Patho 239 Final Exam

A young man has been diagnosed with type 2 diabetes and has been prescribed glyburide. Which of the following statements suggests that the nurse should perform further health education? a) "I'll plan to take my glyburide each night before I go to bed." b) "I'll make sure to check with my doctor before I start taking any other medications." c) "I'll keep in mind that glyburide can possibly cause me to have low blood sugar." d) "I know that glyburide won't cure my diabetes, but it will help me have safe blood sugar levels."

A. "I'll plan to take my glyburide each night before I go to bed."

Oral anti-diabetic agents can be used in various combinations for what purpose? a) Additive effects b) Minimalistic effects c) Maximum effects d) Synergistic effects

A. Additive effects

Which of the following insulin is always clear? (Choose one) a) Humulin R b) Humulin U c) Humulin L d) Humulin N

A. Humulin R

You are preparing patient teaching for a diabetic patient who is to begin pramlintide acetate (Symlin) therapy, which will be taken in addition to his insulin. What would be the priority nursing instruction to include in the patient teaching? a) The drug has a rapid onset of action b) Do not combine the drug with insulin in the same syringe c) The drug is injected subcutaneously immediately before a major meal d) Inject the drug at least 2 inches away form any insulin injection site

C. The drug is injected subcutaneously immediately before a major meal

The client is scheduled to get her breakfast tray at 0700. At what time should she receive her prescribed dose of NPH insulin? a) 1400 (2pm) b) 1100 (11 am) c) 2100 (9 pm) d) 0630 (6:30 am)

D. 0630 (6:30 am)

Which of the following would a nurse identify as an example of a sulfonylurea? a) Metformin b) Acarbose c) Miglitol d) Glyburide

D. Glyburide

A patient with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. Which of the following conditions can account for this effect? a) Dawn phenomenon b) Autonomic neuropathy c) Diabetic ketoacidosis d) Inadequate bedtime insulin

A. Dawn phenomenon

The nurse is caring for a client who is taking a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition? a) Hyperglycemia b) Pulmonary hypertension c) Hypoglycemia d) Congestive heart failure

A. Hyperglycemia

When administering insulin, which of the following would be most appropriate? a) Insert the needle at a 45-degree angle for injection. b) Firmly spread the skin of the area of the intended site of injection. c) Massage the injection site firmly after removing the needle and syringe. d) Shake the vial vigorously to ensure thorough mixing before drawing up the dose.

A. Insert the needle at a 45-degree angle for injection.

Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes. a) Inspect the feet for blisters daily b) Rotate insulin injection sites once a week c) Wear comfortable, open-toe shoes d) Decrease daily walking activity

A. Inspect the feet for blisters daily

A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following effects will result from the action of insulin? a) Promotion of glucose uptake by target cells b) Promotion of gluconeogenesis c) Promotion of fat breakdown d) Initiation of glycogenolysis

A. Promotion of glucose uptake by target cells

A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume? a) The patient is achieving normal glycemic control. b) The patient is at risk for an insulin reaction. c) The patient is at risk for developing hyperglycemia. d) The patient needs to modify his diet related to the low readings.

A. The patient is achieving normal glycemic control.

A client with long-standing type 2 diabetes is surprised at his high blood sugar readings while recovering from an emergency surgery. Which of the following factors may have contributed to the client's inordinately elevated blood glucose levels? a) The stress of the event caused the release of cortisol. b) The tissue trauma of surgery resulted in gluconeogenesis. c) Illness inhibited the release and uptake of glucagon. d) Sleep disruption in the hospital precipitated the dawn effect.

A. The stress of the event caused the release of cortisol.

The nurse instructs a client who has been prescribed extended-release metformin (Glucophage XR) to take the medication at what time? a) With evening meal b) With breakfast and evening meal c) At bedtime d) With afternoon and evening meal

A. With evening meal

The nurse is instructing a client how to take his prescribed pramlintide. Which of the following would be most appropriate? a) "Take the drug orally once a day, preferably in the morning." b) "Give it by subcutaneous injection immediately before your major meals." c) "Take the drug orally with the first bite of each meal." d) "Give yourself an injection 1 hour before you eat breakfast and dinner."

B. "Give it by subcutaneous injection immediately before your major meals."

The nurse assesses a patient's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia? a) 48 mg/dL b) 34 mg/dL c) 65 mg/dL d) 72 mg/dL

B. 34 mg/dL

The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL. The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time? a) Orienting the client to the events surrounding his admission b) Administration of intravenous fluids c) Education related to prevention of DKA d) Monitoring for fever

B. Administration of intravenous fluids

The nurse is caring for a client with type 2 diabetes who is being treated with a regimen called BIDS. The nurse is aware that this regimen consists of what medications? a) Sulfonylurea plus a meglitinide b) Bedtime insulin plus daytime sulfonylurea c) Metformin plus a thiazolidinedione d) Sulfonylurea plus metformin

B. Bedtime insulin plus daytime sulfonylurea

A client receives regular insulin at 8:00 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? a) Between 2:00 PM and 4:00 PM b) Between 10:00 AM and 12:00 PM c) Between 12:00 PM and 8:00 PM d) Between 8:30 AM and 9:30 AM

B. Between 10:00 Am and 12:00 PM

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause? a) Hypoglycemia will occur. b) Blood glucose will elevate. c) Gluconeogenesis will occur. d) An unusable form of glucose will be released.

B. Blood glucose will elevate.

The nurse teaching a patient to use a glucometer should emphasize that the most accurate testing site when blood glucose is rapidly changing or if hypoglycemia is suspect is in which of the following? (Choose one) a) Forearm b) Finger c) Palm d) Thigh

B. Finger

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes .The best diagnostic indicator that would support the client's response would be: a) Fasting blood glucose level b) Glycosylated hemoglobin, hemoglobin A1C (HbA1C) c) Capillary blood glucose sample d) Urine test

B. Glycosylated hemoglobin, hemoglobin A1C (HbA1C)

Which of the following would be least appropriate when administering insulin by subcutaneous injection? a) Inserting the needle at a 45-degree angle b) Massaging the site after removing the needle c) Using a 25 gauge 1/2 -inch needle d) Injecting the insulin slowly

B. Massaging the site after removing the needle

A nurse is caring for a patient diagnosed with type 2 diabetes. Which of the following should the nurse inform the patient are risk factors associated with type 2 diabetes? a) Regular exercise b) Obesity c) Young age d) Polyuria

B. Obesity

A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided? a) Glucose gel in the buccal pocket b) Orange juice orally c) Dextrose IV d) IM glucagon injection

B. Orange juice orally

The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client is complaining of a headache and of being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client? a) Raise the head of the bed. b) Place glucose gel between the gums and cheek. c) Administer regular insulin subcutaneously. d) Give 8 oz orange juice.

B. Place glucose gel between the gums and cheek.

The physician prescribes glyburide for Tim, a newly diagnosed type 2 diabetic. The nurse knows that this medication acts by which mechanism? a) Produces hypoglycemia by preventing glucose absorption from the stomach b) Produces hypoglycemia by increasing insulin secretion from the pancreas c) Produces hypoglycemia by increasing the use of insulin by the muscles d) Produces hypoglycemia by stopping the production of insulin in the liver

B. Produces hypoglycemia by increasing insulin secretion from the pancreas.

The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be: a) Hypoglycemia causes ketone breakdown. b) The brain relies on blood glucose as its main energy source. c) Insulin produces a rebound hyperglycemia. d) Hepatic glycogenolysis.

B. The brain relies on blood glucose as its main energy source.

An insulin dependent diabetic is having trouble with hypoglycemia late in the morning. During the health history the nurse becomes aware of the most likely cause. What would cause the late morning hypoglycemia? a) The patient likes to nap when he comes home from work before his evening meal. b) The patient jogs two miles in the morning before he goes to work. c) The patient likes to have an early lunch with his girlfriend. d) The patient eats oatmeal early in the morning before his morning.

B. The patient jogs two miles in the morning before he goes to work.

What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide (DiaBeta), a sulfonylurea, to repaglinide, a meglitinide? a) "It is more potent and longer lasting, so you should take it every other day." b) "It is less potent, so you will need to take a larger dose." c) "It stimulates insulin production, so you need to eat soon after taking the medication." d) "The two medications are virtually the same."

C. "It stimulates insulin production, so you need to eat soon after taking the medication."

A 59-year-old man with type 2 diabetes is prescribed metformin. When the patient returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond? a) "We should really report this to your physician. He will likely change medications." b) "You should discontinue this medication immediately. I will contact your physician." c) "Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." d) "We should really report this to your physician. The metformin dosage will need to be decreased."

C. "Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy."

A patient is to be administered glipizide (Glucotrol). Which of the following factors would prohibit the administration of glipizide (Glucotrol) to this patient? a) The ingestion of carbohydrates b) Increase in alkaline phosphatase c) Allergy to sulfonamides d) A diagnosis of hypertension

C. Allergy to sulfonamides

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which of these organs does the nurse recognize is reliant on glucose as the major energy source? a) Spleen b) Lungs c) Brain d) Heart

C. Brain

Ms. Newton, a newly diagnosed diabetic, is prescribed glyburide. As the nurse providing instruction, you identify which occurrence as a classic symptom of hyperglycemia? a) Grand mal seizures b) Hemiparesis c) Excessive urination d) Tachycardia

C. Excessive urination

An extremely lethargic patient arrives by ambulance at the emergency department. His blood glucose level is 32 mg/dL. The nurse will anticipate that this patient will be diagnosed with which of the following? a) Dawn phenomenon b) Autonomic neuropathy c) Hypoglycemia d) Diabetic ketoacidosis

C. Hypoglycemia

When describing the effects of incretins on blood glucose control to a group of students, which of the following would an instructor include? a) Increases protein building b) Increases glucagon release c) Increases insulin release d) Increases GI emptying

C. Increases insulin release

Sitagliptin (Januvia) is prescribed for a patient who has been diagnosed with type 2 diabetes. What is the action of sitagliptin (Januvia)? a) It blocks the S phase of the cell cycle. b) It is a synthetically prepared monosodium salt. c) It has been linked to increased beta cell neogenesis. d) It inhibits hydrogen, potassium, and ATPase.

C. It has been linked to increased beta cell neogenesis.

The nurse admits a client with type 2 diabetes who takes metformin (Glucophage), and indicates that the client has a nursing diagnosis of ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing? a) Respiratory alkalosis b) Fluid overload c) Lactic acidosis d) Hyperkalemia

C. Lactic acidosis

The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication? a) Monitor the client for a hypoglycemic reaction at noon. b) Have the client lie quietly for 45 minutes. c) Make sure the client's breakfast is available in the next 5-10 minutes. d) Cleanse the administration site with soap and water before administration.

C. Make sure the client's breakfast is available in the next 5-10 minutes.

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies which of the following as a biguanide? a) Miglitol b) Glipizide c) Metformin d) Tolbutamide

C. Metformin

A patient is prescribed sitagliptin. The nurse would expect to administer this drug by which route? a) Intramuscular b) Intravenous c) Oral d) Subcutaneous

C. Oral

Your client is admitted to the intensive care unit with diabetic ketoacidosis. You know that your client will be placed on an intravenous insulin drip. The only type of insulin which can be administered intravenously is: a) Ultralente. b) Lente. c) Regular. d) NPH.

C. Regular

The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease? a) "Insulin is used to move carbohydrate particles from the gastrointestinal system to the liver." b) "Insulin is stimulated by the liver to break down proteins and provide the body with nutrients." c) "Insulin causes fat to be broken down to provide energy for the body." d) "Insulin assists glucose molecules to enter the cells of muscle and fat tissues."

D. "Insulin assists glucose molecules to enter the cells of muscle and fat tissues."

Which of the following clients would be considered to be exhibiting manifestations of "prediabetes"? a) A retired female registered nurse with a fasting plasma glucose level of 92 mg/dL. b) A school-aged child who had a blood glucose level of 115 following lunch. c) An elderly client who got "light-headed" when he skipped his lunch. Blood glucose level was 60 mg/dL at this time. d) A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL.

D. A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL.

The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection? a) Deltoid b) Thigh c) Hip d) Abdomen

D. Abdomen

The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin? a) Alpha cells b) PP cells c) Delta cells d) Beta cells

D. Beta cells

A client is receiving glipizide as treatment for his type 2 diabetes. The nurse understands that this drug acts by which of the following? a) Inhibiting alpha-glucosidase to delay glucose absorption b) Decreasing insulin resistance c) Increasing the uptake of glucose d) Binding to potassium channels on pancreatic beta cells

D. Binding to potassium channels on pancreatic beta cells

A patient is diagnosed with type 1 diabetes. What distinguishing characteristic is associated with type 1 diabetes? a) Oral agents can control blood sugar. b) Blood glucose levels can be controlled by diet. c) It always starts in childhood. d) Exogenous insulin is required for life.

D. Exogenous insulin is required for life.

The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority? a) Repeat the dose of insulin. b) Bathe the client with tepid water. c) Place the client in the supine position. d) Give the client a concentrated carbohydrate.

D. Give the client a concentrated carbohydrate.

The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client? a) Stat urine for glucose b) Insulin level c) Fasting blood glucose in the AM d) HbA1c

D. HbA1c

Which of the following are risk factors for type 2 diabetes that a nurse should recognize in a client? Select all that apply: a) Younger age b) Caucasian race c) Impaired glucose tolerance d) History of gestational diabetes e) Obesity

D. History of gestational diabetes E. Obesity C. Impaired glucose tolerance

A patient has been prescribed acarbose (Precose). What is the advantage of acarbose? a) The patient does not have to limit food intake. b) It is 90% bound to plasma proteins. c) It is used instead of other antidiabetic agents. d) It delays the digestion of complex carbohydrates.

D. It delays the digestion of complex carbohydrates.

A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which of the following would the nurse include as the primary delivery system for insulin? a) Insulin pen b) Jet injector c) External pump d) Subcutaneous injection

D. Subcutaneous injection

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient's a) potassium level. b) use of salt in his diet. c) blood pressure. d) use of alcohol.

D. Use of alcohol