to insulin protocol, the insulin drip needs to be changed 8 units per hour. At what rate does the nurse set the pump?

40 mL/hr

Which individual is at greatest risk for developing type 2 DM?

56 year old Hispanic woman

Which diabetic patient is at greatest risk for diabetic foot ulcer formation?

75 year old African American male with history of cardiovascular disease.

The nurse is caring for a diabetic patient in the ED. The patient's lab values include serum glucose 353 mg/dL, positive serum ketones, and positive urine ketones. What complication does the nurse suspect?

DKA

Which complications of DM are considered emergencies?

DKA Hypoglycemia Hyperglycemic-hyperosmolar state (HHS)

A diabetic patient is scheduled to have a blood glucose test in the next morning. What does the nurse tell the patient to do before coming in for the test?

Eat the usual diet but have nothing after midnight.

A client has just been diagnosed with DM. Which factor is MOST important for the nurse to assess in the client before providing instruction about the disease and its management?

Education and literacy level

A patient with type 2 DM often has which laboratory value?

Elevated triglycerides

The critical care nurse is caring for an older patient admitted with HHS. What is the first priority in caring for this patient?

Fluid replacement to increase blood volume

When glucagon is administered, what does it do?

Frees glucose from hepatic stores of glycogen.

A patient with Dm has signs and symptoms of hypoglycemia. The patient is alert and oriented with a blood glucose of 56 mg/dL. What does the nurse do next?

Give 8 oz of skim milk and then a carbohydrate and protein snack.

Which insulins are considered to have a rapid onset of action?

Glulisine Aspart Lispro

Which laboratory test is the best indicator of a patient's average blood glucose level and or compliance with the DM regimen over the last 3 months?

Glycosylated hemoglobin (HbA1C)

After a 2 hour glucose challenge, which result demonstrates impaired glucose tolerance?

Greater than 140 mg/dL

In determining if a patient is hypoglycemic, the nurse looks for which characteristics in addition to checking the patient's blood glucose?

Hunger Irritability Palpations Profuse Perspiration

A patient is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin are administered. Two hours after treatment, the blood glucose level is 400 mg/dL. Which complication is the patient most at risk for developing?

Hypoglycemia

Most common cause of medical emergency in clients with diabetes

Hypoglycemia

Which statement about sexual intercourse for patients with diabetes is true?

Impotence is associated with DM in male patients.

Which statement about insulin is true?

Insulin's effectiveness depends on the individual patient's absorption of the drug.

Which statements about type 1 DM are accurate?

It is an auto immune disorder. Age of onset is typically younger than 30. Etiology can be attributed to viral infections.

Which statement is true about insulin?

It is necessary for glucose transport across cell membranes.

Why is glucose vital to the body's cells?

It is used by cells to produce energy.

Which statemetns about type 2 DM are accurate?

It peaks at about the age of 50 most people with type 2 DM are obese people with type 2 Dm have insulin resistance It can be treated with oral antidiabetic medications and insulin

In a patient with hyperglycemia, the respiratory center is triggered in an attempt to excrete more CO2 and acid, thus causing a rapid and deep respiratory pattern. What is the term for this respiratory pattern?

Kussmaul respiration

Which factors differentiate DKA from HHS?

Levle of hyperglycemia Amount of ketones produced

Which statements about sensory alteration in patients with diabetes are accurate?

Loss of pain, pressure, and temperature sensation in the foot increases the risk for injury. Sensory neuropathy causes loss of normal sweating and skin temperature regulation. It can be delayed by keeping the blood glucose level as close to normal as possible.

Intensive therapy with good glucose control results in delays in which diabetic complications?

Macrovascular disease. Cardiovascular disease. Retinopathy. Nephropathy. Neuropathy.

In developing an individualized meal plan for a patient with DM, which goals will be focal points of the plan?

Maintaining blood glucose levels at or as close to the normal range as possible. Patient food preferences. Patient cultural preferences. Limiting food choices only when guided by scientific evidence.

Which are modifiable risk factors for type 2 DM?

Maintaining ideal body weight maintaining adequate physical activity

Which class of antidiabetic medication should be given 1-30 minutes before meals?

Meglitinides, includes nateglinide (Starlix)

Untreated hyperglycemia results in which condition?

Metabolic acidosis

Which oral agent may cause lactic acidosis?

Metformin

Which cultures tend to have a higher incidence of DM?

Mexican American African American American Indian

Which are considered the early signs of diabetic nephropathy?

Microalbuminuria Elevated serum uric acid

The patient's urinalysis shows proteinuria. Which pathophysiology does the nurse suspect?

Nephropathy

What type of exercise does the nurse recommend for a patient with diabetic retinopathy?

Non-weight bearing activities such as swimming.

Early treatment of DKA and HHNS includes IV administration of which fluid?

Normal Saline

For which patient should the health care provider avoid prescribing rosiglitazone (Avandia)?

Patient with symptomatic heart failure

SMBG levels is most important in which patients?

Patients taking multiple daily insulin injections. Patients with hypoglycemia unawareness. Patients using a portable infusion device for insulin administration. Patients with acute illnesses. Pregnant patients.

The nurse caring for 4 DM clients has all of these activities to perform. Which is appropriate to delegate to UAP?

Perform hourly bedside blood glucose checks for a client with hyperglycemia.

A patient with DM presents to the ED with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate "all of the time." How does the nurse document this subjective finding?

Polydipsia and Polyuria

Which electrolyte is most affected by hyperglycemia?

Potassium

An intensive care client with DKA is receiving an insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make?

Potassium level

The diabetic patient experiences early morning hyperglycemia (Somogyi effect) as a result of the counterregulatory response to hypoglycemia. What treatment does the nurse expect for this condition?

Provided an evening snack to ensure adequate dietary intake. Evaluate insulin dosage and exercise program.

What is the recommended protocol for patients with type 2 DM who must lose weight?

Reduce calorie intake moderately and increase exercise.

What type of insulin is used in the emergency treatment of DKA and HHNS (hyperglycemic hyperosmolar nonketotic syndrome)?

Regular Insulin

The patietn with type 2 diabetes is prescribed sitagliptin for glucose regulation. Which key changes does the nurse teach a patient to report to the health care provider immediately?

Report any signs of jaundice. Report any blue-grey discoloration of the abdomen. Report any sudden onset of abdominal pain.

Which statement about insulin administration is correct?

Rotating injection sites improves absorption and prevents lipohypertrophy.

A patient will be using an external insulin pump. What does the nurse tell the patient about the pump?

SMBG levels should be done three or more times a day.

Which class of antidiabetic medication is most likely to cause a hypoglycemic episode because of the long duration of action?

Second generation sulfonylureas, which include glipizide

The patient with DM had a pancreas transplant and takes daily doses of cycloporine (neoral). For which key lab assessment does the nurse monitor?

Serum creatinine

Glucagon is used primarily to treat the patient with which disorder?

Severe hypoglycemia.

The older dulat with DM asks the nurse for advice about beginning an exercise program. What is the nurse's best response?

Start low intensity activities in short sessions. Be sure to include warm up and cool down periods. Changes in activity should be gradual.

A patient with type 2 DM, usually controlled with a second generation sulfonylurea, develops a UTI. Due to the stress of the infection, the patient must be treated with insulin. What additional information about this treatment does the nurse relay to the patient?

The insulin is necessary to supplement the second generation sulfonylurea until the infection clears.

From which injection site is insulin absorbed most rapidly?

Abdomen

A patient has been receiving insulin in the abdomen for 3 days. On day 4, where does the nurse give the insulin injection?

Abdomen, but in an area different from the previous day's injection.

In which situations does the nurse teach a patient to perform urine ketone testing?

Acute illness or stress. When symptoms of DKA are present. When a diabetic patient is in a weight loss program.

A patient with DM has signs and symptoms of hypoglycemia. The patient has a blood glucose of 56 mg/dL, is not alert but responds to voice, and is confused and is unable to swallow fluids. What does the nurse do next?

Administer D50 IV push

Which class of antidiabetic medication should be taken with the first bite of a meal to be fully effective?

Alpha-glucosidase inhibitors, include miglitol (glyset)

Which infection control measures must the nurse teach a patient who will be performing SMBG?

Always wash hands before monitoring glucose. Regular cleaning of the meter is critical. Do not re-use lancets. Do not share blood glucose monitoring equipment.

Which is the BEST referral that the nurse can suggest to a client who has been newly diagnosed with DM?

American Diabetes Association.

The nurse is teaching a patient with DM about proper foot care. Which instructions does the nurse include?

Apply moisturizing cream to the feet after bathing, but not between the toes. Do not go barefoot. Inspect the feet daily.

A patient has been diagnosed with DM. Which aspects does the nurse consider in formulating the teaching plan for this patient?

Assessing visual impairment regarding insulin labels and markings on syringes. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe. Assessing patient motivation to learn and comprehend instructions. Assessing patient's ability to read printed material.

Which explanation best assists a client in differentiating type 1 DM from type 2?

Those with type 2 diabetes make insulin, but in inadequate amounts.

The nurse is providing discharge teaching to a patient about self monitoring of blood glucose (SMBG). What information does the nurse include?

Wash hands before using the meter. Do a retest if the results seem unusual. Do not share the meter.

Which are characteristics of regular insulin?

When mixing types of insulin, this insulin is always drawn up first. This insulin should be given 30 minutes before meals.

A client recently admitted with new onset type 2 DM will be discharged with a self monitoring blood glucose machine. What is the BEST time for the nurse to explain to the client the proper use of the machine?

While performing the test in the hospital.

NaHCO3 is given for

acid-base imbalance of diabetic ketoacidosis

A cold, mottled toe may indicate ___ in DM patients

arterial occlusion secondary to arterial occlusive disease/embolization

What glucose level range does the American Association of Clinical Endocrinologists recommend for a critically ill patient?

between 140 and 180 mg/dL

Which statement about dietary concepts for a patient with DM is true?

carbohydrate counting is emphasized.

HbA1C

glycosylated hemoglobin

Which are signs and symptoms of MILD hypoglycemia?

headache weakness irritability

With insulin therapy, ___ ___ levels fall rapidly as potassium and glucose shifts into the cells.

serum potassium