Exam 3: Chapter 53
The nurse assesses the techniques of a patient with diabetes for self-blood glucose monitoring (BGM) 3 months after initial instruction. Which error in the performance of BGM requires intervention? a. Doing the BGM 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 puncture
C
What assessment findings occur to diabetic ketoacidosis (DKA)? *Select all that apply.* a. Thirst b. Ketonuria c. Dehydration d. Metabolic acidosis e. Kussmaul respirations f. Sweet, fruity breath odor
A, B, C, D, E, F
What information would the nurse include when teaching the patient with prediabetes about ways to prevent or delay the development of type 2 diabetes? *Select all that apply.* a. Exercise regularly b. Maintain a healthy weight c. Have BP checked regularly d. Assess for visual changes on a monthly basis e. Monitor for polyuria, polyphagia, and polydipsia
A, B, E
In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? 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. Increases amino acid transport into cells and protein synthesis
D
The nurse is assessing a new admitted patient with diabetes. Which observation would most concern the nurse? a. Bilateral numbness of both hands b. Rapid respirations with deep inspiration c. Stage 2 pressure injury on the right heel d. Areas of lumps and dents on the abdomen
B
Cortisol, glucagon, epinephrine, and growth hormone are referred to as counterregulatory hormones. What do they do? a. Decrease glucose production b. Stimulate glucose output by the liver c. Increase glucose transport into the cells d. Independently regulate glucose level in the blood
B
Which treatment plan would the nurse give the highest priority to when caring for a patient with metabolic syndrome? a. Achieving a normal weight b. Performing daily aerobic exercise c. Eliminating red meat from the diet d. Monitoring the blood glucose periodically
A
A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? 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
The patient with type 2 diabetes is being prescribed acarbose (Precose) and wants to know about taking it. What would the nurse include in this patient's teaching? *Select all that apply.* a. Take it with the first bite of each meal. b. It is not used in patients with heart failure. c. Endogenous glucose production is decreased. d. Effectiveness is measured by 2-hour postprandial glucose. e. It delays glucose absorption from the gastrointestinal (GI) tract.
A, D, E
What describes the main difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia syndrome (HHS)? 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. Glucose is withheld in HHS until the blood glucose reaches a normal level.
C
Which patient would the nurse plan to teach how to prevent or delay the development of diabetes? a. An obese 40-year-old Hispanic women b. A 20-year-old man whose father has type 1 diabetes c. A 34-year-old woman whose parents both have type 2 diabetes d. A 12-year-old boy whose father has maturity-onset diabetes of the young (MODY)
C
What would the nurse determine a patient has with a 2-hour OGTT of 152 mg/dL? a. Diabetes b. Elevated A1C c. Impaired fasting glucose d. Impaired glucose intolerance
D
Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes, When would the nurse administer lispro insulin? a. Only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. At mealtime or within 15 minutes of meals
D
The home care nurse is reviewing insulin administration with a patient. What action by the patient causes the home care nurse to intervene? a. The patient warms a prefilled refrigerated syringe in the hands before administration. b. The patient stores syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c. The patient places the insulin bottle currently in use in a small container on the bathroom countertop. d. The patient mixes an evening dose of regular insulin with insulin glargline in 1 syringe for administration
D
Which laboratory results indicate the patient has prediabetes? a. Glucose tolerance result of 132 mg/dL (7.3 mmol.L) b. Glucose tolerance result of 240 mg/dL (13.3 mmol/L) c. Fasting blood glucose result of 80 mg/dL (4.4 mmol/L) d. Fasting blood glucose results of 120 mg/dL (6.7 mmol/L)
D
What teaching would be included regarding individualized nutrition therapy for patients using conventional, fixed insulin regimens? 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
When teaching the patient with type 1 diabetes, what would the nurse emphasize as the major advantage of using an insulin pump? 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
A patient with type 1 diabetes use 20 U of Novolin 70/30 (NPH/regular) in the morning and at 6:00 PM. What would the nurse emphasize when teaching the patient about this regimen? 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 24 hours a day. d. Glucose checks before meals are required to determine needed changes in daily dosing.
B
The following interventions are planned for a patient with diabetes. Which intervention can the nurse delegate to assistive personnel (AP)? a. Discuss complications of diabetes. b. Check that the bath water is not too hot. c. Check the patient's technique for drawing up insulin. d. Teach the patient to use a meter for self-monitoring of blood glucose.
B
Which class or oral glucose-lowering agents (OA) is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. Insulin b. Biguanide c. Meglitinide d. Sulfonylurea
B
Which instruction would the nurse include when teaching the patient with diabetes about insulin administration? a. Pull back on the plunger after inserting the needle to check for blood. b. Consistently use the same size of insulin syringe to avoid dosing errors. c. Clean the skin at the injection site with an alcohol swab before each injection. d. Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.
B
Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. It can be prevented by tissue glucose control. b. It occurs with a higher frequency and earlier onset that in the nondiabetic population. c. It is caused by hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. It cannot be modified by reducing risk factors, such as smoking, obesity, and high fat intake.
B
What disorders diseases are related to macrovascular complications of diabetes? *Select all that apply.* a. Chronic kidney disease b. Coronary artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremities e. Capillary and arteriole membrane thickening specific to diabetes
B, D
The patient with diabetes has been diagnosed with autonomic neuropathy. What problems would the nurse assess for in this patient? *Select all that apply.* a. Painless foot ulcers b. Erectile dysfunction c. Burning foot pain at night d. Loss of fine motor control e. Vomiting undigested food f. Painless myocardial infarction
B, E, F
A patient taking insulin has recorded fasting glucose levels about 200 mg/dL (11.1 mmol/L) for the last 5 mornings. What would the nurse have the patient do first? a. Increase the evening insulin dose to prevent the drawn phenomenon. b. Use a single-dose insulin regimen with an intermediate-acting insulin. c. Monitor the glucose level at bedtime, between 2:00 AM and 4:00 AM, and on arising. d. Decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect.
C
When would the nurse observe the patient for symptoms of ketoacidosis? a. Illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. Glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss. c. An insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. The patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.
C
Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? 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
The patient with type 2 diabetes has had trouble controlling his-glucose with several OAs but wants to avoid the risks of insulin. Which medication will increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying? a. Dopamine receptor agonist, bromocriptine (Cycloset) b. Dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin (Januvia) c. Sodium-glucose co-transporter 2 (SGLT2) inhibitor, canagliflozin (Invokana) d. Glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)
D
A 72-year-old woman is diagnosed with diabetes. What does the nurse know about managing diabetes in the older adult? a. It is harder to achieve strict glucose control than in younger patients. b. Treatment is not warranted unless thee patient develops severe hyperglycemia. c. It does not include treatment with insulin because of limited dexterity and vision. d. It usually requires that a younger family member be responsible for care of the patient.
A
A patient with diabetes calls the clinic because of nausea and flu-like symptoms. What is the nurse's best advice? 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 glucose every 1 to 2 houors and call if it rises over 150 mg/dL (8.3 mmol/L).
A
To prevent hyperglycemia or hypoglycemia related to exercise, what would the nurse teach the patient about exercise when using glucose-lowering agents? a. Plan activity and food intake related to glucose levels b. When glucose is greater than 250 mg/dL and ketones are present c. When glucose monitoring reveals that the glucose is in the normal range d. When glucose levels are high, because exercise always has a hypoglycemic effect
A
During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 md/dL (7.33 mmol/L). At a follow-up visit, which laboratory results would a diagnosis be made? *Select all that apply.* a. A1C of 7.5% b. Glycosuria of 3 + c. FPG ≥ 127 mg/dL (7.0 mmol/L) d. Random blod glucose of 126 mg/dL (7.0 mmol/L) e. A 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)
A, C
The patient with diabetes has a blood glucose level of 248 mg/dL. Which assessment findings would be related to this blood glucose level? *Select all that apply.* a. Headache b. Unsteady gait c. Abdominal cramps d. Emotional changes e. Increase in urination f. Weakness and fatigue
A, C, E, F
A nurse working in an outpatient clinical plans a screening program for diabetes. What recommendations for screening would be included? a. OGTT for all minority populations every year b. FPG for all persons at age 45 years and then every 3 years c. Testing people under the age of 21 years for islet cell antibodies d. Testing for type 2 diabetes in all overweight or obese persons
B
A patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medication, but would rather control their glucose with herbal therapy. What would the nurse do? a. Teach the patient with herbal therapy is not safe and should not be used. b. Advise the patient to discuss using herbal therapy with her HCP before using it. c. Encourage the patient to give the prescriptive medication time to work before using herbal therapy. d. Teach the patient that if they take herbal therapy, they will have to monitor their glucose more often.
B
In type 1 diabetes, glucose has an osmotic effect when insulin deficiency prevents to use of glucose for energy. Which symptoms is caused by the osmotic effect of glucose? a. Fatigue b. Polydipsia c. Polyphagia d. Recurrent infections
B
What goals of nutrition therapy are included for the patient with type 2 diabetes? a. Ideal body weight b. Normal-glucose and lipid levels c. A special diabetic diet using dietetic foods d. Five small meals per day with a bedtime snack
B
What characterizes type 2 diabetes? *Select all that apply.* a. B-cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver
A, B, C, D, E, F
Two days after a self-managed hypoglycemic episode at home, the patient tells the nurse that their glucose levels since the episode have been between 80 and 90 mg/dL. How would the nurse respond? a. "That is a good range for your glucose levels." b. "You should call you HCP 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 take only half your insulin dosage for the next few days to get your glucose level back to normal
A
The patient with diabetes is brought to the emergency department by his family members, who say that he has had an infection, is not acting like himself, and is more tired than usual. Number the nursing actions in order of priority for this patient, using number 1 as the first priority and number 6 as the last priority. a. Establish IV access. b. Check blood glucose. c. Ensure patient airway. d. Begin continuous regular insulin drip. e. Administer 0.9% NaCl solution at 1L/hr. f. Establish time of last food and medication(s).
A: 3 B: 2 C: 1 D: 5 E: 4 F: 6
Which tissues require insulin to enable movement of glucose into the tissue cells? *Select all that apply.* a. Liver b. Brain c. Adipose d. Blood cells e. Skeletal muscle
C, E
A patient with diabetes is found unconscious at home, and a family member calls the clinic. After determining that a glucometer is not available, what would the nurse advise the family member to do? a. Have the patient drink some orange juice. b. Administer 10 U of regular insulin subcutaneously c. Call for an ambulance to transport the patient to a medical facility. d. Administer glucagon 1 mg intramuscularly (IM) or subcutaneously.
D
