304 EAQ Alterations in Glucose Regulation
A client has insulin shock. How should the nurse interpret this finding? 1 Blood sugar is low 2 Blood sugar is high 3 Blood pressure is low 4 Blood pressure is high
Hypoglycemia (low blood sugar) in diabetes is sometimes called insulin shock or insulin reaction. Hyperglycemia is high blood sugar and can be caused from a lack of insulin. Shock in this case does not relate to blood pressure.
The nurse plans to teach a client who is diagnosed with type 1 diabetes mellitus about treatment regimens. Which treatments should the nurse include in the teaching plan? Select all that apply. 1 Meal planning 2 Insulin therapy 3 Exercise schedule 4 C-peptide supplements 5 Oral hypoglycemic drugs
All individuals with type 1 diabetes require some combination of insulin therapy, meal planning, and exercise regimen. C-peptide is a component of proinsulin and is indicative of residual beta-cell mass and function, but it is not currently a medication or supplement. Oral hypoglycemic drugs are used to treat type 2 diabetes, not type 1.
A client is diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). Which clinical manifestations will the nurse expect? Select all that apply. 1 Stupor 2 Ketonuria 3 Hypokalemia 4 Severe dehydration 5 Kussmaul respirations
Clinical manifestations of HHNKS include severe dehydration; loss of electrolytes, including potassium; and neurologic changes, such as stupor. Ketonuria and Kussmaul respirations are clinical manifestations of diabetic ketoacidosis.
The nurse instructs a client with type 2 diabetes about risk for infections. Which statement, if made by the client, would indicate that teaching was successful? 1 "I will notice early signs that an infection is occurring." 2 "My body will make stronger white blood cells during infections." 3 "High blood sugars will increase blood flow to my legs and feet." 4 "I may not realize that a sore has developed on the bottom of my foot."
A client with type 2 diabetes may have sensory deficits (loss of pain) related to neuropathy; the client may not have symptoms of pain when a foot sore develops. Clients with diabetes may not have clinical signs of infection related to a suppressed immune response. A suppressed immune response in diabetics causes defective phagocytosis. Diabetics have a decreased blood supply from vascular changes.
Which client meets the diagnostic criteria for diabetes mellitus? 1 A client with a glycosylated hemoglobin of 5.5% 2 A client with a fasting blood glucose of 128 mg/dl 3 A client with a random serum glucose of 197 mg/dl 4 A client with a serum glucose of 185 mg/dl two hours after taking 75 grams of glucose
A fasting blood glucose of 128 mg/dl meets the criteria for diabetes mellitus. A fasting plasma glucose greater than or equal to 126 mg/dl meets the criteria for a diagnosis of diabetes mellitus. A glycosylated hemoglobin of 5.5% does not meet the criteria of 6.5%; a two-hour oral glucose tolerance test result of 185 mg/dl does not meet the criteria of 200 mg/dl; or a random serum glucose of 197 mg/dl does not meet criteria for 200 mg/dl with classic symptoms of hyperglycemia.
A client is experiencing the Somogyi effect. Which clinical findings will the nurse find upon assessment? 1 Hyperglycemia, followed by hypoglycemia 2 Hypoglycemia, followed by rebound hyperglycemia 3 Early morning rise in blood glucose with no hypoglycemia 4 Early morning hypoglycemia without rebound hyperglycemia
The Somogyi effect is a unique combination of hypoglycemia, followed by rebound hyperglycemia. Hyperglycemia, followed by hypoglycemia, is the opposite of the Somogyi effect. The dawn phenomenon is an early morning rise in blood glucose concentration with no hypoglycemia during the night. Somogyi causes rebound hyperglycemia; it does not lack this effect.
A client with diabetes has beta-cell destruction from autoimmune T cell-mediated disease. The nurse will report to the oncoming shift that the client has which type of diabetes? 1 Type 1 2 Type 2 3 Endocrinopathies 4 Gestational diabetes
Type 1 has beta-cell destruction from autoimmune T cell-mediated disease. Type 2 ranges from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance. Endocrinopathies result from endocrine disorders. Gestational diabetes is any degree of glucose intolerance with onset of first recognition during pregnancy.
A client who has type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which diagnostic test result supports this diagnosis? 1 Decreased acetone level 2 Blood sugar level 50 mg/dl 3 Serum glucose level of 345 mg/dl 4 Presence of no ketones in the urine
A glucose level of 345 is above the criteria of 250 mg/dl for diabetic ketoacidosis. Diabetic ketoacidosis would have ketones in the urine rather than no ketones. Blood sugar of 50 is hypoglycemia. Increased acetone level occurs with diabetic ketoacidosis, not decreased.
What are the signs and symptoms of diabetic ketoacidosis? Select all that apply. 1 Pallor 2 Tremors 3 Sweating 4 Fruity breath 5 Kussmaul respirations
A patient with diabetic ketoacidosis has fruity breath and Kussmaul respirations due to elevated blood glucose levels and reduced insulin production. Pallor, tremors, and sweating are signs and symptoms of hypoglycemia.
The nurse is planning an education session for clients with type 1 diabetes mellitus. Which disease characteristics should the nurse include in the teaching plan? Select all that apply. 1 Clients are prone to diabetic ketoacidosis. 2 This type of diabetes results in insulin dependence. 3 Most clients will be diagnosed before 30 years of age. 4 It often is associated with dyslipidemia and hypertension. 5 The genetic abnormality is an autosomal dominant gene mutation.
Clients with type 1 diabetes mellitus are prone to diabetic ketoacidosis. Beta-cell destruction in type 1 diabetes leads to absolute insulin deficiency and insulin dependence. Individuals usually develop type 1 diabetes before 30 years of age. Type 2 diabetes is associated with dyslipidemia and hypertension. Maturity-onset diabetes of youth is associated with autosomal dominant gene mutations.
A client is diagnosed with type 1 diabetes mellitus. Which assessment findings should the nurse expect? 1 Oliguria, dyspepsia, and dysphagia 2 Polydipsia, polyuria, and polyphagia 3 Weight gain, decreased thirst, and fever 4 Hypertension, pruritus, and being overweight
Clinical manifestations of type 1 diabetes mellitus include polydipsia, polyuria, and polyphagia. Weight loss also may occur with type 1 diabetes. Polyuria would occur, not oliguria. Dyspepsia and dysphagia are not clinical manifestations of type 1 diabetes. Clinical manifestations of type 2 diabetes mellitus include hypertension, pruritus, and being overweight.
A nurse checks the client's glycosylated hemoglobin (hemoglobin A1C) level. What is the rationale for the nurse's actions? 1 To check for hyperlipidemia 2 To measure fasting glucose levels 3 To detect acute complications of diabetes 4 To monitor long-term blood glucose control
Hemoglobin A1C levels provide a measure of glucose control during the life span of the red blood cells, which is about 120 days. Hemoglobin A1C does not measure blood lipids or fasting glucose levels. Hemoglobin A1C cannot detect acute complications.
The nurse assesses for microvascular complications in a client with diabetes mellitus. Which conditions is the nurse monitoring for in this client? Select all that apply. 1 Stroke 2 Neuropathy 3 Retinopathy 4 Nephropathy 5 Coronary artery disease 6 Peripheral vascular disease
Microvascular diseases that affect the capillaries include diabetic neuropathy, diabetic retinopathy, and diabetic nephropathy. Macrovascular diseases that affect large- and medium-sized arteries include stroke, coronary artery disease, and peripheral vascular disease.
A nurse is assessing a child 3 years old with suspected type 1 diabetes. Which assessment finding would be consistent with type 1 diabetes? 1 Facial acne 2 Blurred vision 3 Yeast infection 4 Fruity breath odor
Nearly 50% of children who are 4 years or younger are first diagnosed with type 1 diabetes when they present with a sweet or "fruity" breath odor; this is a sign of diabetic ketoacidosis. Facial acne is not related to type 1 diabetes. Blurred vision and yeast infections can occur with type 2 diabetes, but it usually develops in adults.
Two clients, one with type 1 diabetes mellitus and one with type 2, both have polydipsia, polyphagia, and polyuria. How should the nurse interpret these findings? 1 Both have hyperglycemia. 2 Both have an acute illness. 3 Both have too much insulin. 4 Both have pancreatic necrosis.
Polydipsia, polyphagia, and polyuria all are caused by hyperglycemia in diabetes mellitus. They are not general manifestations of an acute illness, and they are not due to excessive insulin or pancreatic necrosis.
Which client should be screened on a regular basis for type 2 diabetes mellitus? 1 A 48-year-old client who has a family history of lung cancer 2 A 36-year-old client who has been diagnosed with paralysis 3 A 24-year-old client who has been diagnosed with diabetes insipidus 4 A 12-year-old client who has been diagnosed with metabolic syndrome
The 12-year-old client is at risk for developing diabetes mellitus. Metabolic syndrome develops during childhood, and clients with this syndrome should be screened on a regular basis for diabetes mellitus. Lung cancer, paralysis, and diabetes insipidus are not risk factors for type 2 diabetes.
Which client is at highest risk for developing type 2 diabetes mellitus? 1 A 50-year-old Asian male who has pancreatic cancer 2 A 68-year-old black female who is obese and sedentary 3 A 48-year-old white female who has osteopenia and diabetes insipidus 4 A 20-year-old Native American male who has a family history of type 1 diabetes
The 68-year-old client has four risk factors: age (65--74 years), black race, obese, and physical inactivity. Osteopenia, diabetes insipidus, and pancreatic cancer are not risk factors for type 2 diabetes. The 20-year-old client has one risk factor, which is race (Native American); a family history of type 1 diabetes is not a risk factor for type 2 diabetes.
A client with type 1 diabetes has morning fasting blood glucose levels between 200 and 240 mg/dl with no hypoglycemia during the night. Which acute complication of diabetes is this client experiencing? 1 Somogyi effect 2 Dawn phenomenon 3 Diabetic ketoacidosis (DKA) 4 Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
The dawn phenomenon is an early morning rise in blood glucose concentration with no hypoglycemia during the night. The Somogyi effect is a unique combination of hypoglycemia followed by rebound hyperglycemia. Clients with DKA will have blood glucose levels greater than 250 mg/dl. Clients with HHNKS will have blood glucose levels greater than 600 mg/dl.
A client, who has type 1 diabetes, introduces the nurse to a family member. The family member wants to know what caused the client's diabetes. What is the nurse's best response? 1 Diabetes causes damage to little blood vessels, and the pancreas cells didn't get enough blood and died. 2 The immune system turned against the pancreas cells and destroyed them, so the body can't make any insulin. 3 Diabetes damages the lining of arteries, reducing the oxygen supply to the pancreas and causing pancreatic cell dysfunction. 4 The body's cells have stopped responding well to insulin, and the body needs more insulin than the pancreas cells can make.
Type 1 diabetes involves autoimmune destruction of the pancreatic beta cells. Type 1 diabetes does not involve insulin resistance; insulin resistance is associated with type 2. All types of diabetes mellitus can cause vasculopathy over time (including microvascular damage and arterial wall damage), and good blood glucose control is needed to minimize this damage. However, such vasculopathy is a long-term complication of diabetes mellitus; it is not the cause.
A client is diagnosed with type 2 diabetes mellitus. Which information should the nurse include when teaching the client about this condition? 1 "It cannot affect your children or siblings." 2 "You have the most common type of diabetes." 3 "Your pancreas has stopped producing insulin." 4 "Daily injections of insulin will always be necessary."
Type 2 diabetes accounts for most cases of diabetes mellitus. Treatment of type 2 diabetes mellitus may include insulin injections, but insulin injections are not always required. Type 2 diabetes mellitus results from a genetic susceptibility and environmental factors. Insulin secretion usually is increased at the time of diagnosis of type 2 diabetes and will decline over the course of the illness. Risk to children and siblings is 10% to 15% in type 2 diabetes. Type 1 diabetes requires daily insulin injections because the pancreas is not producing insulin.
