DIABETES ∙

The nurse is observing a patient administer insulin. Which observation indicates the need for further instruction? (Select all that apply.) a. The patient uses a 90-degree angle to administer the injection. b. The patient cleans the injection site with alcohol before the injection. c. The patient rubs the injection site after administration of the insulin injection. d. The patient draws up the cloudy insulin and then the clear insulin. e. The patient shakes the insulin bottle before administration.

: C, D, E When administering insulin the site is cleaned with alcohol before the injection but not after. Rubbing will alter the rate of absorption. When mixing two types of insulin the clear should be drawn into the syringe first. This prevents contamination of the second vial. Shaking the bottle can damage the solution. The bottle should be gently rolled between the palms of the hands.

The nurse is caring for a patient who is experiencing problems with maintaining glycemic control at night and during the early morning hours. The nurse correctly recognizes that: a. hyperglycemia is produced from counterregulatory hormones. b. hyperglycemia of dawn phenomenon does not react to insulin. c. hypoglycemia quickly follows the dawn phenomenon. d. hyperglycemia of dawn phenomenon is not changed by food intake.

ANS: A Dawn phenomenon is produced in the morning by the circadian release of growth hormones, epinephrine, and glucagon during the night.

The nurse would anticipate laboratory values from a patient in ketoacidosis to reveal: a. increased blood urea nitrogen (BUN). b. normal or decreased CO2. c. increased arterial pH. d. decreased glucose.

ANS: A Diabetic ketoacidosis results when the body attempts to metabolize protein and fats, which results in high BUN readings. The CO2 should be normal or low depending on the effectiveness of Kussmauls respirations. The arterial pH will be low, and there will be high glucose, which the diabetic patient cannot use.

The nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%. What inference can best be made about this patient? a. The patient is demonstrating improved control of hyperglycemia over the last several months. b. The patient has been less compliant with the prescribed treatment regimen. c. The patient is experiencing a reduction in insulin sensitivity. d. The patient has less need for insulin.

ANS: A HbA1c is a diagnostic assessment used to review blood glucose levels retrospectively. A reduction in the value indicates improved glucose control by the patient. There is no evidence of insulin sensitivity. The need for insulin is not decreased in this patient.

The nurse discovers the type 1 diabetic (IDDM) patient drowsy and tremulous, the skin is cool and moist, and the respirations are 32 and shallow. These are signs of: a. hypoglycemic reaction; give 6 oz of orange juice. b. hyperglycemic reaction; give ordered regular insulin. c. hyperglycemic hyperosmolar nonketotic reaction; squeeze glucagon gel in buccal cavity. d. hypoglycemic reaction; give ordered insulin.

ANS: A Hypoglycemic reaction is due to not enough food for the insulin. Quick acting carbohydratessuch as orange juice or longer acting foods such as milk, crackers, and cheeseare beneficial.

The nurse is reviewing the patients prescribed insulin regimen. The nurse notes that the physician has ordered a long-lasting insulin. Which medication will best meet this criteria? a. Lantus b. NovoLog c. Humalog d. Regular

ANS: A Lantus is a long-lasting insulin. It may be administered only one time per day. NovoLog and Humalog are both rapid-onset insulin preparations. Regular insulin is classified as a short-acting insulin. DIF: Cognitive Level: Comprehension REF: 864 OBJ: 1 (clinical)

The patient inquires about the significance of islet cell antibodies. The nurses most informative response is that islet cell antibodies: a. will cause beta cells to quit producing insulin, resulting in diabetes mellitus (DM). b. protect beta cells from viral attack. c. increase production of insulin from beta cells. d. decrease the size of the pancreas.

ANS: A The antibodies cause beta cells to quit production of insulin

The diet of the diabetic is geared toward adequate nutrition and: a. control of weight. b. exclusion of all sweets. c. increase in fats for energy. d. avoidance of all fast foods.

ANS: A The much less stringent diet of the diabetic is focused on adequate nutrition and weight and cholesterol control. The newer diets allow for some sweets and some fast foods. Fats are not adequate sources of energy. Fat intake should be limited to reduce complications related to weight gain and cardiovascular concerns

The nurse counsels the 30-year-old woman with type 2 diabetes who is overweight and noncompliant that control of diabetes would most improve if she were to: a. lose weight. b. take more Glucophage. c. eat a high-protein diet. d. take insulin.

ANS: A Type 2 diabetes is prevalent in the obese. Of the known cases, 80% of them are overweight. Loss of weight decreases hyperglycemia

The nurse is caring for a patient suspected of having ketoacidosis. What early manifestation(s) may be noted with this condition? (Select all that apply.) a. Fruity breath b. Polyuria c. Nausea d. Thirst e. Sunken eyes

ANS: A, B, C, F The hemoglobin A1c is used to gather baseline data and to monitor progress of diabetes control. In 2009, the American Diabetes Association (ADA) also changed its guidelines to include the HbA1c as a diagnostic test for diabetes. It also assists in determining the degree of effectiveness of a patients treatment plan. Newer methods allow this test to be done in a physicians office while the patient waits. D. E. It reflects the average blood glucose level for the previous 2 to 3 months.

The nurse is teaching a patient about the HbA1c laboratory test. Which patient statements indicates teaching has been effective? (Select all that apply.) a. The test shows long-term blood sugar control. b. This test can be used to help diagnose diabetes. c. The test can be done in the physicians office while Im waiting. d. The test looks back at blood sugar averages over the past 6 months. e. If I eat anything with sugar in it the day before the test, it will show up on the test. f. This test can help determine if my treatment plan is managing my diabetes effectively.

ANS: A, B, C, F The hemoglobin A1c is used to gather baseline data and to monitor progress of diabetes control. In 2009, the American Diabetes Association (ADA) also changed its guidelines to include the HbA1c as a diagnostic test for diabetes. It also assists in determining the degree of effectiveness of a patients treatment plan. Newer methods allow this test to be done in a physicians office while the patient waits. D. E. It reflects the average blood glucose level for the previous 2 to 3 months.

When discussing exercise programs with the diabetic, the nurse should stress that the patient should: (Select all that apply.) a. delay the exercise program until glucose is under control. b. check glucose after exercise. c. have a quick source of glucose available while exercising. d. begin slowly and build up to 30 to 45 minutes. e. use abdomen only for injection site for insulin.

ANS: A, C, D, E All options should be observed by the diabetic who exercises except the patient should check the glucose level before exercise rather than after. (CORRECTION SHOULD TAKE GLUCOSE BEFORE DURING AND AFTER EXERCISE

The patient comes to the emergency room with dry hot skin, fruity breath, and deep respirations and is complaining of abdominal pain. The nurse interprets these signs and symptoms as: a. an insulin reaction. b. ketoacidosis. c. rebound hyperglycemia. d. hypoglycemia.

ANS: B All the signs and symptoms mentioned are characteristics of ketoacidosis. An insulin reaction may be referred to as hypoglycemia. The symptoms of hypoglycemia: tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Rebound hyperglycemia, also known as the Somogyi effect, follows a period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects of low blood sugar. The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose, it worsens the problem.

The nurse is discussing insulin administration with an assigned patient. The patient reports that she prefers to use only certain sites for insulin injections. The patient questions why rotation of the sites is important. What response by the nurse is most appropriate? a. Rotating your injection sites will help to reduce your risk of infection. b. If you do not rotate injection sites you are at risk for an erratic absorption of your medication. c. Unsightly fatty tumors can develop when you do not adequately rotate injection sites. d. Failing to rotate injection sites will improve your ability prevent an insulin reaction.

ANS: B Insulin injections are rotated within one body area to enhance absorption. Patients are given charts showing the places on the arms, legs, buttocks, and abdomen where insulin can be injected. Patients should be encouraged to keep a daily record of injection sites to help remember which sites have been used and to avoid the problem of altered or erratic absorption, which is a complication associated with overuse of a single site. The most important way to reduce the incidence of infection is to wash the hands before insulin administration and to avoid reusing syringes. Fatty tumors are not complications of overuse of a single injection site. The term insulin reaction refers to hypoglycemia. Hypoglycemia is not directly associated with the failure to rotate injection sites.

The nurse is caring for a patient who was hospitalized with ketosis. The nurse recognizes that the patient correctly understands the phenomenon when she reports what about the condition? a. I had taken too much insulin to decrease my bodys levels of glucose. b. The condition resulted when my body tried to break down and use my stores of fats. c. When my blood glucose goes over 150 mg/dL, I am at risk for this condition. d. I was exercising too much and had too sharp reductions in my blood glucose level.

ANS: B Persons with type 1 diabetes are more prone to a serious complication, ketosis, associated with an excess production of ketone bodies, leading to ketoacidosis (metabolic acidosis). When the glucose level gets too high the body attempts to metabolize fats for energy, and the result is a buildup of ketone bodies.

recently diagnosed with type 1 diabetes mellitus questions the nurse about her increased thirst level. What should be included in the response by the nurse? a. Diabetes results in a lack of protein absorption causing reduced amino acids, resulting in thirst. b. Elevated levels of blood glucose pull cellular water into circulating volume. c. Thirst results from the bodys increased loss of fluids through polyuria. d. Appetites of both food and water signal the changes of diabetes.

ANS: B Polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling intracellular fluid into the circulating volume.

A patient asks the nurse if stress can be a potential cause of type 2 diabetes. What should be included in the response provided by the nurse? a. Stress decreases the number of alpha cells in the pancreas, thus increasing the workload on the beta cells. b. Periods of stress cause increases in glycogen production by the adrenal cortex. c. Stress is directly associated with decreased insulin tolerance. d. The inhibition of beta cells to glucose is increased in periods of stress.

ANS: B Stress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia.

What instructions should a nurse give to a diabetic patient to prevent injury to the feet? a. Soak feet in warm water every day. b. Avoid going barefoot and always wear shoes with soles. c. Use of commercial keratolytic agents to remove corns and calluses are preferred to cutting off corns and calluses. d. Use a heating pad to warm feet when they feel cool to the touch.

ANS: B Sturdy, properly fitting shoes should be worn. Use of corn removers and heating pads is not beneficial to preserve the health of a diabetics feet.

The nurse outlines the criteria for tight control of hyperglycemia as: (Select all that apply.) a. glucose testing two times a day. b. insulin injections three times a day based on glucometer readings. c. fasting glucose remaining within normal limits. d. maintaining normal weight for height and age. e. maintaining cholesterol within normal limits.

ANS: B, C, D, E Patients attempting tight control follow an intensive therapy plan of blood glucose testing and insulin injections, three or more times a day, or they use an insulin pump. The protocol for control of diabetes mellitus is highly individualized and depends on the type of diabetes a person has, age, general state of health, ability to follow the prescribed regimen, and acceptance of responsibility for managing the illness, along with a host of other factors.

The patient takes his NovoLog 70-30 at 7:00 AM. The nurse suggests the best time to schedule exercise would be at: a. 7:30 AM before peak action of insulin. b. 10:00 AM at peak action of insulin. c. 1:00 PM after peak action of insulin. d. any time after injection.

ANS: C Exercise should occur after peak action time to prevent hypoglycemia. NovoLog is a rapid-acting insulin that peaks 1 to 3 hours after administration.

2:00 AM, the CNA reports that a patient with type 1 diabetes is extremely wet with perspiration, is cool to the touch, and is complaining of hunger. The nurse should: a. give insulin by sliding scale based on glucometer reading. b. notify the night supervisor of the patients deteriorating condition. c. give 6 ounces of orange juice. d. ambulate the patient in the hall to use up excess glucose with exercise.

ANS: C Hypoglycemia is a common complication of type 1 diabetes mellitus. Most often it is a response to either too large a dose of insulin or too much exercise in relation to the amount of food eaten. Symptoms of hypoglycemia include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Management includes providing a source of quick-acting carbohydrate/glucose. Insulin is used to manage hyperglycemia, not hypoglycemia. The patients condition is likely easily managed by the interventions noted and will not warrant notification of the supervisor. The patient will not benefit from exercise as he has limited serum glucose.

The nurse is reviewing the causes for the development of type 1 diabetes mellitus with a patient who is newly diagnosed with the disorder. What major factor in the development of this disease should the nurse include? a. Obesity b. A high-fat diet c. An autoimmune response d. A diet high in concentrated carbohydrates

ANS: C In type 1 diabetes, it is believed that the pancreas may attack itself following certain viral infections or administration of certain drugs; this is called an autoimmune response. Almost 90% of patients newly diagnosed with type 1 diabetes have islet cell antibodies in their blood. B. D. Diet can be a risk factor in many disorders but does not directly cause diabetes. A. Obesity is a risk factor for type 2 diabetes.

The physician prescribes glyburide (Micronase, DiaBeta, Glynase) for a patient, age 57, when diet and exercise have not been able to control type 2 diabetes. What should the nurse include in the teaching plan about this medication? a. It is a substitute for insulin and acts by directly stimulating glucose uptake into the cell. b. It does not cause the hypoglycemic reactions that may occur with insulin use. c. It is thought to stimulate insulin production and increase sensitivity to insulin at receptor sites. d. It lowers blood sugar by inhibiting glucagon release from the liver, preventing gluconeogenesis.

ANS: C Oral hypoglycemics are compounds that stimulate the beta cells in the pancreas to increase insulin release.

A patient at home with type 1 diabetes has a glucose level of 324 mg/dL. It is usually less than 150 mg/dL. What should the patient do first? a. Call the physician. b. Have a glass of orange juice. c. Check the urine for ketones and drink water. d. Exercise and recheck glucose level in 2 hours.

ANS: C Patients with type 1 diabetes are at risk of ketoacidosis when blood glucose is out of control. Hydration is important. Checking the urine for ketones can help determine if ketoacidosis is developing. B. Orange juice will further increase blood glucose. A. The physician should be contacted if it remains high or if ketones are present. D. Exercise is not recommended when glucose is high.

A patient with type 1 diabetes mellitus is preparing for a moderate 30-minute exercise period. Which action best indicates understanding of condition management? a. The patient reduces insulin use during days when exercise periods are planned. b. The patient administers insulin after exercise rather than before exercise. c. The patient eats a high-carbohydrate snack before the exercise period. d. The patient consumes a simple carbohydrate snack after 30 minutes of activity.

ANS: D During moderate exercise (such as brisk walking, bowling, or vacuuming), 5 g of simple carbohydrate should be consumed at the end of 30 minutes and at 30-minute intervals during the continued activity. (A food example with 5 g of simple carbohydrate is 1 tsp honey.)

A patient is experiencing rapid deep breathing, fruity odor, lethargy, and weight loss. Laboratory results include a blood glucose of 720 mg/dL. Which symptom should indicate to the nurse that the patient has type 1 diabetes mellitus? a. Thirst b. Hunger c. Lethargy d. Fruity odor

ANS: D Fruity odor occurs with ketoacidosis in type 1 diabetes, which is very rare in type 2. A. B. C. The symptoms can occur in either type 1 or type 2 diabetes mellitus.

The nurse explains to a newly diagnosed type 1 diabetic that the beta cells can no longer produce adequate insulin because: a. they are inhibited by pituitary disorder. b. an allergic response has altered their response to hyperglycemia. c. alpha cells have proliferated in the islets of Langerhans. d. the bodys immune system has destroyed them.

ANS: D In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction.

A patient with type 1 diabetes mellitus asks what caused the fruity odor that was present at diagnosis. How should the nurse respond? a. Excess sugar is excreted in the urine, which causes the fruity odor. b. The proteins in the blood are metabolized to a substance that has a fruity odor. c. The excess sugar in the blood is metabolized to fructose and excreted via the lungs. d. In the absence of available sugar, the body breaks down fat into ketones, which have a fruity odor.

ANS: D The expired air has a fruity odor caused by the ketones which occurs when fat is broken down and may be mistaken for alcohol. Some nurses have likened the odor to Juicy Fruit gum. A. B. C These responses do not correctly describe the process for the fruity odor.