Questions from ES - Diabetes

Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis? 1 Electrolytes 2 Insulin therapy 3 Sodium bicarbonate 4 Intravenous (IV) fluid

2 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. Electrolytes are given to correct the electrolyte imbalance. Sodium bicarbonate is given to treat metabolic acidosis. IV fluids are indicated for correction of dehydration. Text Reference - p. 1178

Oral agents works on these three defects of type 2 diabetes

Insulin resistance Decreased insulin production Increased hepatic glucose production

Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. Only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. At mealtime or within 15 minutes of meals

d. Lispro is a rapid-acting insulin that has an onset of action of approximately 15 minutes and should be injected at the time of the meal to within 15 minutes of eating. Regular insulin is short acting with an onset of action in 30 to 60 minutes following administration and should be given 30 to 45 minutes before meals

Glycemic Index (GI)

Term used to describe rise in blood glucose levels 2 hours after carbohydrate-containing food is consumed

The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient (select all that apply)? a. Painless foot ulcers b. Erectile dysfunction c. Burning foot pain at night d. Loss of fine motor control e. Vomiting undigested food f. Painless myocardial infarction

b, e, f. Autonomic neuropathy affects most body systems. Manifestations of autonomic neuropathy include erectile dysfunction in men and decreased libido, gastroparesis (nausea, vomiting, gastroesophageal reflux and feeling full), painless myocardial infarction, postural hypotension, and resting tachycardia. The remaining options would occur with sensory neuropathy.

The patient presents to the emergency department with a glucose level of 400 mg/dL, ketone result of 2+, and rapid respirations with a fruity odor. What finding do you anticipate? A. pH below 7.30 B. Urine specific gravity below 1.005 C. High sodium bicarbonate levels D. Low blood urea nitrogen (BUN) level

A. pH below 7.30 Rationale. The patient is in metabolic acidosis, which is a pH below 7.35. Dehydration results in a high urine specific gravity (at the upper end of the normal range, or above 1.025 to 1.030). Sodium bicarbonate levels are low in metabolic acidosis. The dehydration that occurs with DKA elevates the BUN level.

21. What has most likely occurred in a patient who has been diagnosed with endogenous hypoglycemia? a. Taken an overdose of hypoglycemic drugs b. Been following a very restricted fasting diet or is malnourished c. Excessive secretion of insulin or an increase in glucose metabolism d. Exercised unwittingly without replenishing needed fluids and nutrients

ANS: C Endogenous refers to within; in this patient, it refers to internal factors, such as an increase of insulin or glucose metabolism. Both conditions would lead to hypoglycemia

A nurse in the outpatient setting is teaching a patient about the importance of self-monitoring of blood glucose (SMBG) using a glucometer. What should the nurse tell the patient? Select all that apply. 1 Test blood glucose whenever hypoglycemia is suspected. 2 Test blood glucose before and after exercise. 3 Take a blood sample immediately after a meal. 4 Take a blood sample from the side of the finger pad. 5 Wash hands in cold water when preparing to puncture.

1, 2, 4 The nurse should instruct the patient to test blood glucose levels whenever hypoglycemia is suspected so that immediate action can be taken. The patient should test blood glucose before, during and after exercise to determine the effects of exercise on metabolic control. Blood sample should be taken from the side of the finger pad rather than near the center, because there are fewer nerve endings along the side of the finger. Blood glucose is generally tested two hours after a meal to determine if the bolus insulin dose was adequate for the meal. Blood glucose may also be tested before a meal by patients who use insulin pumps or multiple daily injections and base the insulin dose on the carbohydrates in a meal or make adjustments if the preprandial value is above or below target. Hands should be washed in warm water before the finger puncture is made to in order to promote blood flow to the fingers. Text Reference - p. 1168

Which symptoms may be observed in patients with diabetic ketoacidosis? Select all that apply. 1 Hypovolemia 2 Volume overload 3 Visual disturbances 4 Soft and sunken eyes 5 Sweet fruity odor of breath

1, 4, 5

The elderly patient with type 2 diabetes mellitus presents to the clinic with a fever and productive cough. The diagnosis of pneumonia is made. You notice tenting skin, deep tongue furrows, and vital signs of 110/80 mm Hg, 120 beats/minute, and 24 breaths/minute. What assessment is important for you to obtain? A. Blood glucose B. Orthostatic blood pressures C. Urine ketones D. Temperature

A. Blood glucose Rationale. HHS is typically seen in patients with type 2 DIABETES AND INFECTION, such as pneumonia. The main presenting sign is a glucose level above 600 mg/dL. Enough evidence of dehydration already exists that orthostatic vital sign assessments are not a priority, and they are often inaccurate in the elderly due to poor vascular tone. Patients with HHS do not have elevated ketone levels, which is a key distinction between HHS and DKA. Temperature will eventually be taken but is often blunted in the elderly and diabetics. An infectious diagnosis has already been made. The glucose level for appropriate fluid and insulin treatment is the priority.

A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for all minority populations every year b. FPG for all individuals at age 45 and then every 3 years c. Testing people under the age of 21 for islet cell antibodies d. Testing for type 2 diabetes in all overweight or obese individuals

b. The American Diabetes Association recommends that testing for type 2 diabetes with a FPG, A1C, or 2-hour OGTT should be considered for all individuals at the age of 45 and above and, if normal, repeated every 3 years. Testing for immune markers of type 1 diabetes is not recommended. Testing at a younger age or more frequently should be done for members of a high-risk ethnic population, including African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders. Overweight adults with additional risk factors should be tested.

The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with Type 2 diabetes that must be controlled with 70/30-combination insulin. Which intervention should be included in the plan of care? 1. Assess the client's ability to read small print. 2. Monitor the client's serum PT level. 3. Teach the client how to perform a hemoglobin A1c test daily. 4. Instruct the client to check the feet weekly

**1. Age-related visual changes and diabetic retinopathy occur that could lead to the client having difficulty in reading and draw- ing up insulin dosage accurately. 2. The PT level is monitored for clients receiving Coumadin, an anticoagulant, which is not ordered for client with diabetes, Type 1 or 2. 3. Glycosylated hemoglobin is a serum blood test usually performed in a laboratory, not in the client's home. The hemoglobin Alc is performed every three (3) months. Self-monitoring blood glucose (SMBG) should be taught to the client. 4. The client's feet should be checked daily, not weekly. In a week the client could have developed gangrene from an injury that the client did not realize he or she had. TEST-TAKING HINT: Always notice the age of a client if it is given because this is often impor- tant when determining the correct answer for the question. Be sure to read the adjectives such as "weekly," instead of "daily."

The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with Type 1 diabetes at 1600. Which action should the nurse implement? 1. Ensure the client eats the bedtime snack. 2. Determine how much food the client ate at lunch. 3. Perform a glucometer reading at 0700. 4. Offer the client protein after administering insulin.

**1. Humulin N peaks in 4-12 hours, making the client at risk for hypoglycemia between 8:00 PM - 4:00 AM, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia. 2. The food intake at lunch will not affect the client's blood glucose level at midnight. 3. The client's glucometer reading should be done around 2100 to assess the effectiveness of insulin at 1600. 4. Humulin N is an intermediate-acting insulin that has an onset in 2-4 hours but does not peak until 6-8 hours. TEST-TAKING HINT: Remember to look at the adjective or descriptor. Intermediate-acting insulin gives the reader a clue that anything intermediate, instead of longer-acting, action would be incorrect.

The diabetic educator is teaching a class on diabetes Type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion? Select all that apply. 1. Take diabetic medication even if unable to eat the client's normal diabetic diet. 2. If unable to eat, drink liquids that are equal to the client's normal caloric intake. 3. It is not necessary to notify the health-care provider if ketones are in the urine. 4. Test blood glucose levels and test urine ketones once a day and keep a record. 5. Call the health-care provider if glucose levels are higher than 180 mg/dL.

**1. The most important issue to teach clients is to take insulin even if they are unable to eat. Glucose levels are increased with ill- ness and stress. **2. The client should drink liquids such as regular cola, orange juice, or regular gela- tin, which provide enough glucose to pre- vent hypoglycemia when receiving insulin. 3. Ketones indicate a breakdown of fat and must be reported to the HCP because they can lead to metabolic acidosis. 4. Blood glucose levels and ketones must be checked every three (3) to four (4) hours, not daily. **5. The HCP should be notified if the blood glucose level is this high. Regular insulin may need to be prescribed to keep the blood glucose level within acceptable range. TEST-TAKING HINT: This is an alternate-type question that may have more than one correct answer. The test taker should read all options and determine if it is an intervention that is appropriate.

To demonstrate an understanding of Somogyi effect, the nurse correctly identifies which defining characteristics? Select all that apply. - Documented morning hyperglycemia - Caused by not rotating insulin injection sites - May be avoided by consuming a bedtime snack - Treatment is a lower dose of insulin in the evening - Documented hypoglycemia between 2:00 AM and 4:00 AM - Requires an adjustment of administration time of evening insulin

- Documented morning hyperglycemia - May be avoided by consuming a bedtime snack - Treatment is a lower dose of insulin in the evening - Documented hypoglycemia between 2:00 AM and 4:00 AM Hyperglycemia in the morning can be caused by the Somogyi effect, which can be stimulated by too much insulin in the evening. During the night, typically between 2:00 AM and 4:00 AM, hypoglycemia occurs, which stimulates a release in counterregulatory hormones in an attempt to raise the blood sugar. What results is rebound hyperglycemia resulting in higher blood sugar readings upon awakening. The Somogyi effect must be differentiated from dawn phenomenon, which also results in higher morning blood sugar readings. The treatment for Somogyi effect includes consuming a bedtime snack or reducing the evening insulin dose, whereas the treatment for dawn phenomenon is an increase in the evening insulin dose or an adjustment in the timing of the evening insulin dose. Not rotating insulin injection sites does not result in either the Somogyi effect or dawn phenomenon. In fact, current recommendations are to use the same anatomical injection site (e.g., the abdomen) for one week before moving to another anatomical injection site.

A nurse caring for a patient with type 1 diabetes encourages the patient to exercise regularly as part of diabetes management. What precautions should the patient take when exercising? Select all that apply. - Exercise after meals. - Have a warm-up and cool-down period. - Avoid carbohydrate snacks during exercise. - Carry glucose tablets or hard candies when exercising. - Avoid exercise if blood glucose is equal to 120 mg/dL.

- Exercise after meals. - Have a warm-up and cool-down period. - Carry glucose tablets or hard candies when exercising. The nurse should inform the patient to exercise one hour after meals when blood sugar levels are rising. The exercise program should be started gradually and increased slowly, with a warm-up and cool-down period. Patients using medications are at a risk for hypoglycemia when exercising and should always carry a fast-acting source of carbohydrate such as glucose tablets or hard candies or eat small carbohydrate snacks every 30 minutes when exercising. If blood glucose is less than or equal to 100 mg/dL, the patient should retest blood glucose levels after a 15-g carbohydrate snack. The patient should then exercise if glucose levels increase after 15 to 30 minutes.

Which complication of diabetes can cause hypoglycemic unawareness? 1 Diabetic neuropathy 2 Diabetic dermopathy 3 Diabetic ketoacidosis 4 Diabetic nephropathy

1 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. Text Reference - p. 1183

Which drug does the nurse expects to be beneficial in a patient with type 2 diabetes who has the presence of albumin in the urine? 1 Lisinopril 2 Duloxetin 3 Pregabalin 4 Bethanechol

1 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. Duloxetin 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. Text Reference - p. 1182

The nurse is preparing an educational session on Type 2 diabetes for the public. Which symptoms of type 2 diabetes would the nurse include in the presentation? Select all that apply. 1 Fatigue 2 Polyuria 3 Weight loss 4 Visual changes 5 Recurrent infections

1, 2, 4, 5 The onset of type 2 diabetes usually is delayed, resulting in chronic complications having already manifested. The patient will have slower wound healing and infection healing, fatigue, and visual changes as a result of the disease progression. Some patients with type II diabetes may have polyuria. Weight loss is typically seen with type I diabetes. Text Reference - p. 1157

Which conditions may lead to a coma in patients with diabetic ketoacidosis if left untreated? Select all that apply. 1 Dehydration 2 Hypoglycemia 3 Cerebral edema 4 Metabolic acidosis 5 Electrolyte imbalance

1, 4, 5 Dehydration, metabolic acidosis, and electrolyte imbalance may lead to a coma if untreated. Hypoglycemia and cerebral edema are not associated with coma in patients with diabetic ketoacidosis. Text Reference - p. 1176

The client received 10 units of Humulin R, a fast acting insulin, at 0700. At 1030 the unlicensed nursing assistant tells the nurse the client has a headache and is really acting "funny." Which action should the nurse implement first? 1. Instruct the assistant to obtain blood glucose level. 2. Have the client drink eight (8) ounces of orange juice. 3. Go to the client's room and assess the client for hypoglycemia. 4. Prepare to administer one amp 50% Dextrose intravenously.

1. The blood glucose level should be obtained, but it is not the first intervention. 2. If it is determined that the client is having a hypoglycemic reaction, orange juice would be appropriate. **3. Regular insulin peaks in 2-4 hours. There- fore, the nurse should think about the possibility that the client is having a hypo- glycemic reaction and should assess the client. The nurse should not delegate nursing tasks to an assistant if the client is unstable. 4. Dextrose 50% is only administered if the client is unconscious and the nurse suspects hypo- glycemia. TEST-TAKING HINT: When answering a question that requires the nurse to implement an intervention first, all four options will be interventions that are appropriate for the situation but only one answer should be implemented first. The test taker must apply the nursing process, which states assessment of the first intervention.

Despite repeated instructions from a nutritionist, a diabetic patient failed to adhere to the recommended dietary allowance (RDA) for carbohydrates. This resulted in lOW levels of glucose in the blood. Which advice given by the nutritionist would be most appropriate for the patient? 1 "Consume low glycemic index (GI) foods and beverages." 2 "Evaluate blood glucose levels using carbohydrate counting." 3 "Avoid whole grains, vegetables, fruits, and low-fat milk in your diet." 4 "Keep the recommended dietary allowance (RDA) for carbohydrates to a maximum of 130 g/day."

2 "Evaluate blood glucose levels using carbohydrate counting." Evaluation of blood glucose levels using carbohydrate counting will help keep glucose levels within the target range. Consumption of foods and beverages with low GI will FURTHER LOWER blood glucose levels. Avoiding whole grains, vegetables, fruits, and low-fat milk will lower glucose levels. The MINIMUM recommendation for carbohydrate intake is 130 g/day. Text Reference - p. 1166

What is the drug of choice for a 45-year-old patient who has a body mass index (BMI) of 30 kg/m2, random blood glucose of 200 mg/dL, and a history of hypertension? 1 Glipizide 2 Acarbose 3 Metformin 4 Pioglitazone

3 The BMI indicates that the patient is obese, the blood glucose levels are borderline high, and the patient has a history of hypertension. These factors indicate that the patient has prediabetes. Metformin is used to prevent type 2 diabetes in patients with prediabetes who are under 60 years of age. Glipizide, acarbose, and pioglitazone are used only in patients with type 2 diabetes mellitus. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1163

Which symptom reported by a patient would lead the nurse to suspect early undiagnosed type 2 diabetes? 1 Blurred vision 2 Gradual weight gain 3 A wound that will not heal 4 Insomnia

3 Type 2 diabetes presents with vague complaints including fatigue, frequent infections, and delayed wound healing. Blurred vision is a late symptom of uncontrolled diabetes. The patient will present with weight loss. Insomnia is not related to symptoms of undiagnosed diabetes. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." Text Reference - p. 1157

A patient with type 2 diabetes mellitus (DM) is prescribed an oral hyperglycemic agent. The nurse provides the patient with a list of food items with a high glycemic index (GI). What should the nurse include on the list? 1 Baked beans, parboiled rice, and regular milk 2 Oatmeal with regular milk, sweet corn, and a cup of green pea soup 3 Apple, oat bran cereal with regular milk, and slices of raw sweet potatoes 4 Cornflake cereal with regular milk and white bread sandwich with potato stuffing

4 Glycemic index (GI) is the term used to describe the rise in blood glucose levels after a person consumes a food containing carbohydrates. Foods with high GI raise glucose levels higher and more quickly than foods with a low GI. Cornflake cereal, white bread, and potatoes have a GI above 70. Baked beans, parboiled rice, oatmeal, sweet corn, and green pea soup have a medium GI ranging from 56 to 69. Apples, oat bran cereal, regular milk, and raw sweet potatoes have a low GI of about 55 or less. Text Reference - p. 1166

18. A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may a. require administration of insulin while taking prednisone. b. develop acute hypoglycemia during the RA exacerbation. c. have rashes caused by metformin-prednisone interactions. d. need a diet higher in calories while receiving prednisone

A Rationale: Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a complication of RA exacerbation or prednisone use. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient is likely to have an increased appetite when taking prednisone, but it will be important to avoid weight gain for the patient with RA. Cognitive Level: Application Text Reference: pp. 1258, 1267 Nursing Process: Planning NCLEX: Physiological Integrity

The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. 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. Excessive thirst Rationale. The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

A. Increased triglyceride levels Rationale. Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

The patient has a 3:00 AM blood glucose level of 50 mg/dL and a 7:00 AM glucose level of 150 mg/dL. What is the proper explanation of these findings and anticipated intervention? A. Somogyi effect with need for less insulin at night B. Somogyi effect with need for a snack at 3:00 AM C. Dawn phenomenon with need for more insulin in the morning D. Dawn phenomenon with need for less food in the morning

A. Somogyi effect with need for less insulin at night Rationale. Somogyi effect is rebound caused by too much insulin at bedtime. The hypoglycemia produces counterregulatory hormones, causing rebound hyperglycemia. It is treated with less insulin at night. The dawn phenomenon is hyperglycemia in the morning due to release of counterregulatory hormones (e.g., growth hormone, cortisol) in the predawn hours. It is treated by increasing the insulin dose and an appropriate bedtime snack.

The patient with diabetes and shortness of breath is brought from the nursing home to the hospital emergency department. The electrocardiogram (ECG) shows evidence of a myocardial infarction (MI), but the patient denied ever having chest pain. Which is the best explanation of what happened? A. The patient had a "silent" MI related to autonomic neuropathy. B. The patient had chest pain but forgot because of dementia. C. The patient minimized the chest pain because he was worried about costs. D. The patient has the psychologic defense mechanism of denial

A. The patient had a "silent" MI related to autonomic neuropathy. Rationale. Cardiovascular abnormalities associated with autonomic neuropathy include painless myocardial infarction. Shortness of breath related to decreased cardiac functioning can be the first overt sign or symptom. Patients with dementia accurately report chest pain at the time it is occurring when asked, although they may later fail to recall it. Defense mechanisms should not be assumed without further evidence

What therapies are appropriate for patients with diabetes mellitus (select all that apply)? A. Use of statins to treat dyslipidemia B. Use of diuretics to treat nephropathy C. Use of angiotensin-converting enzyme (ACE) inhibitors to treat nephropathy D. Use of laser photocoagulation to treat retinopathy E. Use of protein restriction in patients with early signs of nephropathy

A. Use of statins to treat dyslipidemia C. Use of angiotensin-converting enzyme (ACE) inhibitors to treat nephropathy D. Use of laser photocoagulation to treat retinopathy Rationale. In patients with diabetes who have microalbuminuria or macroalbuminuria, ACE inhibitors (e.g., lisinopril [Prinivil, Zestril]) or angiotensin II receptor antagonists (ARBs) (e.g., losartan [Cozaar]) should be used. Both of these drug classes are used to treat hypertension and have been found to delay the progression of nephropathy in patients with diabetes. The statin drugs are the most widely used lipid-lowering drugs. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with proliferative retinopathy, macular edema, and in some cases of nonproliferative retinopathy.

Which question during the assessment of a diabetic patient will help the nurse identify autonomic neuropathy? a. "Do you feel bloated after eating?" b. "Have you seen any skin changes?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"

ANS: A Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions are also appropriate to ask but would not help in identifying autonomic neuropathy

Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? a. The patient programs the pump for an insulin bolus after eating. b. The patient changes the location of the insertion site every week. c. The patient takes the pump off at bedtime and starts it again each morning. d. The patient plans for a diet that is less flexible when using the insulin pump.

ANS: A In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used. The pump will deliver a basal insulin rate 24 hours a day.

3. A nurse suspects that a patient with type 1 diabetes may be experiencing the Somogyi phenomenon. What symptom supports this suspicion? a. Headache on awakening and enuresis b. 6 AM blood sugar of 58 mg/dL and nausea c. Abdominal pain and elevated blood pressure d. Drowsiness and disorientation after eating

ANS: A The Somogyi phenomenon occurs because of a rebound hyperglycemia after a period of hypoglycemia during the early morning. The patient wakes with a headache, enuresis, nausea and vomiting, nightmares, and a high level of blood sugar

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? a. Choose flat-soled leather shoes. b. Set heating pads on a low temperature. c. Use callus remover for corns or calluses. d. Soak feet in warm water for an hour each day

ANS: A The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to a. give a bolus of 50% dextrose. b. insert a large-bore IV catheter. c. initiate oxygen by nasal cannula. d. administer glargine (Lantus) insulin.

ANS: B HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patient's blood glucose and would be contraindicated

Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness? a. Assess the patient for symptoms of hyperglycemia. b. Give the patient a snack of peanut butter and crackers. c. Have the patient drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours.

ANS: B Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration of IV glucose might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration

15. A patient has come to the physician's office after finding out that her blood glucose level was 135 mg/dL. She states that she had not eaten before the test and was told to come and see her physician. She asks the nurse if she has diabetes. What is the most accurate nursing response? a. "Having a fasting serum glucose that high certainly indicates diabetes." b. "That test indicates that we need to perform more tests that are specific for diabetes." c. "How do you feel? Do you have any other signs of diabetes?" d. "Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a diagnosis."

ANS: B The nurse needs to answer the patient's question in a way that gives information and is not misleading. Although 135 mg/dL is high, a nonpathologic explanation may be found. More tests should be performed to evaluate the patient

An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy? a. Hemoglobin A1C level 6.2% b. Blood pressure 146/88 mmHg c. Heart rate at rest 58 beats/minute d. High density lipoprotein (HDL) level 65 mg/dL

ANS: B To decrease the incidence of macrovascular and microvascular problems in patients with diabetes, the goal blood pressure is usually 130/80. An A1C less than 6.5%, a low resting heart rate (consistent with regular aerobic exercise in a young adult), and an HDL level of 65 mg/dL all indicate that the patient's diabetes and risk factors for vascular disease are well controlled

4. A patient has come into the emergency department accompanied by a friend who states that the patient had been acting very strangely and seems confused. The friend states that the patient has diabetes and takes insulin. Which signs of hypoglycemia might the nurse assess? a. Slow pulse rate and low blood pressure b. Irritability, anxiety, confusion, and dizziness c. Flushing, anger, and forgetfulness d. Sleepiness, edema, and sluggishness

ANS: B When blood sugar levels fall, hormones are activated to increase serum glucose. One of the hormones is epinephrine, which causes these symptoms

Which question by the nurse will help identify autonomic neuropathy in a diabetic patient? a. "Have you observed any recent skin changes?" b. "Do you notice any bloating feeling after eating?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"

ANS: B "Do you notice any bloating feeling after eating?" Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions also are appropriate to ask, but would not help in identifying autonomic neuropathy

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? a. Chest x-ray b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria e. Complete blood count (CBC) f. Monofilament testing of the foot

ANS: B, C, D, F Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible microvascular and macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the diabetic patient presents with symptoms of respiratory or infectious problems but are not routinely included in screening

A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss with the health care provider? a. Hemoglobin A1C level is 7.9%. b. Last eye exam was 18 months ago. c. Glomerular filtration rate is decreased. d. Patient has questions about the prescribed diet.

ANS: C The decrease in renal function may indicate a need to adjust the dose of metformin or change to a different medication. In older patients, the goal for A1C may be higher in order to avoid complications associated with hypoglycemia. The nurse will plan on scheduling the patient for an eye exam and addressing the questions about diet, but the biggest concern is the patient's decreased renal function

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice

ANS: C The patient's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might be given if the patient's symptoms become worse or if the patient is unconscious

A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to a. save the lunch tray for the patient's later return to the unit. b. ask that diagnostic testing area staff to start a 5% dextrose IV. c. send a glass of milk or orange juice to the patient in the diagnostic testing area. d. request that if testing is further delayed, the patient be returned to the unit to eat.

ANS: D Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items

17. A patient with type 1 diabetes has an insulin order for NPH insulin, 35 U, to be given at 0700. The patient has also been instructed not to take anything by mouth (NPO) in preparation for laboratory work that will not be drawn until 1000. What action should the nurse implement? a. Give the insulin as ordered. b. Give the insulin with a small snack. c. Inform the charge nurse. d. Hold the insulin until after the blood draw.

ANS: D Holding the insulin to adhere to the NPO order is appropriate. The patient will not be getting food until after the laboratory work; consequently, the insulin will not be needed until then. Giving the insulin as ordered will create a possibility of hypoglycemia before the blood is drawn. Giving a snack to a patient who is NPO is inappropriate.

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? a. The patient's blood glucose level is 174 mg/dL. b. The patient has gained 2 lb (0.9 kg) since yesterday. c. The patient is scheduled for a chest x-ray in an hour. d. The patient's blood urea nitrogen (BUN) level is 52 mg/dL.

ANS: D The BUN indicates possible renal failure, and metformin should not be used in patients with renal failure. The other findings are not contraindications to the use of metformin

What characterizes type 2 diabetes (select all that apply)? a. β-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

All - a, b, c, d, e, f. Type 2 diabetes is characterized by a. β-cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines (Obesity, a global health problem, is characterized by overproduction of inflammatory adipokines by adipose tissue and this may be the link between obesity, CVD and diabetes) e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver. The roles of the brain, kidneys, and gut in type 2 diabetes development are being studied

10. A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The patient tells the nurse, "I hate to exercise! Can't I just follow the diet to keep my glucose under control?" The nurse teaches the patient that the major purpose of exercise for diabetics is to a. increase energy and sense of well-being, which will help with body image. b. facilitate weight loss, which will decrease peripheral insulin resistance. c. improve cardiovascular endurance, which is important for diabetics. d. set a successful pattern, which will help in making other needed changes

B Rationale: Exercise is essential to decrease insulin resistance and improve blood glucose control. Increased energy, improved cardiovascular endurance, and setting a pattern of success are secondary benefits of exercise, but they are not the major reason. Cognitive Level: Application Text Reference: p. 1269 Nursing Process: Implementation NCLEX: Physiological Integrity

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? 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 impotency experienced by a majority of patients with diabetes.

B (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 impotency and slowed gastric emptying result from microangiopathy and neuropathy

The patient with type 1 diabetes arrives in the emergency department with a glucose level of 390 mg/dL and positive result for ketones. Vital signs are 110/70 mm Hg, 120 beats/minute, and 28 deep, sighing respirations/minute. What is the priority need for the patient? A. Oxygen B. Intravenous (IV) fluids C. Albuterol (Ventolin) D. Metformin (Glucophage)

B Intravenous (IV) Fluids Rationale. A patient in diabetic ketoacidosis (DKA) needs IV fluids and insulin to stop the tissue breakdown resulting in ketone bodies and acidosis. The initial goal is fluid and electrolyte balance. Kussmaul respirations indicate the body is attempting to compensate by blowing off the carbon dioxide, but it is ineffective as long as the body continues to break down the ketone bodies and remains in metabolic acidosis. The issue is not respiratory insufficiency, and a bronchodilator is not indicated. Diabetic ketoacidosis occurs in type 1 diabetes and requires insulin; the pancreas no longer has the ability to respond to oral hypoglycemic medication.

Which is the best patient to share a hospital room with a patient who has diabetes mellitus and is scheduled for surgery? A. Admitted with community-acquired pneumonia B. History of asthma on nebulized breathing treatments C. Cultured vancomycin-resistant enterococcus (VRE) in the stool D. History of tuberculosis and on medications for 1 week

B. History of asthma on nebulized breathing treatments Rationale. The patient with asthma is on nebulized breathing treatments. This patient is not infectious. A patient with diabetes mellitus is more susceptible to infections and should not cohabit with an infectious patient, which all the other patients are

What is a typical finding of hyperosmolar hyperglycemic syndrome (HHS)? A. Occurs in type 1 diabetes as the presenting symptom B. Slow onset resulting in a blood glucose level greater than 600 mg/dL C. Ketone bodies higher than 4+ in urine D. Signs and symptoms of diabetes insipidus

B. Slow onset resulting in a blood glucose level greater than 600 mg/dL Rationale. HHS has a slower onset than diabetic ketoacidosis. HHS is often related to impaired thirst sensation, inadequate fluid intake, or functional inability to replace fluids. Because of the slower onset, the blood glucose levels can be quite high (more than 600 mg/dL) before diagnosis. HHS is seen in type 2 diabetics, and there is enough circulating insulin to prevent ketoacidosis. Diabetes insipidus is related to inadequate antidiuretic hormone secretion or kidney response with dilute, frequent urination. It is not related to HHS.

Which elevated laboratory finding is the best indication of potential diabetic nephropathy? A. Blood urea nitrogen (BUN) level B. Urine albumin-to-creatinine ratio C. Urine specific gravity D. Chloride (Cl-) level

B. Urine albumin-to-creatinine ratio Rationale. Increased Albumin in Urine Increased Creatinine in Blood Screening for nephropathy depends on the urinary albumin-to-creatinine ratio and a serum creatinine level. (Creatinine indicates how well the kidney is filtering). BUN alone, without correction to creatinine, can indicate many other issues, including dehydration and liver function. Unless there is renal failure, urine specific gravity is more indicative of dehydration. Chloride is not a direct indicator of kidney function

29. A type 1 diabetic patient who was admitted with severe hypoglycemia and treated tells the nurse, "I did not have any of the usual symptoms of hypoglycemia." Which question by the nurse will help identify a possible reason for the patient's hypoglycemic unawareness? a. "Do you use any calcium-channel blocking drugs for blood pressure?" b. "Have you observed any recent skin changes?" c. "Do you notice any bloating feeling after eating?" d. "Have you noticed any painful new ulcerations or sores on your feet?"

C Rationale: Hypoglycemic unawareness is caused by AUTONOMIC NEUROPATHY, which would also cause delayed gastric emptying. Calcium-channel blockers are not associated with hypoglycemic unawareness, although -adrenergic blockers can prevent patients from having symptoms of hypoglycemia. Skin changes can occur with diabetes, but these are not associated with autonomic neuropathy. If the patient can feel painful areas on the feet, neuropathy has not occurred. Cognitive Level: Application Text Reference: p. 1281 Nursing Process: Assessment NCLEX: Physiological Integrity

Which symptoms reported by a patient with diabetes mellitus are most important to follow-up? A. "My vision has been getting fuzzier over the past year." B. "I cannot read the small print anymore." C. "There is something like a veil of blackness coming across my vision." D. "I have yellow discharge from one eye."

C. "There is something like a veil of blackness coming across my vision." Rationale. Diabetic retinopathy, particularly proliferative retinopathy, can cause RETINAL DETACHMENT, which has the classic new symptom of a veil coming across the field of vision. This requires emergency treatment. - Chronic blurry vision can be cataracts and is not emergent. - Change in the ability to read things near to the eye (presbyopia or farsightedness) is an age-related change and not emergent. - Conjunctivitis needs treatment but is not as emergent as retinal detachment.

The patient has type 1 diabetes mellitus and is found unresponsive with cool and clammy skin. What action is a priority? A. Obtain a serum glucose level. B. Give hard candy under the tongue. C. Administer glucagon per standing order. D. Notify the health care provider.

C. Administer glucagon per standing order. Rationale. The patient has signs and symptoms of hypoglycemia for which treatment should be the priority. Glucagon stimulates a strong hepatic response to convert glycogen to glucose and therefore makes glucose rapidly available. WAITING FOR A SERUM RESULT (UP TO AN HOUR) IS IMPROPER BECAUSE BRAIN CELLS CONTINUE TO DIE FROM LACK OF GLUCOSE. Nothing solid should be placed in the mouth when the patient has an altered level of consciousness and can aspirate. With obvious symptoms, emergent treatment takes priority over notifying the health care provider. HINT: SERUM VS CAPILLARY GLUCOSE TEST

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI. C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration

C. Cardiac monitoring to detect potassium changes (HHN)

The patient had a hypoglycemic episode and is treated with a concentrated glucose oral tablet. Fifteen minutes later the capillary glucose level (Accu-Check) is 150 mg/dL. What action should you take? A. Administer a second bolus of glucose solution. B. Administer regular insulin per sliding scale. C. Have the patient eat peanut butter and toast. D. Obtain a serum glucose level.

C. Have the patient eat peanut butter and toast Rationale. The patient has had an appropriate response to the glucose. Now a complex carbohydrate is needed to prevent hypoglycemia from reoccurring. There is no need for a second bolus of glucose because the result is within normal range. Insulin is not given, even though the glucose level is slightly elevated. The short-acting glucose is metabolized and insulin administration can increase the risk of a second hypoglycemic reaction. A serum confirmation of the level can be obtained but is not the priority.

The male patient with diabetes and heart disease confides to you that he can no longer have an erection. What is the reason for these changes? A. It is a normal part of aging and is relieved with sildenafil (Viagra). B. It usually is related to emotions and is a temporary problem. C. It is often the first sign of diabetic autonomic neuropathy. D. It indicates that the patient has developed a neurogenic bladder.

C. It is often the first sign of diabetic autonomic neuropathy. Rationale. Erectile dysfunction (ED) is common and often is the first manifestation of autonomic failure. ED is not a normal part of aging, and sildenafil cannot be effective if the problem is related to nerve transmission. Sildenafil should not be taken if the patient is on nitrates. ED is a common long-term complication of diabetes. Neurogenic bladder is related to urinary retention.

The patient with diabetes reports tingling and burning in the lower extremities at night. The patient asks you why the primary health care provider prescribed the selective serotonin reuptake inhibitor (SSRI) duloxetine (Cymbalta). What is the best response? A. The doctor thought the discomfort was causing the patient to be depressed. B. The drug is known to improve patients' moods and enhance coping. C. It regulates pain by affecting neurotransmitters that transmit pain through the spine. D. It deadens the sensitivity to peripheral nerve endings

C. It regulates pain by affecting neurotransmitters that transmit pain through the spine. Rationale. SSRI drugs work by inhibiting the reuptake of norepinephrine and serotonin, which are neurotransmitters that are believed to play a role in the transmission of pain through the spinal cord. Duloxetine is thought to relieve pain by increasing the levels of serotonin and norepinephrine, which improves the body's ability to regulate pain. The drugs are not given specifically for depression, although it may have a mood-enhancing effect. Duloxetine does not deaden the sensitivity of peripheral nerve endings.

The patient with diabetes mellitus confides to you that he is afraid he will lose his vision like his friend did. What is the best response? A. Encourage the patient to look at the blessings he has instead of worrying. B. Verify there is nothing that can influence that outcome but new measures to cope are being developed. C. Stress that tight glycemic control can minimize microvascular complications such as retinopathy. D. Remind the patient that every person is different

C. Stress that tight glycemic control can minimize microvascular complications such as retinopathy. Rationale. Microvascular complications result from thickening of the vessel membrane in the capillaries and arterioles and is in response to chronic hyperglycemia. They are specific to diabetes, and good control can help prevent complications, including retinopathy, which causes blindness. The first option minimizes the patient's concern and gives advice. The second option is inaccurate. The last option is true but minimizes the concern and omits actions the patient can take, such as controlling glucose and seeing an ophthalmologist for early detection of problems.

You are teaching a 54-year-old patient with diabetes about proper composition of the daily diet. You explain that the guideline for carbohydrate intake is A. 80% of daily intake. B. minimum of 80 g/day. C. minimum of 130 g/day. D. maximum of 130 g/day.

C. minimum of 130 g/day Rationale. Type 1 Diabetes: Carb Intake 45 - 60 per meal (135 - 180 Daily) The recommendation for carbohydrate intake is a minimum of 130 g/day. Low-carbohydrate diets are not recommended for diabetes management

The nurse is evaluating the patient who has developed diabetes as a result of another medical condition. The nurse knows that which condition can be linked to diabetes? - Cushing syndrome - Syndrome of inappropriate antidiuretic hormone secretion (SIADH) - Hypothyroidism - Celiac disease

Cushing syndrome Cushing syndrome is treated with corticosteroids, which can then cause diabetes. SIADH and hypothyroidism will not. Celiac disease is another autoimmune disease that a patient with diabetes is at a greater risk of developing

27. A patient recovering from DKA asks the nurse how acidosis occurs. The best response by the nurse is that a. insufficient insulin leads to cellular starvation, and as cells rupture they release organic acids into the blood. b. when an insulin deficit causes hyperglycemia, then proteins are deaminated by the liver, causing acidic by-products. c. excess glucose in the blood is metabolized by the liver into acetone, which is acidic. d. an insulin deficit promotes metabolism of fat stores, which produces large amounts of acidic ketones.

D Rationale: Ketoacidosis is caused by the breakdown of fat stores when glucose is not available for intracellular metabolism. The other responses are inaccurate. Cognitive Level: Application Text Reference: pp. 1278-1279 Nursing Process: Implementation NCLEX: Physiological Integrit

Which assessment is the most sensitive indicator that the IV fluid administration may be too rapid when treating a patient with DKA and a history of renal disease? A. Pedal edema B. Tachypnea C. Urine output of 40 mL/hour D. Change in the level of consciousness

D. Change in the level of consciousness Rationale. Too rapid fluid replacement can lead to hyponatremia and cerebral edema. Pedal edema is a later and relatively insignificant sign. In a bedridden patient, edema is more evident in the sacral area. The Kussmaul respirations are expected; crackles auscultated in the lungs are a more sensitive indicator. The desired urine output for adequate hydration is 30 to 60 mL/hr

The patient in the emergency department is diagnosed with diabetic ketoacidosis. Which laboratory value is essential for you to monitor? A. Magnesium (Mg) B. Hemoglobin (Hb) C. White blood cells (WBCs) D. Potassium (K)

D. Potassium (K) Rationale. Even if the patient has normal potassium levels, there can be significant HYPOKALEMIA when insulin is administered as it pushes the serum potassium intracellularly. This can lead to life-threatening hypokalemia. The other options are not as significant.

What is most helpful in the prevention of nephropathy in a patient with diabetes mellitus? A. Acid-ash diet B. Ensuring adequate fluid intake for renal perfusion C. Preventing obstruction from benign prostatic hyperplasia (BPH) D. Stopping smoking

D. Stopping smoking Rationale. Risk factors for diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Diabetic nephropathy is an intrarenal microvascular complication in which the glomeruli of the kidney are damaged. The acid-ash diet is used to prevent kidney stones, a potential postrenal cause. The kidney receives about 25% of the cardiac output, and inadequate fluids or shock resulting in adequate perfusion is a prerenal cause. BPH is a postrenal cause of kidney pathology

Characterized by hyperglycemia upon awakening. Suggested that the growth hormone and cortisol are excreted increased amounts in the early AM. It is treated by increasing the insulin dosage or an adjustment in administration time.

Dawn Phenomenon

A rebound effect. Hyperglycemia in the AM. A high dose of insulin produces a decline in the blood glucose levels in the night furthermore resulting in the release of counter regulatory hormones. These hormones stimulate lipolysis, gluconeogenesis, and glycogenolysis which produces rebound hyperglycemia. Treated by decreasing the bedtime insulin or a bedtime snack

The Somogyi effect

The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient? The patient will reach a glycosylated hemoglobin level of less than 7%. The patient will follow a diet and exercise plan that results in weight loss. The patient will choose a diet that distributes calories throughout the day. The patient will state the reasons for eliminating simple sugars in the diet.

The patient will reach a glycosylated hemoglobin level of less than 7%. The complications of diabetes are related to elevated blood glucose and the most important patient outcome is the reduction of glucose to near-normal levels. A BMI of 30?9?kg/m2 or above is considered obese, so the other outcomes are appropriate but are not as high in priority

The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level (select all that apply)? a. Headache b. Unsteady gait c. Abdominal cramps d. Emotional changes e. Increase in urination f. Weakness and fatigue

a, c, e, f. Manifestations of hyperglycemia include -Polyuria -Polydispia -Polyphasia (hyper and hypo) -Weakness, fatigue -Blurred Vision (hyper and hypo) -Abdominal cramps -Headache (hyper and hypo)

During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results (select all that apply)? a. A1C of 7.5% b. Glycosuria of 3+ c. FPG ≥127 mg/dL (7.0 mmol/L). d. Random blood glucose of 126 mg/dL (7.0 mmol/L) e. A 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)

a, c. The patient has one prior test result of fasting plasma glucose (FPG) greater than or equal to 126 mg/dL (7.0 mmol/L) 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-hour OGTT level ≥200 mg/dL (11.1 mmol/L), or a patient with classic symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, unexplained weight loss) or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.0 mmol/L).

The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)? a. Maintain a healthy weight. b. Exercise for 60 minutes each day. c. Have blood pressure checked regularly. d. Assess for visual changes on a monthly basis. e. Monitor for polyuria, polyphagia, and polydipsia.

a, 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

Priority Decision: A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. Administer the usual insulin dosage. b. Hold fluid intake until the nausea subsides. c. Come to the clinic immediately for evaluation and treatment. d. Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L).

a. During minor illnesses, the patient with diabetes should continue drug therapy and fluid and food intake. Insulin is important because counter regulatory hormones may increase blood glucose during the stress of illness. Food or a carbohydrate liquid substitution is important because during illness the body requires extra energy to deal with the stress of the illness. Blood glucose monitoring should be done every 4 hours, and the health care provider should be notified if the level is 300 mg/dL or higher for 2 tests in a row (13.9 mmol/L) or if fever, ketonuria, or nausea and vomiting occur.

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. Metabolic syndrome is a cluster of abnormalities that include elevated glucose levels, abdominal obesity, elevated BP, high levels of triglycerides, and low levels of high-density lipoproteins (HDLs). Overweight individuals with metabolic syndrome can prevent or delay the onset of diabetes through a program of weight loss. Regular physical activity is also important, but normal weight is most important.

To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? a. Plan activity and food intake related to blood glucose levels b. When blood glucose is greater than 250 mg/dL and ketones are present c. When glucose monitoring reveals that the blood glucose is in the normal range d. When blood glucose levels are high, because exercise always has a hypoglycemic effect

a. To plan for exercise, a person with diabetes must monitor blood glucose and make adjustments to insulin dose (if taken) and food intake to prevent exercise- induced hypoglycemia. Exercise is delayed if blood glucose is ≥250 mg/dL with ketones. Before exercise if blood glucose is ≤100 mg/dL a 15-g carbohydrate snack is eaten. Blood glucose levels should be monitored before, during, and after exercise to determine the effect of exercise on the levels.

What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)? a. Chronic kidney disease b. Coronary artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremities e. Capillary and arteriole membrane thickening specific to diabetes

b, d. Rationale: a. Chronic kidney disease (micro) b. Coronary artery disease (macro) c. Microaneurysms and destruction of retinal vessels (micro) d. Ulceration and amputation of the lower extremities (macro - however, neuropathy may also contribute to not feeling ulcerations) e. Capillary and arteriole membrane thickening specific to diabetes (micro)

Which class of oral glucose-lowering agents (OA) is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. Insulin b. Biguanide c. Meglitinide d. Sulfonylurea

b. Biguanides (e.g., metformin [Glucophage]) are most commonly used with type 2 diabetes. They reduce glucose production by the liver and increase insulin sensitivity at the tissue level that improves glucose transport into the cells. Insulin is not taken orally, as it is ineffective. Meglitinides and sulfonylureas increase insulin production from the pancreas

What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. Ideal body weight b. Normal serum glucose and lipid levels c. A special diabetic diet using dietetic foods d. Five small meals per day with a bedtime snack

b. The specific goals of nutrition therapy for people with diabetes include maintaining near-normal blood glucose levels and achievement of optimal serum lipid levels and BP. Dietary modifications are believed to be important factors in preventing both short- and long-term complications of diabetes. Loss of weight, which may or may not be to ideal body weight, may improve insulin resistance. There is no longer a specific "diabetic diet," and use of dietetic foods is not necessary for glucose control. Most patients with diabetes eat three meals a day, and some require a bedtime snack for control of nighttime hypoglycemia. The other goals of nutrition therapy include prevention of chronic complications of diabetes, attention to individual nutritional needs, and maintenance of the pleasure of eating

Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. It can be prevented by tight glucose control. b. It occurs with a higher frequency and earlier onset than in the nondiabetic population. c. It is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake.

b. Macrovascular complications occur with a higher frequency and earlier onset than in the nondiabetic population. (pg 1148) The development of atherosclerotic vessel disease seems to be promoted by the altered lipid metabolism common in diabetes. Although tight glucose control may help to delay the process, it does not prevent it completely. Atherosclerosis in patients with diabetes does respond somewhat to a reduction in general risk factors, as it does in nondiabetics, and reduction in fat intake, control of hypertension, abstention from smoking, maintenance of normal weight, and regular exercise should be carried out by all patients. *For Microvascular Complications - tight glucose control can prevent or minimize the complications

Priority Decision: The nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as the priority by the nurse? a. Bilateral numbness of both hands b. Stage II pressure ulcer on the right heel c. Rapid respirations with deep inspiration d. Areas of lumps and dents on the abdomen

c. Rapid deep respirations are symptoms of diabetic ketoacidosis (DKA), so this is the priority of care. Stage II pressure ulcers and bilateral numbness are chronic complications of diabetes. The lumps and dents on the abdomen indicate the patient has lipodystrophy and may need to learn about site rotation of insulin injections

What describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? a. DKA requires administration of bicarbonate to correct acidosis. b. Potassium replacement is not necessary in management of HHS. c. HHS requires greater fluid replacement to correct the dehydration. d. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level.

c. The management of DKA is similar to that of HHS except that HHS requires greater fluid replacement because of the severe hyperosmolar state. Bicarbonate is not usually given in DKA to correct acidosis unless the pH is <7.0 because administration of insulin will reverse the abnormal fat metabolism. Total body potassium deficit is possible in both conditions, requiring monitoring and possibly potassium administration, and in both conditions glucose is added to IV fluids when blood glucose levels fall to 250 mg/dL (13.9 mmol/L).

Priority Decision: The patient with diabetes is brought to the emergency department by his family members, who say that he has had an infection, is not acting like himself, and he is more tired than usual. Number the nursing actions in the order of priority for this patient. a. Establish IV access. b. Check blood glucose. c. Ensure patent airway. d. Begin continuous regular insulin drip. e. Administer 0.9% NaCl solution at 1 L/hr. f. Establish time of last food and medication(s).

c. Ensure patent airway. b. Check blood glucose. a. Establish IV access. e. Administer 0.9% NaCl solution at 1 L/hr. d. Begin continuous regular insulin drip. f. Establish time of last food and medication(s). As with all patients, first establish an airway. With a patient with diabetes and abnormal behavior, the blood glucose must then be checked to determine if the patient's symptoms are related to the diabetes. In this case, it is Hyperglycemia, so an IV must be started for fluid resuscitation and insulin administration. The last food intake and times at which medications were recently taken may establish a cause for the hyperglycemia and aid in determining further treatment.

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 produce insulin. c.The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d.The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome.

d Rationale: Hyperosmolar hyperglycemic syndrome (HHS) is a life-threatening syndrome that can occur in a patient with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis (DKA) but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion

The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has a. diabetes. b. elevated A1C. c. impaired fasting glucose. d. impaired glucose tolerance.

d. Impaired glucose tolerance exists when a 2-hour OGTT level is higher than normal but lower than the level diagnostic for diabetes (i.e., >200 mg/dL). Impaired fasting glucose exists when fasting glucose levels are greater than the normal of 100 mg/dL but less than the 126 mg/dL diagnostic of diabetes. Both abnormal values indicate prediabetes

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 gluconeogenesis

Which laboratory results would indicate that the patient has prediabetes? a. Glucose tolerance result of 132 mg/dL (7.3 mmol/L) b. Glucose tolerance result of 240 mg/dL (13.3 mmol/L) c. Fasting blood glucose result of 80 mg/dL (4.4 mmol/L) d. Fasting blood glucose result of 120 mg/dL (6.7 mmol/L)

d. Prediabetes is defined as impaired glucose tolerance and impaired fasting glucose or both. Fasting blood glucose results between 100 mg/dL (5.56 mmol/L) and 125 mg/dL (6.9 mmol/L) indicate prediabetes. A diagnosis of impaired glucose tolerance is made if the 2-hour oral glucose tolerance test (OGTT) results are between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L).