Glucose Regulation
Which mechanism of action explains how glyburide decreases serum glucose levels? 1-Stimulates the pancreas to produce insulin 2-Accelerates the liver's release of stored glycogen 3-Increases glucose transport across the cell membrane 4-Decreases absorption of glucose from the gastrointestinal system
1-Stimulates the pancreas to produce insulin Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Antidiabetic medications of the biguanide chemical class improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this medication to be effective.
The nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. Which interventions would the nurse include to decrease the risk of complications? Select all that apply. One, some, or all responses may be correct. 1-Examine the feet daily. 2-Wear well-fitting shoes. 3-Perform regular exercise. 4-Powder the feet after showering. 5-Visit the primary health care provider weekly. 6-Test bathwater with the toes before bathing.
1-examine the feet daily. 2-Wear well-fitting shoes. 3-Perform regular exercise. Clients with diabetes often have peripheral neuropathies and are unaware of discomfort or pain in the feet; the feet should be examined every night for signs of trauma. Well-fitting shoes prevent pressure and rubbing that can cause tissue damage and the development of ulcers. Daily exercise increases the uptake of glucose by the muscles and improves insulin use.
An unconscious adolescent with type 1 diabetes is brought to the emergency department. The blood glucose level is 742 mg/dL (41.2 mmol/L). Which finding would the nurse expect during the initial assessment? 1-Pyrexia 2-Hyperpnea 3-Bradycardia 4-Hypertension
2-Hyperpnea Rapid breathing (hyperpnea) is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a characteristic compensatory mechanism for correcting metabolic acidosis. An increase in temperature (pyrexia) will occur if an infection is present; it is not a response to hyperglycemia. Tachycardia, not bradycardia, results from the hypovolemia of dehydration. Hypotension, not hypertension, may result from the decreased vascular volume associated with hyperglycemia.
An unconscious adolescent with type 1 diabetes is brought to the emergency department. The blood glucose level is 742 mg/dL (41.2 mmol/L). Which finding would the nurse expect during the initial assessment? 1-Pyrexia 2-Hyperpnea 3-Bradycardia 4-Hypertension
2-Hyperpnea Rapid breathing (hyperpnea) is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a characteristic compensatory mechanism for correcting metabolic acidosis. An increase in temperature (pyrexia) will occur if an infection is present; it is not a response to hyperglycemia. Tachycardia, not bradycardia, results from the hypovolemia of dehydration. Hypotension, not hypertension, may result from the decreased vascular volume associated with hyperglycemia.
Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with a diabetic coma? 1-Sodium bicarbonate, causing alkalosis 2-Ketones as a result of rapid fat breakdown, causing acidosis 3- Nitrogen from protein catabolism, causing ammonia intoxication 4-Glucose from rapid carbohydrate metabolism, causing drowsiness
2-Ketones as a result of rapid fat breakdown, causing acidosis Ketones are produced when fat is broken down for energy. Although rarely used, sodium bicarbonate may be administered to correct the acid-base imbalance resulting from ketoacidosis; acidosis is caused by excess acid, not excess base bicarbonate. Diabetes does not interfere with removal of nitrogenous wastes. Carbohydrate metabolism is impaired in the client with diabetes.
An adolescent who has just been found to have type 1 diabetes asks the nurse about exercise. Which is the best response by the nurse? 1- "Exercise should be restricted." 2- "Exercise will increase blood glucose." 3-"Extra snacks are needed before exercise." 4-"Extra insulin is required during exercise."
3- "Extra snacks are needed before exercise." Exercise lowers the blood glucose level; an extra snack can prevent hypoglycemia. Exercise is encouraged, not restricted. Exercise lowers, not increases, blood glucose. Extra insulin is contraindicated because exercise decreases the blood glucose level; extra insulin may precipitate hypoglycemia.
The health care provider prescribes an oral hypoglycemic medication for the client with type 2 diabetes. Which statement will the nurse need to consider when developing the teaching plan? 1-Oral hypoglycemics work by decreasing absorption of carbohydrates. 2-Oral hypoglycemics work by stimulating the pancreas to produce insulin. 3-Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. 4-Serious adverse effects are not a problem for oral hypoglycemics.
3- Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the medication prescribed. Oral hypoglycemic medications can have serious adverse effects.
A client's breath has a sweet, fruity odor. Which condition is affecting this client? 1-Gum disease 2-Uremic acidosis 3-Diabetic acidosis 4-Infection inside a cast
3-Diabetic acidosis A client with diabetic acidosis has a sweet, fruity odor to the breath.
The nurse is reviewing the laboratory report of an adolescent with type 1 diabetes. Which test is considered the most accurate in the evaluation of the effectiveness of diet and insulin therapy over time? 1-Blood pH 2-Serum protein level 3-Serum glucose level 4-Glycosylated hemoglobin
4-Glycosylated hemoglobin The glycosylated hemoglobin (GHb) test provides an accurate long-term index of the child's average blood glucose level for the 10- to 12-day period before the test; the more glucose the red blood cells were exposed to, the greater the GHb percentage. A high blood pH may indicate developing ketoacidosis, but it reflects short-term variations. Serum protein readings do not reflect the effectiveness of glucose management. Serum glucose readings reflect short-term (hours) variations.
