Endocrine Diabetes Mellitus

Type 1 diabetes

A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the child's pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes?

Your body is using protein and fat for energy instead of glucose.

A 16-year-old patient newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The patient is upset because friends frequently state, "You look anorexic." Which of the following statements would be the best response by the nurse to help this patient understand the cause of weight loss due to this condition?

The effects of hormonal changes during pregnancy -Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance

A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor?

Ketoacidosis

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?

"You'll need less insulin when you exercise or reduce your food intake."

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?

To restore liver glycogen and prevent secondary hypoglycemia

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?

Regular -Regular insulin is administered intravenously to treat DKA. It is added to an IV solution and infused continuously. Glargine, NPH, and Lente are only administered subcutaneously.

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?

Blood glucose level 1,100 mg/dl

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?

They increase the need for insulin.

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?

Serum glucose level of 52 mg/dl

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?

Administer glucose.

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?

has type 2 diabetes.

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client:

rapid-acting insulin only.

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:

Administering 1 ampule of 50% dextrose solution, per physician's order

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?

Underlying problem of insulin resistance

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason?

Coma, anxiety, confusion, headache, and cool, moist skin

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?

"Diet, exercise, and weight loss can eliminate the need for medication."

A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate?

Always carry a form of fast-acting sugar.

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote?

8:30 AM.

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R, taken at 6:30 AM will reach peak effectiveness by:

Nervousness, diaphoresis, and confusion

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?

Increased urine output

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

The presence of a tingling sensation

A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse should question the patient about what sign or symptom that would suggest the possible development of peripheral neuropathy?

Albumin

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate?

wash and inspect the feet daily.

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:

beta cells of the pancreas.

A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the:

The short-acting insulin is withdrawn before the intermediate-acting insulin.

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?

Increased thirst, increased hunger, and increased urination

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?

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.

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?

"Lately, I drink and drink and can't seem to quench my thirst."

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes?

5% to 10% of all diagnosed cases

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?

Seventh cause of death in the United States

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. One of the women in your lecture group asks if you know the death rate from diabetes mellitus. What is your response?

ntermediate-acting

NPH is an example of which type of insulin?

Teach the patient about actions to slow the progression of nephropathy.

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action?

4 to 6 hours

What is the duration of regular insulin?

Sulfonylureas

Which of the following categories of oral antidiabetic agents exert their primary action by directly stimulating the pancreas to secrete insulin?

Presence of islet cell antibodies

Which of the following clinical characteristics is associated with Type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus [IDDM])?

Can control blood glucose through diet and exercise

Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])?

Patient's eating and sleeping habits

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus?

• 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.

Which of the following factors will cause hypoglycemia in a client with diabetes? Select all that apply.

Humalog

Which of the following is the most rapid acting insulin?

Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision. -Diabetic retinopathy is the leading cause of blindness among people between 20 and 74 years of age in the United States; it occurs in both type 1 and type 2 diabetes.

Which of the following would be included in the teaching plan for a patient diagnosed with diabetes mellitus?

Insulin resistance.

nurse understands that a major concern with type 2 diabetes is:

Deficient fluid volume related to osmotic diuresis

A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority?

Metformin

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?

• Normal bedtime blood glucose • Increase in blood glucose from 3:00 AM until breakfast • Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM • Elevated blood glucose at bedtime

A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply.

• Blurred or deteriorating vision • Fatigue and irritability • Polyuria and polydipsia • Wounds that heal slowly or respond poorly to treatment

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis.

1/2 cup fruit juice or regular soft drink

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?

providing client education at every opportunity.

A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be:

Participation in a support group for persons with diabetes

A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is likely to have minimal contact with the health care system. In order to ensure that the patient maintains adequate blood sugar control over the long term, the nurse should recommend which of the following?

Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan?

• Ketosis-prone • Little endogenous insulin • Younger than 30 years of age

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.)

Need exogenous insulin.

A patient who is diagnosed with type 1 diabetes would be expected to:

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?

Stress has likely caused an increase in the patient's blood sugar levels.

A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment?

Lose weight, if obese.

A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individual's risk for developing diabetes?

100

Once digested, what percentage of carbohydrates is converted to glucose?

NPH

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?

Regular

What is the only insulin that can be given intravenously?

"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:

3 AM -During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.

When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day?

Insulin is an anabolic hormone.

Which factor presents the most likely cause for weight gain in a diabetic client who is controlled with insulin?

Using sterile technique during the dressing change

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?

High sugar pulls fluid into the bloodstream, which results in more urine production.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus?

Promote absorption.

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic?

Ketones -Ketones are byproducts of fat breakdown, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not byproducts of fat breakdown.

Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine?

Glarginet (Lantus) -Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.

Which of the following insulins are used for basal dosage?

• Elevated blood urea nitrogen (BUN) and creatinine • More common in type 1 diabetes • Rapid onset

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.

• Hypertension • Obesity • Family history • Age greater of 45 years or older • History of gestational diabetes

Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply.

• Decreased renal function • Taste changes • Decreased vision

Which of the following is an age-related change that may affect diabetes? Select all that apply.

A glucose challenge test should be performed between 24 to 28 weeks.

Which of the following is true regarding gestational diabetes?

The patient has not consumed food and continues to take insulin or oral antidiabetic medications.

Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus?

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.

Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin?

"I'm going to give your son some insulin. Then I'll be happy to talk with you."

A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is:

6.5% -Normally the level of glycosylated hemoglobin is less than 7%. Thus a level of 6.5% would indicate that the client's blood glucose level is well-controlled.

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well-controlled?

The client's consumption of carbohydrates

A male client, aged 42, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client?

Control blood glucose levels.

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important?

15 to 20 g of a fast-acting carbohydrate such as orange juice.

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer:

Exercise -Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels.

A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the body's need for insulin?

Change the needle every 3 days.

A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site?

Glucagon

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?

Presence of autoantibodies against islet cells

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?

Recognition of hypoglycemia and hyperglycemia

A nurse is teaching basic "survival skills" to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address?

180 mg/dL

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds:

IV administration of 50% dextrose in water

A patient has been brought to the emergency department by paramedics after being found unconscious. The patient's Medic Alert bracelet indicates that the patient has type 1 diabetes and the patient's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?

"The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years."

A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurse's best response?

Half of a cup of juice, followed by cheese and crackers

A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer?

• Increases lean muscle mass • Increases resting metabolic rate as muscle size increases • Decreases total cholesterol • Increases glucose uptake by body muscles

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply.

Glycosylated hemoglobin level

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?

Sensory neuropathy

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet?

It carries glucose into body cells.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action?

It enhances transport of glucose across the cell wall.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action?

Increase frequency of glucose self-monitoring.

The nurse is educating the diabetic client on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include?

• May improve blood glucose levels • Decrease the need for exogenous insulin • Help reduce cholesterol levels

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? (Select all that apply.)

Reflects the amount of glucose stored in hemoglobin over past several months.

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order?

Insufficient insulin production

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes?

0.45 normal saline

The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids would the nurse anticipate infusing for this patient?

When mixing insulin, the regular insulin is drawn up into the syringe first.

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?