QUIZ #9

Metformin (glucophage) 2g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500mg. How many tablets should the nurse administer? Round your answer to a whole number

4 tablets

A nurse is formulating a teaching plan for a client recently diagnosed with type 2 DM. What interventions should the nurse include that will decrease the risk of complications? Select all that apply A. Examining the feet daily B. Wearing well-fitting shoes C. Performing regular exercise D. Powdering the feet after showering E. Visiting the heath care provider weekly F. Testing bath water with the toes before bathing

A. Examinging the feet daily B. Wearing well-fitting shoes C. Performing regular exercise

Which diabetic patient is at greatest risk for diabetic foot ulcer formation? A. 75-year old African American male with history of CV disease B. 53-year old Caucasian female with history of renal insufficiency C. 38-year old American Indian with history of gastric ulcers D. 28-year old Caucasian male with history of chronic kidney disease

A. 75-year old African American male with history of CV disease

Which class of antidiabetic medication should be taken with the first nite of a meal to be fully effective? A. Alpha-glycosidase inhibitors, which include miglitol (Glyset) B. Bigunanides, which include metformin (glucophage) C. Meglitinides, which include nateglinide (Starlix) D. Second-generation sulfonylureas, which include glipizide (glucotrol)

A. Alpha-glycosidase inhibitors, which include miglitol (glyset)

A client with type 1 diabetes has an above the knee amputation because of severe lower extremity arterial disease. What is the nurses primary responsibility 2 days after surgery when preparing the client to eat dinner? A. Checking the clients serum globose level B. Assisting the client out of bed into a chair C. Placing the client in the high-Fowler position D. Ensuring the clients residual limb is elevated

A. Checking the clients serum glucose level

Which complications of DM are considered emergencies? Select all that apply A. Diabetic Ketoacidosis (DKA) B. Hypoglycemia C. Diabetic retinopathy D. Hyperglycemic-hyperosmolar state (HHS) E. Diabetic neuropathy

A. DKA B. Hypoglycemia D. HHS

A diabetic patient is scheduled to have a blood glucose test the next morning. What does the nurse tell the patient to do before coming in for the test? A. Eat the usual diet but have nothing after midnight B. Take the usual oral hypoglycemic tablet in the morning C. Eat a clear liquid breakfast in the morning D. Follow the usual diet and medication regimen

A. Eat the usual diet but have nothing after midnight

You are caring for an 81-year old adult with type 2 DM, hypertension, and peripheral vascular disease. Which admission assessment findings increase the patients risk for development of hyperglycemic, hyperosmolar syndrome? Select all that apply A. Hydrocholothiazide (HCTZ) prescribes to control her diabetes B. Weight gain of 6 pounds over the past month C. Avoids consuming liquids in the evening D. Blood pressure of 168/94mmHg E. Urine output of 50-75mL/hr

A. HCTZ perscribed to control her diabetes C. Avoids consumug liquids in the evening

The nurse is preparing to teach a diabetic patient how to select appropriate shoes. Which points must be included in the teaching plan? Select all that apply A. It is best to have the shoes fitted by an experienced shoe fitter such as a podiatrist B. The shoes should be 1-1.5 inches longer than your longest toe C. The heels of the shoes should be less than 2 inches high D. Avoid tight-fitting shoes, which can cause tissue damage to your feet E. You should get at least two pairs of shoes so you can change them at midday and in the evening

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

Which statements about type 2 DM are accurate? Select all that apply A. It peaks at about the age of 50 B. Most people with type 2 DM are obese C. It typically has an abrupt onset D. People with type 2 DM have insulin resistance E. It can be treated with oral antidiabetic medications and insulin

A. It peaks at about the age of 50 B. Most people with type 2 DM are obese D. People with type 2 DM have insulin resistance E. It can be treated with oral antidiabetic medications and insulin

Intensive therapy with good glucose control regulates in delays in which diabetic complications? Select all that apply A. Macro vascular disease B. CV disease C. Stroke D. Retinopathy E. Nephropathy F. Neuropathy

A. Macrovasular diease B. CV diease D. Retinopathy E. Nephropathy F. Neuropathy

What type of exercise does the nurse recommend for the patient with diabetic retinopathy? A. Non-weight bearing activities such as swimming B. Weight-bearing activities such as jogging C. Vigorous aerobic and resistance exercises D. Weight training and heavy lifting

A. Non-weight bearing activities such as swimming

For which patient should the health care provider avoid prescribing rosiglitazone (Avandia)? A. Patient with symptomatic heart failure B. Patient with new-onset asthma C. Patient with kidney disease D. Patient with hyperthyroidism

A. Patient with symptomatic heart failure

The patient with type 2 DM is prescribed sitaliptin (Januvia) fr glucose regulation. Which key changes does the nurse teach a patient to report to the health care provider immediately? Select all that apply A. Report any signs of jaundice B. Report any signs of bleeding C. Report any blue-grey discoloration of the abdomen D. Report any cough or flu symptoms E. Report any sudden onset of abdominal pain

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

A patient asks the nurse how insulin injection site rotation should be accomplished. What is the nurse's best response? A. Rotation within one site is preferred to avoid changes in insulin absorption B. Change rotation sites after a week or two to avoid lipohypertrophy C. Rotation from site to site each day is best for the best insulin absorption D. Always rotate insulin injection sites within 4-5 inches from the umbilicus

A. Rotation withine one site is preferred to avoid changes in insulin absorption

You are caring for a diabetic patient admitted with hypoglycemia that occurred at home. Which teaching points for treatment of hypoglycemia at one would you include in a teaching plan for the patient and family before discharge? Select all that apply A. Signs and symptoms of hypoglycemia include, hunger, irritability, weakness, headache, and blood glucose level of less than 60mg/dL B. Treat hypoglycemia with 4-8g of carbohydrates such as glucose tablets or 1/4 cup of fruit juice C. Retest blood glucose in 30 min D. Repeat the carbohydrate treatment if the symptoms do not resolve E. Eat a small snack of carbohydrate and protein if the next meal is more than an hour away

A. Signs and symptoms of hypoglycemia include: hungar, irritability, weakness, headachem and blood glucose level of less than 60mg/dL D. Repeat the carbohydrate treatment if the symptoms do not resolve E. Eat a small snack of carbohydrate or protein if the next meal is more than an hour away

Along with exercise what is the recommended calorie reduction for a patient with diabetes who must lose weight? A. 100-200 B. 250-500 C. 501-600 D. 601-750

B. 250-500

Which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established? A. Alpha-glycosidase inhibitors, which include miglitol (glyset) B. Biguanides, which include metformin (glucophage) C. Meglitinides, which include nateflinide (starlix) D. Second-generation sulfonyureas, which include glipizide (glucotrol)

B. Biguanides, whcih include metformin (glucophage)

Which descriptors are typical type 2 diabetes mellitus (DM)? Select all that apply. A. Autoimmune process causes beta cells destruction B. Cells have a decreased ability to respond to insulin C. Diagnosis is based on results of 100g-glucose tolerance test D. Most patients diagnosed are obese adults E. Usually has abrupt onset of thirst and weight loss

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

A patient with type 2 DM often has which lab value? A. Elevated thyroid studies B. elevated triglycerides C. Ketones in the urine D. Low hemoglobin

B. Elevated triglycerides

The critical care nurse is caring for an older patient admitted with HHS. What is the first priority in caring for this patient? A. Slowly decreasing blood glucose B. Fluid replacement to increase blood volume C. Potassium replacement to prevent hypokalemia D. Diuretic therapy to maintain kidney function

B. Fluid replacement to increase blood volume

A patient with DM has signs and symptoms of hypoglycemia. The patient is alert and oriented with a blood glucose level of 56mg/dL. What does the nurse do next? A. Give a glass of orange juice with two packets of sugar and continue to monitor the patient B. Give 8oz of skim milk and then a carbohydrate and protein snack C. Give a complex carbohydrate and continue to monitor the patient D. Administer D50 TV push and give the patient something to eat

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

Which statement about insulin is true? A. Exogenous insulin is necessary for management of all cases of type 2 DM B. Insulin's effectiveness depends on the individual patients absorption of the drug C. Insulin doses should be regulated according to self-monitoring urine glucose levels D. Insulin administered in multiple diesels per day decreases the flexibility of a patients lifestyle

B. Insulins effectiveness depends on the inividual patients absorpion of the drug

Which diabetic complication is associated with neuropathy? A. End-state kidney disease B. Muscle weakness C. Permanent blindness D. Eye hemorrhage

B. Muscle weakness

The older adult with DM asks the nurse for advice about beginning an exercise program. What is the nurses best response? Select all that apply A. Begin with high-intensity activities B. Start low-intensity activities in short sessions C. Be sure to include warm-up and cool-down periods D. Start with periods of 20 min or less E. Changes in activity should be gradual

B. Start low-intensity activities in short session C. Be sure to include warm-up and cool-down periods E. Changes in activity should be gradual

A diabetic patient is on a mixed-dose insulin protocol of 8 units regular insulin and 12 units NPH insulin at 0700. At 1030 the patient reports feeling uneasy, shaky and has a headache. Which is the probable explanation for this? A. The NPH insulin's action is peaking and there is an insufficient blood glucose level. B. The regular insulin's action is peaking and there is an insufficient blood glucose level C. The patient consumed too many calories at breakfast and now has an elevated blood glucose level D. Symptoms are unrelated to the insulin administered in the early morning of food taken at lunch time

B. The regular insulins action is peaking and there is an insufficient blood glucose level

While you are performing an admission assessment on a patient with type 2 DM, he tells you that he routinely drinks 3 beers each day. What is your priority follow-up question at this time? A. Do you have ay days when you do no drink? B. When during the day do you drink your beers? C. Do you drink any other forms of alcohol? D. Have you ever had a lipid profile completed?

B. When during the day do you drink your beers?

Which are considered the early signs of diabetic nephropathy? Select all that apply A. Positive urine red blood cells B. Microalbuminuria C. Positive urine glucose D. Positive urine white blood cells E. Elevated serum uric acid

B.microaluminuria E. Elevated serum uric acid

Which individual is at greasiest risk for developing type 2 DM? A. 25-year old African American woman B. 36-year old African American man C. 56-year old Hispanic woman D. 40-year old Hispanic man

C. 56-year old Hispanic woman

Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? A. Providing O2 B. Encouraging carbohydrates C. Administering fluid replacement D. Teaching facts about dietary principles

C. Administering fluid replacement

A patient has newly-diagnosed type 2 DM. Which action should you assign to an LPN/LVN instead of a UAP? A. Measuring the patients vital signs every shift B. Checking the painters glucose level before each meal C. Administering subcut insulin on a sliding scale as needed D. Assisting the patient with morning care

C. Administering subcut inslulin on a sliding scale as needed

The nurse is teaching a patient with diabetes about proper form care. What instructions does the nurse include? Select all that apply A. Use running alcohol to toughen the skin on the soles of the feet B. wear-open toes shoes or sandals in warm weather to prevent perspiration C. Apply moistening cream to the feet after bathing but not between the toes D. Use cold water for bathing the feet to prevent inadvertent thermal injury E. Do not go barefoot F. Inspect the feet daily

C. Apply moistening cream to the feet after bathing but not between the toes E. Do no go barefoot F. Inspect the feet daily

The patient with diabetes has a foot that is warm, swollen, and painful. Walking causes the arch of the foot to collapse and gives the food a "rocker bottom" shape. Which foot deformity does the nurse recognize? A. Hallux valgus B. Claw-toe deformity C. Charcot foot D. Diabetic foot ulcer

C. Charcot foot

A nurse is caring foe 2 clients newly diagnosed with diabetes. One client has type 1 and the other client has type 2. The nurse determines that the main difference between type 1 and 2 is that type 1: A. Onset of disease is slow B. Excessive weight is a contributing factor C. Complications are not present at the time of diagnosis D. Treatment involves diet, exercise, and oral medications

C. Complications are not present at the time of diagnosis

You are preparing to review a teaching plan for a patient with type 2 DM. To determine the patients level of compliance with his prescribed diabetic regimen, which values would you be sure to review? A. Fasting glucose level B. Oral glucose tolerance test results C. Glycosylated hemoglobin (HgbA1c) level D. Finger stick glucose findings for 24 hours

C. Glycosylated hemoglobin (hgbA1c) level

Which statement by a patient with DM indicates an understanding of the principles of self-care? A. I don't like the idea of sticking myself fro often to measure my sugar B. I plan to ensure the sugar in my urine at least 4 times a day C. I plan to get my spouse to exercise with me to keep me company D. If I get a cold, i can take my regular cough medication until i feel better

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

Which statement about sexual intercourse for patients with diabetes is true? A. The incidence of sexual dysfunction is lower in men than women B. Retrograde ejaculation does not interfere with male fertility C. Impotence is associated with DM in male patients D. Sexual dysfunction in female patients includes inability to achieve pregnancy

C. Impotence is associated with DM in male patients

A nurse is assessing a client experiencing a die attic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketonic syndrome (HHNS) should the nurse identify when assessing this client? A. Fluid loss B. Glycosuria C. Kussmaul respiration D. Increased blood glucose level

C. Kussmaul respiration

Which statements about sensory alteration in patients with diabetics are accurate? Select all that apply A. Healing of for wounds is reduced because of impaired sensation B. Very few patients with diabetic foot ulcers have peripheral sensory neuropathy C. Loss of pain, pressure, and temperature sensation in the foot increases the risk for injury D. Sensory neuropathy causes loss of normal sweating and skin temperature regulation E. It can be delayed by keeping the blood glucose level as close to normal as possible.

C. Loss of pain, pressure and temp sensation in the foot increases the risk for injury D. Sensory neuropathy causes loss of normal sweating and skin temp regulation E. It an be deylayed by keeping the blood glucose level as close to normal as possible

Which class of antidiabetic medication should be given 1-30 min fore meals? A. Alpha-glycosidase inhibitors, which include miglitol (glyset) B. Biguanides, which include metformin (glucophage) C. Meglitinides, which include nateflinide (starlix) D. Second-generation sulfonyureas, which include glipizide (glucotrol)

C. Meglitinides, which include nateglinide (starlix)

Which oral agent mat cause lactic acidosis? A. Nateglinide B. Repaglinide C. Metformin D. Miglitol

C. Metformin

What is the recommended protocol for for patients with type 2 DM who must lose weight? A. Participate in an aerobic program twice a week for 20 min each session B. Slowly increase insulin dosage until mild hypoglycemia occurs C. Reduce calorie intake moderately and increase exercise D. Reduce daily calorie intake to 100 calories and monitor urine for ketones.

C. Reduce calorie intake moderately and increase exercise

Which statement about insulin administration is correct? A. Insulin may be given orally, IV, or Subcut B. Insulin injections should spaced no closer than one half-inch apart C. Rotating injection sites improves the absorption and prevents lipohypertrophy D. Shake the bottle of intermediate-acting insulin, and then draw it into the syringe

C. Rotating injection sits iproves the absorption and prevents lipohypertrophy

A patient with diabetes has signs and symptoms of hypoglycemia. The patient has a blood glucose of 56mg/dL, is not alert but responds to voice and is confused and is unable to swallow fluids. What does the nurse do next? A. Give a glass or orange juice with two packets of sugar and continue to monitor the patient B. Give a glass of orange or other type of juice and continue to monitor the patient C. Give a complex carbohydrate and continue to monitor the patient D. Administer D50 IV push

D. Administer D50 IV push

A client with diabetes is given instructions about foot care. The nurse determines that the instructions are understood when the client states i will: A. Cut my toenails before bathing B. Soak my feet daily for one hour C. Examine my feet using a mirror at least once a week D. Break in my new shoes over the course of several week

D. Break in my new shoes over the course of several weeks

Which are modifiable risk factors for type 2 DM? Select all that apply A. Age B. Family history C. Working in a low-stress environment D. Maintaining ideal body weight E. Maintaining adequate physical activity

D. Maintaining an ideal body weight E. Maintaining adequate physical activity

A patient has newly-diagnosed type 2 DM. Which tasks should you delegate to the UAP? A. Arranging a consult with the dentition B. Assessing the patients insulin injection technique C. Teaching the patient to use a glucose test to monitor glucose at home D. Reminding the patient to check glucose level before each meal

D. Reminding the patient to check glucose level before each meal

A client tells the nurse during the admission history that an oral hypoglycemic agent is taken daily. For which condition does the nurse conclude that an oral hypoglycemic agent may be prescribed by the health care provider? A. Ketosis B. Obesity C. Type 1 diabetes D. Reduced insulin production

D. Reuced insulin production

Which class of antidiabetic medication is most likely to cause a hypoglycemic episode because of the long duration of action? A. Alpha-glycosidase inhibitors, which include miglitol (glyset) B. Biguanides, which include metformin (glucophage) C. Meglitinides, which include nateflinide (starlix) D. Second-generation sulfonyureas, which include glipizide (glucotrol)

D. Second-generation sulfonyureas, which include glipizide (glucotrol)

A UAP tells you that, while assisting with the morning care of a postoperative patient with type 2 diabetes who has been given insulin, the patient asked if she would always need to take insulin now. What is your priority for teaching the patient? A. Explain to the patient that she is know considered to have type 1 diabetes B. Tell the patient to monitor fingerstick glucose level every 4 hours after discharge C. Teach the patient that a person with type 2 diabetes does not always need insulin. D. Talk with the patient about the relationship between illness and increased glucose levels

D. Talk with the patient about the relationship between illness and increased glucose levels

A patient with type 2 DM usually controlled with a second-generation sulfonylureas, develops a UTI. Due to the stress of the infection, the patient must be treated with insulin. What additional information about this treatment does the nurse relay to the patient? A. The sulfonylureas must be discontinued and insulin taken until the infection clears. B. Insulin will now be necessary to control the patients diabetes for life C. The sulfonylureas dose must be reduced until the infection clears D. The insulin is necessary to supplement the second-generation sulfonylurea until the infection clears

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