Chapter 48 - Diabetes (Med Surg) EAQ's

Which is an insulin-dependent tissue? 1 Brain 2 Kidney 3 Skeletal muscle 4 Red blood cells

3 Skeletal muscle Skeletal muscles have specific receptors that are activated by insulin that permit the transportation of glucose into the cells. The brain, kidney, and red blood cells do not have receptors; instead they require only a specific amount of glucose for normal functioning. Text Reference - pp. 1121, 1123

Which blood glucose level indicates hyperglycemia? 1 60 to 70 mg/dL 2 80 to 110 mg/dL 3 100 to 125 mg/dL 4 200 to 250 mg/dL

4 200 to 250 mg/dL Hyperglycemia is a condition in which the blood glucose level is greater than 200 mg/dL. If the blood glucose level ranges from 60 to 70 mg/dL, it indicates hypoglycemia. The blood glucose level is considered normal if it ranges from 80 to 110 mg/dL. The blood glucose level ranges from 100 to 125 mg/dL in prediabetes. Text Reference - p. 1124

A patient with type 2 diabetes wants to stop taking metformin (Glucophage) and manage the diabetes with diet and exercise. The patient states that cutting out carbohydrates was featured on television recently as a treatment for diabetes and is considering the paleo diet. Which responses by the nurse are most appropriate? Select all that apply. 1 "Weight loss for overweight patients is recommended as a management strategy for type 2 diabetes." 2 "You should maintain a healthy balance of nutrients to maintain blood glucose and overall health." 3 "There is no ideal number of carbohydrates to consume, so you should individualize your meal plan." 4 "Carbohydrates are only found in grain-based products, so any diet that eliminates these foods is best recommended." 5 "Patients with diabetes only need to be concerned with their blood sugars, not with their lipid levels or blood pressure goals."

1 "Weight loss for overweight patients is recommended as a management strategy for type 2 diabetes." 2 "You should maintain a healthy balance of nutrients to maintain blood glucose and overall health." 3 "There is no ideal number of carbohydrates to consume, so you should individualize your meal plan." Weight loss is recommended for overweight patients with type 2 diabetes. Dietary goals for patients with type 2 diabetes include maintaining a healthy balance of nutrients to maintain blood glucose levels without spikes. The American Diabetes Association recognizes that there is no ideal number of carbohydrates for every patient and recommends that patients customize their diets with their health care providers to maintain dietary control of diabetes. Patients with diabetes need to be concerned with blood sugars, lipid levels, weight, and maintaining blood pressure goals to lower cardiovascular risks. Carbohydrates are found in grains, fruits, vegetables, and low-fat dairy products. Text Reference - p. 1133

Which persons are the most suited for diabetes screening? Select all that apply. 1 A person with hypertension 2 A person who is physically inactive 3 A person with polycystic ovarian syndrome 4 A person who delivered a baby weighing 9 lbs 5 A person whose body mass index (BMI) is 25 kg/m2

1 A person with hypertension 2 A person who is physically inactive 3 A person with polycystic ovarian syndrome Hypertension, absence of physical activity, and polycystic ovarian syndrome are the risk factors of diabetes. In hypertension, there is decreased perfusion to tissues, which may increase the risk of developing diabetes. Absence of physical activity results in weight gain due to the lack of utilization of the energy produced by the body. Hormonal imbalance is seen in patients with polycystic ovarian syndrome, which may increase the risk for diabetes. A BMI of less than 25 kg/m2 and delivering a baby weighing less than 9 lbs do not indicate a risk for developing diabetes. Text Reference - p. 1138

What are components of metabolic syndrome? Select all that apply. 1 Abdominal obesity 2 Elevated glucose levels 3 Elevated blood pressure 4 Low levels of triglycerides 5 Increased levels of high-density lipoproteins (HDL)

1 Abdominal obesity 2 Elevated glucose levels 3 Elevated blood pressure The components of metabolic syndrome are abdominal obesity, elevated glucose levels, and elevated blood pressure. Low levels of triglycerides and increased levels of HDL are not components of metabolic syndrome. Text Reference - p. 1123

What is the primary defect factor associated with type 1 diabetes mellitus? 1 Absent or minimal insulin production 2 Alteration in production of adipokines 3 Decreased insulin production over time and insulin resistance 4 Abnormal increase in insulin production by the pancreas over time

1 Absent or minimal insulin production Type 1 diabetes mellitus is a result of the absence or minimal production of insulin by the pancreas. Alteration in production of adipokines, decreased insulin production over time, and insulin resistance are the defect factors associated with type 2 diabetes mellitus. An abnormal increase in the insulin over time does not cause diabetes. Text Reference - pp. 1121-1122

The nurse is caring for a patient admitted to the health care facility with type 1 diabetes. What leads to type 1 diabetes? 1 Autoimmune destruction of pancreatic β-cells 2 Presence of unresponsive insulin receptors 3 Decrease in the production of insulin 4 Inappropriate glucose production by the liver

1 Autoimmune destruction of pancreatic β-cells Type 1 diabetes is caused by autoimmune destruction of the pancreatic β-cells, resulting in a total absence of insulin production. Type 2 diabetes mellitus is caused by unresponsive insulin receptors, decrease in the production of insulin, inappropriate glucose production by the liver, or altered production of hormones and cytokines by adipose tissue. Text Reference - pp. 1121-1122

A patient with diabetes mellitus has a neurogenic bladder leading to urinary retention. How is the Credé maneuver performed to help the patient completely empty the bladder? 1 By performing mild massage downward over the lower abdomen and bladder 2 By performing mild massage downward over the upper abdomen and bladder 3 By performing moderate massage downward over the lower abdomen and bladder 4 By performing moderate massage downward over the upper abdomen and bladder

1 By performing mild massage downward over the lower abdomen and bladder The Credé maneuver involves mild massage downward over the lower abdomen and bladder with low pressure. This massage helps in relaxing the lower abdominal muscles, which may in turn help in complete bladder emptying. The upper abdomen is not involved in the Credé maneuver. Moderate massage on the lower or upper abdomen involves applying high pressure, so reflux of urine may occur and result in renal infection. Text Reference - p. 1150

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

1 C-peptide level Proinsulin is the precursor of insulin. Enzymatic activity helps 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. Text Reference - p. 1121

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? 1 Cushing syndrome 2 Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 3 Hypothyroidism 4 Celiac disease

1 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. Text Reference - p. 1124

Which key factors could be linked with diabetes mellitus type 1? Select all that apply. 1 Endogenous insulin is not present in diabetes mellitus. 2 Islet cell antibodies are absent in diabetes mellitus type 1. 3 Diabetes mellitus type 1 is more common with people of young age. 4 Resistance of ketosis is found except in conditions of infection or stress. 5 Diabetes mellitus type 1 is diagnosed in 5 to 10 percent of the total diabetes cases. 6 Requirement of insulin is mandatory in all the cases of diabetes mellitus type 1.

1 Endogenous insulin is not present in diabetes mellitus. 3 Diabetes mellitus type 1 is more common with people of young age. 5 Diabetes mellitus type 1 is diagnosed in 5 to 10 percent of the total diabetes cases. 6 Requirement of insulin is mandatory in all the cases of diabetes mellitus type 1. Endogenous insulin is absent in patients with diabetes mellitus. Diabetes mellitus type 1 is more common in young people but can occur at any age, with 5 to 10 percent of the total diabetes diagnoses being type 1 diabetes. Insulin is required for all patients with type 1 diabetes. Islet cell antibodies are often present in diabetes mellitus type 1 patients; absence of these islet cells is associated with diabetes mellitus type 2. The development of type 1 ketosis occurs at onset or during insulin deficiency. Ketosis resistance, except during infections or stress, is associated with diabetes mellitus type 2. Text Reference - p. 1121

The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient 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 Excessive thirst 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. Text Reference - p. 1122

Which assessment 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

1 Fatigue 2 Excessive thirst 3 Frequent urination 5 Unexplained weight loss Excessive thirst, frequent urination, fatigue, and unexplained weight loss are clinical symptoms of both type 1 and type 2 diabetes mellitus (DM). Recurrent infections are a clinical manifestation of type 2 DM and not of type 1 DM. Text Reference - p. 1124

Which complications would the nurse expect in a pregnant woman diagnosed with diabetes at 20 weeks of gestation? Select all that apply. 1 Higher risk for cesarean delivery 2 Increased risk of perinatal death 3 Increased risk of diabetes mellitus in the infant 4 Increased risk of gaining abnormal weight and becoming obese 5 Increased risk of developing type 1 diabetes mellitus within 10 years

1 Higher risk for cesarean delivery 2 Increased risk of perinatal death Diabetes developed during pregnancy is called gestational diabetes. Women with gestational diabetes have a higher risk for cesarean delivery and an increased risk of perinatal death. Risk factors associated with juvenile diabetes include family history of diabetes and having certain human leukocyte antigen (HLA) types, not gestational diabetes in the mother. Obesity is a risk factor for developing gestational diabetes, not necessarily a result of it. Women with a history of gestational diabetes are at a risk of developing type 2, not type 1, diabetes mellitus within 10 years. Text Reference - pp. 1123-1124

A registered nurse is teaching a student nurse about polyphagia in diabetes type 2 patients. Which reason regarding the occurrence of polyphagia in diabetes given by the student nurse indicates ineffective learning? 1 Increased levels of insulin in the blood 2 Increased levels of glucose in the blood 3 Increased levels of free fatty acids in the blood 4 Increased levels of free amino acids in the blood

1 Increased levels of insulin in the blood Polyphagia develops due to insufficiency of insulin that is due to destruction of β-cells of the pancreas. The glucose level increases and the insulin-dependent tissues are unable to utilize the glucose due to insufficient insulin, which leads to polyphagia. The minimal utilization of glucose by the adipose tissue results in increased lipolysis, which increases the free fatty acids level in the blood and causes polyphagia. A nominal amount of glucose utilization by the muscles generates higher levels of free amino acids due to increased protein catabolism and results in polyphagia. Text Reference - p. 1124

Which hormone regulates the normal blood glucose level in the body? 1 Insulin 2 Glucagon 3 Epinephrine 4 Growth hormone

1 Insulin Insulin is a hormone secreted by beta cells in the Islet of Langerhans of the pancreas. It helps in regulating the blood glucose level. Glucagon is a hormone secreted by the alpha cells of the Islet of Langerhans. It increases the blood glucose level by counteracting the mechanism of insulin. Epinephrine is a hormone secreted by the adrenal gland. It may not be helpful in maintaining the blood glucose level. Growth hormone is secreted by the pituitary gland and it helps in growth of all tissues and bones in the body. Text Reference - p. 1120

Which medication is categorized as a starch blocker? 1 Miglitol 2 Alogliptin 3 Nateglinide 4 Glimepiride

1 Miglitol Miglitol is categorized as an alpha-glucosidase inhibitor, also known as a starch blocker. Alogliptin is a dipeptidyl peptidase-4 inhibitor. Nateglinide is a meglitinide and glimepiride is a sulfonylureas. Text Reference - p. 1130

The nurse is providing education on managing type 2 diabetes with lifestyle modification to a group of patients. Which topics should the nurse include in the education session? Select all that apply. 1 Proper nutrition 2 Regular physical activity 3 Drug therapy with insulin 4 Maintenance of recommended body weight 5 Drug therapy with oral agents

1 Proper nutrition 2 Regular physical activity 4 Maintenance of recommended body weight In newly diagnosed type 2 diabetics, proper nutrition, regular physical activity, and maintenance of recommended body weight or promoting weight loss are the focus to try and control the disease. Medications are not considered topics for lifestyle change. Text Reference - pp. 1124-1125

The patient with type 1 diabetes mellitus eats a large meal but does not take insulin as prescribed. In what order do the following physiologic events occur in the development of a hyperglycemic emergency? 1. Fat metabolism leads to ketonemia 2. Insufficient insulin in the blood stream 3. Fat is mobilized for energy from the adipose tissue 4. Potassium and water are excreted with H+ and ketones in the urine 5. Organic acid accumulation in the blood causes metabolic acidosis

1. Insufficient insulin in the blood stream 2. Fat is mobilized for energy from the adipose tissue 3. Fat metabolism leads to ketonemia 4. Organic acid accumulation in the blood causes metabolic acidosis 5. Potassium and water are excreted with H+ and ketones in the urine A patient with type 1 diabetes who develops blood glucose greater than 250 mg/dL is at risk to develop diabetic ketoacidosis (DKA). In DKA, the patient's cells lack fuel (glucose), despite excess serum glucose, because there is insufficient insulin available to metabolize the glucose and drive it into the cells. So the body turns to fat for fuel and produces ketones as a by-product of fat metabolism. Ketonemia decreases the serum pH as H+ ions accumulate and hyperglycemia causes osmotic diuresis, leading to the excretion of electrolytes, especially potassium and chloride (as a carrier of H+). Text Reference - pp. 1142-1143

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? 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 "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." 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. Text Reference - pp. 1122-1124

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 - pp. 1133-1134

Which statement from the patient with diabetes mellitus indicates effective learning? 1 "I will have lots of fruit juices." 2 "I will carry extra insulin during travel." 3 "I will skip doses of insulin when I am sick." 4 "I will not exercise because it increases my blood glucose level."

2 "I will carry extra insulin during travel." Carrying extra insulin during travel is important in case an insulin vial is lost or broken. Having lots of fruit juices would not help in diabetes management because juice contains sugars that are easily absorbed. Skipping insulin doses when the patient is sick worsens the condition. Exercising might help in lowering blood glucose levels, and may help in keeping the patient healthy. Text Reference - p. 1140

What may be the fasting blood glucose value of a patient with prediabetes? 1 70 to 130 mg/dL 2 100 to 125 mg/dL 3 Less than 70 mg/dL 4 Greater than 200 mg/dL

2 100 to 125 mg/dL The fasting blood glucose level of a patient with prediabetes may range from 100 to 125 mg/dL. The normal blood glucose levelranges from 70 to 130 mg/dL. A blood glucose level less than 70 mg/dL indicates hypoglycemia. A blood glucose level greater than 200 mg/dL indicates hyperglycemia. Text Reference - p. 1123

When should the nurse instruct the patient to monitor the blood sugar if dawn phenomenon is suspected? 1 1 AM 2 3 AM 3 5 AM 4 Upon arising

2 3 AM The blood sugar should be checked between 2 AM and 4 AM. This is the time when the patient's blood sugar will be at its lowest. The counter-regulatory hormones will now be released and the rising blood sugar will show hyperglycemia if the patient has dawn phenomenon. Checking the blood glucose levels at 1 AM, 5 AM, and upon rising would likely not show the hyperglycemia the nurse is suspecting. Text Reference - p. 1130

The nurse, reviewing hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) and diabetic ketoacidosis recalls that with HHNKS, which condition occurs? 1 Hyperglycemia 2 Absence of ketones 3 High serum osmolarity 4 Decreased in serum potassium

2 Absence of ketones Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) is different from diabetic ketoacidosis (DKA) because of the absence of ketone production. HHNKS is seen in type 2 non-insulin-dependent diabetics. Ketones are not released because there is some insulin available to transport glucose across cell membranes. Therefore, fat is not catabolized for energy. In DKA there is no insulin available, so fats are broken down for energy, releasing ketones as a by-product. Hyperglycemia, issues with serum potassium, and issues with serous osmolarity are seen in both HHNKS and DKA. Text Reference - pp. 1145-1146

Which tissue has specific receptors for insulin and is considered an insulin-dependent tissue? 1 Hepatic tissue 2 Adipose tissue 3 Nervous tissue 4 Vascular tissue

2 Adipose tissue Adipose tissue is insulin dependent, because it requires insulin to "unlock" its receptor sites, which allows the transport of glucose into the cells for consumption. Hepatic tissue, nervous tissue, and vascular tissue do not directly depend on insulin for the transport of glucose. They need a supply of glucose only for their normal functioning. Text Reference - p. 1121

Which treatment strategy would be most effective for an obese patient who has had type 2 diabetes for more than four years who has a body mass index (BMI) of 40 kg/m 2 and 8% A1C? 1 Insulin therapy 2 Bariatric surgery 3 Nutritional therapy 4 Pancreas transplantation

2 Bariatric surgery Bariatric surgery is a stomach and/or intestinal operation that decreases the BMI level, helps to maintain blood glucose levels, and helps in recovering from type 2 diabetes in obese patients. Insulin therapy helps in maintaining the glucose level in the body; however, it will not be very effective in decreasing the BMI level. Nutritional therapy only will not be effective in completely curing type 2 diabetes. Pancreas transplantation is effective for type 1 diabetes only. Text Reference - p. 1137

What are the clinical manifestations of diabetes mellitus type 2? Select all that apply. 1 Ketoacidosis 2 Candidal infection 3 Recurrent infections 4 Abdominal cramping 5 Recurrent vaginal yeast 6 Prolonged wound healing

2 Candidal infection 3 Recurrent infections 5 Recurrent vaginal yeast 6 Prolonged wound healing Candidal infection, recurrent infections, recurrent vaginal yeast, and prolonged wound healing are clinical manifestations of diabetes mellitus type 2. Recurrent infection involves the symptomatic reactivation of the latent infection. Wound healing is prolonged for patients with diabetes mellitus due to an impaired immune system. Ketoacidosis and abdominal cramping are key symptoms of diabetes mellitus type 1. Text Reference - p. 1124

Which medications may induce diabetes? Select all that apply. 1 Isoniazid 2 Clozapine 3 Phenytoin 4 Rifampicin 5 Prednisone

2 Clozapine 3 Phenytoin 5 Prednisone Clozapine is an atypical antipsychotic medication used in the treatment of psychosis and may induce diabetes. Phenytoin is an anticonvulsant drug used in the treatment of convulsions and may induce diabetes in some patients. Prednisone is a corticosteroid and may cause diabetes in some patients. Isoniazid is an anti-TB drug that does not induce diabetes. Rifampicin is an antitubercular drug that does not induce diabetes. Text Reference - p. 1124

Diabetic ketoacidosis (DKA) is caused by a profound deficiency of insulin and is characterized by: Select all that apply. 1 Hypoglycemia 2 Dehydration 3 Hyperglycemia 4 Absence of ketones 5 Ketosis

2 Dehydration 3 Hyperglycemia 5 Ketosis Characteristics of DKA include profound dehydration, severe hyperglycemia, and presence of ketones. Hypoglycemia and absence of ketones are not signs of DKA. Text Reference - pp. 1143-1144

A patient who had been diagnosed with pre-diabetes six months ago is following up in the outpatient diabetes clinic. The nurse is reviewing the assessment data and understands the best reflection of good management of this condition is what? 1 A 20-pound weight loss 2 Hemoglobin A1C of 5.5 percent 3 Reduction of total cholesterol to 200 mg/dL 4 Decrease in polyuria, polydipsia, and polyphagia

2 Hemoglobin A1C of 5.5 percent Individuals with pre-diabetes are at increased risk for development of type-2 diabetes mellitus. Prediabetes is an intermediate stage between normal glucose homeostasis and elevated blood glucose levels (diabetes). The best indicator of control of this condition is a hemoglobin A1C within normal limits for the nondiabetic patient. Hemoglobin A1C measures the amount of glucose that binds with the component of hemoglobin (A1C), which gives an indication of average glucose levels in the blood over a 90-day period. Although a reduction of risk factors through weight reduction, dietary management, and exercise is important, weight loss and cholesterol within normal limits does not reflect prevention of diabetes. Because the patient does not have true diabetes, the patient would not be experiencing the classic symptomology of the disease: polyuria, polydipsia, and polyphagia. Text Reference - p. 1123

The laboratory test reports of a hospitalized average adult patient reveal the estimated insulin level to be more than 0.6 U/kg body weight. Which complications does the nurse suspect? Select all that apply. 1 Enhanced gluconeogenesis 2 Increased protein synthesis 3 Stored protein from muscle releases 4 Enhanced glycogen storage in muscle 5 Enhanced fat deposition in adipose tissue 6 Decreased release of stored glucose from liver

2 Increased protein synthesis 4 Enhanced glycogen storage in muscle 5 Enhanced fat deposition in adipose tissue 6 Decreased release of stored glucose from liver The average amount of insulin secreted daily by an adult is approximately 40 to 50 U or 0.6 U/kg body weight. Insulin facilitates a normal blood glucose range by promoting glucose transport to cell cytoplasm across cell membrane. A high level of glucose may result in increased protein synthesis, enhanced glycogen storage in muscle, enhanced fat deposition in adipose tissue, and decreased release of stored glucose from the liver. A decrease in the insulin level may cause other activities in the body, such as enhanced protein synthesis and enhanced fat deposition in adipose tissue. Text Reference - pp. 1120-1121

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 Red-yellow lesions, with shiny atrophic skin 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 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. Text Reference - p. 1151

What is the effect of counterregulatory hormones on insulin? 1 They inhibit glucose production in the body. 2 They maintain the blood glucose level in the body. 3 They help insulin in decreasing the level of glucose in the body. 4 They increase the movement of glucose into the cells of the body.

2 They maintain the blood glucose level in the body. Counterregulatory hormones are antagonist to insulin. They help in maintaining the blood glucose level by increasing the blood glucose level and decreasing the movement of glucose into the cells. Counterregulatory hormones key up the glucose production. Their function is contradictory to insulin, because they increase the level of glucose in the body. They decrease the movement of glucose in the cells of the body. Text Reference - p. 1121

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

2 Viral infection 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. Text Reference - p. 1122

A patient visits a primary health care provider's clinic and reports recent and sudden weight loss associated with symptoms of polydipsia and polyuria. Which medical condition would the nurse suspect if the patient is advised to undergo an autoantibody test? 1 Cancer 2 Depression 3 Type 1 diabetes 4 Acquired Immunodeficiency Syndrome (AIDS)

3 Type 1 diabetes Polydipsia and polyuria are the classic symptomatic manifestations of type 1 diabetes. Type 1 diabetes can also be diagnosed using the autoantibody testing. Cancer, depression, and AIDS may result in sudden weight loss; however, they do not present with symptoms of polydipsia and polyuria. Text Reference - pp. 1121-1122

A patient who was recently diagnosed with type 2 diabetes mellitus completed a teaching session about disease management. Which statement by the patient indicates understanding of type 2 diabetes mellitus? 1 "I will always be able to manage my diabetes with pills." 2 "As I get older, I will be able to decrease my diabetes medicine." 3 "If I become ill, I will need to check my blood sugar more frequently." 4 "As long as I take my medication, I do not have to follow a diabetic diet."

3 "If I become ill, I will need to check my blood sugar more frequently." Illness may increase blood glucose on people with type 2 diabetes. Diabetes is a progressive disease and as time goes on, patients with diabetes type 2 may need to increase oral medications or begin insulin therapy. Nutritional therapy is an integral part of diabetes management. Text Reference - p. 1139

A patient, admitted with type 1 diabetes, asks the nurse what "type 1" means. What is the nurse's best response? 1 "There is decreased insulin secretion, cellular resistance to insulin that is produced, or both." 2 "An increased amount of adipose tissue has led to an insufficient amount of insulin being produced." 3 "The body produces autoantibodies that destroy beta cells in the pancreas." 4 "The insulin being made is not used by the tissues properly, leading to high blood sugar."

3 "The body produces autoantibodies that destroy beta cells in the pancreas." In type 1 diabetes mellitus, the pancreas is unable to make any insulin and the patient will require life-long exogenous insulin to control blood sugars. There is no cellular resistance and insulin secretion is absent, not decreased. Patients with type 1 diabetes are typically very thin; adipose tissue does not result in a decreased insulin production. It cannot be used by the tissues and cells because none is being produced. Text Reference - pp. 1121-1122

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 A wound that will not heal 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 gain as the disease progresses, not early on. Insomnia is not related to symptoms of undiagnosed diabetes. Text Reference - p. 1123

A 45-year-old woman with a body mass index (BMI) of 35 kg/m 2 and with a history of gestational diabetes reports increased thirst, frequent urination, and fatigue. What would be the possible diagnosis of the patient? 1 Prediabetes 2 Idiopathic diabetes 3 Adult-onset diabetes 4 Juvenile-onset diabetes

3 Adult-onset diabetes Gestational diabetic individuals are at higher risk to develop type 2 diabetes, also known as adult-onset diabetes. Patients with prediabetes do not have any symptoms of gestational diabetes. Idiopathic diabetes is a form of type 1 diabetes also known as juvenile-onset diabetes. Text Reference - p. 1122

What is the pathophysiologic cause of type 1 diabetes mellitus? 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 Autoimmune destruction of pancreatic β cells 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. Text Reference - pp. 1121-1122

A patient having human leukocyte antigen (HLA)-DR3 has viral hemorrhagic fever. What will be the effect on the glucose level of the patient? 1 Coexistence of HLA-DR3 and viral hemorrhagic fever will not affect the glucose level. 2 Coexistence of HLA-DR3 and viral hemorrhagic fever will inhibit the production of glucose. 3 Coexistence of HLA-DR3 and viral hemorrhagic fever will result in excessive increase in the glucose level. 4 Coexistence of HHLA-DR3 and viral hemorrhagic fever will result in excessive decrease in the glucose level.

3 Coexistence of HLA-DR3 and viral hemorrhagic fever will result in excessive increase in the glucose level. Coexistence of HLA-DR3 and viral hemorrhagic fever will result in excessive increase in the blood glucose level, because the combination of human leukocyte antigen-DR3 and a viral infection causes damage to the β-cells of the pancreas. This inhibits the production of insulin. The glucose level will be affected. The conjunction of HLA-DR3 and viral infection will increase the glucose level instead of inhibiting the glucose level. The glucose level will not decrease; it will increase. Text Reference - p. 1122

Which conditions may cause a patient to develop diabetes mellitus? Select all that apply. 1 Glaucoma 2 Astigmatism 3 Cystic fibrosis 4 Hyperthyroidism 5 Hemochromatosis 6 Recurrent pancreatitis

3 Cystic fibrosis 4 Hyperthyroidism 5 Hemochromatosis 6 Recurrent pancreatitis Diabetes may occur due to some other medical conditions. Cystic fibrosis, hyperthyroidism, hemochromatosis, and recurrent pancreatitis result from destruction, damage, interference, or injury to pancreatic cell function and can result in diabetes. Glaucoma and astigmatism are not related to pancreatic cell dysfunction. Text Reference - p. 1124

A patient's diagnostic reports show 5.5 percent of A1C. Which condition does this value indicate? 1 Diabetes 2 Hypoglycemia 3 Impaired fasting glucose 4 Impaired glucose tolerance

3 Impaired fasting glucose An A1C level of 5.5 percent signifies approximately 111.15 mg/dL of glucose (estimated average glucose = 28.7 of A1C - 46.7) and the range of impaired fasting glucose is 100 to 125 mg/dL. Therefore, 5.5 percent of A1C indicates an impaired fasting glucose level. Diabetes is considered if the blood glucose levels are more than 200 mg/dL. Hypoglycemia is a condition in which the blood glucose level is below 70 mg/dL. Impaired glucose tolerance occurs only when the blood glucose level ranges from 140 to 199 mg/dL. Text Reference - p. 1123

Which condition does the nurse suspect if a patient's diagnostic report shows a fasting blood glucose level of 122 mg/dL? 1 Diabetes mellitus type 1 2 Diabetes mellitus type 2 3 Impaired fasting glucose 4 Impaired glucose tolerance

3 Impaired fasting glucose Impaired fasting glucose is a prediabetic condition and the blood glucose level may range from 100 to 125 mg/dL. The fasting blood glucose level is 122 mg/dL, which indicates that it is a condition between diabetes and glucose homeostasis. In type 1 and type 2 diabetes, the fasting blood glucose level may be very high. Impaired glucose tolerance is a prediabetic condition; however, the blood glucose levels would range from 140 to 199 mg/dL. Text Reference - p. 1123

Which syndrome does the nurse suspect in a patient who has symptoms of hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein (HDL), and abdominal obesity? 1 Barret's esophagus 2 Cushing's syndrome 3 Metabolic syndrome 4 Irritable bowel syndrome

3 Metabolic syndrome Metabolic syndrome is a cluster of conditions such as increased blood pressure, body fat around the waist, and abnormal cholesterol levels, which increase the risk of diabetes. Barrett's esophagus is a condition where the inner lining of the esophagus changes to resemble the intestinal lining, and it predisposes one to adenocarcinoma. Cushing's syndrome is a hormonal disorder that occurs due to abnormally high levels of cortisol in the body. Irritable bowel syndrome is characterized by chronic discomfort associated with defecation. Text Reference - p. 1123

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 Metformin 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. Text Reference - p. 1130

Which factor may lead to coexistence of hyperinsulinemia and hyperglycemia? 1 The β-cells of the pancreas are damaged. 2 More insulin is produced than is required. 3 The insulin receptors do not respond to the insulin and the production of insulin increases. 4 The insulin receptors do not respond to the insulin but production of insulin is occurring at a normal rate.

3 The insulin receptors do not respond to the insulin and the production of insulin increases. When the insulin receptors do not respond to insulin, it delays the transportation of glucose into the cell. Therefore, the pancreas produces high levels of insulin in response to an increased blood glucose level. This results in hyperinsulinemia and hyperglycemia at the same time. If the β-cells of the pancreas are damaged, there will be no or less production of insulin, which will not result in hyperinsulinemia. When both the conditions coexist, the blood glucose level increases, thereby increasing the insulin production. During insulin resistance, β-cells produce more insulin than normal in response to the increased blood glucose level. Text Reference - pp. 1122-1123

A patient is receiving treatment for hypertension and prediabetes. Which drug dose should be reduced to lower the risk of diabetes? 1 Miglitol 2 Glipizide 3 Thiazides 4 Rosiglitazone

3 Thiazides Thiazides are given to patients with hypertension. If high doses of thiazides are administered for a long period of time, it may lead to diabetes because thiazides are diabetes-inducing drugs. Therefore, for a patient with prediabetes, the doses of thiazides should be reduced. Miglitol is prescribed to patients with diabetes to help reduce the blood glucose level after lunch or dinner. Glipizide is given for treatment of diabetes to enhance the production of insulin by the pancreas. Rosiglitazone is given to patients suffering from insulin resistance because they act as insulin sensitizers. Text Reference - p. 1132

A nurse is evaluating an overweight patient in the adult ambulatory clinic for a yearly physical. The patient has a family history of type 2 diabetes and is afraid of developing this disease. How should the nurse respond? 1 "There is only a genetic link in type 1 diabetes." 2 "Weight plays no role in the development of type 2 diabetes." 3 "In type 2 diabetes, the pancreas is unable to produce insulin, so symptoms would already be noticeable." 4 "Metabolic abnormalities such as insulin resistance and being overweight play a role in developing type 2 diabetes."

4 "Metabolic abnormalities such as insulin resistance and being overweight play a role in developing type 2 diabetes." Patients with metabolic abnormalities such as being overweight increase the risk of insulin resistance and inappropriate insulin secretion, which can lead to type 2 diabetes. There is a genetic link associated with type 2 diabetes, although the link is not fully understood at this time. People with first-degree relatives suffering from this disease are 10 times more likely to be diagnosed as well. Overweight patients have increased adipocytes, which secrete hormones (adipokines) that play a role in glucose and fat metabolism and likely contribute to the development of this disease. Type 1 diabetes is characterized by the autoimmune destruction of insulin-producing beta cells in the pancreas, which causes the downstream effects of the disease. Text Reference - p. 1123

The charge nurse is making assignments for the day shift. An appropriate assignment to the licensed practical nurse (LPN) would be: 1 A 45-year-old type 1 diabetic who is nothing by mouth (NPO) for an endoscopy at noon 2 A 28-year-old who is a type 1 diabetic being admitted with diabetic ketoacidosis (DKA) 3 An 8-year-old newly diagnosed type 1 diabetic who is being discharged 4 A 62-year-old type 1 diabetic with a bedside glucose meter reading of 285 who is due for sliding scale coverage

4 A 62-year-old type 1 diabetic with a bedside glucose meter reading of 285 who is due for sliding scale coverage Insulin can be administered by the licensed practical nurse (LPN). The most appropriate assignment would be the patient who has a scheduled sliding scale dose due. A diabetic patient who is NPO for surgery must be monitored closely, which is within the scope of practice for an LPN; however, the patient is not going to surgery until noon and therefore a plan must be in place to avoid hypoglycemia. Developing a plan to avoid hypoglycemia is not within the scope of practice of the LPN. A newly admitted patient with DKA requires close observation and frequent interventions by the RN to prevent acute complications. A newly diagnosed diabetic patient will have complex discharge instructions, including an evaluation of understanding of the teaching plan on management of disease, which is beyond the scope of practice of the LPN. Text Reference - p. 1152

A patient is admitted with diabetic ketoacidosis. Which signs/symptoms would the nurse expect to find upon physical examination? 1 Blood sugar 200 mg/dL and bradypnea 2 Hypotension and blood sugar 68 mg/dL 3 Diaphoresis and extreme hunger 4 Dry skin and ketonuria

4 Dry skin and ketonuria In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. The patient also will present with dry, loose skin. Blood pressure will not be low and respiratory rate will be increased, not decreased. Text Reference - pp. 1142-1144

Patients with metabolic syndrome have a higher risk of developing type 2 diabetes. Which of these 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 blood pressure (BP) 5 Decreased levels of high-density lipoproteins (HDL)

4 Elevated blood pressure (BP) 5 Decreased levels of high-density lipoproteins (HDL) If an individual has elevated blood pressure (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 high-density lipoproteins (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. Text Reference - p. 1123

Which diagnostic test is the most appropriate to assess the risk of diabetes in a patient who reports polyuria and a family history of diabetes? 1 Hematocrit test 2 Serum creatinine test 3 Postprandial blood test 4 Glycosylated hemoglobin test

4 Glycosylated hemoglobin test Glycosylated hemoglobin is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods. As the average amount of plasma glucose increases, the fraction of glycosylated hemoglobin increases in a predictable way. This serves as a marker for the average blood glucose level over a period of three months. Hematocrit is the erythrocyte volume in the blood. A serum creatinine test is an indicator of renal function. A postprandial blood test determines the amount of glucose in the blood after a meal. Text Reference - p. 1123

The glycosylated hemoglobin (A1C) for a patient is 7 percent. Calculate the estimated average glucose (eAG) for this patient. Record your answer using a whole number. ____ mg/dL

46.7mg/dL eAG = 28.7 × A1C - 46.7 Text Reference - p. 1124