NURS 440 - Chapter 48 (Diabetes Mellitus)

The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included? (SATA) a. Exercise regularly b. Maintain a healthy weight c. Have BP checked regularly d. Assess for visual changes on a monthly basis e. Monitor for polyuria, polyphagia and polydipsia

A, B, E To reduce the risk of developing diabetes, the patient with prediabetes should maintain a healthy weight, learn to monitor for symptoms of diabetes, have blood glucose and glycosylated hemoglobin (A1C) tested regularly, exercise regularly and eat a healthy diet

Which tissues require insulin to enable movement of glucose into the tissue cells> (SATA) a. Liver b. Brain c. Adipose d. Blood cells e. Skeletal muscle

C, E Adipose tissue and skeletal muscle require insulin to allow the transport of glucose into the cells. Brain, liver, and blood cells require adequate glucose supply for normal function, but do not depend directly on insulin for glucose transport

Which lab results indicate the patient has prediabetes? a. Glucose tolerance result of 132 b. Glucose tolerance result of 240 c. Fasting blood glucose result of 80 d. Fasting blood glucose result of 120

D Prediabetes is defined as impaired glucose tolerance and impaired fasting glucose or both. Fasting glucose results between 100 and 125 indicate prediabetes. A diagnosis of impaired glucose tolerance is made if the 2 hr OGTT results are between 140 and 199.

Priority decision When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan? a. Achieving a normal weight b. Performing daily aerobic exercise c. Eliminating red meat from the diet d. Monitoring the blood glucose periodically

A, C The pt has 1 prior test result of fasting plasma glucose greater than or equal to 126, that meets criteria for a diagnosis of diabetes, and the result is confirmed on this follow-up visit. The A1C is 7.5% and greater than diagnostic criteria of 6.5% or higher. The other diagnostic criteria include a 2 hr OGTT level greater than or equal to 200, or a pt with classic symptoms of hyperglycemia (P, P, P and unexplained weight loss) or hyperglycemic crisis, a random plasma glucose over 200

In type 1 diabetes, glucose has an osmotic effect when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. Fatigue b. Polydipsia c. Polyphagia d. Recurrent infections

B Polydipsia is caused by fluid loss from polyuria when high glucose levels cause osmotic diuresis. Cellular starvation from lack of glucose and the use of body fat and protein for energy contribute to fatigue, weight loss, and polyphagia in type 1 diabetes

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. Enhances the breakdown of adipose tissue for energy b. Stimulates hepatic glycogenolysis and gluconeogenesis c. Prevents the transport of triglycerides into adipose tissue d. Increases amino acid transport into cells and protein synthesis

D Insulin is an anabolic hormone that is responsible for growth, repair and storage. It facilitates movement of amino acids into cells, synthesis of protein, storage of glucose as glycogen, and deposition of triglycerides and lipids as fat into adipose tissue. Fat is used for energy when glucose levels are depleted. Glucagon is responsible for hepatic glycogenolysis and gluconeogensis

What characterizes type 2 diabetes? (SATA) a. Beta-cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver

A, B, C, D, E, F Type 2 DM is characterized by beta-cell exhaustion, insulin resistance, genetic predisposition, altered production of adipokines, inherited defect in insulin receptors, and inappropriate glucose production by the liver. The roles of the brain, kidneys, and gut in Type 2 DM development are being studied

Cortisol, glucagon, epinephrine, and growth hormone are referred to as counterregulatory hormones because they: a. Decrease glucose production b. Stimulate glucose output by the liver c. Increase glucose transport into the cells d. Independently regulate glucose level in the blood

B The counter regulatory hormones have the opposite effect of insulin by stimulating glucose production and output by the liver and by decreasing glucose transport into the cells. The counter regulatory hormones and insulin together regulate the blood glucose level

Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. An obese 40 y/o Hispanic woman b. A 20 y/o man whose father has type 1 diabetes c. A 34 y/o woman whose parents both have type 2 diabetes d. A 12 y/o boy whose father has maturity-onset diabetes of the young (MODY)

C Type 2 diabetes has a strong genetic influence (8% to 14% risk for offspring) and offspring of parents who both have type 2 diabetes have an increased chance of developing it. In contrast, type 1 is associated with a genetic susceptibility that is related to human leukocyte antigens (HLAs). Offspring of a mother with type 1 have a 1-4% chance of developing the disease, while offspring of a father with diabetes have 5-6% risk. Other risk factors for type 2 diabetes include obesity; NA, hispanic, or african anscestry; 55+ y/o. Although 50% of people with a parent with MODY will develop MODY, it is autosomal dominant, and treatment depends on which genetic mutation caused it. It is not associated with obesity or HTN and is not currently preventable.