Medical Surgical Nursing Chapter 49 Diabetes Mellitus

After giving 6 oz of orange juice to a patient with hypoglycemia, the nurse finds that the patient's blood glucose level is 65 mg/dL. What would be the most appropriate nursing action in this situation? 1 Giving 15 g of carbohydrate 2 Administering 5% to 10% dextrose infusion 3 Giving 25 to 50 mL of 50% glucose intravenously 4 Administering 1 mg intramuscular (IM) glucagon

1 A patient with a blood glucose level less than 70 mg/dL should be given 15 g of carbohydrates (5 to 6 oz of fruit juice) initially. If the glucose is still less than 70 mg/dL, then another 15 g of carbohydrates should be given. Dextrose (5% to 10%) is added to the fluid regimen in patients who are on treatment for diabetic ketoacidosis if the blood glucose level approaches 250 mg/dL. Administering 25 to 50 mL of 50% glucose intravenously and 1 mg IM glucagon is indicated for an unconscious patient or if the symptoms of hypoglycemia are worsening. Text Reference - p. 1179

Which complication of diabetes can cause hypoglycemic unawareness? 1 Diabetic neuropathy 2 Diabetic dermopathy 3 Diabetic ketoacidosis 4 Diabetic nephropathy

1 Autonomic neuropathy is a type of diabetic neuropathy. Autonomic neuropathy can affect all the systems in the body leading to hypoglycemic unawareness. Diabetic dermopathy may cause acanthosis nigricans and necrobiosis lipoidica diabeticorum. Diabetic ketoacidosis may cause dehydration, metabolic acidosis, and electrolyte disturbance. Diabetic nephropathy leads to reduction in the glomerular filtration rate of the kidneys. Text Reference - p. 1183

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? 1 Cheese 2 Broccoli 3 Chicken 4 Oranges

1 Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes. Text Reference - p. 1166

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 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. 1157

The nurse is assigned to care for a patient with type 2 diabetes. To encourage the patient to become an active participant in his or her care, what action should the nurse take? 1 Assess the patient's understanding of the disease 2 Make a list of food restrictions for proper diabetes management 3 Refer the patient to a nutritionist 4 Set long-term goals to decrease the risk of complications

1 For teaching to be effective, the first step is assessing the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. Food restrictions, nutritionist referral, and setting long-term goals can occur once the nurse is confident the patient understands what it means to have diabetes. Text Reference - p. 1171

The nurse has taught a patient who was admitted with diabetes, cellulitus, and osteomyelitis about the principles of foot care. The nurse determines that additional teaching is necessary when the patient makes which statement? 1 "Taking a hot bath every day will help with my circulation." 2 "I should avoid walking barefoot at all times." 3 "I should look at the condition of my feet every day." 4 "I need a podiatrist to treat my ingrown toenails."

1 Hot water may injure tissue related to decreased sensation and should be avoided. Patients with diabetes mellitus should inspect the feet daily for broken areas that are at risk for delayed wound healing, avoid walking barefoot, and have a podiatrist for foot care. Text Reference - p. 1184

After administering an intramuscular (IM) glucagon injection in an unconscious patient, why does the nurse turns the patient on the side? 1 To prevent aspiration 2 To avoid postural hypotension 3 To promote the patient's comfort 4 To help the patient regain consciousness

1 IM glucagon is administered for hypoglycemia. Because nausea is a common reaction after glucagon injection, the patient should be turned to one side until gaining consciousness in order to prevent aspiration if vomiting occurs. Because the patient is unconscious, turning to the side will not promote the patient's comfort. The patient who is unconscious due to severe hypoglycemia will regain consciousness due to administration of the glucagon injection. Text Reference - p. 1180

The nurse is reviewing laboratory results for the patient with diabetes and coronary artery disease. Which laboratory result would help predict possible macrovascular disease as a complication of diabetes? 1 Increased low-density lipoproteins 2 Decreased blood urea nitrogen 3 Increased white blood cell count 4 Decreased C-reactive protein

1 Increased low-density lipoprotein levels are associated with the macrovascular changes in diabetes mellitus. For this reason, the patient should limit the amount of fat in the diet. A decreased blood urea nitrogen or C-reactive protein is not clinically significant. An increased white blood cell count would indicate infection. Text Reference - p. 1181

What is a risk factor associated with macrovascular complications of diabetes mellitus? 1 Obesity 2 Seizures 3 Hypovolemia 4 Adrenal insufficiency

1 Obesity increases the risk for blood vessel and cardiovascular disease. Hypoglycemia, if untreated, results in seizures and coma. Hypovolemia, due to excessive dehydration, may lead to shock. Patients with adrenal insufficiency may have minimal glycogen stores and may not respond to glucagon therapy. Text Reference - p. 1181

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 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. 1155

While caring for a patient with diabetic ketoacidosis, the nurse finds that the patient is experiencing rapid, deep breathing due to dyspnea. Which physiologic cause does the nurse suspect? 1 Altered pH balance 2 Dry mucous membranes 3 Increased serum osmolality 4 Increased endogenous insulin secretion

1 Rapid, deep breathing due to dyspnea is a characteristic feature of Kussmaul respirations, which occur due to metabolic acidosis. Altered pH balance in the body is responsible for metabolic acidosis. Dry mucous membranes are one of the manifestations of severe dehydration. Increased serum osmolality results in neurologic manifestations such as somnolecence, coma, seizures, hemiparesis, and aphasia in patients with hyperosmolar hyperglycemic syndrome (HHS). Increased endogenous insulin secretion results in hypoglycemia. Text Reference - p. 1176

The patient with diabetes should consume fiber as part of a healthy diet. The current recommendation for persons with diabetes is 1 25 to 30 g/day 2 20 to 25 g/day 3 40 to 50 g/day 4 10 to 20 g/day

1 The American Diabetes Association (ADA) recommends that diabetics consume 25 to 30 grams of fiber daily. This is the same level recommended for the nondiabetics, because there is no evidence that a higher intake of fiber is essential. Forty to 45 grams is too much fiber for the patient to consume, and 10 to 25 grams is not enough fiber. Text Reference - p. 1166

The nurse is evaluating the teaching session on nutrition for the newly diagnosed diabetic patient. Which statement indicates an understanding of the teaching? 1 "When my blood sugar is less than 70 mg/dL, I will take 15 grams of a fast-acting carbohydrate, such as orange juice, and recheck in 15 minutes." 2 "When my blood sugar is less than 70 mg/dL I will drink 8 ounces of milk and recheck in 15 minutes." 3 "I will eat a few hard candies when my blood sugar is less than 70 and recheck in 15 minutes." 4 "When my blood sugar is less than 70 mg/dL, I will take 3 to 4 sugar tablets and recheck in 30 minutes."

1 The patient understands the need for a fast acting sugar and the need to recheck in 15 minutes. Milk is not a fast-acting carbohydrate, so it will take longer for the low blood sugar to stabilize. The patient's statement about the hard candies does not indicate that the patient understands the need for 15 to 20 grams of carbohydrates. Rechecking blood sugar in 30 minutes is waiting too long to check blood sugar. Text Reference - p. 1179

One of the unlicensed assistive personnel (UAP) reports to the nurse that a patient with diabetes is slow to respond, pale, and diaphoretic. What is the nurse's priority intervention? 1 Obtain a bedside glucose reading. 2 Ask patient to drink 4 ounces of orange juice. 3 Ask the unlicensed assistive personnel (UAP) to obtain a set of vital signs. 4 Administer 50 mL of 50% dextrose intravenously.

1 The patient with diabetes is exhibiting signs and symptoms of hypoglycemia. The priority intervention at this time is to validate assessment findings with a bedside glucose reading. Although vital signs may add to assessment data findings, they are not as much a priority as validating hypoglycemia and initiating treatment. Because the patient is experiencing a change in level of consciousness, management of the hypoglycemia via oral nourishment is contraindicated. If the patient has an existing intravenous (IV) line, then treatment of documented hypoglycemia with intravenous dextrose may be indicated. Text Reference - p. 1179

Which drug does the nurse expects to be beneficial in a patient with type 2 diabetes who has the presence of albumin in the urine? 1 Lisinopril 2 Duloxetin 3 Pregabalin 4 Bethanechol

1 The presence of albumin in the urine indicates nephropathy in patients with diabetes. Angiotensin converting enzyme inhibitors such as lisinopril may delay the progression of nephropathy in diabetic patients. Duloxetin is a selective serotonin reuptake inhibitor, that is used for symptomatic treatment of sensory neuropathy. Pregabalin is an antiseizure medication used for neuropathic pain in diabetic patients. Bethanechol is a cholinergic agonist that is indicated for the treatment of neurogenic bladder. Text Reference - p. 1182

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 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 - p. 1155

The nurse is caring for a patient in an outpatient diabetes clinic. Which statement by the patient indicates an understanding of the teaching? 1 "I will be sure to measure my finger stick blood glucose level four times a day, and more frequently when I am ill." 2 "When I am ill, I will eliminate my Lantus insulin and only cover my finger stick blood glucose if it is over 250." 3 "When I am ill, I will continue to take my Lantus insulin only." 4 "When I am ill I will only take my rapid acting insulin."

1 When a patient with diabetes is ill, it is recommended he or she continues checking blood sugar every four hours and more frequently to prevent hyperglycemia and hypoglycemia during illness. The diabetic patient should adhere to the sick day rules, which indicate to continue with your basal dosing of insulin and continue to correct a finger stick blood sugar greater than 200. The patient also should be checking urine ketones for two blood sugars over 250 in a row. Text Reference - p. 1168

What are the symptoms of peripheral arterial disease? Select all that apply. 1 Cold feet 2 Loss of hair 3 Dependent rubor 4 Urinary retention 5 Bowel incontinence

1, 2, 3 Peripheral arterial disease causes decreased blood flow to the lower extremities. Cold feet, loss of hair, and dependent rubor are the signs of peripheral arterial disease. Urinary retention and bowel incontinence are symptoms of autonomic neuropathy. Text Reference - p. 1184

The nurse is providing discharge instructions to a patient who has a neurogenic bladder. Which self-care activities would the patient identify to facilitate bladder emptying to help prevent urinary stasis and infection? Select all that apply. 1 Sitting to void 2 Using the Credé maneuver when voiding 3 Emptying the bladder at least three times a day 4 Tightening the abdominal muscles when voiding 5 Maintaining a fluid restriction of 1200 mL per day

1, 2, 4 Sitting to void, the Credé maneuver, and tightening the abdominal muscles when voiding all aid in fully emptying the bladder, which will help to prevent urinary stasis and infection. The patient should also empty the bladder every three hours. Fluid restriction will not aid in emptying the bladder. Text Reference - p. 1183

A nurse caring for a patient with type 1 diabetes encourages the patient to exercise regularly as part of diabetes management. What precautions should the patient take when exercising? Select all that apply. 1 Exercise after meals. 2 Have a warm-up and cool-down period. 3 Avoid carbohydrate snacks during exercise. 4 Carry glucose tablets or hard candies when exercising. 5 Avoid exercise if blood glucose is equal to 120 mg/dL.

1, 2, 4 The nurse should inform the patient to exercise one hour after meals when blood sugar levels are rising. The exercise program should be started gradually and increased slowly, with a warm-up and cool-down period. Patients using medications are at a risk for hypoglycemia when exercising and should always carry a fast-acting source of carbohydrate such as glucose tablets or hard candies or eat small carbohydrate snacks every 30 minutes when exercising. If blood glucose is less than or equal to 100 mg/dL, the patient should retest blood glucose levels after a 15-g carbohydrate snack. The patient should then exercise if glucose levels increase after 15 to 30 minutes. Text Reference - p. 1167

A nurse in the outpatient setting is teaching a patient about the importance of self-monitoring of blood glucose (SMBG) using a glucometer. What should the nurse tell the patient? Select all that apply. 1 Test blood glucose whenever hypoglycemia is suspected. 2 Test blood glucose before and after exercise. 3 Take a blood sample immediately after a meal. 4 Take a blood sample from the side of the finger pad. 5 Wash hands in cold water when preparing to puncture.

1, 2, 4 The nurse should instruct the patient to test blood glucose levels whenever hypoglycemia is suspected so that immediate action can be taken. The patient should test blood glucose before and after exercise to determine the effects of exercise on metabolic control. Blood sample should be taken from the side of the finger pad rather than near the center, because there are fewer nerve endings along the side of the finger. Blood glucose is generally tested two hours after a meal to determine if the bolus insulin dose was adequate for the meal. Blood glucose may also be tested before a meal by patients who use insulin pumps or multiple daily injections and base the insulin dose on the carbohydrates in a meal or make adjustments if the preprandial value is above or below target. Hands should be washed in warm water before the finger puncture is made to in order to promote blood flow to the fingers. Text Reference - p. 1168

The nurse is preparing an educational session on Type 2 diabetes for the public. Which symptoms of type 2 diabetes would the nurse include in the presentation? Select all that apply. 1 Fatigue 2 Polyuria 3 Weight loss 4 Visual changes 5 Recurrent infections

1, 2, 4, 5 The onset of type 2 diabetes usually is delayed, resulting in chronic complications having already manifested. The patient will have slower wound healing and infection healing, fatigue, and visual changes as a result of the disease progression. Some patients with type II diabetes may have polyuria. Weight loss is typically seen with type I diabetes. Text Reference - p. 1157

The nurse is providing education to a patient that is diagnosed with diabetes mellitus (DM). What instructions are appropriate for the nurse to include in the teaching? Select all that apply. 1 "You should decrease your dietary sugar intake." 2 "I will teach you how to self-administer your insulin." 3 "It is important to consume a diet that is high in fats." 4 "It is important for you to reduce your physical activity." 5 "You should monitor your blood sugar as prescribed."

1, 2, 5 The nurse should teach the patient to decrease dietary sugar intake, self-administer insulin, and regularly monitor blood glucose levels as prescribed. A high-fat diet increases the patient's cholesterol levels and may increase the blood sugar levels. Reduction of physical exercise can also lead to increase in blood glucose level. Text Reference - p. 1175

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? Select all that apply. 1 The level may be increased as a result of dehydration that accompanies hyperglycemia. 2 The patient may be excreting extra sodium and retaining potassium because of malnutrition. 3 The level is consistent with renal insufficiency that can develop with renal nephropathy. 4 The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. 5 This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.

1, 3, 4 The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control. Text Reference - p. 1172

Which symptoms may be observed in patients with diabetic ketoacidosis? Select all that apply. 1 Hypovolemia 2 Volume overload 3 Visual disturbances 4 Soft and sunken eyes 5 Sweet fruity odor of breath

1, 4, 5

Which conditions may lead to a coma in patients with diabetic ketoacidosis if left untreated? Select all that apply. 1 Dehydration 2 Hypoglycemia 3 Cerebral edema 4 Metabolic acidosis 5 Electrolyte imbalance

1, 4, 5 Dehydration, metabolic acidosis, and electrolyte imbalance may lead to a coma if untreated. Hypoglycemia and cerebral edema are not associated with coma in patients with diabetic ketoacidosis. Text Reference - p. 1176

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/m2 and 8% A1C? 1 Insulin therapy 2 Bariatric surgery 3 Nutritional therapy 4 Pancreas transplantation

2 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. 1170

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 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. 1154

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 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 - p. 1166

The nurse provides education to a patient with type 1 diabetes. Which statement made by the patient indicates a need for further instruction? 1 "I'll have a snack available when I exercise." 2 "I'll check my blood sugar level after every meal." 3 "I'll eat my meals and snacks at regular times every day." 4 "I'll start learning how to make high-fiber, low-fat foods."

2 Fingerstick blood glucose testing should be performed before meals. Checking the blood glucose after meals will yield inaccurate results. This is of essential concern if the patient is basing insulin dosage on fingerstick blood glucose results. Having a snack nearby during exercise, eating meals and snacks at regular times, and eating high-fiber, low-fat foods are all correct in regard to diabetes management. Text Reference - p. 1169

Which complication of diabetes mellitus can be monitored by fundus photography? 1 Neuropathy 2 Retinopathy 3 Nephropathy 4 Dermatopathy

2 Fundus photography helps to examine the interior surface of the eye (fundus). Therefore, fundus photography helps to detect the microvascular damage caused by chronic hyperglycemia to the retina, known as retinopathy. Neuropathy can be monitored by a comprehensive foot examination. Diabetic nephropathy can be monitored by checking for microalbuminuria and serum creatinine. Dermatopathy can be monitored by frequent skin examinations. Text Reference - p. 1181

Which statement by a patient shows ineffective learning about diabetes management? 1 "I will exercise daily." 2 "I will drink fruit juices daily." 3 "I will walk wearing shoes daily." 4 "I will have yearly influenza vaccination."

2 Having fruit juices daily does not help in diabetes management, because it contains sugars that are easily absorbed. Exercising daily helps to maintain good health. Wearing shoes daily will avoid injuries to feet, which is important, because wound healing is delayed in diabetic patients. Diabetic patients have weakened immune systems and are more prone to flu. Therefore, annual vaccination against influenza is required. Text Reference - p. 1175

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 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 byproduct. Hyperglycemia, issues with serum potassium, and issues with serous osmolarity are seen in both HHNKS and DKA. Text Reference - p. 1178

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 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 - p. 1156

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: 1 A 20-pound weight loss 2 Hemoglobin A1C of 5.5% 3 Reduction of total cholesterol to 200 mg/dL 4 Decrease in polyuria, polydipsia, and polyphagia

2 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. 1157

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include? 1 Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. 2 Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. 3 Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. 4 Macroangiopathy causes slowed gastric emptying and the sexual impotence experienced by a majority of patients with diabetes.

2 Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotence and slowed gastric emptying result from microangiopathy and neuropathy. Text Reference - p. 1181

The nurse is conducting a teaching session about nephropathy as a complication of diabetes. Which information would be appropriate for the nurse to include in the session? 1 Vessels may begin to bleed, resulting in permanent blindness. 2 Controlling blood sugar and blood pressure will reduce the risk of kidney injury. 3 Organ damage resulting from changes in large and medium-sized blood vessels can be prevented by careful glucose control. 4 This will not occur if one does not require insulin to control diabetes.

2 Microangiopathy occurs in diabetes mellitus. When the kidneys are affected, the patient has nephropathy. Maintaining control of blood sugar and blood pressure will decrease microvascular organ damage and help to preserve kidney function. Blindness occurs as a result of microvascular damage, not bleeding. Organ damage is caused from small vessel damage. Regardless of the treatment type, nephropathy can occur if blood sugars are not controlled properly. Text Reference - p. 1181

Which process is related to nonproliferative retinopathy? 1 Hemorrhage 2 Microaneurysm 3 Neovascularization 4 Retinal detachment

2 Partial occlusion of the small blood vessels in the retina causes microaneurysms in nonproliferative retinopathy. Hemorrhage is seen in proliferative retinopathy because of fragile, newly formed blood vessels. In proliferative retinopathy, the retinal capillaries become occluded, resulting in the formation of new vessels. This process is called as neovascularization. Partial or complete retinal detachment occurs if the new blood vessels pull the retina while the vitreous contract. Text Reference - p. 1181

A patient with type 1 diabetes mellitus has received a prescription for propranolol. What does the nurse recognize as the major concern for this patient? 1 Frequent night sweats 2 Lessened ability to sense hypoglycemia 3 More frequent episodes of hyperglycemia 4 The need for an increased basal insulin dosage

2 Patients who are hypoglycemic experience a drop in blood glucose level below normal and most often complain of weakness, nervousness, tremors, and diaphoresis. Propranolol (Inderal) can mask hypoglycemia-induced tachycardia, thereby decreasing the diabetic patient's ability to sense a drop in blood sugar. Propranolol does not cause night sweats or require an increased insulin dosage. Diabetic and nondiabetic patients may notice a slight increase in blood sugar, but this is not as significant a priority as the patient's not being able to sense hypoglycemia. Text Reference - p. 1175

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? 1 "I should only walk barefoot in nice dry weather." 2 "I should look at the condition of my feet every day." 3 "I am lucky my shoes fit so nice and tight because they give me firm support." 4 "When I am allowed up out of bed, I should check the shower water with my toes."

2 Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. The patient should not walk barefoot. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first. Text Reference - p. 1173

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 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. 1163

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 The fasting blood glucose level of a patient with prediabetes may range from 100 to 125 mg/dL. The normal blood glucose level ranges 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. 1156

A patient with type 2 diabetes mellius (DM) receives a prescription for metformin. The nurse identifies that which statement is characteristic of this medication? 1 It causes weight gain. 2 It decreases hepatic glucose production. 3 It should not be given with sulfonylureas. 4 It is inappropriate for initial management of type 2 DM.

2 The primary action of metformin is to reduce glucose production by the liver. Metformin often causes weight loss instead of weight gain. Metformin can be administered in conjunction with sulfonylureas. Metformin is preferred for the initial management of type 2 diabetes. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1163

Which class of drugs used to treat diabetes mellitus (DM) may be referred to as "insulin sensitizers"? 1 Sulphonylureas 2 Thiazolidinediones 3 α-glucosidase inhibitors 4 Dipeptidyl peptidase-4 (DPP-4) inhibitors

2 Thiazolidinediones are a class of drugs used to treat diabetes mellitus (DM). They are often referred to as an "insulin sensitizers." This class of drugs improves insulin sensitivity, transport, and utilization at target tissues. Sulphonylureas increase insulin production by the pancreas. α-glucosidase inhibitors slow down absorption of carbohydrate in the small intestine. DPP-4 inhibitors enhance the activity of incretins, which stimulate release of insulin from pancreatic βcells. This class of drug also decreases hepatic glucose production. Text Reference - p. 1163

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

2 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. 1154

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? 1 6:00 PM on the evening before the test 2 Midnight before the test 3 4:00 AM on the day of the test 4 7:00 AM on the day of the test

2 Typically, a patient is prescribed to be nothing by mouth (NPO) for eight hours before a fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 AM should not have any food or beverages containing any calories after midnight. Text Reference - p. 1157

Which drug may result in weight gain as a side effect? 1 Biguanides 2 Meglitinides 3 Dopamine agonist 4 Dipeptidyl peptidase-4 inhibitors

2 Weight gain is a common side effect seen with meglitinides. Biguanides, dopamine agonists, and dipeptidyl peptidase-4 inhibitors may not result in weight gain. Text Reference - p. 1164

Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis? 1 Electrolytes 2 Insulin therapy 3 Sodium bicarbonate 4 Intravenous (IV) fluid

2 When the body cannot utilize glucose for energy, it burns fat for energy resulting in the production of ketones. Insulin therapy is useful for reducing the serum ketone levels. Electrolytes are given to correct the electrolyte imbalance. Sodium bicarbonate is given to treat metabolic acidosis. IV fluids are indicated for correction of dehydration. Text Reference - p. 1178

The nurse is monitoring a family caregiver who is learning to inject pramlintide prescribed for glucose control. The nurse should intervene when noting which caregiver action? 1 Gently rolling the insulin vial before drawing up prescribed dose. 2 Preparing the injection site on the back of the arm with an alcohol wipe. 3 Injecting air equal to prescribed dose into vial before withdrawing dose. 4 Drawing up pramlintide in separate syringe from other mealtime insulin prescribed.

2 Pramlinitide is administered subcutaneously before major meals. Because of the variation of absorption from injection sites in the arm, only the thigh or abdomen are appropriate sites for this medication. Gently rolling an insulin vial before drawing up a dose aids in mixing insulin solution. To ease in withdrawal of the dose, adding equal amounts of air into the vial before removing dose will equalize pressure within the vial. Pramlintide should not be mixed in the same syringe with any other insulin. Text Reference - p. 1165

What are the clinical manifestations of type 1 diabetes mellitus? Select all that apply. 1 Fatigue 2 Excessive thirst 3 Frequent urination 4 Recurrent infections 5 Unexplained weight loss

2, 3, 5 Excessive thirst, frequent urination, and unexplained weight loss are clinical symptoms of both type 1 and type 2 diabetes mellitus. Fatigue and recurrent infections are clinical manifestations of type 2 diabetes. Text Reference - p. 1157

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, 4, 5, 6 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 - p. 1154

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

3 An A1C level of 5.5 % 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% 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. 1157

The nurse is preparing the care plan for a patient with diabetes who is on bromocriptine therapy. Which intervention included in the care plan will be beneficial for the patient? 1 Providing vitamin K-rich food 2 Monitoring serum thyroid levels 3 Assisting the patient when changing position 4 Monitoring for the symptoms of myocardial infarction

3 Bromocriptine is a dopamine agonist that may cause orthostatic hypotension, which in turn causes the patient to become dizzy when changing position. Therefore, the nurse should assist the patient when changing position to prevent accidental falls. Bromocriptine does not reduce absorption of vitamin K. Hence, the nurse does not provide vitamin K-rich food to the patient. The nurse does not monitor thyroid hormone levels, because bromocriptine does not impair thyroid functioning. Bromocriptine does not increase the risk of myocardial infarction. Text Reference - p. 1163

A 45-year-old woman with a body mass index (BMI) of 35 kg/m2 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 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. 1157

A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? 1 Central apnea 2 Hypoventilation 3 Kussmaul respirations 4 Cheyne-Stokes respirations

3 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. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis. Text Reference - p. 1175

An 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 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 - p. 1156

Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis? 1 Polyuria 2 Hypokalemia 3 Cerebral edema 4 Metabolic acidosis

3 Incorrect fluid replacement especially with hypotonic fluids may cause a sudden drop in serum sodium resulting in cerebral edema. Polyuria is a manifestation of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Hypokalemia may be seen with severe dehydration. Metabolic acidosis is observed with diabetic ketoacidosis due to fluid losses. Text Reference - p. 1178

A nurse is reviewing the laboratory findings of a diabetic patient. What condition does the nurse suspect? 1 Diabetic retinopathy 2 Diabetic neuropathy 3 Diabetic ketoacidosis 4 Diabetic nephropathy

3 Laboratory findings of blood glucose level greater than 250 mEq/L, arterial blood pH less than 7.30, serum bicarbonate level less than 16 mEq/L, and the presence of moderate to large ketone bodies in the urine or serum indicate diabetic ketoacidosis. Diabetic retinopathy is microvascular damage to the retina; it may not be associated with these manifestations. Diabetic neuropathy is nerve damage due to diabetes mellitus. Diabetic nephropathy is damage to nephrons due to hyperglycemia. Text Reference - p. 1176

A patient is prescribed lispro therapy. Related to meal times, the nurse should instruct the patient to administer the insulin when? 1 On an empty stomach, between meals 2 Simultaneously with a meal 3 15 minutes after a meal 4 30 to 45 minutes before a meal

3 Lispro is a rapid-acting synthetic insulin that has an onset of action of approximately 15 minutes. Lispro should be administered 15 minutes after mealtime because its rapid action closely mimics natural insulin secretion in response to a meal. Lispro is not administered on an empty stomach or simultaneously with a meal. Short-acting regular insulin, not rapid-acting synthetic insulin, is administered 30 to 45 minutes before a meal to ensure the onset of action coincides with meal absorption. Text Reference - p. 1160

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse tell the patient to best explain how this medication works? 1 Increases insulin production from the pancreas 2 Slows the absorption of carbohydrate in the small intestine 3 Increases rate of hepatic glucose production; augments glucose uptake by tissues, especially muscles 4 Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying

3 Metformin is a biguanide that increases the rate of hepatic glucose production and augments glucose uptake by tissues, especially muscles. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying. Text Reference - p. 1164

Which drug is used for treating neurogenic bladder? 1 Valsartan 2 Gabapentin 3 Bethanechol 4 Amitryptyline

3 Neurogenic bladder may develop as a sensation in the inner bladder wall causing urinary retention. A cholinergic agonist drug such as bethanechol is used for treating this condition. Valsartan is an angiotensin receptor blocker that is used in patients with diabetes and microalbuminuria. Gabapentin is an antiseizure medication used for treating neuropathic pain. Amitryptyline is a tricyclic antidepressant used in the treatment of neuropathic pain. Text Reference - p. 1183

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 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 - p. 1156

A patient diagnosed with diabetes mellitus is suspected of having insulin resistance. The nurse identifies that which medication would be most beneficial for the patient? 1 Glipizide 2 Acarbose 3 Piogltazone 4 Repaglinide

3 Pioglitazone, a thiazolidinedione, is used to improve insulin sensitivity in patients having insulin resistance. Glipizide, a sulfonylurea, is prescribed to stimulate insulin production. Acarbose, an α-glucosidase inhibitor, is used to lower postprandial blood glucose. Repaglinide, a meglitinide, stimulates insulin production in the pancreas. Text Reference - p. 1163

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? 1 8:40 PM to 9:00 PM 2 9:00 PM to 11:30 PM 3 10:30 PM to 1:30 AM 4 12:30 AM to 8:30 AM

3 Regular insulin exerts peak action in two to five hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 to 30 minutes, with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM. Text Reference - p. 1159

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

3 Skeletal muscles have specific receptors, which 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 - p. 1154

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 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. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1163

Which complication of diabetes can be diagnosed by the ankle-brachial index? 1 Diabetic neuropathy 2 Diabetic nephropathy 3 Peripheral arterial disease 4 Hyperosmolar hyperglycemic syndrome

3 The ankle-brachial index is used to diagnose peripheral arterial disease. Diabetic neuropathy is diagnosed based on the symptoms and by examining the patient's lower extremities. Increased serum creatinine, decreased glomerular filtration rate, and albuminuria is indicative of diabetic nephropathy. Hyperosmolar hyperglycemic syndrome is suspected if the blood glucose levels are more than 600 mg/dL, with a marked increase in serum osmolality. Text Reference - p. 1184

The nurse is discussing a healthy eating plan for a patient with diabetes. What should the nurse include in the teaching about diabetes and diet? 1 Avoid nonnutritive sweeteners. 2 Consume a high-protein diet for weight loss. 3 Consume carbohydrates with alcohol. 4 Include 50-60 g/day of dietary fiber.

3 The nurse should inform the patient to eat carbohydrates when drinking alcohol to reduce the risk for alcohol-induced hypoglycemia. Nutritive and nonnutritive sweeteners may be included in a healthy meal plan in moderation. The amount of daily protein in the diet for people with diabetes should be 15% to 20% of the total calories consumed. High-protein diets are not recommended as a weight loss method for people with diabetes. There is no evidence that a person with diabetes should consume more fiber than an individual who does not have diabetes. The current recommendation for the general population is 25 to 30 g/day. Text Reference - p. 1166

Which statement by a patient indicates an insufficient understanding of the prescribed medication metformin? 1 "I should take this medication in the morning with breakfast." 2 "I will need to have my hemoglobin A1c level checked in three months." 3 "I may have diarrhea with this medication but I should not stop taking it." 4 "I will take this medication when my blood sugar is greater than 200 mg/dL."

4 Metformin should be taken daily for diabetes control; it is not indicated for as-needed use. It should be taken with breakfast and may initially cause diarrhea, which will resolve. Text Reference - p. 1164

Which intervention may help prevent further complications in an unconscious patient with a history of diabetes whose blood sugar level is found to be 65 mg/dL? 1 Administering 100 mL of whole milk orally 2 Administering 15 g of fast-acting carbohydrate orally 3 Administering 25 to 50 mL of 50% glucose intravenously 4 Administering 20 to 40 U of 30/70 insulin subcutaneously

3 The patient should be immediately administered 25 to 50 mL of 50% glucose intravenously, which would rapidly raise the glucose concentration in the blood stream. An oral route of administration of fast-acting carbohydrate is not appropriate in an unconscious patient. Treatment with carbohydrate that contains fats, such as whole milk, should be avoided, because the fat will decrease the absorption of glucose and delay the response. Insulin is to be administered in patients with hyperglycemia. Text Reference - p. 1179

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 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. 1157

The nurse is caring for a patient diagnosed with diabetes mellitus (DM) who has developed insulin resistance. Which class of glucose-lowering agents can reduce insulin resistance? 1 DPP-IV inhibitors 2 Dopamine agonists 3 Thiazolidinediones 4 α- glucosidase inhibitors

3 Thiazolidinediones are often referred to as "insulin sensitizers." These agents improve insulin sensitivity, transport, and utilization at target tissues. Because they do not increase insulin production, thiazolidinediones do not cause hypoglycemia when used alone. Examples of thiazolidinediones include rosiglitazone and piglitazone. DPP-IV inhibitors inactivate the hormone incretin. Dopamine agonists activate dopamine receptors and α- glucosidase inhibitors delay carbohydrate absorption in the small intestine. Text Reference - p. 1163

A patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? 1 Routine insulin therapy and exercise 2 Administer a different antibiotic for the UTI 3 Cardiac monitoring to detect potassium changes 4 Administer intravenous (IV) fluids rapidly to correct dehydration

3 This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement. Text Reference - p. 1178

After a teaching session with the registered nurse, the newly diagnosed patient with type 1 diabetes mellitus is correct when he or she makes which statement? 1 "If I lose weight, I will be able to stop taking insulin." 2 "My pancreas will produce more insulin as I recover." 3 "I will need to be medicated with insulin for the rest of my life." 4 "I will be able to take insulin pills once my blood sugar is stabilized.

3 Type 1 diabetes is caused by destruction of pancreatic β-cells, which causes permanent insulin insufficiency and eventual absence. Weight loss and recovery will not affect insulin production. Exogenous insulin is not absorbed in the GI system and therefore must be given parenterally. Text Reference - p. 1156

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 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 loss. Insomnia is not related to symptoms of undiagnosed diabetes. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." Text Reference - p. 1157

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 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 - p. 1156

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, 4, 5, 6 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. 1157

A patient whose laboratory report shows a blood glucose level of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 is on therapeutic management. At a follow-up visit, the patient has severe hypokalemia (2 mEq/L). Which therapeutic intervention might have caused severe hypokalemia in this patient? 1 Administration of 0.9% NaCl 2 Administration of 1 mg glucagon 3 Administration of 5% to 10% dextrose 4 Administration of 0.1 U/kg/hr of insulin

4 Blood glucose of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 indicates that the patient has diabetic ketoacidosis. Administration of 0.1 U/kg/hr of insulin is responsible for the severe hypokalemia. Administration of 0.9% NaCl is useful for fluid restoration in patients with dehydration. Administration of 1 mg glucagon is beneficial for patients with severe hypoglycemia; 5%-10% dextrose is added to the fluid regimen of diabetic ketoacidosis patients when blood sugar level approaches 250 mg/dL. Text Reference - p. 1176

A patient with diabetes experiences hypoglycemia. What does the nurse educate the patient that a cause of this condition may be? 1 Mild illness with fever 2 Insufficient injection of insulin 3 Overeating at a family holiday dinner 4 Exercise without a carbohydrate-based snack

4 Exercise without a carbohydrate-based snack could result in hypoglycemia. Mild illness, insufficient insulin dosage, and overeating are situations that would cause hyperglycemia, or an increased blood glucose level. Text Reference - p. 1167

A patient with type 2 diabetes mellitus (DM) is prescribed an oral hyperglycemic agent. The nurse provides the patient with a list of food items with a high glycemic index (GI). What should the nurse include on the list? 1 Baked beans, parboiled rice, and regular milk 2 Oatmeal with regular milk, sweet corn, and a cup of green pea soup 3 Apple, oat bran cereal with regular milk, and slices of raw sweet potatoes 4 Cornflake cereal with regular milk and white bread sandwich with potato stuffing

4 Glycemic index (GI) is the term used to describe the rise in blood glucose levels after a person consumes a food containing carbohydrates. Foods with high GI raise glucose levels higher and more quickly than foods with a low GI. Cornflake cereal, white bread, and potatoes have a GI above 70. Baked beans, parboiled rice, oatmeal, sweet corn, and green pea soup have a medium GI ranging from 56 to 69. Apples, oat bran cereal, regular milk, and raw sweet potatoes have a low GI of about 55 or less. Text Reference - p. 1166

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 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. 1157

The nurse has been teaching a patient newly diagnosed with diabetes mellitus to test his or her own blood glucose level. During evaluation of his or her technique, the nurse determines that the teaching has been adequate when the patient performs which task? 1 Reports control of diabetes is present when blood sugar level is less than 65 mg/dL. 2 Chooses a puncture site in the center of the finger pad. 3 Runs the hand under cool water for 30 seconds to cleanse the site. 4 Hangs the arm in the dependent position for one minute before puncturing.

4 Hanging the hand down will promote blood flow to the finger and allow for an adequate blood sample. A blood sugar of 65 mg/dL is considered low and does not necessarily mean the diabetes is well controlled. The patient should select a site on the side of a fingertip, not on the center of a finger pad, and the site should be washed with soap and warm water. Text Reference - p. 1168

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 ketonurea

4 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 - p. 1176

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 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. 1185

Which is an insulin-dependent diabetes? 1 Prediabetes 2 Gestational diabetes 3 Adult-onset diabetes 4 Juvenile-onset diabetes

4 Juvenile-onset diabetes is also known as type 1 diabetes. Type 1 diabetes is an insulin-dependent diabetes, because there is lack of insulin due to breakdown of islet cells. Prediabetes is a condition in which the blood glucose levels are above normal, but not enough to be diagnosed as diabetes. Gestational diabetes is seen during pregnancy; it may be insulin-dependent or non-insulin-dependent diabetes. Adult-onset diabetes is also known as type 2 diabetes. Type II diabetes is non-insulin-dependent diabetes, because some insulin is produced by the pancreas, but it is either insufficient for the needs of the body, poorly used by the tissues, or both. Text Reference - p. 1156

1 "I must limit fats in my diet to help prevent neuropathy." 2 "I should use a hot water bottle on my feet when they feel cold." 3 "I should have an eye examination at least once every two years for glaucoma screening." 4 "It is important that I take my blood pressure medication to help prevent kidney damage."

4 Patients with diabetes who have albumin in their urine should receive angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists to treat hypertension, which would also delay the progression of nephropathy. Dietary fat intake will not affect kidney function. Hot water bottle use increases the risk of tissue damage because of the diabetic's neuropathy and delayed healing. Diabetics should have an eye examination once a year to screen for retinopathy. Text Reference - p. 1181

A patient with a history of type 2 diabetes is diagnosed with heart failure. Which medication would be a poor choice for controlling the patient's diabetes? 1 Acarbose 2 Glyburide 3 Nateglinide 4 Pioglitazone

4 Pioglitazone can worsen heart failure. Therefore, it should be avoided in diabetic patients with heart failure. Glyburide, acarbose, and nateglinide are not contraindicated in heart failure patients. Text Reference - p. 1163

The nurse is caring for a diabetic patient with neurogenic bladder. What should the nurse tell the patient about emptying the bladder? 1 Empty the bladder every five hours. 2 Relax abdominal muscles during voiding. 3 Massage the lower abdomen horizontally. 4 Use the Credé maneuver to completely empty the bladder.

4 The nurse should instruct the patient with neurogenic bladder to use the Credé maneuver to completely empty the bladder; the Credé maneuver involves mild downward massage over the lower abdomen and bladder. The nurse should also instruct the patient to empty the bladder every three hours in a sitting position to prevent stasis and subsequent infection. The patient should tighten the abdominal muscles and massage the lower abdomen downward to empty the bladder completely. Text Reference - p. 1183

The nurse is teaching a patient with diabetes about proper dietary recommendations. The nurse determines that the patient understands the teaching when he or she makes which statement? 1 "I should increase my daily intake of saturated fat to decrease my blood sugar." 2 "I need more protein now that I have diabetes." 3 "I do not need to limit my alcohol intake as long as it is low in sugar." 4 "I should have no more than 60 grams of carbohydrates in each meal.

4 The percent of dietary calories that should be eaten as carbohydrates is 55% to 60%. Protein calories make up 12% to 20% of calories; less than 30% of calories should derive from fat. Each meal should contain 45 to 60 grams of carbohydrates; protein intake is unchanged, and saturated fat should be minimized. Alcohol intake should also be limited to one drink per day for women and two per day for men. Text Reference - p. 1165

A patient with type 2 diabetes takes oral hypoglycemics and is admitted to the hospital with a urinary tract infection (UTI). The patient asks why insulin injections have been prescribed. What explanation should the nurse provide? 1 Insulin acts synergistically with the antibiotic that was prescribed. 2 Insulin should have been prescribed for the patient to take at home. 3 Oral hypoglycemic medications are contraindicated in patients with UTIs. 4 The infection increases the glucose level, resulting in a need for more insulin.

4 When the body is under stress, as in an acute illness, the need for insulin is more than oral hypoglycemics can provide. Insulin injections are usually required until the illness resolves. Insulin does not act synergistically with antibiotics, the patient did not need insulin at home, and oral hypoglycemics are not contraindicated in patients with UTIs. Text Reference - p. 1175