2/23- 3rd test
A pt with untreated type I DM may lapse into a coma because of acidosis. an increased in which component in the blood is a direct cause of this type of acidosis a. ketones b. glucose c. lactic acid d. glutamic acid
a
a client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same result as a fingerstick. what is the nurse's best response to this question? a. there is no difference between readings b. these types of monitors are meant for children c. readings are on a different scale for each monitor d. faster readings can be obtained from a fingerstick
a
a nurse identifies that the client is experiencing a hypoglycemic reaction. which nursing intervention should the nurse implement to relieve the symptoms associated with this reaction? a. giving 4 oz pf fruit juice b. administering 5% dextrose c. withholding a subsequent dose of insulin d. providing a snack of cheese and dry crackers
a
which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? a monitoring for signs of hypoglycemia b. withholding glucose in any form until the situation is corrected c. giving fruit juices, broth, and milk as soon as the client is able to take fluids orally d. regulating insulin dosage according to the amount of ketones found int he cline't urine
a
a client with type DM I comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. the client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. which complications of insulin therapy should the nurse conclude that the client is experiencing? a. somogyi effect b. down phenomenon c. diabetic ketoacidosis d. hyperosmolar nonketotic syndrome
a
a diabetic pt is scheduled to have a blood glucose test the next morning. what does the nurse tell the pt to do before coming in for the test? a. eat the usuals diet but have nothing after midnight b. take the usual oral hypoglycemic tablet in the morning c. eat a clear liquid breakfast in the morning d. follow the usual diet and medication regimen
a
a nurse is caring for a client with diabetes who is scheduled for a radiographic study requiring contrast. which should the nurse expect the HCP to prescribe? a. acetylcysteine (Acetadote) before the test b. renal-friendly contrast medium for the test c. forced diuresis with mannitol (Osmitrol) after the test d. hydration with dextrose and water throughout the test
a
Which factors differentiate DKA from HHA? (Select all that apply) a. level of hyperglycemia b. amount of ketones produced c. serum bicarb levels d. amount of volume depletion e. dosage of insulin needed
ab
which are signs and symptoms of mild hypoglycemia? (Select all that apply) a. headache b. weakness c. cold, clammy skin d. irritably e. pallor f. tachycardia
abd
which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established? alpha-glucosidase inhibitors, which include miglitol (glyset) b. biguanides, which include metformin (glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)
b
which class of antidiabetic medication should be taken with the first bite of a meal to be fully effective? a. alpha-glucosidase inhibitors, which include miglitol (glyset) b. biguanides, which include metformin (glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)
b
why is glucose vital to the body's cells? a. it is used to build cell membranes b. it is used by cells to produce energy c. it affects the process of protein metabolism d. it provides nutrients for genetic material
b
The diabetic pt experiences early morning hyperglycemia (Somogyi effect) as result of the counter-regulatory response to hypoglycemia. what treatment does the nurse expect for this condition? (Select all that apply) a. administer a 10 pm dose of intermediate-acting insulin b. provide an evening snack to ensure adequate dietary intake c. evaluate insulin dosage and exercise program d. add an oral antidiabetic drug to patient's regimen e. increase blood glucose checks to every 2 hours around the clock
bc
a nurse is assessing a client with diagnosis of hypoglycemia. what clinical manifestation support this diagnosis? (Select all that apply) a. thirst b. palpation c. diaphoresis d. slurred speech e. hyperventilation
bcd
a ot has been diagnosed with DM. Which aspects does the nurse consider in formulation the teaching plan for this pt? (Select all that apply) a. covering all needed information in one teaching session b. assessing visual impairment regarding insulin labels an marking on syringes c. assessing manual dexterity to determine if the pt is able to draw insulin into a syringe d. assessing pt motivation to learn and comprehend instructions e. assessing the pt's ability to read printed material
bcde
in determining if a pt is hypoglycemic, the nurse looks for which characteristics in addition to checking the pt's blood glucose? (Select all that apply) a. nausea b. hunger c. iriitatbility d. palpitations e. profuse perspiration f. rapid, deep respirations
bcde
the nurse is providing discharge teaching to a patient about self- monitoring of blood glucose (SMBG). what information does the nurse include? (Select all that apply) a. only perform SMBG before breakfast b. wash hands before using the meter c. do a retest if the results seem unusual d. it is okay to reuse lancets In the home setting e. do not share the meter
bce
Which insulins are considered to have a rapid onset of action? (Select all that apply) a. Novolin 70/30 b. Glulisune c. Humulin N d. Aspart e. Lispro
bde
a nurse is caring for a client newly diagnosed with DM I. when the HCP tries to regulate this client's insulin regimen, the client experiences episodes of hypoglycemia and 15 g of a simple sugar is prescribed. what is the reason this is administered when a client experiences hypoglycemia? a. inhibits glycogensis b. stimulates release of insulin c. increases blood glucose levels d. provides more storage of glucose
c
a nurse is monitoring a client's fasting plasma glucose level. at which FPG level should the nurse identify that the client has prediabetes? a. 70 mg/dl b. 100 mh/dl c. 130 mg/dl d. 160 mg/dl
c
a pt has been receiving insulin in the abdomen for 3 days. on day 4, where does the nurse give the insulin injection? a. deltoid b. thigh c. abdomen, but in an area different from the previous day's injections d. abdomen, in the same are as the previous day's injections
c
after a 2-hour glucose challenge, which result demonstrated impaired glucose tolerance? a. less than 100 mg/dL b. less than 140 mg/dL c. greater than 140 mg/dL d. greater than 250 mg/dL
c
in pt with hylergylcemia, the respiratory center is triggered in an attempt to excrete more carbon dioxide and acid, thus causing a rapid and deep respiratory pattern. What is the term for this respiratory pattern? a. tachypnea b. Cheyne-Stokes respiration c. Kussmaul respiration d. Biot respiration
c
what type of insulin is used in the emergency treatment of DKA and HHNS a. NPH b. lente c. regular d. protamine zinc
c
which oral agent may cause lactic acid? a. Nateglinide b. Repaglinide c. metformin d. miglitol
c
which statement is true about insulin? a. it is secreted by alpha cells in the islets of Langerhans b. it is a catabolic hormone that builds up glucagon reserves c. it is necessary for glucose transport across cell membranes d. it is stored in muscles and converted to fat for storage
c
a n nurse is caring for a client with DM I and the hip prescribes one tube of glucose gel. what is the primary reason for the administration of glucose gel to this client? a. diabetic acidosis b. hyperinsulin secretion c. insulin-induced hypoglycemia d. idiosyncratic reactions to insulin
ca
a nurse is collecting information about a client who has those I DM and who is being admitted because of DKA coma. which factors can predispose a client to this condition? SELECT ALL THAT APPLY a. taking too much insulin b. getting too much exercise c. excessive emotional stress d. running a fever with the flu e. eating fewer calories than prescribed
cd
a nurse is caring for a client admitted to the hospital for DKA. which clinical findings related to this event should the nurse document in the client's clinical record? SELECT ALL THAT APPLY a. sweating b. retinopathy c. acetone breath d. increased arterial bicarb level e. decreased arterial carbon dioxide level
ce
a 25-year-old female pt with type I DM tells the nurse, "I have two kidneys and im still young. I expect to be around for a long time, so why should I worry about my blood sugar?" what is the nurse's best response? a. you have little to worry about as long as your kidneys keep making urine b. you should discuss this with your physician because you are being unrealistic c. you would be right if your diabetes was managed with insulin d. keeping your blood sugars under control now can hep to prevent damage to both kidneys
d
a client's blood gases reflect DKA. which clinical indicator should the nurse expect to identify when monitoring this client's laboratory values? a. increased pH b. decreased PO2 c. increased PCO2 d. decreased HCO3
d
a client's problem with ineffective control of DM I is identified when a sudden decreases in blood glucose level is followed by a rebound hyperglycemia. what should the nurse do when this event occurs? a. give the client a glass of OJ b. seek an order to increase the insulin dose at bedtime c. encourage the client to eat smaller, more frequent meals d. collaborate with the HCP to alter the insulin prescription
d
a pt is diagnosed with DKA. which insulin should the nurse expect the HCP to prescribe? a. Insulin Lispro (Humalog) b. Insulin glargine (Lantus) c. NPH insulin (Novolin N) d. Regular insulin (Novolin R)
d
Which are modifiable risk factors for type 2 DM? (Select all that apply) a. age b. family history c. working in a low-stress environment d. maintaining ideal body weight e. maintaining adequate physical activity
de
a nurse is caring for several clients with type I DM and they each have a prescription for a specific type of insulin. which insulin does the nurse conclude has the fastest onset of action? a. insulin lispro b. insulin glargine c. NPH insulin d. regular insulin
a
a nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. what information should the nurse include in the discussion about what causes diabetic acidosis? a. breakdown of fat stores for energy b. ingestion of too many highly acidic foods c. excessive secretion of endogenous insulin d. increased amounts of cholesterol in the extracellular compartment
a
a pt admitted to the ER has ketones in the blood and urine. which situation associated with this physiologic finding should be the nurse's focus when collecting addition data about this pt? a. starvation b. alcoholism c. bone healing d. positive nitrogen balance
a
a pt is admitted to the hospital with a diagnosis of DKA. what is the initial intervention that the nurse should expect the HCP to prescribe for this client? a. IV fluids b. potassium c. NPH insulin (Novolin N) d. sodium polystyrene (Kayexalate)
a
a pt is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dL. Which complications is the pt most at risk for developing? a. hypoglycemia b. pulmonary embolus c. renal shutdown d. pulmonary edema
a
a pt will be using an external insulin pump. what does the nurse tell the pt about the pump a. SMBG levels should be done three or more times a day b. the insulin supply must be replaced every 2-4 weeks c. the pumps battery should be checked on a regular weekly schedule d. the needle site but be changed every day
a
a pt with DKA is on an insulin drip of 50 units of regular insulin in 250 ml of normal saline. the current blood glucose level is 549 mg/dL. according to insulin protocol, the insulin drop needs to be changed to 8 units per hour. at what rate does the nurse set the pump? a. 40 ml/hr b. 50 ml/hr c. 60 ml/hr d. 75 ml/hr
a
the nurse is caring fodder a diabetic pt in the ER. the pt's lab values include serum glucose 353 mg/dL, positive serum ketones, and positive urine ketones. what complications does the nurse suspect? a. DKA b. HHS c. hyperglycemia d. hypoglycemia
a
Which infection controls measure the nurse teach a pt who will be performing SMBG? (Select all that apply) a. always wash hands before monitoring glucose b. regular cleaning of the meter is critical c. do not reuse lancets d. do not share blood glucose monitoring equipment e. sterilize blood glucose monitor before each use
abcd
the nurse is caring for a pt with DM. the pt's urine is positive for ketones. what does the nurse instruct the pt with regard to exercise? a. when urine ketones are present, you should not exercise b. you may exercise as ling as serum ketones are negative c. if you exercise now, be sure to perform aerobic exercise d. exercise is always a good option because it helps with glucose utilization
a
the pt's urinalysis shows proteinuria. which pathophysiology does the nurse suspect? a. nephropathy b. neuropathy c. retinopathy d. gastroparesis
a
a nurse is caring for a client admitted to the hospital for DKA. which clinical manifestations should the nurse expect? a. dry skin b. abdominal pain c. kussmaul respirations d. absence of ketones in the urine e. blood glucose level of less than 100 mg/dl
abc
which cultures tend to have a higher incidence of DM (Select all that apply) a. Mexican American b. African American c. Caucasian d. American Indian e. Eastern European
abd
which statements about type II DM are accurate? (Select all that apply) a. it peaks about the age of 50 b. most people with type 2 DM are obese c. it typically has an abrupt onset d. people with type II DM have insulin resistance e. it can be treated with oral antidiabetic medication and insulin
abde
a client has a hypoglycemic reaction to insulin. which client responses child the nurse document as clinical manifestations of hypoglycemia? SELECT ALL THAT APPLY. a. pallor b. tremors c. glycosuria d. acetonuria e. diaphoresis
abe
which statements about type I DM are accurate? (Select all that apply) a. it is an autoimmune disorder b. most people with type I DM are obese c. age of onset is typically younger than 30 d. etiology can be attributed to viral infections e. it can be treated with oral anti diabetic medications and insulin
acd
SMBG levels is most important in which patients? (Select all that apply) a. pts taking multiple daily insulin injections b. pts with mild type II DM c. pts with hypoglycemic unawareness d. pts using a portable infusion device for insulin administration e. pts with acute illness f. pregnant pts
acdef
In which situations does the nurse teach a pt to perform urine ketone testing? (select all that apply) a. acute illness or stress b. when blood glucose levels are above 240 mg/dL c. when symptoms of DKA are present d. to evaluate the effectiveness of DKA treatment e. when a diabetic patient is in a weight-loss program
ace
a nurse concluded that a client has a hypoglycemic reaction to insulin. which clinical findings support this conclusion? SELECT ALL THAT APPLY a. irritably b. glycosuria c. dry, hot skin d. heart palpitations e fruity odor of breath
ad
a client is learning alternate site testing (AST) for glucose monitoring. which client statement indicates to the nurse that additional teaching is necessary? a. I need to rub my forearm vigorously until warm before testing at this site b. the fingertip is preferred for glucose monitoring if hyperglycemia is suspected c. alternate site testing is unsafe if I am experiencing a rapid change in glucose level d. I have to make sure that my current glucose monitor can be used at an alternative site
b
a nurse is caring for a postoperative pt who has diabetes. which is the most common cause of DKA that the nurse needs to consider when caring for this pt? a. emotional stress b. presence of infection c. increased insulin dose d. inadequate food intake
b
a nurse is caring for a pt with diagnosis to type I DM who has develop diabetic coma. which element excessively accumulates in the blood to precipitate the sign and symptoms associated with this condition? a. sodium bicarb, causing alkalosis b. ketones as a result of rapid fat breakdown, causing acidosis c. nitrogen from protein catabolism, causing ammonia intoxication d. glucose from rapid carbohydrate metabolism, causing drowsiness
b
a nurse is working in the diabetes clinic is evaluating a cline't success with managing the medical regimen, which is the best indication that a client with type 1 DM is successfully managing the disease? a. reduction in excess body weight b. stabilization of the serum glucose c. demonstrated knowledge of the disease d. adherence to the prescription for insulin
b
a pt with diabetes presents to the ER with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate " all of the time". How does the nurse document this subjective finding a. polydipsia and polyphagia b. polydipsia and polyuria c. polycoria and polyuria d. polyphagia and polyesthesia
b
a pt with type I DM is planning to travel by air and asks the nurse about preparations for the trip. What does the nurse tell the pt to do. a. pack insulin and syringes in a labeled, crushproof kit in the checked luggage b. carry all necessary diabetes supplies in a clearly identified pack aboard the plane c. ask the flight attendant to put the insulin in the galley refrigeratory once on the plane d. take only minimal supplies and get the prescription filled at his or her destination
b
from which injection site is insulin absorbed most rapidly? a. buttocks b. abdomen c. deltoid d. thigh
b
what glucose level range does the American Association of Clinical Endocrinologist recommend for a critically ill pt? a. between 100 and 130 mg/dL b. between 140 and 180 mg/dL c. between 180 and 200 mg/dL d. between 200 and 240 mg/dL
b
when glucagon is administered, what does it do? a. competes for insulin at the receptor sites b. frees glucose from hepatic stores of glycogen c. supplies glycogen directly to the vital tissues d. provides a glucose substitute for rapid replacement
b
which are characteristics of regular insulin? (Select all that apply) a. this insulin does not have a peak time b. when mixing types of insulin, this insulin is always drawn up first c. this insulin is given once daily for basal insulin coverage d. this insulin should be given 30 minutes before meals e. this insulin should not be diluted or mixed with any other insulin
bd
which are considered the early signs of diabetic nephropathy? (Select all that apply) a. positive urine red blood cells b. microalbuminuria c. positive urine glucose d. positive urine white blood cells e. elevated serum uric acid
be
Glucagon is used primarily to treat the pt with which disorder? a. DKA b. Idiosyncratic reaction to insulin c. severe hypoglycemia d. HHNS
c
Which class of antidiabetic medication should be given 1-30 minuted before meals? alpha-glucosidase inhibitors, which include miglitol (glyset) b. biguanides, which include metformin (glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)
c
Which electrolyte his most affected by hyperglycemia? a. sodium b. chloride c. potassium d. magnesium
c
a client has a glycosylated hemoglobin measurement of 6%. what should the nurse conclude about this type of client when planning a teaching plan based on the results of this laboratory test? a. is experiencing a rebound hyperglycemia b. needs the insulin changed to a different type c. has followed the treatment plan as prescribed d. requires further teaching regarding nutritional guidelines
c
a client with type 1 DM has a fingerstick glucose level of 258 mg/dl at bedtime. a prescription for sliding scale regular insulin exists. what should the nurse do? a. call the HCP b. encourage the intake of fluids c. administer the insulin prescribed d. give the client a half cup of orange juice
c
a nurse administers the prescribed regular insulin to a client with DKA. in addition, the nurse anticipates that the IV solution prescribed will contain potassium to replenish potassium ions in the extracellular fluid that are being: a. rapidly lost from the body bu copious diaphoresis present during coma. b. carried with glucose to the kidneys to be exerted in the urine in increased amounts c. quickly used u during the rapid series of catabolic reaction stimulated by insulin and glucose d. moved into the intracellular fluid compartment because of the generalized anabolism induced by insulin and glucose
d
a pt will be using an external insulin pump. what does the nurse tell the pt about the pump a. SMBG levels can be done only twice a day b. the insulin supply must be replaced every 2-4 weeks. c. the pump's battery should be checked on a regular weekly schedule d. the needle must be changed every 2 to 3 days
d
a pt with type I DM is taking a mixture of NPH and regular insulin at home. the pt has been NPO for surgery since midnight, what actual dies the nurse take regarding the pt's morning dose of insulin? a. administer the dose that is routinely prescribed at home because the pt has type I DM and needs the insulin b. administer half the dose because the pt is NPO c. hold the insulin with all the other medications because the pt is NOI and there is no need for insulin d. contact the HCP for an order regarding insulin
d
a urine specimen is needed to test for the presence of ketones in a client who is diabetic. what should the nurse do when collecting this specimen from a urinary retention catheter? a. disconnect the catheter and drain the urine into a clean container b. clean the drainage valve and remove the urine from the catheter bag c. wipe the catheter with alcohol and drain the urine into a sterile test tube d. clamp the catheter, cleanse the port, and use a sterile syringe to remove urine
d
according to the American diabetes association (ADA), which laboratory finding is most indicative of DM? a. fasting blood glucose = 80 mg/dL b. 2-hour postprandial blood glucose = 110 mg/dL c. 1-hour glucose tolerance blood glucose= 110 mg/dL d. 2-hour glucose tolerance blood glucose = 210 mg/dL
d
early treatment of DKA and HHNS included IV administration of which fluid? a. glucagon b. potassium c. Bicarb d. Normal Saline
d
untreated hyperglycemia results in which condition? a. respiratory acidosis b. metabolic alkalosis c. respiratory alkalosis d. metabolic acidosis
d
which class of antidiabetics medications is most likely to cause a hypoglycemic episode because of the long duration of action? alpha-glucosidase inhibitors, which include miglitol (glyset) b. biguanides, which include metformin (glucophage) c. Meglitinides, which include nateglinide (Starlix) d. Second-generation sulfonylureas, which include glipizide (Glucotrol)
d
which laboratory test is the best indicators of a pt's average blood glucose level and/or compliance with the DM regimen over the last 3 months a. postprandial blood glucose test b. oral glucose tolerance test (OGTT) c. casual blood glucose test d. Glycosylated hemoglobin (HbA1c)
d