ch 48

The nurse would encourage a patient newly diagnosed with type 2 diabetes to limit intake of which foods to help reduce the percent of fat in the diet? 1 Cheese 2 Broccoli 3 Chicken 4 Oranges

1 Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help to avoid macrovascular changes.

Which action would the nurse take first when teaching the patient with type 2 diabetes to become an active participant in his or her care? 1 Assess the patient's understanding of the disease. 2 Make a list of food restrictions for proper diabetes management. 3 Refer the patient to a nutritionist. 4 Set long-term goals to decrease the risk of complications.

1 For teaching to be effective, the first step is assessing the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. Food restrictions, nutritionist referral, and setting long-term goals can occur once the nurse is confident the patient understands what it means to have diabetes.

A patient diagnosed with type 1 diabetes has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse would be performed initially? 1 Check the patient's blood sugar at 3:00 AM. 2 Provide the patient with an evening snack. 3 Rotate insulin injection sites between the abdomen, thigh, and arm. 4 Contact the health care provider to increase the evening insulin dose.

1 Hyperglycemia in the morning may be caused by the Somogyi effect. If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 and 4:00 AM for hypoglycemia will help determine whether the cause is the Somogyi effect. Diabetics should be given evening snacks to prevent hypoglycemia during the night, but glucose assessment is a priority to rule out the Somogyi effect. Injection sites are rotated to prevent lipodystrophy. An increased dose of evening insulin may cause further decrease in early morning glucose and increased rebound hyperglycemia.

Which laboratory parameter assesses the function of pancreatic β-cells? 1 C-peptide level 2 Hemoglobin level 3 Urine-specific gravity 4 Serum creatinine level

1 Proinsulin is the precursor of insulin. Enzymatic activity helps to split proinsulin into insulin and C-peptide. Therefore the function of pancreatic beta cells can be assessed by measuring C-peptide levels. Hemoglobin levels indicate the oxygen-carrying capacity of the blood. Urine-specific gravity indicates fluid and electrolyte balance. Serum creatinine levels indicate renal function.

When teaching the patient with diabetes about repaglinide, which instruction regarding the timing of the medication would the nurse teach the patient? 1 Immediately before meals 2 When blood sugar levels are greater than 250 mg/dL 3 Two hours after meals 4 At bedtime

1 Repaglinide is an oral antidiabetic agent that should be given any time from 30 minutes to just before meals. It is given on a fixed schedule rather than only when blood sugars are elevated. The medication will not be effective if administered after meals or at bedtime.

Which symptom reported by a patient with type 2 diabetes mellitus is considered one of the classic clinical manifestations of diabetes? 1 Excessive thirst 2 Gradual weight gain 3 Overwhelming fatigue 4 Recurrent blurred vision

1 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.

The nurse would instruct the patient with diabetes to fast for which period of time when scheduled for a fasting blood glucose level at 8:00 a.m.? 1 At least eight hours 2 4:00 a.m. on the day of the test 3 After dinner the evening before the test 4 7:00 a.m. on the day of the test

1 Typically, a patient is prescribed to be NPO for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 a.m. should not have any food or beverages containing any calories after midnight. It is not necessary to fast longer than eight hours; 4:00 a.m. and 7:00 a.m. would not allow for sufficient time to fast for morning laboratory testing.

Which statements made by the nurse to a patient newly diagnosed with type 1 diabetes would be included in a teaching plan? Select all that apply. 1 "You should decrease your dietary sugar intake." 2 "I will teach you how to self-administer your insulin." 3 "It is important to consume a diet that is high in fats." 4 "It is important for you to reduce your physical activity." 5 "You should monitor your blood sugar as prescribed." 00:00:02 Question Answer Confidence ButtonsJust a guessPretty sureNailed it

1, 2, 5 The nurse should teach the patient to decrease dietary sugar intake, self-administer insulin, and regularly monitor blood glucose levels as prescribed. A high-fat diet increases the patient's cholesterol levels and may increase the blood sugar levels. Reduction of physical exercise can also lead to an increase in blood glucose level.

Which symptoms may be observed in patients with diabetic ketoacidosis (DKA)? Select all that apply. 1 Lethargy 2 Flushed, moist skin 3 Hypoventilation 4 Soft and sunken eyes 5 Sweet fruity odor of breath

1, 4, 5 Dehydration in patients with DKA results in lethargy, soft and sunken eyes, and sweet fruity odor of breath. Skin would be flushed and dry, not moist. Patients with DKA typically experience a rapid, deep-breathing pattern known as Kussmaul respirations, not hypoventilation, as a means of correcting the acid-base imbalance caused by the condition.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. Which response by the nurse is accurate? 1 "With type 2 diabetes, the body of the pancreas becomes inflamed." 2 "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." 3 "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." 4 "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

2 In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. In type 1 diabetes mellitus, the patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas.

After administering glucagon to an unconscious patient, the nurse would place the patient in which position? 1 Supine 2 Side-lying 3 High-Fowler's 4 Semi-Fowler's

2 Nausea is a common reaction after glucagon injection. The patient should be placed in the side-lying position to prevent aspiration should the patient vomit. The supine, high-Fowler's, and semi-Fowler's positions are not advisable because of the risk of aspiration of vomitus.

Which assessment finding supports the nurse's suspicion that a diabetic patient has necrobiosis lipoidica diabeticorum? 1 Reddish, flat, and oval patches on the shins 2 Red-yellow lesions, with shiny atrophic skin 3 Reddish-brown, scaly, and round patches on the thighs 4 Velvety, light-brown to black skin thickening on the neck

2 Necrobiosis lipoidica diabeticorum is an uncommon skin condition seen in patients with diabetes. It is characterized by red-yellow lesions, with atrophic skin that becomes shiny and transparent, revealing tiny blood vessels under the surface. Diabetic dermopathy is the most common diabetic skin lesion; it is characterized by reddish-brown, round, or oval patches. They are scaly initially, and then they flatten and become indented. The lesions appear most frequently on the shins but can also be found on the front of the thighs, forearms, sides of the feet, scalp, and trunk. Acanthosis nigricans is a skin pigmentation characterized by velvety, light-brown to black skin thickening, predominantly seen on flexures, axillae, and the neck.

Which class of drugs used to treat diabetes may be referred to as "insulin sensitizers"? 1 Sulfonylureas 2 Thiazolidinediones 3 α-glucosidase inhibitors 4 Dipeptidyl peptidase-4 (DPP-4) inhibitors

2 Thiazolidinediones are a class of drugs used to treat diabetes mellitus (DM). They are often referred to as an "insulin sensitizers." This class of drugs improves insulin sensitivity, transport, and utilization at target tissues. Sulfonylureas increase insulin production by the pancreas. α-glucosidase inhibitors slow down absorption of carbohydrate in the small intestine. DPP-4 inhibitors enhance the activity of incretins, which stimulate release of insulin from pancreatic β-cells. This class of drug also decreases hepatic glucose production.

Which factor is associated with type 1 diabetes mellitus? 1 Obesity 2 Viral infection 3 Sedentary lifestyle 4 High-carbohydrate diet

2 Type 1 diabetes mellitus is caused due to a complete pancreatic shutdown. One of the many causes is a viral infection that may trigger production of antibodies against the pancreas. Obesity, sedentary lifestyle, and intake of a high-carbohydrate diet may increase the risk for type 2 diabetes mellitus.

Which drug may result in weight gain as a side effect? 1 Biguanides 2 Meglitinides 3 Dopamine agonist 4 Dipeptidyl peptidase-4 inhibitors

2 Weight gain is a common side effect seen with meglitinides. Biguanides, dopamine agonists, and dipeptidyl peptidase-4 inhibitors may not result in weight gain.

Which findings are associated with type 1 diabetes mellitus? Select all that apply. 1 Fatigue 2 Excessive thirst 3 Frequent urination 4 Recurrent infections 5 Unexplained weight loss

2, 3, 5 Excessive thirst, frequent urination, and unexplained weight loss are clinical symptoms of both type 1 and type 2 diabetes mellitus. Fatigue and recurrent infections are clinical manifestations of type 2 diabetes.

Which goal of the treatment plan for a patient with diabetic ketoacidosis (DKA) would be the initial focus? 1 Treatment for hypokalemia 2 Rapid reduction of elevated blood glucose 3 Rehydration through IV fluid replacement 4 Reduction of ketosis by encouraging oral nourishment

3 Fluid imbalance is potentially life threatening for patients with DKA. The initial goal of therapy is to establish IV access and begin fluid replacement. Once urine output is established, electrolyte replacement will be addressed. Potassium levels will need to be monitored because insulin therapy, which is needed to correct the hyperglycemia, may further reduce the potassium level. Insulin therapy will be used to lower the blood glucose gradually to prevent rapid drops in serum glucose, which could lead to fluid shifts and the potential for cerebral edema. Ketosis results from the use of fat stores for energy because excess glucose is not being transported to the cells and used as a source of energy. Patients with DKA often present with nausea and vomiting; oral nourishment may be limited until symptoms lessen.

Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis? 1 Polyuria 2 Hypokalemia 3 Cerebral edema 4 Metabolic acidosis

3 Incorrect fluid replacement especially with hypotonic fluids may cause a sudden drop in serum sodium resulting in cerebral edema. Polyuria is a manifestation of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Hypokalemia may be seen with severe dehydration. Metabolic acidosis is observed with diabetic ketoacidosis due to fluid losses.

Which pathophysiologic cause of type 1 diabetes mellitus is correct? 1 Insulin resistance of the body tissues 2 Decreased mass count of pancreatic β-cells 3 Autoimmune destruction of pancreatic β-cells 4 Fatigued pancreatic β-cells due to overproduction of insulin

3 Pancreatic β-cells are the main source of insulin production in the body. Autoimmune destruction of pancreatic β-cells results in minimal or no production of insulin. Absence of insulin is the factor associated with type 1 diabetes mellitus. Insulin resistance is the condition where insulin is produced by the pancreas, but its uptake is resisted by the tissues. This factor is associated with type 2 diabetes mellitus. A decreased mass count of pancreatic β-cells and fatigued pancreatic β-cells produce insufficient insulin for the normal metabolism, so these factors are associated with type 2 diabetes.

Which pathologic change is the cause of microaneurysms in nonproliferative retinopathy? 1 Retinal edema 2 Neurovascularization 3 Partial blood vessels occlusion 4 Intraretinal hemorrhages

3 Partial occlusion of small blood vessels in the retina causes microaneurysms in the capillary walls. Retinal edema is caused by leakage of the capillary fluids from the walls of microaneurysms. Occlusion of retinal capillaries leads to neurovascularization, which is the formation of new blood vessels to supply the retina with blood. Intraretinal hemorrhages may occur due to leakage of the capillary fluids from microaneurysms.

Which complication of diabetes can be diagnosed by the ankle-brachial index? 1 Diabetic neuropathy 2 Diabetic nephropathy 3 Peripheral arterial disease 4 Hyperosmolar hyperglycemic syndrome

3 The ankle-brachial index is used to diagnose peripheral arterial disease. Diabetic neuropathy is diagnosed based on the symptoms and by examining the patient's lower extremities. Increased serum creatinine, decreased glomerular filtration rate, and albuminuria are indicative of diabetic nephropathy. Hyperosmolar hyperglycemic syndrome is suspected if the blood glucose levels are more than 600 mg/dL, with a marked increase in serum osmolality.

Which assessment parameter would the nurse review to determine how well a patient's diabetes mellitus has been controlled over the past two to three months? 1 Fasting blood glucose 2 Oral glucose tolerance 3 Glycosylated hemoglobin 4 Random fingerstick blood glucose

3 When the glucose level is increased, glucose molecules attach to hemoglobin in the red blood cells (RBCs) and is called glycosylated hemoglobin. This attachment lasts for the life of the RBC, two to three months. Monitoring the numbers of these attachments makes it possible to assess the average blood glucose for the previous two to three months. Fasting blood glucose, oral glucose tolerance, and random fingerstick blood glucose tests are used to measure the current blood glucose level, which is different from the glycosylated hemoglobin level.

A college student, newly diagnosed with type 1 diabetes, has a headache, changes in vision, and is anxious, but does not have the portable blood glucose monitor with him or her. Which action would the campus nurse advise the patient to take? 1 Eat a piece of pizza. 2 Drink some diet soft drink. 3 Eat 15 g of simple carbohydrates. 4 Take an extra dose of rapid-acting insulin.

3 When the patient with type 1 diabetes is unsure about the meaning of the symptoms he or she is experiencing, the patient should treat himself or herself for hypoglycemia to prevent seizures and coma from occurring. The patient should also be advised to check the blood glucose as soon as possible. The fat in the pizza and the diet soft drink would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.

Which intervention will be beneficial for a patient with a blood glucose level of 250 mg/dL who is receiving treatment for hyperosmolar hyperglycemic syndrome? 1 Administering 0.9% NaCl 2 Administering 0.1 unit/kg/hr of insulin 3 Administering IM glucagon 4 Administering IV fluids containing glucose

4 A patient with hyperosmolar hyperglycemic syndrome whose blood glucose level approaches 250 mg/dL should receive IV fluids containing glucose to prevent hypoglycemia. NaCl 0.9% is administered in patients with diabetic ketoacidosis. Administering 0.1 unit/kg/hr of insulin is indicated to correct hyperglycemia and hyperketonemia. IM glucagon is administered in hypoglycemic patients who are unconscious.

Which mechanism is altered in individuals with type 1 diabetes? 1 Defective insulin receptors in muscle 2 Excess glucose production by the liver 3 Increased glucagon secretion by the pancreas 4 Autoimmune destruction of the β-cells of the pancreas

4 Autoimmune destruction of the β-cells is the primary defect in type 1 diabetes. Defective insulin receptors in muscle, excess glucose production by the liver, and increased glucagon secretion by the pancreas occur in individuals with type 2 diabetes, but not type 1.

After admitting a patient with diabetic ketoacidosis (DKA) to the emergency department, which nursing intervention is a priority? 1 Administer IV insulin 2 Administer oxygen 3 Insert a Foley catheter 4 Establish IV access

4 Because fluid imbalance in a patient with DKA is potentially life threatening, the initial goal of therapy is to establish IV access and begin fluid and electrolyte replacement. Insulin is administered IV only after a potassium level is determined, because insulin administration may cause hypokalemia. Administration of oxygen and insertion of a Foley catheter may be necessary in the initial emergency management of DKA, but obtaining IV access is a priority.

Which foods would the nurse encourage a patient with diabetes mellitus and coronary artery disease to limit intake of to help reduce the percentage of saturated fat in their diet? 1 Chicken and turkey 2 Frozen and canned vegetables 3 Enriched flour products 4 Dairy products

4 Cheese and dairy products are higher in fat and calories than vegetables, fruit, enriched flour products, or poultry and should be limited.

Which components may result in metabolic syndrome? Select all that apply. 1 Low body weight 2 Low glucose levels 3 Low levels of triglycerides 4 Elevated BP 5 Decreased levels of high-density lipoproteins (HDL)

4, 5 If an individual has elevated BP, he or she is at a greater risk of developing type 2 diabetes as a result of having metabolic syndrome. A decreased level of HDL is also a risk factor for metabolic syndrome, which may lead to type 2 diabetes mellitus. Low body weight, low glucose levels, and low levels of triglycerides are not associated with the development of metabolic syndrome; therefore these are not risk factors for the onset of type 2 diabetes.

What is the correct order of the events leading to ketoacidosis?

Ketoacidosis begins with a deficiency of insulin. The lack of insulin leads to decreased glucose utilization. Fat stores are broken down for energy use when glucose is not available. The breakdown of fat stores results in the production of ketones, which accumulate and cause a metabolic acidic state: ketoacidosis.

A patient's blood glucose level before breakfast is 324 mg/dL. The nurse reviews the electronic medical record and notes that the patient receives a high dose of insulin each evening at bedtime. The nurse suspects that the patient's hyperglycemia is most likely due to which problem with insulin therapy? 1 Lipodystrophy 2 Somogyi effect 3 Allergic reaction 4 Dawn phenomenon

The Somogyi effect occurs when a patient receives a high dose of evening/bedtime insulin that produces a decline in blood glucose levels during the night. As a result, counter regulatory hormones are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia. Lipodystrophy is atrophy or hypertrophy of the subcutaneous tissue. Allergic reactions related to insulin occur as local inflammatory reactions and do not produce hyperglycemia. The dawn phenomenon also is characterized by hyperglycemia that is present on awakening; however, it is caused by growth hormone and cortisol excretion during the early morning hours and is unrelated to the amount of insulin given at nighttime.