Ch. 49 Diabetes

Biguanide (2)

1. Increases glucose uptake, especially in muscles. 2. Primary effect is decreased glucose production by liver.

Characteristics of Type 2 Diabetes (6)

1. Insulin resistance 2. Beta cell secretory exhaustion 3. Inherited defect in insulin receptors 4. Inappropriate glucose production by the liver 5. Altered production of adipokines 6. Compensatory increased insulin production

List 5 s/sx that are present in DKA that are not seen in HHS.

1. Kussmaul's respirations 2. Ketouria 3. Sweet fruity odor to breath 4. Decreased arterial pH (acidosis) 5. Ketonemia

Autonomic neuropathy (3)

1. Male impotence. 2. Delayed gastric emptying. 3. Painless myocardial infarction.

A patient with type 1 diabetes uses 20U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6pm. When teaching the pt about this regimen, the nurse stresses that A. Hypoglycemia is most likely to occur before the noon meal. B. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. C. Flexibility in food intake is possible because insulin is available 24hrs/day. D. Pre-meal glucose checks are required to determined needed changes in daily dosing.

B. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia.

The type of diabetes that is strongly related to human leukocyte (HLA) is:

Type 1

Two days following a self-managing hypoglycemic episode at home, the pt tells the nurse that his blood glucose levels since the episode have been between 80 and 90mg/dL. The best response by the nurse is a. "That is a good range for your glucose levels." b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia, and you should increase your food intake." d. "You should only take half your insulin dosage for the next few days to get your glucose level back to normal."

a. "That is a good range for your glucose levels."

A pt with diabetes calls the clinic because she is experiencing nausea and flulike symptoms. The nurse advises the pt to a. administer the usual insulin dosage. b. hold fluid intake until the nausea subsides. c. come to the clinic immediately for evaluation and treatment. d. monitor the blood glucose every 1 to 2 hours and call if the glucose rises over 150mg/dL (8.3mmol/L).

a. administer the usual insulin dosage.

A 72-year-old woman is diagnosed with diabetes. The nurse recognizes that management of diabetes in the older adult a. does not require as tight glucose control as in younger diabetics. b. is usually not treated unless the pt becomes severely hyperglycemic. c. does not include treatment with insulin because of limited dexterity and vision. d. usually requires that a younger family member be responsible for care of the pt.

a. does not require as tight glucose control as in younger diabetics.

In nutritional management of all types of diabetes, it is important for the pt to a. eat regular meals at regular times b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars from the diet. d. limit saturated fat intake to 30% of dietary calorie intake.

a. eat regular meals at regular times

When caring for a pt with metabolic syndrome, the nurse gives the highest priority to teaching the pt about a. maintaining a normal weight. b. performing daily aerobic exercise. c. eliminating red meat from the diet. d. monitoring the blood glucose periodically.

a. maintaining a normal weight

A diabetic pt is learning to mix regular insulin and NPH insulin in the same syring. The nurse determines that additional teaching is needed when the pt a. withdraws the NPH dose into the syringe first. b. injects air equal to the NPH dose into the NPH vial first. c. removes any air bubbles after withdrawing the first insulin. d. adds air equal to the insulin dose into the regular vial and withdraws the dose.

a. withdraws the NPH dose into the syringe first.

The following intervetions are planned for a diabetic pt. Which intervention can the nurse delegate to nursing assistant? a. Discuss complications of diabetes. b. Check that the bath water is not too hot. c. Check the pts technique for drawing up insulin. d. Teach the pt to use glucometer for in-home glucose monitoring.

b. Check that the bath water is not too hot.

Goals of nutritional therapy for the pt with type 2 diabetes include maintenance of a. ideal body weight b. normal serum glucose and lipid levels c. a special diabetic diet using diabetic foods. d. five small meals per day with a bedtime snack.

b. normal serum glucose and lipid levels

In diabetes, atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems a. can be prevented by tight glucose control b. occurs with a higher frequency and earlier onset than in the nondiabetic population. c. is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake.

b. occurs with a higher frequency and earlier onset than in the nondiabetic population.

In addition to promoting the transport of glucose from the blood into the cell, insulin also a. enhances the breakdown of adipose tissue for energy. b. stimulates hepatic glycogenolysis and gluconeogenesis. c. prevents the transport of triglycerides into adipose tissue. d. accelerates the transport of amino acids into cells and their synthesis into proteins.

d. accelerates the transport of amino acids into cells and their synthesis into proteins.

A diabetic pt is found unconscious at home, and a family member calls the clinic. After determining that no glucometer is available, the nurse advises the family member to a. try to arouse the pt to drink some orange juice. b. administer 10U of regular insulin subQ. c. call for an ambulance to transport the pt to a medical facility. d. administer glucagon 1mg IM or suQ.

d. administer glucagon 1mg IM or suQ.

Lispro insulin (Humalog) with NPH insulin is ordered for a pt with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, it should be administered a. only once a day. b. 1 hour before meals. c. 30 to 45mins before meals. d. at mealtime or withing 15mins of meals.

d. at mealtime or withing 15mins of meals.

The treatment for DKA and HHS differs primarily in that a. DKA requires administration of bicarbonate to correct acidosis. b. potassium replacement is not necessary in management of HHS. c. HHS requires greater fluid replacement to correct the dehydration. d. administration of glucose is withheld in HHS until the blood glucose reaches a normal level.

c. HHS requires greater fluid replacement to correct the dehydration.

The nurse is assessing a newly admitted diabetic pt. Which of these observations should be addressed as a priority by the nurse? a. Bilateral numbness of both hands. b. Stage II pressure ulcer on the right heel. c. Rapid respirations with deep inspiration. d. Areas of lumps and dents on the abdomen.

c. Rapid respirations with deep inspiration.

Ketoacidosis occurs as a complication of diabetes when a. illnesses causing nausea and voming lead to bicarbonate loss with body fluids. b. the glucose level becomes so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amts of fatty acids rather than glucose for energy. d. the pt skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.

c. an insulin deficit causes the body to metabolize large amts of fatty acids rather than glucose for energy.

The nurse assesses the diabetic pts technique of self-monitoring of blood glucose (SMBG) 3 months after initial instruction. An error in the performance of SMBG noted by the nurse that requires intervention is a. doing the SMBG before and after exercising. b. puncturing the finger on the side of the finger pad. c. cleaning the puncture site with alcohol before the puncture. d. holding the hand down for a few minutes before the pucture.

c. cleaning the puncture site with alcohol before the puncture.

A pt taking insulin has recorded fasting glucose levels above 200mg/dL (11.1mmol/L) on awakening for the last five mornings. The nurse advises the pt to a. increase the evening insulin dose to prevent the dawn phenomenon. b. use a single-dose insulin regimen with an intermediate-acting insulin. c. monitor the glucose level at bedtime, between 2 and 4am, and on arising. d. decrease the evening insulin dosage to prevent night hypoglycemia and Somogyi effect.

c. monitor the glucose level at bedtime, between 2 and 4am, and on arising.

Polyphagia

cellular starvation from lack of glucose and use of fat and protein for energy.

Which of the following pts would a nurse plan to teach how to prevent or delay the development of diabetes? a. A 62-year-old obese white man. b. An obese 50-year-old Hispanic woman. c. A child whose father has type 1 diabetes. d. A 34-year old woman whose parents both have type 2 diabetes.

d. A 34-year old woman whose parents both have type 2 diabetes.

Polyuria

high glucose levels cause loss of glucose in urine with osmotic diuresis.

In type 1 diabetes, the body's own _____ cells are attacked and destroyed.

pancreatic beta

Polydipsia

thirst caused by fluid loss of polyuria.

Sensory neuropathy (3)

1. Atrophy of small muscles of the hands and feet. 2. Pain and paresthesia of the legs. 3. Foot ulcers without pt feeling pain.

Microvascular (2)

1. Damage to small vessels that supply the renal glomeruli. 2. Capillary and arteriole membrane thickening specific to diabetes.

Thiazolidinediones (2)

1. Decreases endogenous glucose production. 2. Not used in pts with heart failure.

Sulfonylurea (3)

1. Decreases glycogenolysis 2. Enhances cell sensitivity to insulin 3. Stimulates production and release of insulin and enhances cellular sensitivity to insulin.

alpha-Glucosidase inhibitor (3)

1. Delays glucose absorption from the gastrointestinal tract. 2. Effectiveness measured by 2-hour postprandial glucose. 3. Taken with the first bite of each meal.

Characteristics of Type 1 Diabetes (4)

1. Immune mediated 2. Genetic predisposition 3. Beta-cell destruction 4. Exposure to a virus

Hyperglycemia (5)

1. Nausea and vomiting 2. Headache 3. Increased dietary intake 4. Precipitated by stress 5. Changes in vision

Macrovascular (3)

1. Related to altered lipid metabolism of diabetes. 2. Ulceration and amputation of the lower extremities. 3. Ischemic heart disease.

Meglitinide (2)

1. Should be taken within 30 minutes of each meal. 2. Rapid and short-acting release of insulin from pancreas.

Hypoglycemia (5)

1. Slurred speech and irritability 2. Headache 3. Too much exercise without food 4. Cold, clammy skin 5. Changes in vision

Four hormones released that are counter-regulatory to insulin are:

1. cortisol 2. epinephrine 3. glucagon 4. growth hormone

Tissues that require insulin for glucose transport are _____ and _____ tissues.

1. skeletal muscle 2. adipose

When teaching the patient with diabetes about insulin administration, the nurse instructs the patient to A. Pull back on the plunger after inserting the needle to check for blood. B. Clean the skin at the injection site with an alcohol swab before each injection. C. Consistently use the same size of the appropriate strength insulin syringe to avoid dosing errors. D. Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.

C. Consistently use the same size of the appropriate strength insulin syringe to avoid dosing errors.

The nurse determines that a patient with a 2-hour (OGTT) of 152mg/dL has A. Diabetes B. Impaired fasting glucose C. Impaired glucose tolerance D. Elevated glycosylated hemoglobin

C. Impaired glucose tolerance

The major advantage of using an insulin pump is that a. tight glycemic control can be maintained. b. errors in insulin dosing are less likely to occur. c. complications of insulin therapy are prevented. d. frequent blood glucose monitoring is unnecessary.

a. tight glycemic control can be maintained.

A nurse working in an outpatient clinic plans a screening program for diabetes. Recommendations for screening would include a. OGTT for all minority populations every year. b. FPG for all individuals at age 45 and then every 3yrs. c. testing all people under the age of 21 for islet cell antibodies. d. testing for type 2 diabetes only in overweight or obese individuals.

b. FPG for all individuals at age 45 and then every 3yrs.

To prevent hyperglycemia or hypoglycemia with exercise, the nurse teaches the pt using glucose-lowering agents that exercise should be undertaken. a. only after a 10-to15g carb snack is eaten. b. about 1hr after eating, when blood glucose levels are rising. c. when glucose monitoring reveals that the blood glucose is in normal range. d. when blood glucose levels are high because exercise always has a hypoglycemic effect.

b. about 1hr after eating, when blood glucose levels are rising.

During routine health screening, a patient was found to have a fasting plasma glucose (FPG) of 132mg/dL (7.33mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on (select all that apply) a. glucosuria of 3+ b. an A1C of 7.5% c. a FPG of >126mg/dL (7.33mmol/L) d. random blood glucose of 126mg/dL (7.0mmol/L) e. a 2-hour oral glucose tolerance test (OGTT) of 190mg/dL (10.5mmol/L)

b. an A1C of 7.5% c. a FPG of >126mg/dL (7.33mmol/L)

Following the teaching of foot care to a diabetic pt, the nurse determines that additional instruction is needed when the pt says a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful."

d. "I'll know if I have sores or lesions on my feet because they will be painful."

The home care nurse should intervene to correct a pt whose insulin administration includes a. warming a prefilled frigerated syringe in the hands before administration. b. storing syringes prefilled with NPH and regular insulin needle-up in the fridge. c. placing the insulin bottle currently in use in a small container on the bathroom countertop. d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.

d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.