Diabetes ( Prepu Hard-Ones)
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:
10 to 15 g of a simple sugar
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?
10-15 mins R: The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.
What is the duration of regular insulin?
4 to 6 hrs
NPH is an example of which type of insulin? A. Long-acting B. Rapid-acting C. Short-acting D. Intermediate-acting
D
Which of the following insulins are used for basal dosage? A. Lispro (Humalog) B. Aspart (Novolog) C. NPH (Humulin N) D. Glarginet (Lantus)
D R: Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.
When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day?
3AM R:During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? A. "You should take your insulin after you eat breakfast and dinner." B. "Your insulin will begin to act in 15 minutes." C. "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." D. "Your insulin will last 8 hours, and you will need to take it three times a day."
A R:NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours. See Table 30-3 in the text.
Which type of insulin acts most quickly? A. Regular B. NPH C. Lispro D. Glargine
C R: The onset of action of rapid-acting lispro is within 10 to 15 minutes. The onset of action of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate-acting NPH insulin is 3 to 4 hours. The onset of action of very long-acting glargine is ~6 hours.
A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R, taken at 6:30 AM will reach peak effectiveness by:
8:30-9:30 R: Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.
An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? A. Systemic inflammatory response syndrome B. Diabetic ketoacidosis C. Hyperglycemic hyperosmolar syndrome D. Multiple-organ dysfunction syndrome
C R: Hyperglycemic hyperosmolar syndrome (HHS) occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes (Reynolds, 2012). The clinical picture of HHS is one of hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis) (see Table 51-7).
A client with diabetic ketoacidosis has been brought into the ED. Which intervention is not a goal in the initial medical treatment of diabetic ketoacidosis? A. Monitor serum electrolytes and blood glucose levels. B. Administer glucose. C. Administer potassium replacements. D. Administer isotonic fluid at a high volume.
B R: Insulin is given intravenously. Insulin reduces the production of ketones by making glucose available for oxidation by the tissues and by restoring the liver's supply of glycogen. As insulin begins to lower the blood glucose level, the IV solution is changed to include one with glucose. Periodic monitoring of serum electrolytes and blood glucose levels is necessary. Isotonic fluid is instilled at a high volume, for example, 250 to 500 mL/hour for several hours. The rate is adjusted once the client becomes rehydrated and diuresis is less acute. Potassium replacements are given despite elevated serum levels to raise intracellular stores.
Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? A. Serum glycosylated hemoglobin (Hb A1c) B. Urine ketones C. 6-hour glucose tolerance test D. Fasting blood glucose test
A R:Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.
The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? A. When mixing insulin, the NPH insulin is drawn up into the syringe first. B. When mixing insulin, the regular insulin is drawn up into the syringe first. C. If two different types of insulin are ordered, they need to be given in separate injections. D. There is no need to inject air into the bottle of insulin before withdrawing the insulin.
B R: When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.
Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? A. Biguanides B. Sulfonylureas C. Alpha-glucosidase inhibitors D. Thiazolidinediones
B B: A functioning pancreas is necessary for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate the action of insulin on peripheral receptor sites. Alpha-glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first? A. Check the client's urine for the presence of sugar and acetone. B. Administer 50% glucose intravenously. C. Encourage the client to drink orange juice with added sugar. D. Infuse 1000 mL D5W over a 12-hour period.
B R: The unconscious, hypoglycemic client needs immediate treatment with IV glucose. If the client does not respond quickly and the blood glucose level continues to be low, glucagon, a hormone that stimulates the liver to release glycogen, or 20 to 50 mL of 50% glucose is prescribed for IV administration. A dose of 1,000 mL D5W over a 12-hour period indicates a lower strength of glucose and a slow administration rate. Checking the client's urine for the presence of sugar and acetone is incorrect because a blood sample is easier to collect and the blood test is more specific and reliable. An unconscious client cannot be given a drink. In such a case glucose gel may be applied in the buccal cavity of the mouth.
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? A. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." B. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." C. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." D. "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released."
C R:Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.
A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? A. Type 1 diabetes always develops before the age of 20. B. New cases of diabetes will be split roughly evenly between type 1 and type 2. C. New cases of diabetes are highly uncommon in older adults. D. The participants are unlikely to develop a new onset of type 1 diabetes.
D R:Type 1 diabetes usually (but not always) develops in people younger than 20. In older adults, an onset of type 2 is far more common. A significant number of older adults develops type 2 diabetes.
Which factor is the focus of nutrition intervention for clients with type 2 diabetes?
Weight loss is the focus of nutrition intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms; even a mild to moderate weight loss such as 10 to 20 lb may lower blood glucose levels and improve insulin action.
A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? A. 8:00 AM B. 7:45 AM C. 8:30 AM D. 8:15 AM
7:45 AM
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) A. Ketosis-prone B. Obesity at diagnoses C. Little endogenous insulin D. Younger than 30 years of age E. Older than 65 years of age
A,C,D R:Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent.
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. A. Absent ketones B. Elevated blood urea nitrogen (BUN) and creatinine C. More common in type 1 diabetes D. Normal arterial pH level E. Rapid onset
B,C, E R:DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.
Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. A. Client has been sleeping excessively. B. Client has not consumed sufficient calories. C. Client has been exercising more than usual. D. Client is experiencing effects of the aging process. E. Client has not consumed food and continues to take insulin or oral antidiabetic medications.
B,C,E R: Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia.
The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find? A. Serum bicarbonate of 19 mEq/L B. Blood glucose level of 250 mg/dL C. Blood pH of 6.9 D. PaCO2 of 40 mm Hg
C R: With DKA, blood glucose levels are elevated to 300 to 1000 mg/dL or more. Urine contains glucose and ketones. The blood pH ranges from 6.8 to 7.3. The serum bicarbonate level is decreased to levels from 0 to 15 mEq/L. The compensatory breathing pattern can lower the partial pressure of carbon dioxide in arterial blood (PaCO2) to levels of 10 to 30 mm Hg.
Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic? A. Minimize discomfort. B. Prevent muscle destruction. C. Promote absorption. D. Avoid infection.
C R:Subcutaneous injection sites require rotation to avoid breakdown and/or buildup of subcutaneous fat, either of which can interfere with insulin absorption in the tissue. Infection and discomfort are risks involved with injection site but not the primary reason for rotation of sites. Insulin is not injected into the muscle.
A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? A. Between 8:00 and 10:00 a.m. B. Between 4:00 and 6:00 p.m. C. Between 7:00 and 9:00 p.m. D. This insulin has no peak action and does not cause a hypoglycemic reaction.
D R: "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? A. Hyponatremia B. Polyphagia C. Ketonuria D. Hypoglycemia
D R: The therapeutic goal for diabetes management is to achieve normal blood glucose levels (euglycemia) without hypoglycemia while maintaining a high quality of life.
Which statement is correct regarding glargine insulin? A. It is absorbed rapidly. B. It is given twice daily. C. Its peak action occurs in 2 to 3 hours. D. It cannot be mixed with any other type of insulin.
D R:Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.
A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer (3)
Metformin ( a biguanide) Rosiglitazone and pioglitazone (thiazolidinediones) R: Metformin is a biguanide and, along with the thiazolidinediones (rosiglitazone and pioglitazone), are categorized as insulin sensitizers; they help tissues use available insulin more efficiently.
Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply. A. Decreases total cholesterol B. Increases lean muscle mass C. Increases glucose uptake by body muscles D. Decreases the levels of high-density lipoproteins E. Increases resting metabolic rate as muscle size increases
a,b,c,e, R:All of the options are benefits of exercise except the effect of decreasing the levels of HDL. Exercise increases the levels of HDL.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? A. "Test your blood glucose every 4 hours." B. "Don't take your insulin or oral antidiabetic agent if you don't eat." C. "Follow your regular meal plan, even if you're nauseous." D. "It's okay for your blood glucose to go above 300 mg/dl while you're sick."
A R: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.
A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? A. Below-normal serum potassium level B. Serum alkalosis C. Serum ketone bodies D. Elevated serum acetone level
A R:A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: A. rapid-acting insulin only. B. short- and intermediate-acting insulins. C. intermediate- and long-acting insulins. D. short- and long-acting insulins.
A R:A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.
A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance? A. glycosylated hemoglobin B. All options are correct. C. postprandial glucose D. hematocrit A1c
A R:Once a client with diabetes receives a treatment regimen to follow, the physician can assess the effectiveness of treatment and the client's compliance by obtaining a hemoglobin A1c test. The results of this test reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. Normally, the level of glycosylated hemoglobin is less than 7%. Amounts of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? A. 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution B. 100 units of regular insulin in normal saline solution C. 100 units of regular insulin in dextrose 5% in water D. 100 units of NPH insulin in dextrose 5% in water
B R:Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.
Which of the following would the nurse most likely assess in a client with diabetes who is experiencing autonomic neuropathy? A. Paresthesias B. Skeletal deformities C. Erectile dysfunction D. Soft tissue ulceration
C R:Autonomic neuropathy affects organ functioning. According the American Diabetes Association, up to 50% of men with diabetes develop erectile dysfunction when nerves that promote erection become impaired. Skeletal deformities and soft tissue ulcers may occur with motor neuropathy. Paresthesias are associated with sensory neuropathy.
A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client? A. "It does not matter what time of day I take this medication." B. "This medication needs to be taken after the midday meal." C. "I will take this medication in the morning, 15 minutes before breakfast." D. "I will take this medication in the morning, with my first bite of breakfast."
D R: Alpha-glucosidase inhibitors such as acarbose and miglitol, delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation. They must be taken with the first bite of food to be effective.
