NUR334 PrepU: Chapter 33-Diabetes Mellitus and the Metabolic Syndrome

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?

Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen.

A patient with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of the following might the nurse suggest as a long-acting insulin to provide a consistent basal level?

Glargine (Lantus).

An adolescent male with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which of the following responses by his mother is most accurate?

"Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road."

Which manifestation indicates a client is at risk for developing diabetes mellitus?

2 hour oral GTT 175 mg/dL.

A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by participants should the nurse follow up first?

"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."

The health care provider has prescribed Repaglinide 2 mg for a client diagnosed with type 2 diabetes. The most important information for the nurse to give the client would be:

"Take the medication 15 to 30 minutes before each meal."

Following an oral glucose tolerance, a 36 year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous pregnancies. What should her primary care provider tell her about this new health problem?

"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars."

A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2 diabetes mellitus? Select all that apply.

-Autoimmune beta cell damage. -Abrupt onset of symptoms. -Onset before age 20.

A woman in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate? Select all that apply.

-Insulin. -Glyburide.

A nurse is evaluating patients for the risk of developing type 2 diabetes. Which of the following patients has the highest risk?

A 45-year-old obese woman with a sedentary lifestyle.

A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?

Administration of 15 to 20 g of glucose in a concentrated carbohydrate source.

The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin?

Beta cells.

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause?

Blood glucose will elevate.

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which of these organs does the nurse recognize is reliant on glucose as the major energy source?

Brain.

A client with pancreatitis is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parental nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the patient for which clinical manifestations (listed below)?

Dry lips, excess urine output, and seizures.

A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first?

Check blood glucose.

Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes?

Complete failure of insulin secretion.

The family of a client in the hospital with diabetes mellitus out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond?

Glucose is unused without insulin, so body fats are used for energy.

Which of the following statements best describes an aspect of the normal process of glucose metabolism?

Glucose that exceeds metabolic needs is converted and stored by the liver.

A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

Glycosylated hemoglobin 5.2%.

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes. The best diagnostic indicator that would support the client's response would be:

Glycosylated hemoglobin, hemoglobin A1C (HbA1C).

When educating a patient about glargine (Lantus), the nurse should explain that this medication:

Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.

A patient has been admitted with diabetic ketoacidosis. The Emergency Department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which of the following clinical manifestations?

Headaches, dizziness, change in level of consciousness.

A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?

Helping the client make meaningful changes to his diet and activity level.

A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?

Hypoglycemia.

The diagnosis of type 1 diabetes would be confirmed by:

Insulin is not available for use by the body.

The nurse has just completed teaching a client newly diagnosed with type 1 diabetes about rapid-acting insulin. The nurse determines that teaching was effective when the client selects:

Lispro.

A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information?

Maintain healthy blood pressure and blood sugar levels.

A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided?

Orange juice orally.

The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary healthcare provider for further evaluation?

Random blood glucose 195 mg/dL.

A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

Random blood glucose 85 mg/dL.

A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 12.1 mmol/l and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?

Short acting.

Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?

Somogyi effect.

The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be:

The brain relies on blood glucose as its main energy source.

A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume?

The patient is achieving normal glycemic control.

The nurse is caring for a client with diabetes who has developed gastroparesis. Which of these symptoms does the nurse expect the client to report?

Vomiting after eating.

An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics?

Weight loss, glucose monitoring, and oral anti hyperglycemic medications.

The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which of these risk factors in the teaching?

Woman with a family history of diabetes.