Diabetes Prep U
When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? a) 5 AM b) 7 AM c) 9 AM d) 3 AM
3 AM Explanation: During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.
What is the only insulin that can be given intravenously? a) Ultralente b) Lantus c) Regular d) NPH
Regular Correct Explanation: Insulins other than regular are in suspensions that could be harmful if administered IV.
NPH is an example of which type of insulin? a) Intermediate-acting b) Short-acting c) Rapid-acting d) Long-acting
Intermediate-acting Explanation: NPH is intermediate-acting insulin.
A patient receives a daily injection of glargine (Lantus) insulin at 7:00 AM. When should the nurse monitor this patient for a hypoglycemic reaction? a) Between 8:00 and 10:00 AM b) D This insulin has no peak action and does not cause a hypoglycemic reaction. c) Between 7:00 and 9:00 PM d) Between 4:00 and 6:00 PM
D This insulin has no peak action and does not cause a hypoglycemic reaction. Explanation: Peakless basal or very long-acting insulins are approved by the Food and Drug Administration for use as a basal insulin—that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.
Which of the following is an age-related change that may affect diabetes and its management? a) Increased thirst b) Hypotension c) Decreased renal function d) Increased bowel motility
Decreased renal function Correct Explanation: Decreased renal function affects the management of diabetes. Other age-related changes that may affect diabetes and its management include hypertension, decreased bowel motility, and decreased thirst.
During a follow-up visit 3 months following a new diagnosis of type 2 diabetes, a patient reports exercising and following a reduced-calorie diet. Assessment reveals that the patient has only lost 1 pound and did not bring the glucose-monitoring record. Which of the following tests will the nurse plan to obtain? a) Glycosylated hemoglobin level b) Oral glucose tolerance test c) Urine dipstick for glucose d) Fasting blood glucose level
Glycosylated hemoglobin level Explanation: Glycosylated hemoglobin is a blood test that reflects average blood glucose levels over a period of approximately 2 to 3 months. When blood glucose levels are elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycated hemoglobin level becomes.
Which of the following clinical manifestations of type 2 diabetes occurs if glucose levels are very high?
Blurred vision Correct Explanation: Blurred vision occurs when the blood glucose levels are very high. The other clinical manifestations are not consistent with type 2 diabetes.
A nurse is caring for a client with diabetes mellitus. The client has a blood glucose level of 40 mg/dL. Which of the following rapidly absorbed carbohydrate would be most effective?
1/2 cup fruit juice or regular soft drink Correct Explanation: In a client with hypoglycemia, the nurse uses the rule of 15: Give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.
The nurse is administering lispro (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? a) 10 to 15 minutes b) 30 to 40 minutes c) 3 hours d) 1 to 2 hours
10 to 15 minutes Correct Explanation: The onset of action of rapid-acting Humalog is within 10 to 15 minutes. It is used for rapid reduction of glucose level
As a nurse educator, you have been invited to your local senior center to discuss health-maintaining strategies for older adults. During your education session on nutrition, you approach the subject of diabetes mellitus, its symptoms and consequences. What is the prevalence of type 1 diabetes? a) 10% to 15% of all diagnosed cases b) 0% to 5% of all diagnosed cases c) 15% to 20% of all diagnosed cases d) 5% to 10% of all diagnosed cases
5% to 10% of all diagnosed cases Explanation: Type 1 diabetes accounts for approximately 5% to 10% of all diagnosed cases of diabetes (National Diabetes Information Clearinghouse [NDIC], 2012b).
Which of the following statements is true regarding gestational diabetes? a) Its onset is usually in the first trimester. b) A glucose challenge test should be performed between 24 and 28 weeks. c) It occurs in most pregnancies. d) There is a low risk for perinatal complications.
A glucose challenge test should be performed between 24 and 48 weeks. It occurs in 2% to 5% of all pregnancies. Onset is usually in the second or third trimester. There is an above-normal risk for perinatal complications.
A client with diabetic ketoacidosis has been brought into the ED where you practice nursing. Which of the following interventions is not a goal in the initial medical treatment of diabetic ketoacidosis? a) Monitor serum electrolytes and blood glucose levels. b) Administer isotonic fluid at a high volume. c) Administer glucose. d) Administer potassium replacements.
Administer glucose. Correct Explanation: Insulin is given intravenously. Insulin reduces the production of ketones by making glucose available for oxidation by the tissues and by restoring the liver's supply of glycogen. As insulin begins to lower the blood glucose level, the IV solution is changed to include one with glucose. Periodic monitoring of serum electrolytes and blood glucose levels is necessary. Isotonic fluid is instilled at a high volume, for example, 250 to 500 mL/hour for several hours. The rate is adjusted once the client becomes rehydrated and diuresis is less acute. Potassium replacements are given despite elevated serum levels to raise intracellular stores.
Matt Thompson, a 37-year-old farmer, has been diagnosed with pre diabetes. Following his visit with his primary care provider, you begin your client education session to discuss treatment strategies. What can be the consequences of untreated pre diabetes? a) CVA b) Cardiac disease c) Type 2 diabetes d) All options are correct.
All options are correct. Explanation: The NIDDK has developed criteria that identify people with prediabetes, which can lead to type 2 diabetes, heart disease, and stroke.
Insulin is secreted by which of the following types of cells? a) Neural cells b) Melanocytes c) Beta cells d) Basal cells
Beta cells Correct Explanation: Insulin is secreted by the beta cells, in the islets of Langerhans of the pancreas. In diabetes, cells may stop responding to insulin, or the pancreas may decrease insulin secretion or stop insulin production completely. Melanocytes are what give the skin its pigment. Neural cells transmit impulses in the brain and spinal cord. Basal cells are a type of skin cell.
Which of the following factors will cause hypoglycemia in a client with diabetes? Select all that apply. a) Client has not consumed sufficient calories. b) Client is experiencing effects of the aging process. c) Client has been exercising more than usual. d) Client has not consumed food and continues to take insulin or oral antidiabetic medications. e) Client has been sleeping excessively.
Client has not consumed food and continues to take insulin or oral antidiabetic medications. • Client has not consumed sufficient calories. • Client has been exercising more than usual. Explanation: Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia.
Which of the following would be inconsistent as a cause of DKA?
Competency in injecting insulin. Being able to competently inject insulin is not a cause of DKA. Undiagnosed and untreated diabetes decreased or missed dose of insulin, and illness or infection are potential causes of DKA
Which of the following would be considered a "free" item from the exchange list? a) Green salad b) Medium apple c) 1 tsp olive oil d) Diet soda
Diet soda Explanation: Free items include unsweetened iced tea, diet soda, and ice water with lemon. A green salad is exchanged for 1 vegetable. A medium apple is 1 fruit; 1 tsp of olive oil is 1 fat.
Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin?
Do not mix with other insulins Correct Explanation: Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa. Glargine is absorbed very slowly over a 24-hour period and can be given once a day. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period.
Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin? a) Draw up the drug first, then add regular insulin. b) It is rapidly absorbed, has a fast onset of action. c) Administer the total daily dosage in two doses. d) Do not mix with other insulins.
Do not mix with other insulins. Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.
Which of the following insulins are used for basal dosage? a) Aspart (Novolog) b) Glarginet (Lantus) c) Lispro (Humalog) d) NPH (Humulin N)
Glarginet (Lantus) Explanation: Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.
A nurse is preparing to discharge a patient with coronary artery disease (CAD) and hypertension (HTN) who is at risk for type 2 diabetes. Which of the following information is important to include in the discharge teaching? a) How to control blood glucose through lifestyle modification with diet and exercise b) How to monitor ketones daily c) How to recognize signs of diabetic ketoacidosis (DKA) d) How to self-inject insulin
How to control blood glucose through lifestyle modification with diet and exercise Explanation: Persons at high risk for type 2 diabetes receive standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo, or an intensive program of lifestyle modifications. The 16-lesson curriculum of the intensive program of lifestyle modifications focuses on weight reduction of greater than 7% of initial body weight and physical activity of moderate intensity. It also includes behavior modification strategies designed to help patients achieve the goals of weight reduction and participation in exercise. These findings demonstrate that type 2 diabetes can be prevented or delayed in persons at high risk for the disease.
Which of the following is the most rapid acting insulin? a) Humalog b) Ultralente c) NPH d) Regular
Humalog Correct Explanation: The onset of action of rapid-acting Humalog is within 10 to 15 minutes. The onset of action of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate acting NPH is 3 to 4 hours. The onset of action of long-acting Ultralente is 6 to 8 hours.
A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. Which of the following symptoms would she include when reviewing classic symptoms associated with diabetes? a) Increased thirst, increased hunger, and increased urination b) Increased weight loss, increased dehydration, and increased fatigue c) Loss of appetite, increased urination, and dehydration d) Increased weight gain, increased appetite, and increased thirst
Increased thirst, increased hunger, and increased urination Explanation: The three classic symptoms of both types of diabetes mellitus are polyuria, polydipsia, and polyphagia. Weight loss, dehydration, and fatigue are additional symptoms.
Which of the following statements is correct regarding glargine (Lantus) insulin? a) It is absorbed rapidly. b) It is given twice daily. c) Its peak action occurs in 2 to 3 hours. d) It cannot be mixed with any other type of insulin.
It cannot be mixed with any other type of insulin. Correct Explanation: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is not a peak in action. It is approved to give once daily.
Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine? a) Creatinine b) Hemoglobin c) Cholesterol d) Ketones
Ketones Correct Explanation: Ketones are byproducts of fat breakdown, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not byproducts of fat breakdown.
A nurse is teaching a patient recovering from diabetic ketoacidosis (DKA) about management of "sick days." The patient asks the nurse why it is important to monitor the urine for ketones. Which of the following statements is the nurse's best response? a) Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood. b) When the body does not have enough insulin hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic byproducts to be released. c) Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy. d) Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid.
Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy. Explanation: Ketones (or ketone bodies) are byproducts of fat breakdown, and they accumulate in the blood and urine. Ketones in the urine signal a deficiency of insulin and control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy
A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition? a) All options are correct b) Hyperosmolar hyperglycemic nonketotic syndrome c) Ketoacidosis d) Hepatic disorder
Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. The most likely cause is ketoacidosis. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level. The most likely cause is ketoacidosis.
A characteristic of type 2 diabetes includes which of the following? a) Often have islet antibodies b) Little insulin c) Ketosis-prone when insulin absent d) No islet cell antibodies
No islet cell antibodies Explanation: Type 2 diabetes is characterized by no islet cell antibodies or a decrease in endogenous insulin or increase with insulin resistance. Type 1 diabetes is characterized by production of little or no insulin; the patient is ketosis-prone when insulin is absent and often has islet cell antibodies.
A 36-year-old mother of six has been recently diagnosed with type 2 diabetes. She reports increased hunger and food consumption while continuing to lose weight. What is the term used to describe this condition? a) Polyphagia b) Polydipsia c) Polyuria d) Anorexia
Polyphagia Correct Explanation: While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose. Polyphagia describes a medical symptom that means excessive hunger or appetite.
A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which of the following factors as a cause of type 1 diabetes? a) Rare ketosis b) Presence of autoantibodies against islet cells c) Obesity d) Altered glucose metabolism
Presence of autoantibodies against islet cells Explanation: There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.
A client with diabetes mellitus is receiving an oral antidiabetic agent. Which of the following aspects should the nurse observe when caring for this client?
Signs of hypoglycemia Correct Explanation: The nurse should observe the client receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Observe the client receiving an oral antidiabetic agent for signs of hypoglycemia.
A patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient? a) Polyuria b) Blurred vision c) Signs of hypoglycemia d) Polydipsia
Signs of hypoglycemia Correct Explanation: The nurse should observe the patient receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are the symptoms of diabetes mellitus.
A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. Which of the following demonstrates that the nurse understands the correct procedure for preparing this medication? a) The intermediate-acting insulin is withdrawn before the short-acting insulin. b) If administered immediately, there is no requirement for withdrawing one type of insulin before another. c) The short-acting insulin is withdrawn before the intermediate-acting insulin. d) Different types of insulin are not to be mixed in the same syringe.
The short-acting insulin is withdrawn before the intermediate-acting insulin. Explanation: When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next, a practice referred to as "clear to cloudy."
The greatest percentage of people have which type of diabetes? a) Impaired glucose tolerance b) Type 2 c) Type 1 d) Gestational
Type 2 diabetes accounts for 90% to 95% of all diabetes. Type 1 accounts for 5% to 10% of all diabetes. Gestational diabetes has an onset during pregnancy. Impaired glucose tolerance is defined as an oral glucose tolerance test value between 140 mg/dL and 200 mg/dL.
The nurse is teaching a patient about self-administration of insulin and mixing of regular and neutral protamine Hagedorn (NPH) insulin. Which of the following is important to include in the teaching plan? a) There is no longer a need to inject air into the bottle of insulin before insulin is withdrawn. b) When mixing insulin, the regular insulin is drawn up into the syringe first. c) If two different types of insulin are ordered, they need to be given in separate injections. d) When mixing insulin, the NPH insulin is drawn up into the syringe first.
When mixing insulin, the regular insulin is drawn up into the syringe first. Correct Explanation: When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before drawing into the syringe. The American Diabetic Association (ADA) recommends that the regular insulin be drawn up first. The most important issues are (1) that patients are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) that patients not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.
Julie is a 32-year-old client who has an appointment at the weight loss clinic where you practice nursing. She has gained 55 lb in the last 3 years and is concerned about developing type 2 diabetes mellitus. Additionally, her healthcare provider told her that she has metabolic syndrome, and although her healthcare provider discussed that with her, she is asking the nurse to please review it with her again. What are the conditions which contribute to developing metabolic syndrome? Select all that apply. a) Low LDL b) All options are correct. c) Abdominal obesity d) Elevated blood glucose levels
• Abdominal obesity • Elevated blood glucose levels Explanation: Metabolic syndrome includes obesity, especially in the abdominal area; high blood pressure (BP); elevated triglyceride, low-density lipoprotein (LDL), blood glucose levels; and a low high-density lipoprotein (HDL) level.
