Ch. 37 Diabetes Mellitus and Its Complications

The nurse is assessing a client with type 2 diabetes mellitus​ (T2DM). Which sequence of events occurs in the pathophysiological process of the development of stage 3​ T2DM?

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In which​ order, from greatest to​ least, might the listed clients develop type 1 diabetes​ mellitus?

1. ​​14-year-old whose pancreatic​ beta-cell mass has decreased​ 75% 2. 7-year-old boy whose twin sister was recently diagnosed with T1DM 3. ​3-year-old diagnosed with hepatitis A virus 4. ​2-year-old who drinks three​ 8-oz glasses of​ cow's milk daily

Urbanization and a Westernized lifestyle have been established as risks for the development of type 2 diabetes mellitus​ (T2DM). Which statement explains this​ occurrence? (Select all that​ apply.)

A. ​"A sedentary lifestyle leads to central​ obesity." B. "A high-calorie diet leads to the increase of adipose tissue and free fatty​ acids."

A client is being tested for diabetes mellitus. Which diagnostic test result should the nurse expect for this​ client? (Select all that​ apply.)

A.Random glucose level is 200​ mg/dL or higher. C. Fasting plasma glucose level is 126​ mg/dL or higher on at least 2 occasions. E. HbA1c is​ 6.5% or greater.

Which instruction should the nurse provide a client about the pathophysiology of diabetes mellitus​ (DM)?

B. Diabetes mellitus eventually leads to increased free fatty acid production. In diabetes mellitus​ (DM), the ability of insulin to decrease lipolysis is​ impaired, leading to increased free fatty acid production. Insulin insufficiency will lead to episodes of​ hyperglycemia. Insulin resistance leads to​ decreased, not​ increased, glucose uptake by the muscles.

Which client is at risk for developing type 2 diabetes mellitus​ (T2DM)? (Select all that​ apply.)

A. 23-year-old Pima Indian living in the Southwest United States B. 45-year-old client whose parents have been diagnosed with​ T2DM, but who tries to follow a healthy diet D. ​42-year-old Mexican American who is slightly overweight and lives a Westernized lifestyle E. 33-year-old client whose mother had gestational diabetes and was a​ high-birth-weight infant

The nurse is caring for a client with diabetes mellitus​ (DM). Which clinical manifestation might be related to the effects of​ polyuria? (Select all that​ apply.)

A. Hypotension C. Fatigue D. Glucosuria Polyuria in clients with diabetes mellitus​ (DM) is a result of osmotic​ diuresis, which can lead to dehydration and volume depletion. Clinical manifestations of diabetes mellitus that are related to the effects of polyuria include​ polyphagia, polydipsia,​ fatigue, weight​ loss, hypotension,​ tachycardia, and glucosuria

A client with type 2 diabetes mellitus​ (T2DM) has been diagnosed with hyperglycemic hyperosmolar syndrome​ (HHS). Which clinical manifestation should the nurse assess in the​ client? (Select all that​ apply.)

A. Severe dehydration C. Hemiparesis E. Electrolyte imbalances

A client is being evaluated for diabetes mellitus​ (DM). Which laboratory test should the nurse expect to be prescribed for this​ client? (Select all that​ apply.)

B. Fasting plasma glucose level​ (FPG) C. Random serum glucose level E. Glycosylated hemoglobin​ (HbA1c) level

Which risk factor for type 2 diabetes mellitus​ (T2DM) should the nurse assess in a​ client? (Select all that​ apply.)

B. Socioeconomic factors C. Obesity and physical inactivity E. African American descent Risk factors for type 2 diabetes mellitus​ (T2DM) include obesity and physical​ inactivity, genetics and family​ history, diet, socioeconomic​ factors, and education. Ethnic groups that are at high risk for T2DM include African​ Americans, American​ Indians, Hispanics, and Pima Indians.

A client with type 2 diabetes mellitus​ (T2DM) has a microalbuminuria level of 75 mg​ albumin/24 hr. Which client statement should the nurse​ address?

B. ​"Because I am having no symptoms and the lab result is only slightly​ elevated, there is not a need for treatment at this​ time." Aggressive treatment of even minor elevations in blood pressure can preserve kidney function and delay the progression of nephropathy. Diabetic nephropathy develops in several​ stages, with the first sign being an elevated​ microalbuminuria, although the client is typically asymptomatic. Glucose control and the duration of type 2 diabetes mellitus​ (T2DM) impact the development of diabetic nephropathy. As diabetic nephropathy progresses hypertension and severe proteinuria develop. Glomerular filtration rate​ (GFR) will decrease as serum creatinine increases.​ Eventually, the result is​ end-stage kidney​ failure, which requires dialysis.

The nurse prepares to care for a client with diabetes mellitus. Which statement should the nurse make to describe this disease process to the​ client?

B. ​"Diabetes is a group of metabolic disorders characterized by the inability to effectively metabolize​ carbohydrates, proteins, and​ fats." Diabetes mellitus​ (DM) is a group of metabolic disorders characterized by the inability to effectively metabolize​ carbohydrates, proteins, and fats as a result of defects in insulin​ secretion, insulin​ action, or​ both, which results in hyperglycemia. It affects the endocrine functions of the pancreas.

A client with type 1 diabetes mellitus​ (T1DM) is experiencing​ nausea, vomiting,​ fatigue, and abdominal pain. Which risk factor should the nurse most likely associate with this​ client?

D. Infection Nausea,​ vomiting, fatigue, and abdominal pain are clinical manifestations of diabetic ketoacidosis​ (DKA). DKA is characterized by​ hyperglycemia, metabolic​ acidosis, and ketonemia. A decrease in insulin due to missed doses or administering lower than prescribed doses can precipitate DKA. The most common precipitating factor in the development of DKA is infection.

A client with type 2 diabetes mellitus is​ diaphoretic, shaky, and very drowsy. Which measurement should the nurse expect to assess in this​ client?

C. Blood glucose 42​ mg/dL Clinical manifestations of hypoglycemia are classified as autonomic nervous system​ (ANS) symptoms and neuroglycopenic symptoms. ANS symptoms include​ sweating, palpitations,​ tremors, and hunger. Neuroglycopenic symptoms result from lack of glucose to the central nervous system​ (CNS) and include difficulty​ speaking, visual​ disturbances, drowsiness,​ confusion, seizures, and coma.

Which is a finding from the Diabetes Prevention Program that impacts the way type 2 diabetes mellitus​ (T2DM) is​ treated?

C. The lifestyle intervention program was more successful at preventing T2DM than treatment with metformin. Lifestyle interventions decreased the incidence of type 2 diabetes mellitus​ (T2DM) by​ 58%, while treatment with metformin decreased the incidence of T2DM by​ 31%.

A client with type 2 diabetes mellitus​ (T2DM) has a glycosylated hemoglobin​ (HbA1c) level of​ 8.5%. Which interpretation about the test result is​ accurate?

C. The test result is above the recommended levels for HbA1c. HbA1c blood test reflects average blood glucose levels over a period of three months. For clients with​ diabetes, the recommended levels for HbA1c are between​ 6% and​ 7%, which corresponds to blood glucose levels of 120 to 140​ mg/dL. The result of​ 8.5% is above the recommended level and corresponds to serum blood glucose levels of 200​ mg/dL. HbA1c levels of​ 13% or higher are dangerously​ high, corresponding to serum blood glucose levels of 300​ mg/dL or greater.

The nurse is instructing a client recently diagnosed with type 1 diabetes mellitus​ (T1DM) and decreased insulin production. Which explanation should the nurse use to help the client understand when insulin may be​ needed?

C. ​"After eating​ carbohydrates, insulin levels should rise to stimulate the​ body's use of glucose in tissue​ building." After eating​ carbohydrates, the client will be in the absorptive state. Insulin levels should rise to stimulate glucose uptake by the​ tissues, primarily muscle. The effect of the hormone insulin is tissue growth. Because insulin production has decreased and will eventually​ cease, it is during the absorptive state that insulin will be needed.

A client missed the midday meal and is now diaphoretic and confused. Because the nurse knows that the ratio of glucagon to insulin has increased in an effort to provide glucose to the brain and nervous​ tissue, which metabolic state is the client most likely​ in?

D. Postabsorptive During the postabsorptive​ state, glucose levels fall. The focus is on providing glucose to fuel the brain and nervous tissue. The ratio of glucagon to insulin​ increases, and free fatty acids are released from adipose tissue to be broken down for energy.

The nurse is teaching a client with type 1 diabetes mellitus​ (T1DM). Which client statement requires​ follow-up?

D. ​"As long as my blood sugar is under​ control, I do not need to follow up with my eye​ doctor." Even when blood glucose is under​ control, annual eye exams are necessary. If diabetic retinopathy is detected prior to the onset of​ symptoms, treatment can delay the progress of the disease and preserve vision.

The nurse is teaching a client with type 1 diabetes mellitus​ (T1DM) about the signs and symptoms of diabetic ketoacidosis​ (DKA). Which client statement indicates to the nurse that the teaching has been​ effective?

D. ​"Increased thirst may indicate that I need to check my blood​ glucose." Increased thirst indicates​ dehydration, possibly due to hyperglycemia and diabetic complications. Fluid volume depletion due to hyperglycemia results in weight loss. Hyperglycemia causes osmotic​ diuresis, which results in dehydration. Increased thirst is a compensatory mechanism for dehydration. Blurred vision and fatigue are clinical manifestations of hyperglycemic hyperosmolar syndrome​ (HHS). Blurred vision is a result of fluid accumulation in the lens in response to hyperglycemia. Fatigue occurs in response to altered metabolism of​ carbohydrates, proteins, and lipids.