Exam 2 modules 5-8

A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching? Select all that apply. "Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue." "Insulin interferes with glucagon from the pancreas." "Insulin interferes with the release of growth hormone from the pituitary."

"Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue."

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: 138 mg/dL, 2 hours postprandial. 80 mg/dL, 1 hour postprandial. 120 mg/dL, 1 hour postprandial. 90 mg/dL before meals.

138 mg/dL, 2 hours postprandial.

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: 2:30 PM. 10:30 AM. 12:30 PM. 8:30 AM.

8:30 AM.

Which statement is true regarding gestational diabetes? It occurs in most pregnancies. Onset usually occurs in the first trimester. A glucose challenge test should be performed between 24 and 28 weeks. There is a low risk for perinatal complications.

A glucose challenge test should be performed between 24 and 28 weeks.

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? Bacteria White blood cells Albumin Red blood cells

Albumin

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? Fasting blood glucose level Glucose via a urine dipstick test Glycosylated hemoglobin level Glucose via an oral glucose tolerance test

Glycosylated hemoglobin level

Which type of insulin acts most quickly? Glargine Lispro Regular NPH

Lispro

Three P's of hyperglycemia

Polyuria (excessive urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger)

Short acting (R) insulin (examples, onset, peak, duration, indications)

Regular insulin (Humalog R, Humulin R, Novolin R, Ilentin) 30-60 min 2-3 hours 4-6 hours before meals

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? Autonomic neuropathy Retinopathy Sensory neuropathy Nephropathy

Sensory neuropathy

THYROID HORMONE PATHWAY

TSH from anterior pituitary T3 (Triiodothyronine) & T4 (thyroxine) from thyroid gland

ADRENAL GLANDS

sit on top of kidney and produce: - epinephrine and norepi - glucocorticoids - androgens

ADRENAL INSUFFICIENCY

*Addisons disease* Sx: muscle weakness, hypotension hypoglycemia, weight loss, fatigue, low adrenocortical hormone levels (ACTH) treatment: fluid replacement, lifetime use of corticosteroids, high carb and protein diet

ADRENAL OVERACTIVITY

*Cushing's syndrome* Sx: abdominal fat and hump on back, moon face, edema, Treatment: corticosteroid treatment as well

Diseases associated with hyperthyroidism

*Graves disease* - autoimmune - often have bulging eyes *Thyroid storm* - abrupt onset - febrile (greater than 106 F) - dehydration - tachycardia greater than 140 - confusion, psychosis, seizures - severe N/V/D

hypoglycemia (symptoms and treatment options)

- tachycardia, sweating, tremors, nervousness, confusion, headaches, palpitations, hunger PO: 15 g of simple carb snack or glucose tablet other: glucagon SQ/ IM, 50% dextrose IV recheck blood sugar in 15 minutes

A nurse is caring for an older adult client who has type 2 diabetes mellitus. She suspects that the patient is exhibiting symptoms of diabetic ketoacidosis (DKA) instead of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which of the following are indicators of a diagnosis of DKA? Select all that apply. Blood glucose level of 280 mg/dL Serum osmolality of 380 mOsm/L Arterial pH of 7 Plasma bicarbonate level of 13 mEq/L Plasma bicarbonate level of 26 mmol/L

Blood glucose level of 280 mg/dL Arterial pH of 7 Plasma bicarbonate level of 13 mEq/L

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? Administer the total daily dosage in two doses. Do not mix with other insulins. It is rapidly absorbed and has a fast onset of action. Draw up the drug first, then add regular insulin.

Do not mix with other insulins.

HYPERTHYROIDISM (patho, symptoms, treatment)

high levels of T3 T4, low TSH Sxs: speeding up of body and mind, always hot, facial flushing, tachycardia, HTN, high metabolic activity (weight loss), muscle wasting, edema Treatment: meds (PTU, methimazole), surgical removal of thyroid gland (watch for sxs of hypothyroidism now)

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? ketoacidosis hyperosmolar hyperglycemic nonketotic syndrome hepatic disorder All options are correct.

ketoacidosis

DKA (def, symptoms and treatment)

occurs with type 1 if no insulin present, body cant use glucose so cells breakdown fat and protein leading to increased ketones in the body Sx: hyperglycemia (300-1000), dehydration, acidosis (low blood pH, low serum bicarb, low PCO2/ kussmauls respirations), ketones in blood and urine Treatment: hydration, insulin infusion, electrolyte balance, monitor for fluid overload

LADA DIABETES (latent autoimmune diabetes of adults)

slow progressive destruction of beta cells; shared features of DM-I and DM-II

Diseases associated with hypothyroidism

*Hashimotos disease* - most common form - autoimmune disease *Myxedema coma* - severe acute manifestation - marked hypotension, hypothermia, respiratory depression, coma and death

HYPOTHYROIDISM (patho, symptoms, treatment)

low T3 and T4 (high TSH) Sx: slowing down of body and mind, dry and cold skin, constipation, bradycardia, slow reflexes Treatment: levothyroxine (synthetic thyroid hormone), lifetime medical management

HYPOPARATHYROIDISM (patho, symptoms, and treatment)

low levels of serum Ca due to inactive PTH Sx: hypocalcemia, vitamin D deficiency, tetany also, spasms, irritability, depression, cardiac arrhythmias

PARATHYROID GLANDS

these are found in the thyroid and are responsible for release of calcium. Breaks down bone, releasing calcium into bloodstream for absorption and increases the kidney's ability to retain the calcium

Types of insulin

Rapid acting--immediate response needed Short acting--before meals Intermediate acting--after meals Long acting--basal rate (morning or bedtime)

Which instruction about insulin administration should a nurse give to a client? "Discard the intermediate-acting insulin if it appears cloudy." "Shake the vials before withdrawing the insulin." "Always follow the same order when drawing the different insulins into the syringe." "Store unopened vials of insulin in the freezer at temperatures well below freezing."

"Always follow the same order when drawing the different insulins into the syringe."

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: 2 to 5 g of a simple carbohydrate. 10 to 15 g of a simple carbohydrate. 18 to 20 g of a simple carbohydrate. 25 to 30 g of a simple carbohydrate.

10 to 15 g of a simple carbohydrate.

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? 10 to 15 minutes 30 to 40 minutes 1 to 2 hours 3 hours

10 to 15 minutes

A nurse is aware that insulin secretion increases 3 to 5 minutes after a meal and then returns to baseline. If a patient ate breakfast at 7:30 AM, the nurse would expect a baseline level by: 8:30 AM 10:30 AM 2:30 PM 12:30 PM

10:30 AM *baseline blood sugar returns 3 hours after eating*

INSULIN (function)

Allows for cellular uptake of glucose so it can be utilized; stimulated storage of glucose in liver and muscle (glycogen); stores excess glucose as adipose tissue

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?

Blood glucose level 1,100 mg/dl

Diagnostic criteria for diabetes

Fasting glucose > 126 Random glucose >200 AIC > 6.5%

Long acting insulin (examples, onset, peak, duration, indications)

Glargine (Lantus, Toujeo) 1 hour no peak 24 hours basal rate Detemir (Levemir) 6 hours no peak 24-36 hours basal rate

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? The client continues medication therapy despite adequate food intake The client has not consumed sufficient calories. The client has been exercising more than usual. The client has eaten and has not taken or received insulin.

Has eaten and not taken or received insulin

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? Hypocalcemia and hyperkalemia Hyperkalemia and hyperglycemia Hypernatremia and hypercalcemia Hypokalemia and hypoglycemia

Hypokalemia and hypoglycemia

What is most important for teaching item for those with diabetes and illness such as the flu?

Increase frequency of glucose self-monitoring

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? Increases ability for glucose to get into the cell and lowers blood sugar Creates an overall feeling of well-being and lowers risk of depression Decreases need for pancreas to produce more cells Decreases risk of developing insulin resistance and hyperglycemia

Increases ability for glucose to get into the cell and lowers blood sugar

Which statement is correct regarding glargine insulin? Its peak action occurs in 2 to 3 hours. It cannot be mixed with any other type of insulin. It is absorbed rapidly. It is given twice daily.

It cannot be mixed with any other type of insulin.

Rapid acting insulin (examples, onset, peak, duration, indications)

Lispro insulin (Humalog) Aspart 10-15 min 1 hour 2-4 hours rapid reduction of blood sugar

Which is the primary dietary consideration for a client receiving insulin isophane suspension (NPH) at breakfast? Make sure breakfast is not delayed. Provide fewest amount of carbohydrates at lunch meal. Encourage midday snack. Delay dinner meal.

Midday snack

Intermediate acting (N) insulin (examples, onset, peak, duration, indications)

NPH (Humulin N, Novolin N, Ilentin N, Lente) 2-4 hours 4-12 hours 16-20 hours after meals

Long term diabetes complications

Neuropathy: [nerve damage] peripheral [hands and feet] and autonomic [gastroparesis, heart rate, bowels, etc] Retinopathy: leads to blindness Nephropathy: leads to decreased kidney function

Oral antidiabetic agents (indications)

Only for DM-II examples: metformin/ Glucophage, Sulfonylureas--> stimulate beta cells in pancreas to produce insulin Biguanides--> inhibit production of glucose by the liver, increases the body tissue's sensitivity to insulin so it can better utilize it Alpha inhibitors --> delay absorption of carbs into bloodstream Non-sulfonylureas--> stimulate pancreas to produce insulin Thiazolidenediones--> improve action of insulin DPP-4 inhibitors--> improve secretion of insulin

What insulin does the nurse know can be used intravenously?

Rapid-acting Short-acting

What is the only insulin that can be given IV?

Regular

Blood serum levels of which thyroid hormone indicate overall function? T3 T4 TSH

TSH

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? The short-acting insulin is withdrawn before the intermediate-acting insulin. The intermediate-acting insulin is withdrawn before the short-acting insulin. Different types of insulin are not to be mixed in the same syringe. If administered immediately, there is no requirement for withdrawing one type of insulin before another

The short-acting insulin is withdrawn before the intermediate-acting insulin.

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? Underlying problem of insulin resistance Need for lifelong immunosuppressive therapy Increased risk for urologic complications Need for exocrine enzymatic drainage

Underlying problem of insulin resistance

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? There is no need to inject air into the bottle of insulin before withdrawing the insulin. When mixing insulin, the regular insulin is drawn up into the syringe first. If two different types of insulin are ordered, they need to be given in separate injections. When mixing insulin, the NPH insulin is drawn up into the syringe first.

When mixing insulin, the regular insulin is drawn up into the syringe first.

Hyperglycemia hyperosmolar syndrome (def, symptoms, treatment)

also lack of insulin, however no ketosis Sx: hyperglycemia, massive amounts of urine production (dehydration and loss of electrolytes--particularly sodium), increased osmolality, hypotension, tachycardia Treatment: rehydration, insulin administration, monitor fluids and electrolytes

TYPE 1 DIABETES

beta cells are destroyed, therefore no natural insulin production; islet cell antibodies fasting hyperglycemia is present

TYPE 2 DIABETES

beta cells still produce insulin, however at an impaired rate; cells are resistant to the insulin so they don't get the glucose fasting hyperglycemia is present

Methimazole (for thyroid) mechanism of action

blocks synthesis of thyroid hormone

Glycosylated hemoglobin (normal value)

blood test that indicates the amount of glucose in the blood over the previous few months; used to indicate how well diabetes mellitus is being controlled want under 7%

Typical insulin regimen

combo of short acting and long acting insulin

HYPERPARATHYROIDISM (patho, symptoms and treatment)

elevated levels of serum Ca Sxs: may be asymptomatic or may experience fatigue, apathy, muscle weakness or cardiac arrhythmias/ arrest. In severe cases, tetany (numbness, tingling and carpopedal spasms) may occur treatment: removal of abnormal glands and hydration (to prevent calcification)

SIADH (patho, symptoms, treatment)

excessive ADH secretion results in severely retained fluids and hyponatremia, fluid overload Symptoms: hyponatremia, osmolarity greater than 280 treatment: diuretics, fluid restriction

Hypothyroidism is related to deficiency of what electrolyte?

iodine

peritonitis

leak in the intestines causing inflammation and infection if the peritoneal cavity

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: urine glucose level. fasting blood glucose level. serum fructosamine level. glycosylated hemoglobin level.

Glycosylated Hgb

DIABETES INSIPIDUS (DI) (patho, symptoms, treatment)

antidiuretic hormone ADH (which helps the body to retain necessary water) is not secreted, or there is a resistance of the kidney to ADH. symptoms: massive quantities of urine output, confusion, drop is serum osmolarity, hypotension, tachycardia, hypernatremia treatment: vasopressin; thiazide diuretics, fluid replacement

Exercise and diabetes

exercise causes an increase in blood glucose and a drop in insulin eat snack before exercising and monitor glucose levels