ch 48 sectn 1

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Which findings are associated with diabetic ketoacidosis (DKA)? Select all that apply. 1 Hypoglycemia 2 Dehydration 3 Hyperglycemia 4 Absence of ketones 5 Ketosis

2, 3, 5 Characteristics of DKA include profound dehydration, severe hyperglycemia, and the presence of ketones. Hypoglycemia and absence of ketones are not signs of DKA.

Which question would the nurse ask a patient with polyuria, polydipsia, and polyphagia to rule out a false-negative glucose result? 1 "Have you had any illnesses recently?" 2 "Have you recently taken acetaminophen?" 3 "Have you been severely restricting your carbohydrate intake?" 4 "Have you been lying around and resting a lot for the past few days?"

2 Acetaminophen can cause a false-negative result on glucose tests. Illness, severe restriction of carbohydrates, and bed rest cause higher glucose levels.

Which condition can lead to a secondary cause of 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.

Which hormone regulates the normal blood glucose level in the body? 1 Insulin 2 Glucagon 3 Epinephrine 4 Growth hormone

1 Insulin is a hormone secreted by β-cells in the Islet of Langerhans of the pancreas. It helps in regulating the blood glucose level. Glucagon is a hormone secreted by the α-cells of the Islet of Langerhans. It increases the blood glucose level by counteracting the mechanism of insulin. Epinephrine is a hormone secreted by the adrenal gland. It may not be helpful in maintaining the blood glucose level. Growth hormone is secreted by the pituitary gland, and it helps in growth of all tissues and bones in the body.

Which medication is categorized as a starch blocker? 1 Miglitol 2 Alogliptin 3 Nateglinide 4 Glimepiride

1 Miglitol is categorized as an alpha-glucosidase inhibitor, also known as a starch blocker. Alogliptin is a dipeptidyl peptidase-4 inhibitor. Nateglinide is a meglitinide, and glimepiride is a sulfonylureas.

An RN is teaching a student nurse about polyphagia in diabetes type 2 patients. Which reason regarding the occurrence of polyphagia in diabetes given by the student nurse indicates a need for further learning? 1 Increased levels of insulin in the blood 2 Increased levels of glucose in the blood 3 Increased levels of free fatty acids in the blood 4 Increased levels of free amino acids in the blood

1 Polyphagia develops due to insufficiency of insulin that is due to destruction of β-cells of the pancreas. The glucose level increases and the insulin-dependent tissues are unable to utilize the glucose due to insufficient insulin, which leads to polyphagia. The minimal utilization of glucose by the adipose tissue results in increased lipolysis, which increases the free fatty acids level in the blood and causes polyphagia. A nominal amount of glucose utilization by the muscles generates higher levels of free amino acids due to increased protein catabolism and results in polyphagia.

Which laboratory parameter assesses the function of pancreatic β-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 to 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.

Which instruction regarding the Credé's maneuver would the nurse give to a patient with diabetes mellitus who has a neurogenic bladder causing urinary retention? 1 Perform mild massage downward over the lower abdomen and bladder. 2 Perform mild massage downward over the upper abdomen and bladder. 3 Perform moderate massage downward over the lower abdomen and bladder. 4 Perform moderate massage downward over the upper abdomen and bladder.

1 The Credé's maneuver involves mild massage downward over the lower abdomen and bladder with low pressure. This massage helps to relax the lower abdominal muscles, which may in turn help to complete bladder emptying. The upper abdomen is not involved in the Credé's maneuver. Moderate massage on the lower or upper abdomen involves applying high pressure, so reflux of urine may occur and result in renal infection.

Which factor is the primary defect associated with type 1 diabetes mellitus? 1 Absent or minimal insulin production 2 Alteration in production of adipokines 3 Decreased insulin production over time and insulin resistance 4 Abnormal increase in insulin production by the pancreas over time

1 Type 1 diabetes mellitus is a result of the absence or minimal production of insulin by the pancreas. Alteration in production of adipokines, decreased insulin production over time, and insulin resistance are the defect factors associated with type 2 diabetes mellitus. An abnormal increase in the insulin over time does not cause diabetes.

Which complications would the nurse expect in a pregnant woman diagnosed with diabetes at 20 weeks of gestation? Select all that apply. 1 Higher risk for cesarean delivery 2 Increased risk of perinatal death 3 Increased risk of diabetes mellitus in the infant 4 Increased risk of gaining abnormal weight and becoming obese 5 Increased risk of developing type 1 diabetes mellitus within 10 years

1, 2 Diabetes developed during pregnancy is called gestational diabetes. Women with gestational diabetes have a higher risk for cesarean delivery and an increased risk of perinatal death. Risk factors associated with juvenile diabetes include family history of diabetes and having certain human leukocyte antigen (HLA) types, not gestational diabetes in the mother. Obesity is a risk factor for developing gestational diabetes, not necessarily a result of it. Women with a history of gestational diabetes are at a risk of developing type 2, not type 1, diabetes mellitus within 10 years.

Which persons are the most suited for diabetes screening? Select all that apply. 1 A person with hypertension 2 A person who is physically inactive 3 A person with polycystic ovarian syndrome 4 A person who delivered a baby weighing 9 lbs 5 A person whose body mass index (BMI) is 25 kg/m2

1, 2, 3 Hypertension, absence of physical activity, and polycystic ovarian syndrome are the risk factors of diabetes. In hypertension, there is decreased perfusion to tissues, which may increase the risk of developing diabetes. Absence of physical activity results in weight gain due to the lack of utilization of the energy produced by the body. Hormonal imbalance is seen in patients with polycystic ovarian syndrome, which may increase the risk for diabetes. A BMI of less than 25 kg/m2 and delivering a baby weighing 9 lbs do not indicate a risk for developing diabetes.

Which components are associated with metabolic syndrome? Select all that apply. 1 Abdominal obesity 2 Elevated glucose levels 3 Elevated BP 4 Low levels of triglycerides 5 Increased levels of high-density lipoproteins (HDL)

1, 2, 3 The components of metabolic syndrome are abdominal obesity, elevated glucose levels, and elevated BP. Low levels of triglycerides and increased levels of HDL are not components of metabolic syndrome.

Which symptoms would the nurse include in a presentation on type 2 diabetes? 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 is usually 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 2 diabetes may have polyuria. Weight loss is typically seen with type I diabetes.

Which key factors could be linked with diabetes mellitus type 1? Select all that apply. 1 Endogenous insulin is absent in diabetes mellitus. 2 Islet cell antibodies are absent in diabetes mellitus type 1. 3 Diabetes mellitus type 1 is more common with people of young age. 4 Resistance of ketosis is found except in conditions of infection or stress. 5 Diabetes mellitus type 1 is diagnosed in 5% to 10% of the total diabetes cases. 6 Requirement of insulin is mandatory in all the cases of diabetes mellitus type 1.

1, 3, 5, 6 Endogenous insulin is absent in patients with diabetes mellitus. Diabetes mellitus type 1 is more common in young people but can occur at any age, with 5% to 10% of the total diabetes diagnoses being type 1 diabetes. Insulin is required for all patients with type 1 diabetes. Islet cell antibodies are often present in diabetes mellitus type 1 patients; absence of these islet cells is associated with diabetes mellitus type 2. The development of type 1 ketosis occurs at onset or during insulin deficiency. Ketosis resistance, except during infections or stress, is associated with diabetes mellitus type 2.

To help delay the development of type 2 diabetes, which instructions would the nurse recommend to a patient who has an oral glucose test value of 160 mg/dL? Select all that apply. 1 Maintain a healthy weight. 2 Include 50 g/day of fiber in diet. 3 Consume a high-protein diet for weight loss. 4 Monitor for polyuria, polyphagia, and polydipsia. 5 Regularly monitor blood glucose and glycosylated hemoglobin levels. 00:00:02 Question Answer Confidence ButtonsJust a guessPretty sureNailed it

1, 4, 5 The nurse should inform the patient with a risk for developing type 2 diabetes to maintain a healthy weight and to monitor for symptoms of diabetes, such as polyuria (excessive urination), polyphagia (excessive hunger), and polydipsia (excessive thirst). It is important for the nurse to educate patients at risk for developing diabetes to take action to prevent or delay the development of type 2 diabetes by regularly monitoring blood glucose and glycosylated hemoglobin levels. A dietary intake of 25 to 30 g/day of fiber is a general recommendation. There is no evidence that increased fiber in the diet will delay the risk of diabetes. High-protein diets are not recommended as a weight-loss method for people with diabetes or people at risk for diabetes.

Which statement made by the patient with diabetes mellitus indicates effective learning? 1 "I will have lots of fruit juices." 2 "I will carry extra insulin during travel." 3 "I will skip doses of insulin when I am sick." 4 "I will not exercise because it increases my blood glucose level."

2 Carrying extra insulin during travel is important in case an insulin vial is lost or broken. Having lots of fruit juices would not help in diabetes management because juice contains sugars that are easily absorbed. Skipping insulin doses when the patient is sick worsens the condition. Exercising might help in lowering blood glucose levels and may help to keep the patient healthy.

Which effect do counter regulatory hormones have on insulin? 1 They inhibit glucose production in the body. 2 They maintain the blood glucose level in the body. 3 They help insulin to decrease the level of glucose in the body. 4 They increase the movement of glucose into the cells of the body.

2 Counter regulatory hormones are antagonist to insulin. They help to maintain the blood glucose level by increasing the blood glucose level and decreasing the movement of glucose into the cells. Counter regulatory 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.

A diabetic patient failed to adhere to the recommended dietary allowance (RDA) for carbohydrates, which resulted in low levels of glucose in the blood. Which advice given by the nutritionist would be appropriate for this 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 to 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.

Which condition occurs in hyperosmolar hyperglycemia syndrome (HHS) but not in diabetic ketoacidosis (DKA)? 1 Hyperglycemia 2 Absence of ketones 3 High serum osmolarity 4 Decreased serum potassium

2 HHS is different from DKA because of the absence of ketone production. HHS 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 by-product. Hyperglycemia, issues with serum potassium, and issues with serous osmolarity are seen in both HHS and DKA.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. Which response by the nurse is accurate? 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.

Which data is a good indicator that a patient diagnosed six months ago with prediabetes has been managing the condition well? 1 A 20-pound weight loss 2 Hemoglobin A1C of 5.5 percent 3 Reduction of total cholesterol to 200 mg/dL 4 Decrease in polyuria, polydipsia, and polyphagia

2 Individuals with prediabetes 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 are 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.

Which assessment finding supports the nurse's suspicion that a diabetic patient has necrobiosis lipoidica diabeticorum? 1 Reddish, flat, and oval patches on the shins 2 Red-yellow lesions, with shiny atrophic skin 3 Reddish-brown, scaly, and round patches on the thighs 4 Velvety, light-brown to black skin thickening on the neck

2 Necrobiosis lipoidica diabeticorum is an uncommon skin condition seen in patients with diabetes. It is characterized by red-yellow lesions, with atrophic skin that becomes shiny and transparent, revealing tiny blood vessels under the surface. Diabetic dermopathy is the most common diabetic skin lesion; it is characterized by reddish-brown, round, or oval patches. They are scaly initially, and then they flatten and become indented. The lesions appear most frequently on the shins but can also be found on the front of the thighs, forearms, sides of the feet, scalp, and trunk. Acanthosis nigricans is a skin pigmentation characterized by velvety, light-brown to black skin thickening, predominantly seen on flexures, axillae, and the neck.

At what time would the nurse instruct the patient to monitor the blood sugar if dawn phenomenon is suspected? 1 1:00 a.m. 2 3:00 a.m. 3 5:00 a.m. 4 Upon arising

2 The blood sugar should be checked between 2:00 a.m. and 4:00 a.m. (e.g., 3:00 a.m.). 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 1:00 a.m., 5:00 a.m., and upon rising would likely not show the hyperglycemia the nurse is suspecting.

Which fasting blood glucose range indicates 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.

Which factor is 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.

Which medications may induce diabetes? Select all that apply. 1 Isoniazid 2 Clozapine 3 Phenytoin 4 Rifampicin 5 Prednisone

2, 3, 5 Clozapine is an atypical antipsychotic medication used in the treatment of psychosis and may induce diabetes. Phenytoin is an anticonvulsant drug used in the treatment of convulsions and may induce diabetes in some patients. Prednisone is a corticosteroid and may cause diabetes in some patients. Isoniazid is an anti-tuberculosis (TB) drug that does not induce diabetes. Rifampicin is an antitubercular drug that does not induce diabetes.

Which findings are associated with 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.

Which clinical manifestations are associated with diabetes mellitus type 2? Select all that apply. 1 Ketoacidosis 2 Candida infection 3 Recurrent infections 4 Abdominal cramping 5 Recurrent vaginal yeast 6 Prolonged wound healing

2, 3, 5, 6 Candida infection, recurrent infections, recurrent vaginal yeast, and prolonged wound healing are clinical manifestations of diabetes mellitus type 2. Recurrent infection involves the symptomatic reactivation of the latent infection. Wound healing is prolonged for patients with diabetes mellitus due to an impaired immune system. Ketoacidosis and abdominal cramping are key symptoms of diabetes mellitus type 1.

Which complications would be associated with an insulin level more than 0.6 U/kg of body weight? 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.

Which condition would an A1C of 5.5% 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.

Which effect will a coexistence of human leukocyte antigen (HLA-DR3) and a viral infection have on the glucose level of a patient? 1 No effect on the glucose level 2 Inhibition on the production of glucose 3 Excessive increase in the glucose level 4 Excessive decrease in the glucose level

3 Coexistence of HLA-DR3 and viral hemorrhagic fever will result in excessive increase in the blood glucose level because the combination of human leukocyte antigen-DR3 and a viral infection causes damage to the β-cells of the pancreas. This inhibits the production of insulin. The glucose level will be affected. The conjunction of HLA-DR3 and viral infection will increase the glucose level instead of inhibiting the glucose level. The glucose level will not decrease; it will increase.

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. Which type of diabetes would be included in a teaching plan for this 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.

Which statement by the patient recently diagnosed with type 2 diabetes mellitus indicates understanding of disease management? 1 "I will always be able to manage my diabetes with pills." 2 "As I get older, I will be able to decrease my diabetes medicine." 3 "If I become ill, I will need to check my blood sugar more frequently." 4 "As long as I take my medication, I do not have to follow a diabetic diet."

3 Illness may increase blood glucose on people with type 2 diabetes. Diabetes is a progressive disease, and as time goes on, patients with diabetes type 2 may need to increase oral medications or begin insulin therapy. Nutritional therapy is an integral part of diabetes management.

Which condition would the nurse teach a patient about if the patient's diagnostic report shows a fasting blood glucose level of 122 mg/dL? 1 Diabetes mellitus type 1 2 Diabetes mellitus type 2 3 Impaired fasting glucose 4 Impaired glucose tolerance

3 Impaired fasting glucose is a prediabetic condition, and the blood glucose level may range from 100 to 125 mg/dL. The fasting blood glucose level is 122 mg/dL, which indicates that it is a condition between diabetes and glucose homeostasis. In type 1 and type 2 diabetes, the fasting blood glucose level may be very high. Impaired glucose tolerance is a prediabetic condition; however, the blood glucose levels would range from 140 to 199 mg/dL.

A patient, admitted with type 1 diabetes, asks the nurse what "type 1" means. Which response by the nurse is accurate? 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 body produces autoantibodies and the pancreas is unable to make any insulin. 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.

About which syndrome would the nurse teach a patient who has symptoms of hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein (HDL), and abdominal obesity? 1 Barrett's esophagus 2 Cushing syndrome 3 Metabolic syndrome 4 Irritable bowel syndrome

3 Metabolic syndrome is a cluster of conditions such as increased BP, body fat around the waist, and abnormal cholesterol levels, which increases the risk for diabetes. Barrett's esophagus is a condition where the inner lining of the esophagus changes to resemble the intestinal lining, and it predisposes one to adenocarcinoma. Cushing syndrome is a hormonal disorder that occurs due to abnormally high levels of cortisol in the body. Irritable bowel syndrome is characterized by chronic discomfort associated with defecation.

Which pathophysiologic cause of type 1 diabetes mellitus is correct? 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.

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

3 Skeletal muscles have specific receptors that 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.

Which drug would be a good 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.

Which drug dose would be reduced to lower the risk for diabetes in patients with hypertension and prediabetes? 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.

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 gain as the disease progresses, not early on. Insomnia is not related to symptoms of undiagnosed diabetes.

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 Insulin receptors do not respond to the insulin, and the production of insulin increases. 4 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.

Which mechanism is altered in individuals with type 1 diabetes? 1 Defective insulin receptors in muscle 2 Excess glucose production by the liver 3 Increased glucagon secretion by the pancreas 4 Autoimmune destruction of the β-cells of the pancreas

4 Autoimmune destruction of the β-cells is the primary defect in type 1 diabetes. Defective insulin receptors in muscle, excess glucose production by the liver, and increased glucagon secretion by the pancreas occur in individuals with type 2 diabetes, but not type 1.

Which diagnostic test would be done 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 but wouldn't be used to diagnose diabetes.

Which blood glucose level indicates hyperglycemia? 1 60 to 70 mg/dL 2 80 to 110 mg/dL 3 100 to 125 mg/dL 4 200 to 250 mg/dL

4 Hyperglycemia is a condition in which the blood glucose level is greater than 200 mg/dL. If the blood glucose level ranges from 60 to 70 mg/dL, then it indicates hypoglycemia. The blood glucose level is considered normal if it ranges from 80 to 110 mg/dL. The blood glucose level ranges from 100 to 125 mg/dL in prediabetes.

Which signs/symptoms would the nurse expect to find upon physical examination in a patient admitted with diabetic ketoacidosis? 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 Kussmaul respirations

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 glucose will be elevated, not decreased or normal. BP will not be low (hypotension), and respiratory rate will be increased, not decreased (bradypnea).

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 2 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.

Which assignment made by the charge nurse would be appropriate for the licensed practical nurse (LPN)? 1 A 45-year-old type 1 diabetic who is 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 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.

Which question would the nurse ask a patient admitted to the hospital with frequent urination and excessive thirst to support the diagnosis of diabetes? 1 "What is your name?" 2 "What is your height?" 3 "What is your weight?" 4 "Do you have a family history of diabetes?"

4 The patient's family history is needed to know if there is any family history of diabetes. The patient's name is necessary to identify the patient but not the clinical condition. Parameters such as height and weight of the patient are required to calculate the body mass index (BMI). However, the nurse does not ask the patient his or her height and weight; rather, height and weight are measured.

Place in order the following physiologic events that occur in the development of diabetic ketoacidosis (DKA).

A patient with type 1 diabetes who develops blood glucose greater than 250 mg/dL is at risk to develop DKA. In DKA, the patient's cells lack fuel (glucose), despite excess serum glucose, because there is insufficient insulin available to metabolize the glucose and drive it into the cells. So the body turns to fat for fuel and produces ketones as a by-product of fat metabolism. Ketonemia decreases the serum pH as H+ ions accumulate and hyperglycemia causes osmotic diuresis, leading to the excretion of electrolytes, especially potassium and chloride (as a carrier of H+).

The glycosylated hemoglobin (A1C) for a patient is 7%. Calculate the estimated average glucose (eAG) for this patient. Record your answer using a whole number. ____ mg/dL

ch 48 sectn 1

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