Ch. 64
The nurse receives a report on a 52-year-old patient with type 2 diabetes. Which complication of diabetes does the nurse report to the provider? 1 Visual changes 2 Respiratory distress 3 Poor glucose control Correct4 Decreased peripheral perfusion
A cold, mottled toe may indicate arterial occlusion secondary to arterial occlusive disease or embolization; this must be reported to avoid potential gangrene and amputation. Although one glucose reading is elevated, the hemoglobin A 1c indicates successful glucose control over the past 3 months. After the age of 40, reading glasses may be needed because of difficulty in accommodating to close objects. Lungs are clear and no evidence of distress is noted.
Which of these patients with diabetes does the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit? 1 76-year-old who was admitted with fatigue and shortness of breath 2 58-year-old with sensory neuropathy who needs teaching about foot care 3 68-year-old with diabetic ketoacidosis who has an IV running at 250 mL/hr Correct4 70-year-old who needs blood glucose monitoring and insulin before each meal
A nurse from the labor/delivery unit would be familiar with blood glucose monitoring and insulin administration because patients with type 1 and gestational diabetes are frequently cared for in the labor/delivery unit. The 58-year-old with sensory neuropathy, the 68-year-old with diabetic ketoacidosis, and the 76-year-old with fatigue and shortness of breath all have specific teaching or assessment needs that are better handled by nurses more familiar with caring for older adults with diabetes.
The nurse is caring for a patient with diabetes mellitus with autonomic neuropathy. What nursing intervention will the nurse perform for this patient? Select all that apply. Correct1 Assess the patient for urine retention Correct2 Apply lotion to areas of dry, cracked skin 3 Determine if the patient has any loss of sensation in the toes Correct4 Instruct the patient to move positions slowly to avoid getting dizzy 5 Assess the patient for asymmetric weakness of the lower extremities
Autonomic neuropathy may occur in patients with diabetes mellitus. Urinary retention may occur in this condition, and the nurse will assess the patient for urine retention. Dry, cracked skin may occur with this condition, and the nurse will apply lotion to areas of dry, cracked skin. Orthostatic hypotension may occur with this condition, and the nurse will instruct the patient to move positions slowly to avoid getting dizzy. Loss of sensation in the toes may occur in distal symmetric polyneuropathy, not in autonomic neuropathy. Weakness of the lower extremities may occur in focal ischemia, not autonomic neuropathy.
The nurse is caring for a patient with continuous glucose monitoring (CGM) and obtains an elevated reading. Which action would the nurse take first? 1 Administer insulin. 2 Notify the provider. 3 Continue to monitor hourly readings. Correct4 Confirm the results with a finger stick test.
CGM is meant to supplement, not replace, finger stick tests. An elevated reading would be confirmed with a finger stick test. Insulin should be given only after confirming the results of any of the CGM systems. The provider would be notified if the finger stick reading was out of range and the orders indicated that a call was warranted. If the reading on CGM is elevated, continuing to monitor readings without an intervention is considered neglectful behavior and puts the patient at risk.
A patient has been newly diagnosed with diabetes mellitus. Which factors does the nurse emphasize should be monitored regularly by the patient to prevent and detect complications of the disease? Select all that apply. Correct1 Feet Correct2 Urine Correct3 Vision 4 Hepatic function Correct5 Kidney function Correct6 Hemoglobin A 1c
Diabetes affects vision in multiple ways (e.g., retinopathy), so vision must be monitored. Diabetes results in nephropathy, so kidney function as well as urine (for microalbuminuria) should be monitored. Inspection of the feet is important to detect injury caused by a lack of sensation because of neuropathy. Hemoglobin A 1c levels should be monitored and kept below 7%. The liver is not affected by diabetes alone.
The nurse is providing screening for diabetes. What findings are consistent with both type 1 and type 2 diabetes diagnosis? Select all that apply. Correct1 Fatigue Correct2 Polyuria Correct3 Polydipsia 4 Weight loss 5 Hypertension
Fatigue, polyuria, and polydipsia are all findings consistent with both type 1 and type 2 diabetes. Weight loss is consistent with type 1 diabetes. Hypertension is not directly related to either diagnosis.
A patient newly diagnosed with type 1 diabetes is receiving education about the types of premeal insulin. What selection by the patient indicates the teaching was effective? Correct1 Insulin aspart 2 Insulin detemir 3 Insulin glargine 4 Isophane insulin NPH
Insulin aspart is a rapid-acting insulin administered for premeal insulin control. Insulin detemir and glargine are long-acting insulins that are administered for basal regulation. NPH is an intermediate-acting insulin and is not indicated for premeal glucose coverage.
The nurse is teaching a patient about the storage of NPH and regular insulins. Which information does the nurse convey? 1 Insulin vials must be refrigerated after they are opened. 2 Do not draw insulin more than 24 hours in advance of injecting it. Correct3 Refrigerate insulin vials not in use, or if the ambient temperature exceeds 86° F. 4 When storing premixed syringes with NPH and regular insulins, shake the syringe before using.
Insulin in use may be kept at room temperature for up to 28 days to reduce irritation caused by injecting cold insulin; vials not in use should be refrigerated. Predrawn syringes may be stored up to 30 days when refrigerated and should be rolled between the hands before using; shaking insulin should be avoided.
The nurse is triaging a patient diagnosed with type 2 diabetes who is prescribed metformin. It is suspected that the patient is having an adverse drug interaction. What question by the nurse is priority? 1 "Has anyone else been taking your medication?" 2 "Do you know how to properly use an insulin syringe?" Correct3 "Are you currently taking any over-the-counter medications?" 4 "Is there a chance you could have given yourself the wrong insulin?"
It is important to ask the patients if they are taking any over-the-counter medications to identify any possible adverse drug interactions. Someone else taking the patient's medication will not cause the patient to have an adverse drug interaction. The question does not state the patient is taking insulin; metformin is an oral antidiabetic medication.
What macrovascular complications may occur as a result of diabetes mellitus? Select all that apply. 1 Retinopathy 2 Neuropathy 3 Nephropathy Correct4 Cardiovascular disease Correct5 Cerebrovascular disease
Macrovascular complications, damage to the large blood vessels, occur in diabetes mellitus. Both cardiovascular disease and cerebrovascular disease are macrovascular complications of diabetes mellitus. Retinopathy, neuropathy, and nephropathy are microvascular complications of diabetes. Microvascular complications occur due to damage to the small blood vessels of the body.
A 5'8", 225-pound patient with metabolic syndrome has a blood pressure of 158/96 mm Hg, a high-density lipoprotein cholesterol level of 39 mg/dL, and a waist size of 44 inches. Which recommendation does the nurse make to this patient? 1 "Do not consume any concentrated sweets." Correct2 "Consume fewer calories to reduce your weight." 3 "Measure your abdominal circumference weekly." 4 "Drink plenty of water to reduce your blood pressure."
Metabolic syndrome increases the risk for atherosclerosis. Lifestyle changes including weight reduction to within 20% of ideal body weight, along with diet and exercise, reduce cardiovascular risk. Although many individuals with metabolic syndrome have hyperglycemia, the diet can accommodate occasional sweets. Measurement of abdominal circumference weekly is not an effective assessment or intervention to address this patient's issue of metabolic syndrome. Drug therapy may be required to achieve desired lipid and blood pressure outcomes rather than fluids.
What should the nurse include when reviewing microvascular complications of a patient with type 2 diabetes mellitus? Select all that apply. Correct1 Neuropathy Correct2 Retinopathy Correct3 Nephropathy 4 Coronary heart disease 5 Peripheral vascular disease
Microvascular complications of blood vessel structure and function lead to neuropathy, retinopathy, and nephropathy. Macrovascular, not microvascular, complications include coronary heart disease and peripheral vascular disease.
In reviewing the health care provider admission requests for a patient admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis? Correct1 1 ampule NaHCO 3 IV now 2 IV regular insulin at 2 units/hr 3 IV normal saline at 100 mL/hr 4 20 mEq KCl for each liter of IV fluid
NaHCO 3 is given for the acid-base imbalance of diabetic ketoacidosis, not the hyperglycemic-hyperosmolar state, which presents with hyperglycemia and absence of ketosis/acidosis. KCl 20 mEq for each liter of IV fluid will correct hypokalemia from diuresis. IV regular insulin at 2 units/hr will correct hyperglycemia. IV normal saline at 100 mL/hr will correct dehydration.
A patient with type 2 diabetes experiences a stroke and the nurse is caring for the patient in the intensive care unit (ICU). What factor puts this patient at greater risk for a poor clinical outcome? 1 Patients with diabetes do not seek the care needed when having a stroke. 2 Patient with diabetes experience increased vessel damage to the brain during a stroke due to elevated insulin levels. 3 Patients with diabetes do not present the same way as other patients without diabetes who are having a stroke. Correct4
Patients with diabetes experience brain damage that would normally not cause damage in a patient without diabetes. Patients with diabetes who experience a stroke often have poorer outcomes than those without diabetes. Patients with diabetes mellitus are likely to suffer irreversible brain damage with carotid emboli that produce only transient ischemic attacks in people without DM. Thus, patients with diabetes experience brain damage that would normally not cause damage in a patient without diabetes. Patients with diabetes are no less likely to seek care than others. Elevated insulin levels do not increase vessel damage and are not a pathophysiological factor of diabetes. Patients with diabetes who are experiencing a cardiovascular event such as a myocardial infarction may not present the same way as other patients without diabetes; however, this is not true regarding stroke.
The nurse is providing teaching to a patient with visual impairment about safe insulin administration. Which action by the patient indicates effective teaching? Incorrect1 Avoids moving plunger in and out 2 Has home health aides administer insulin Correct3 Places rubber band around fast-acting insulin 4 Places the bottle on a flat surface while withdrawing insulin
Placing a rubber band around fast-acting insulin will differentiate short-acting insulin from long-acting insulin. Moving the plunger in and out can help avoid air bubbles. Having the home health aide administer insulin does not help the patient understand self-administration. The insulin bottle should not be placed on a flat surface when measuring insulin; it should be held up to reduce air bubbles.
A patient with diabetes mellitus has had a cholecystectomy. The nurse prioritizes blood glucose management in the patient's plan of care for which reason? 1 Patients who are diagnosed with diabetes have increased anxiety. Correct2 Patients with postoperative hyperglycemia are prone to poor wound healing. 3 Patients with diabetes who undergo surgery are likely to develop hypoglycemia. 4 Patients with diabetes should not receive insulin when they do not eat a meal.
Postoperative hyperglycemia is associated with increased mortality and morbidity after surgical procedures. Preoperative hyperglycemia may cause neutrophil dysfunction and increased infection rates. Pain triggers an increase in blood glucose levels and an increased need for insulin. There is no evidence that patients with diabetes have more anxiety than others. Patients with diabetes receive insulin postoperatively to maintain blood glucose levels between 140 and 180 mg/dL regardless of oral intake.
The nurse is concerned that a patient with diabetes mellitus is at risk for developing chronic kidney disease (CKD). What findings did the nurse use to make this clinical determination? Select all that apply. Correct1 Blood pressure 168/90 mm Hg 2 Increased urine output during the night Correct3 12-year history of type 2 diabetes mellitus Correct4 Fasting blood glucose levels between 180 and 200 mg/dL Correct5 Stopped taking prescribed angiotensin receptor blocker (ARB)
Risk factors for chronic kidney disease (CKD) in the patient with diabetes include uncontrolled hypertension, which would be validated by the patient's blood pressure being 168/90 mm Hg; a 10- to 15-year history of diabetes mellitus; poor blood glucose control, which is validated by the patient's fasting blood glucose levels being between 180 and 200 mg/dL; and not taking a medication that is known protect the kidneys, such as the prescribed angiotensin receptor blocker (ARB). Increased urine output during the night could be caused by an elevated blood glucose level causing polyuria or fluid accumulation from poor cardiovascular functioning filtered through the kidneys during sleep.
Which outcome is essential for the nurse to include in the plan of care for a patient who has been newly diagnosed with diabetes mellitus? 1 Emphasizing the importance of daily foot inspection Correct2 Ensuring the patient recognizes the signs and symptoms of hypoglycemia 3 Ensuring that the family or caregiver can administer insulin prior to patient discharge 4 Teaching the patient to recognize how many carbohydrate units may be consumed with each meal
Some symptoms of hypoglycemia include diaphoresis, tremor, anxiety, confusion, hunger, loss of consciousness, and even seizure and brain damage; therefore, it is essential for the patient to recognize these symptoms and intervene immediately in order to prevent severe hypoglycemia. Diabetes education is complex and the nurse must first distinguish and emphasize survival skills information from the material the patient can learn after discharge. Inspecting the feet daily is important to detect for early signs of tissue damage, especially when neuropathy is present; however, it does not take priority over learning to recognize and treat hypoglycemia. The patient who needs insulin will return; therefore, demonstrate insulin administration. It is not essential the family do so prior to discharge. The patient's diet may be based on units of carbohydrate measurement; this does not take priority over managing hypoglycemia, which is potentially life threatening.
The nurse is teaching a patient about insulin administration. Which actions by the patient demonstrate an accurate understanding of the teaching provided? Select all that apply. Correct1 Inserting needle at 90-degree angle 2 Recapping needle after administration 3 Rubbing the area after injecting insulin Correct4 Turning bottle upside down to withdraw insulin 5 Drawing air out of bottle before withdrawing insulin
The needle should be inserted at a 90-degree angle, and the bottle should be inverted before withdrawing insulin. The needle should not be recapped after administering insulin; instead, it should be discarded immediately. The area should not be rubbed after insulin is administered. Air is placed into the bottle, not drawn up.
A patient with type 1 diabetes and a limited income is under nursing care. What nutritional teachings will the nurse provide to the patient? Select all that apply. Correct1 Avoid gaining weight. 2 Food intake should remain the same on all days. 3 See the registered dietician at least once every two years. Correct4 Dietary information should be shared with the person who prepares the meals. 5 If you are in a low-income bracket, you may seek less frequent evaluation and counseling.
The nurse should teach type 1 diabetes patients to avoid gaining weight. Dietary information should be shared with the person who prepares the meals. Patients should see a registered dietician at least once a year, not once every two years. Food intake should not remain the same on all days; it may need adjustment during illness, planned exercise, and social occasions. Patients with low incomes may need more, not less, frequent evaluation and counseling.
A patient diagnosed with diabetes plans to engage in strenuous exercise. The patient has a blood sugar level of 285 mg/dL. What action by the patient demonstrates an understanding of the teaching about diabetes? 1 Patient administers bolus insulin. Correct2 Patient checks urine for ketone bodies. 3 Patient engages in strenuous exercise. 4 Patient contacts the health care provider.
The patient should check the urine for ketone bodies with a blood sugar level of greater than 250 mg/dL. The patient should check for ketone bodies before administering insulin. The patient should not contact the health care provider until after checking for ketones. The patient should not engage in strenuous activity before checking for ketone bodies.
The nurse has just taken a change-of-shift report on a group of patients on the medical-surgical unit. Which patient does the nurse assess first? Correct1 Patient taking glyburide who is dizzy and sweaty 2 Patient taking metformin who has abdominal cramps 3 Patient taking repaglinide who has nausea and back pain 4 Patient taking pioglitazone who has bilateral ankle swelling
The patient taking glyburide who is dizzy and sweaty has symptoms consistent with hypoglycemia and should be assessed first because this patient displays the most serious adverse effect of antidiabetic medications. Although the patient taking repaglinide who has nausea and back pain requires assessment, the patient taking glyburide takes priority. Metformin may cause abdominal cramping and diarrhea, but the patient taking it does not require immediate assessment. Ankle swelling is an expected side effect of pioglitazone.
Which instructions would the nurse include when educating a patient with diabetes about how to prevent fasting hyperglycemia known as "dawn phenomenon"? 1 "Administer Humalog (insulin lispro) between 5 and 6 a.m." 2 "Administer Humulin R (insulin [human recombinant]) between 5 and 6 a.m." 3 "Administer Lantis (insulin glargine) at 10 p.m. instead of with the evening meal." Correct4 "Administer Humulin 70/30 (insulin isophane and insulin regular) at 10 p.m. instead of with the evening meal."
To prevent fasting hyperglycemia known as the "dawn phenomenon," the patient would be instructed to administer Humulin 70/30 at 10 p.m. instead of with the evening meal. Dawn phenomenon results from a nighttime release of adrenal hormones that cause blood glucose elevations in the early morning. It is managed by providing more insulin in the overnight period. Giving a dose of intermediate-acting insulin such as Humulin 70/30 at 10 p.m. instead of with an evening meal will provide more insulin for the overnight period, reducing the chance of dawn phenomenon. Humalog and Humulin R are, respectively, rapid- and short-acting insulins that are not appropriate for this purpose. Administering Lantis at 10 p.m. instead of with the evening meal will not help prevent dawn phenomenon, because insulin glargine is a 24-hour acting insulin.
The nurse is teaching the parents of a pediatric patient who has recently been diagnosed with type 1 diabetes mellitus. What statement will the nurse include about the pathophysiology of the disease? 1 "The body starts to attack itself and destroy the cells that convert insulin in the liver." Correct2 "The body starts to attack itself and destroy the cells that make insulin in the pancreas." Incorrect3 "Consistently high insulin levels leads to the inability of the cells to recognize and utilize the insulin." 4 "Consistently high glucose levels leads to the increase in insulin secretion that cannot be utilized by the cells."
Type 1 diabetes mellitus is an autoimmune disorder where the body begins to attack the beta cells, which are the insulin-forming cells, in the pancreas. This type of diabetes does not destroy the cells in the liver. In this type of diabetes insulin levels are absent, not elevated. High glucose levels are not what cause type 1 diabetes mellitus.
