Med-Surg Ch 64 Diabetes
What must the nurse teach a patient with type I DM about preventing the loss of insulin potency? (Select all that apply.) A. "Avoid exposing insulin to temperatures below 36°F (2.2°C) or about 86°F (30°C)." B. "Freeze bottles of insulin for long-term storage." C. "Always shake NPH insulin to make sure it is evenly cloudy." D. "Do not expose insulin to heat or light." E. "Insulin glargine (Lantus) should be stored in refrigerator." F. "A slight loss in potency may occur for bottles in use for more than 30 days."
A. "Avoid exposing insulin to temperatures below 36°F (2.2°C) or about 86°F (30°C)." D. "Do not expose insulin to heat or light." E. "Insulin glargine (Lantus) should be stored in refrigerator."
The nurse is preparing to teach a diabetic patient how to select appropriate shoes. Which points must be included in the teaching plan? (Select all that apply.) A. "It is best to have the shoes fitted by an experienced shoe fitter such as a podiatrist." B. "The shoes should be 1 to 1.5 inches longer than your longest toe." C. "The heels of the shoes should be less than 2 inches high." D. "Avoid tight-fitting shoes, which can cause tissue damage to your feet." E. "You should get at least two pair of shoes so you can change them at mid-day and in the evening." F. "Buy your shoes later in the day, when feet are normally larger."
A. "It is best to have the shoes fitted by an experienced shoe fitter such as a podiatrist." C. "The heels of the shoes should be less than 2 inches high." D. "Avoid tight-fitting shoes, which can cause tissue damage to your feet." E. "You should get at least two pair of shoes so you can change them at mid-day and in the evening." F. "Buy your shoes later in the day, when feet are normally larger."
A patient asks the nurse how insulin injection site rotation should be accomplished. What is the nurse's BEST response? A. "Rotation within one site is preferred to avoid changes in insulin absorption." B. "Change rotation sites after a week or two to avoid lipohypertrophy." C. "Rotation from site to site each day is best for the most insulin absorption." D. "Always rotate insulin injection sites within 4-5 inches from the umbilicus."
A. "Rotation within one site is preferred to avoid changes in insulin absorption."
The nurse is caring for a patient with DM. The patient's urine is positive for ketones. What does the nurse instruct the patient with regard to exercise? A. "When urine ketones are present, you should not exercise." B. "You may exercise as long as serum ketones are low positive." C. "If you exercise now, be sure to perform aerobic exercises." D. "Exercise is always a good option because it helps with glucose utilization."
A. "When urine ketones are present, you should not exercise."
A patient with diabetic ketoacidosis is on an insulin drip of 50 units of regular insulin in 250 mL of normal saline. The current blood glucose level is 549 mg/dL. According to insulin protocol, the insulin drip needs to be changed to 8 units per hour. At what rate does the nurse set the pump? A. 40 mL/hr B. 50 mL/hr C. 60 mL/hr D. 75 mL/hr
A. 40 mL/hr
Which diabetic patient is at greatest risk for diabetic foot ulcer formation? A. 75-year-old African-American male with history of cardiovascular disease B. 53-year-old Caucasian female with history of renal insufficiency C. 38-year-old American Indian with history of gastric ulcers D. 28-year-old Caucasian male with history of chronic disease
A. 75-year-old African-American male with history of cardiovascular disease
In which situations does the nurse teacher a patient to perform urine ketone testing? (Select all that apply.) A. Acute illness or stress B. When blood glucose levels are above 200 mg/dL C. When symptoms of diabetic ketoacidosis (DKA) are present D. To evaluate the effectiveness of diabetic ketoacidosis(DKA) treatment E. When a diabetic patient is in a weight-loss program F. When a diabetic patient has a diagnosis of hyper glycemic - hyperosmolar state(HHS)
A. Acute illness or stress C. When symptoms of diabetic ketoacidosis (DKA) are present E. When a diabetic patient is in a weight-loss program
Which class of antidiabetic medication should be taken with the FIRST bite of a meal to be fully effective? A. Alpha-Glucosidase inhibitors, which include miglitol B. Biguanides, which include metformin C. Meglitinides, which include nateglinide D. Second generation sulfonylureas, which include glipizide
A. Alpha-Glucosidase inhibitors, which include miglitol
Which infection control measures must the nurse teach a patient who will be performing SMBG? (Select all that apply.) A. Always wash hands before monitoring glucose. B. Regular cleaning of the meter is critical. C. Do not reuse lancets. D. Do not share blood glucose monitoring equipment. E. Sterilize blood glucose monitor before each use. F. Family members who help with testing should wear gloves.
A. Always wash hands before monitoring glucose. B. Regular cleaning of the meter is critical. C. Do not reuse lancets. D. Do not share blood glucose monitoring equipment. F. Family members who help with testing should wear gloves.
The nurses is caring for a diabetic patient in the ED. The patient's lab values include serum glucose 353 mg/dL, positive serum ketones, and positive urine ketones. What complication does the nurses suspect? A. DKA B. HHS C. Hyperglycemia D. Hypoglycemia
A. DKA
The female patient has type II DM. Which types of sexual dysfunction should the nurse teach may occur for this patient? (Select all that apply.) A. Decreased libido B. Excessive vaginal lubrication C. Painful intercourse D. Failure to achieve orgasm E. Decreased sexual response F. Increase fear of sexual encounters
A. Decreased libido C. Painful intercourse E. Decreased sexual response
Which complications of DM are considered emergencies? (Select all that apply.) A. Diabetic ketoacidosis (DKA) B. Hypoglycemia C. Diabetic retinopathy D. Hyperglycemic-hyperosmolar state (HHS) E. Diabetic neuropathy F. Diabetic nephropathy
A. Diabetic ketoacidosis (DKA) B. Hypoglycemia D. Hyperglycemic-hyperosmolar state (HHS)
A patient with diabetes is scheduled to have a blood glucose test the next morning. Which instruction does the nurse give the patient? A. Eat the usual diet but have nothing after midnight. B. Take the usual or a hypoglycemic tablet in the morning. C. Eat a clear liquid breakfast in the morning. D. Follow the usual diet and medication regimen.
A. Eat the usual diet but have nothing after midnight.
A patient is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dL. Which complication is the patient MOST at risk for developing? A. Hypoglycemia B. Pulmonary embolus C. Renal shutdown D. Pulmonary edema
A. Hypoglycemia
The nurse is teaching a patient with diabetes about proper foot care. Which instructions does the nurse include?(Select all that apply.) A. Inspect feet daily. B. Wear open-toed shoes or sandals in warm weather to prevent perspiration. C. Apply moisturizing cream to the feet after bathing but not between the toes. D. Use cold water for bathing the feet to prevent inadvertent thermal injury. E. Do not go barefoot. F. Use rubbing alcohol to toughen the skin on the soles of the feet.
A. Inspect feet daily. C. Apply moisturizing cream to the feet after bathing but not between the toes. E. Do not go barefoot.
Which statement about type 1 DM are accurate? (Select all that apply.) A. It is an autoimmune disorder. B. Most people with type I DM are obese. C. Age of onset is typically younger than 30. D. Etiology may be attributed to viral infections. E. It can be treated with oral antidiabetic medications and insulin. F. It involves insulin resistance that progresses leading to decreased beta cell secretion of insulin.
A. It is an autoimmune disorder. C. Age of onset is typically younger than 30. D. Etiology may be attributed to viral infections.
Which statements about type II DM are accurate? (Select all that apply.) A. It peaks at about the age of 50. B. Most people with type II DM are obese. C. It typically has an abrupt onset. D. People with type II DM have insulin resistance. E. It can be treated with oral antidiabetic medications and insulin. F. Presence of metabolic syndrome increases the risk for type II DM.
A. It peaks at about the age of 50. B. Most people with type II DM are obese. D. People with type II DM have insulin resistance. E. It can be treated with oral antidiabetic medications and insulin. F. Presence of metabolic syndrome increases the risk for type II DM.
Intensive therapy with good glucose control results in delayed occurrence in which diabetic complications? (Select all that apply.) A. Macrovascular disease B. Cardiovascular disease C. Stroke D. Retinopathy E. Nephropathy F. Neuropathy
A. Macrovascular disease B. Cardiovascular disease D. Retinopathy E. Nephropathy F. Neuropathy
In developing an individualized meal plan for a patient with diabetes, which goals will be focal points of the plan?(Select all that apply.) A. Maintain blood glucose levels at or as close to the normal range as possible. B. Allow patient food preferences. C. Permit patients to eat as much as they desire. D. Honor patient cultural preferences. E. Limit food choices only when guided by scientific evidence. F. Include the family member who buys groceries and prepares meals in the teaching.
A. Maintain blood glucose levels at or as close to the normal range as possible. B. Allow patient food preferences. D. Honor patient cultural preferences. E. Limit food choices only when guided by scientific evidence. F. Include the family member who buys groceries and prepares meals in the teaching.
On assessment, the patient has abdominal obesity (waist 40 inches/100 cm), a fasting blood glucose level of 100 mg/dL, blood pressure 140/92, and a triglyceride level of 150 mg/dL. What condition is indicated by these findings? A. Metabolic syndrome B. Kidney failure C. Gestational diabetes D. Atherosclerosis
A. Metabolic syndrome
Which are symptoms of diabetic neuropathy? (Select all that apply.) A. Metatarsalgia B. Hyperalgesia C. Loss of vision D. Decreased urine output E. Allodynia F. Numbness and tingling in legs
A. Metatarsalgia B. Hyperalgesia E. Allodynia F. Numbness and tingling in legs
People from which cultures tend to have a higher incidence of DM? (Select all that apply.) A. Mexican American B. African American C. Caucasian D. American Indian E. Eastern European F. Alaskan Indian
A. Mexican American B. African American D. American Indian F. Alaskan Indian
What type of exercise does the nurse recommend for the patient with diabetic retinopathy? A. Non-weight-bearing activities such as swimming B. Weight-bearing activities such as jogging C. Vigorous aerobic and resistance exercises D. Weight training and heavy lifting
A. Non-weight-bearing activities such as swimming
For which patient should be healthcare provider avoid prescribing rosiglitazone? A. Patient with symptomatic heart failure B. Patient with new onset asthma C. Patient with kidney disease D. Patient with hyperthyroidism
A. Patient with symptomatic heart failure
The nurse is caring for a patient recovering from DKA. Which patient care task could be delegated to the unlicensed assistant personnel (UAP)? A. Record urine output every hour. B. Assess mental status every hour. C. Assess central venous pressure every 30 minutes. D. Teach patient about causes of DKA.
A. Record urine output every hour.
The patient with type II diabetes is prescribe sitagliptin for glucose regulation. Which he changes does the nurse teach a patient to report to the health care provider immediately? (Select all that apply.) A. Report any signs of jaundice. B. Report any signs of bleeding. C. Report any blue-gray discoloration of the abdomen. D. Reporting any cough or flu symptoms. E. Report any sudden onset of abdominal pain. F. Report any rash or other signs of allergic reaction.
A. Report any signs of jaundice. C. Report any blue-gray discoloration of the abdomen. E. Report any sudden onset of abdominal pain. F. Report any rash or other signs of allergic reaction.
A patient will be using an external insulin pump. What instruction does the nurse gives the patient about the pump? A. SMBG levels should be done three or more times a day. B. The instant supply must be replaced every 2 to 4 weeks. C. The pumps battery should be checked on a regular weekly schedule. D. The needle site must be changed everyday.
A. SMBG levels should be done three or more times a day.
Which factors differentiate diabetic ketoacidosis (DKA) from hyperglycemic-hyperosmolar (HHS) state? (Select all that apply.) A. Sudden versus gradual onset B. Amount of ketones produced C. Serum bicarbonate levels D. Amount of volume depletion E. Dosage of insulin needed F. Level of hyperglycemia
A. Sudden versus gradual onset B. Amount of ketones produced F. Level of hyperglycemia
Which are common causes of hypoglycemia? (Select all that apply.) A. Too much insulin compared with food intake and physical activity B. Increased food intake especially after missed or delayed meals C. Insulin injection at the wrong time relative to food intake and physical activity D. Decreased insulin sensitivity as a result of regular exercise and weight loss E. Decreasing insulin clearance from progressive kidney failure F. Decrease liver glucose production after alcohol ingestion
A. Too much insulin compared with food intake and physical activity C. Insulin injection at the wrong time relative to food intake and physical activity E. Decreasing insulin clearance from progressive kidney failure F. Decrease liver glucose production after alcohol ingestion
The patient's urinalysis shows proteinuria. Which pathophysiology does the nurse suspect? A. nephropathy B. neuropathy C. Retinopathy D. gastroparesis
A. nephropathy
From which injection site is insulin absorbed most rapidly? A. Buttocks B. Abdomen C. Deltoid D. Thigh
B. Abdomen
The patient has been diagnosed with DM. Which aspects does the nurse consider in formulating the teaching plan for this patient? (Select all that apply.) A. Covering all of the information in one teaching session B. Assessing visual impairment regarding insulin levels and markings on syringes C. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe D. Assessing patient motivation to learn and comprehend instructions E. Assessing the patient's abilities to read printed material F. Assisting patients to choose an SMBG device that is best for their level of visual impairment
B. Assessing visual impairment regarding insulin levels and markings on syringes C. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe D. Assessing patient motivation to learn and comprehend instructions E. Assessing the patient's abilities to read printed material F. Assisting patients to choose an SMBG device that is best for their level of visual impairment
What glucose level range does the American Association of Clinical Endocrinologists recommend for a critically ill patient? A. Between 100 and 130 mg/dL B. Between 140 and 180 mg/dL C. Between 180 and 200 mg/dL D. Between 200 and 240 mg/dL
B. Between 140 and 180 mg/dL
Which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established? A. Alpha-glucosidase inhibitors, which include miglitol B. Biguanides, which include metformin C. Meglitinides, which include nateglinide D. Second-generation sulfonylureas, which include glipizide
B. Biguanides, which include metformin
Which statement about dietary concepts for patient with diabetes is true? A. Alcoholic beverage consumption is unrestricted. B. Carbohydrate counting is emphasize when adjusting dietary intake of nutrients. C. Sweeteners should be avoided because of the side effects. D. Both soluble and insoluble fiber foods should be limited.
B. Carbohydrate counting is emphasize when adjusting dietary intake of nutrients.
A patient with type I DM is planning to travel by air and asked The nurse about preparations for the trip. What does a nurse tell the patient to do? A. Pack insulin and syringes in a labeled, crushproof kit in the checked luggage. B. Carry all necessary diabetes supplies in a clearly identified pack aboard the plane. C. Ask the flight attendant to put the insulin in the gallery refrigerator once on the plane. D. Take only minimal supplies and get the prescription filled at his or her destination.
B. Carry all necessary diabetes supplies in a clearly identified pack aboard the plane.
Which statement about type II diabetes mellitus (DM) are MOST characteristic? (Select all that apply.) A. Autoimmune process causes beta cell destruction. B. Cells have decreased ability to respond to insulin. C. Diagnosis is based on results of 100-g glucose tolerance test. D. Most patients diagnosed are obese adults. E. Usually has abrupt onset of thirst and weight loss. F. Most patients are not dependent on insulin.
B. Cells have decreased ability to respond to insulin. D. Most patients diagnosed are obese adults. F. Most patients are not dependent on insulin.
The patient with type to DM often has which laboratory value? A. Elevated thyroid studies B. Elevated triglycerides C. Ketones in the urine D. Low hemoglobin
B. Elevated triglycerides
The critical care nurse is caring for an older patient admitted with HHS. What is the FIRST PRIORITY in caring for this patient? A. Slowly decreasing blood glucose B. Fluid replacement to increase blood volume C. Potassium replacement to prevent hypokalemia D. Diuretic therapy to maintain kidney function
B. Fluid replacement to increase blood volume
A patient with BM has signs and symptoms of hypoglycemia. The patient is alert and oriented with a blood glucose of 56 mg/dL. What does the nurse do NEXT? A. Give a glass of orange juice with two packets of sugar and continue to monitor the patient. B. Give 8 oz of skim milk, then a carbohydrate and protein snack if next meal is more than an hour away. C. Give a complex carbohydrate and continue to monitor patient. D. Administer D50 IV push in give the patient something to eat.
B. Give 8 oz of skim milk, then a carbohydrate and protein snack if next meal is more than an hour away.
The patient asked the nurse "Why am I getting glucagon?"Which response by the nurse is MOST accurate? A. Glucagon competes for insulin at the receptor sites. B. Glucagon frees glucose from hepatic stores of glycogen. C. Glucagon supplies glycogen directly to the vital tissues. D. Glucagon is a glucose substitute for rapid replacement
B. Glucagon frees glucose from hepatic stores of glycogen.
Which insulins are considered to have a rapid onset of action? (Select all that apply.) A. Novolin 70/30 B. Glulisine C. Humulin N D. Aspart E. Lispro F. Glargine
B. Glulisine D. Aspart E. Lispro
In determining if a patient is hypoglycemic, in addition to checking the patient's blood glucose, the nurse assesses the patient for which characteristics? (Select all that apply.) A. Nausea B. Hunger C. Irritability D. Tremors E. Profuse perspiration F. Rapid, deep respirations
B. Hunger C. Irritability D. Tremors E. Profuse perspiration
The healthcare provider prescribes empagliflozin for the patient with diabetes. For which complication will the nurse be sure to monitor while the patient is taking this drug? A. Heart failure B. Impaired renal function C. Pulmonary edema D. Gastrointestinal distress
B. Impaired renal function
Which characteristic describes a needleless insulin injection system? A. The patient must be able to operate the pump, adjust the settings, then respond to alarms. B. Insulin is given by jet injection, is absorbed at a faster rate, and has a shorter duration of action. C. A continuous subcutaneous infusion of a basal dose of insulin is provided. D. If a meal is skipped, an additional mealtime dose of insulin is not given.
B. Insulin is given by jet injection, is absorbed at a faster rate, and has a shorter duration of action.
Which statement about insulin is true? A. Exogenous insulin is necessary for management of all cases of type II DM. B. Insulin's effectiveness depends on the patient's absorption of the drug. C. Insulin doses should be regulated according to self-monitoring urine glucose levels. D. Insulin administered in multiple doses per day decreases the flexibility of the patient's lifestyle.
B. Insulin's effectiveness depends on the patient's absorption of the drug.
Why is glucose vital to the body's cells? A. It is used to build cell membranes. B. It is used by cells to produce energy. C. It affects the process of protein metabolism. D. It provides nutrients for genetic material.
B. It is used by cells to produce energy.
The nurse is teaching a newly diagnosed patient with type I DM. Which topics are considered survival information to be taught during the initial phase of DM education? (Select all that apply.) A. In-depth discussion of DM pathophysiology B. Learning how to prepare and administer insulin C. Sick day management rules D. Recognition of hypoglycemia and hyperglycemia E. Discussion of the actions of insulin F. Monitoring blood glucose and urine ketones
B. Learning how to prepare and administer insulin C. Sick day management rules D. Recognition of hypoglycemia and hyperglycemia F. Monitoring blood glucose and urine ketones
What statements about sensory alteration in patients with diabetes are accurate?(Select all that apply.) A. Very few patients with diabetic foot ulcers have peripheral sensory neuropathy. B. Loss of pain, pressure, and temperature sensation in the foot increases the risk for injury. C. Sensory neuropathy causes loss of normal sweating and skin temperature regulation. D. Sensory alterations can be delayed by keeping the blood glucose level as close to normal as possible. E. Reduce blood flow to the foot results in increased risk for ulcer formation. F. Healing of foot wounds is reduced because it impaired sensation.
B. Loss of pain, pressure, and temperature sensation in the foot increases the risk for injury. C. Sensory neuropathy causes loss of normal sweating and skin temperature regulation. D. Sensory alterations can be delayed by keeping the blood glucose level as close to normal as possible. E. Reduce blood flow to the foot results in increased risk for ulcer formation.
Which are considered the early signs of diabetic nephropathy? (Select all that apply.) A. Positive urine red blood cells B. Microalbuminuria C. Positive urine glucose D. Positive urine white blood cells E. Elevated serum uric acid F. Hypertension
B. Microalbuminuria E. Elevated serum uric acid F. Hypertension
Which diabetic complication is associated with diabetic peripheral neuropathy? A. End-stage kidney disease B. Muscle weakness C. Permanent blindness D. Retinal hemorrhage
B. Muscle weakness
A patient with type I diabetes mellitus presented to the emergency department with a blood sugar of 640 mg/dL and reports being constantly thirsty or having to urinate "all of the time." How does the nurse document this subjective finding? A. Polydipsia and polyphagia B. Polydipsia and polyuria C. Polycoria and polyuria D. Polyphagia and polyesthesia
B. Polydipsia and polyuria
The diabetic patient experiences a early-morning hyperglycemia as a result of the counterregulatory response to hypoglycemia. What action does the nurse expect for this condition? (Select all that apply.) A. Adminster a 10 PM dose of intermediate-acting insulin. B. Provide an evening snack to insure adequate dietary intake. C. Evaluate insulin dosage and exercise program. D. Add an oral antidiabetic drug to patient's regimen. E. Increase blood glucose checks to every 2 hours around the clock. F. Diagnosis is accomplished by blood glucose monitoring during the night.
B. Provide an evening snack to insure adequate dietary intake. C. Evaluate insulin dosage and exercise program. F. Diagnosis is accomplished by blood glucose monitoring during the night.
The older adult with DM asked the nurse for advice about beginning an exercise program. What is the nurse's best response? (Select all that apply.) A. Begin with high-intensity activities. B. Start low-intensity activities in short sessions. C. Be sure to include warm-up and cool-down periods. D. Start with exercise periods of 20 minutes or less. E. Gradually change activities. F. Exercise programs should avoid causing hypoglycemia.
B. Start low-intensity activities in short sessions. C. Be sure to include warm-up and cool-down periods. E. Gradually change activities. F. Exercise programs should avoid causing hypoglycemia.
A diabetic patient is on a mixed-dose insulin protocol of 8 units of regular insulin and 12 units NPH insulin at 7 AM. At 10:30 AM, the patient reports feeling uneasy, shaky, and has a headache. Which is the probable explanation for this? A. The NPH insulin's action is peaking, and there is an insufficient blood glucose level. B. The regular insulin's action is peaking, and there is an insufficient blood glucose level. C. The patient consumed too many calories at breakfast and now has an elevated blood glucose level. D. The symptoms are unrelated to the insulin administered in the early morning or food taken in at lunchtime.
B. The regular insulin's action is peaking, and there is an insufficient blood glucose level.
The patient with DM is prescribed an angiotensin-converting enzyme inhibitor (ACEI). What lab value does the nurse expect will be checked while the patient is on this drug? A. Serum sodium B. Urine albumin C. Serum calcium D. Urine potassium
B. Urine albumin
The nurse is providing discharge teaching to a patient about self-monitoring of blood glucose )SMBG). What information does the nurse include?(Select all that apply.) A. Only perform SMBG before breakfast. B. Wash hands before using the meter. C. Do a retest if the results seem unusual. D. It is okay to reuse lancets in the home setting. E. Do not share the meter. F. How to calibrate the machine.
B. Wash hands before using the meter. C. Do a retest if the results seem unusual. E. Do not share the meter. F. How to calibrate the machine.
Which are characteristics of regular insulin? (Select all that apply.) A. This insulin does not have a peak time. B. When mixing types of insulin, this insulin is always drawn up first. C. This insulin is given once daily for basal insulin coverage. D. This insulin should be given 30 minutes before meals. E. This insulin should not be diluted or mixed with any other insulin. F. This insulin should be gently rolled between the hands before it is drawn up.
B. When mixing types of insulin, this insulin is always drawn up first. D. This insulin should be given 30 minutes before meals.
The postoperative patient with DM has experienced relatively good glucose control during hospitalization. Suddenly the patient has an unexpected increase in blood glucose level. What should the nurse suspect? A. Family bringing in food for patient consumption B. Wound infection occurring before fever C. Postoperative rise in glucose due to new drugs D. Respiratory infection acquired from a visitor
B. Wound infection occurring before fever
Which statement by a patient with DM indicates an understanding of the principles of self-care? A. "I don't like the idea of sticking myself so often to measure my sugar." B. "I plan to measure the sugar in my urine at least four times a day." C. "I plan to get my spouse to exercise with me to keep me company." D. "If I get a cold, I can take my regular cough medication until I feel better."
C. "I plan to get my spouse to exercise with me to keep me company."
A patient with type II DM is prescribed albiglutide. What KEY information must the nurse provide about this drug? A. "Take this drug with the first bite of your meal." B. "Albiglutide comes in pill form and is taken every morning before breakfast." C. "This drug is administered subcutaneously once a week." D. "Be sure to carry a glucose source with you at all times."
C. "This drug is administered subcutaneously once a week."
The patient has a history of hypoglycemic unawareness. What specific information must the nurse stress when teaching the patient about SMBG? A. "Alternative site monitoring will allow you to use other sites than your fingers." B. "SMBG monitoring will help you to avoid episodes of hypoglycemia." C. "You should avoid the use of alternative site monitoring when doing SMBG." D. "Today's meter systems require a very small blood sample."
C. "You should avoid the use of alternative site monitoring when doing SMBG."
The patient has an HbA1C level of 8.0. The nurse understands that this means the patients mean glucose level is which of the following? A. 126 mg/dL (7.0 mmol/L) B. 154 mg/dL (8.6 mmol/L) C. 183 mg/dL (10.2 mmol/L) D. 212 mg/dL (13.4 mmol/L)
C. 183 mg/dL (10.2 mmol/L)
Which individual is at greatest risk for developing type II DM? A. 25-year-old African American woman B. 36-year-old African-American man C. 56-year-old Hispanic woman D. 40-year-old Hispanic man
C. 56-year-old Hispanic woman
A patient has been receiving insulin in the abdomen for 3 days. On day 4, where does the nurse give the injection? A. Deltoid B. Thigh C. Abdomen, but in an area different from the previous day's injection D. Abdomen, in the same area as the previous day's injection
C. Abdomen, but in an area different from the previous day's injection
The patient with diabetes has a foot that is warm, swollen, and painful. Walking causes the arch of the foot to collapse and gives the foot a "rocker bottom" shape. Which foot deformity does the nurse recognize? A. Hallux valgus B. Claw-toe deformity C. Charcot foot D. Diabetic foot ulcer
C. Charcot foot
After a two hour glucose challenge, which result demonstrates impaired glucose tolerance? A. Less than 100 mg/dL B. Less than 140 mg/dL C. Greater than 140 mg/dL D. Greater than 250 mg/dL
C. Greater than 140 mg/dL
Which statement about sexual intercourse for patients with diabetes is true? A. The incidence of sexual dysfunction is lower in men than women. B. Retrograde ejaculation does not interfere with male fertility. C. Impotence is associated with DM in male patients. D. Sexual dysfunction in female patients includes inability to achieve pregnancy.
C. Impotence is associated with DM in male patients.
A 47-year-old patient with a history of type II DM and emphysema who report smoking three packs of cigarettes per day is admitted to the hospital with a diagnosis of acute pneumonia. The patient is placed on his regular oral antidiabetic agents, sliding-scale insulin, and antibiotic medications. On day two of hospitalization, the health care provider orders prednisone therapy. What does the nurse expect the blood glucose to do? A. Decrease B. Stay the same C. Increase D. Returned to normal
C. Increase
Which statement about insulin administration is correct? A. Insulin maybe given orally, intravenously, or subcutaneously. B. Insulin injections should be spaced no closer than 1/2 inch apart. C. Insulin absorption is fastest in the abdomen except for a 2-inch radius around the naval. D. Shake the bottle of intermediate-acting insulin and then draw it into the syringe.
C. Insulin absorption is fastest in the abdomen except for a 2-inch radius around the naval.
Which statement is true about insulin? A. It is secreted by alpha cells in the islets of Langerhans. B. It is a catabolic hormone that builds up glucagon reserves. C. It is necessary for glucose transport across cell membranes. D. It is stored in muscles and converted to fat for storage.
C. It is necessary for glucose transport across cell membranes.
A patient with hyperglycemia displays a rapid and deep respiratory pattern. The nurse would describe this as which respiratory pattern? A. Tachypnea B. Cheyne-Stokes respiration C. Kussmaul respiration D. Biot respiration
C. Kussmaul respiration
Which class of antidiabetic medication should be taken JUST BEFORE or with meals? A. Alpha-glucosidase inhibitors, which include miglitol B. Biguanides, which include metformin C. Meglitinides, which include nateglinide D. Second-generation sulfonylureas, which include glipizide
C. Meglitinides, which include nateglinide
Which oral agent may cause lactic acidosis in patients with kidney impairment? A. Nateglinide B. Repaglinide C. Metformin D. Miglitol
C. Metformin
When assessing a patient with hyperglycemia the nurse would evaluate the patient for changes in which electrolyte? A. Sodium B. Chloride C. Potassium D. Magnesium
C. Potassium
What is the recommended protocol for patients with type II DM who must lose weight? A. Participate in an aerobic program twice a week for 20 minutes each session. B. Slowly increase insulin dosage until mild hypoglycemia occurs. C. Reduce calorie intake moderately and increase exercise. D. Reduce daily calorie intake to 1000 cal and monitor urine for ketones.
C. Reduce calorie intake moderately and increase exercise.
What type of insulin is used in the emergency treatment of diabetic ketoacidosis (DKA) and hyperglycemic-hyperosmolar (HHS) state? A. NPH B. Lente C. Regular D. Protamine zinc
C. Regular
The patient with DM had a pancreas transplant and takes daily doses of cyclosporine. For which key lab assessment does the nurse monitor? A. Serum electrolytes B. CBC with differential count C. Serum creatinine D. Clotting studies
C. Serum creatinine
Glucagon is used primarily to treat the patient with which disorder? A. Diabetic ketoacidosis (DKA) B. Idiosyncratic reaction to insulin C. Severe hypoglycemia D. Hyperglycemic - hyperosmolar state(HHS)
C. Severe hypoglycemia
The male diabetic patient asks the nurse for advice about alcohol consumption. What is the nurse's BEST response? A. "It is best to have alcohol near bedtime." B. "As long as your diabetes is under control you can drink as much as you like." C. "You should drink only one alcoholic beverage with each meal." D. "Avoid more than two drinks a day and have them with or shortly after meals."
D. "Avoid more than two drinks a day and have them with or shortly after meals."
A 25-year-old female patient with type I DM tells the nurse, "I have two kidneys and I'm still young. I expect to be around for a long time, so why should I worry about my blood sugar?" What is the nurses BEST response? A."You have little to worry about as long as your kidneys keep making urine." B. "You should discuss this with your provider because you are being unrealistic." C. "You would be right if your diabetes was managed with insulin." D. "Keep your blood sugar under control now can help to prevent damage to both kidneys."
D. "Keep your blood sugar under control now can help to prevent damage to both kidneys."
According to American Diabetes Association, which laboratory finding is most indicative of DM? A. Fasting blood glucose = 80 mg/dL B. 2-hour postprandial blood glucose = 110 mg/dL C. 1-hour glucose tolerance blood glucose = 110 mg/dL D. 2-hour glucose tolerance blood glucose = 210 mg/dL
D. 2-hour glucose tolerance blood glucose = 210 mg/dL
A patient with diabetes has signs and symptoms of hypoglycemia. The patient has a blood glucose of 18 mg/dL, is not alert but responds to voice, and is confused and is unable to swallow fluids. What does the nurse do NEXT? A. Give a glass of orange juice with two packets of sugar and continue to monitor the patient. B. Give a glass of orange juice or other type of juice and continue to monitor the patient. C. Giving a complex carbohydrate and continue to monitor the patient. D. Administer subcutaneous or IM glucagon and 50% IV dextrose.
D. Administer subcutaneous or IM glucagon and 50% IV dextrose.
The patient will be using rapid acting insulin injected by an external insulin pump. What does the nurse tell the patient about the pump? A. SMBG levels can be done only twice a day. B. The insulin supply must be replaced every 2 to 4 weeks. C. The pumps battery should be checked on a regular weekly schedule. D. Be sure to match your insulin dose to the carbohydrate (CHO) content of your diet.
D. Be sure to match your insulin dose to the carbohydrate (CHO) content of your diet.
Which drug does the nurse expect will be prescribed for patient with burning neuropathy? A. Gabapentin B. Amitriptyline hydrochloride C. Duloxetine D. Capsaicin cream 0.075%
D. Capsaicin cream 0.075%
What is the basic principle of meal planning for patient with type I DM? A. Five small meals per day plus a bedtime snack B. Taking extra insulin when planning to eat sweet foods C. High-protein, low-carbohydrate, and low-fiber foods D. Considering the effects and peak action times of the patient's insulin
D. Considering the effects and peak action times of the patient's insulin
The patient with type 1 DM is taking a mixture of NPH and regular insulin at home. The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patient's morning dose of insulin? A. Administer the dose that is routinely prescribed at home because the patient has type I DM and needs the insulin. B. Administer half the dose because the patient is NPO. C. Hold the insulin with all the other medications because the patient is NPO and there is no need for insulin. D. Contact the health provider for an order regarding the insulin.
D. Contact the health provider for an order regarding the insulin.
Which laboratory test is the best indicator of a patient's average blood glucose level and/or compliance with the DM regimen over the last 3 month? A. Postprandial blood glucose test B. Oral glucose tolerance test(OGT T) C. Casual blood glucose test D. Glycosylated hemoglobin (HbA1C)
D. Glycosylated hemoglobin (HbA1C)
The nurse is teaching people in a community education class about modifiable risk factors for type II DM. Which factors would the nurse discuss? (Select all that apply.) A. Age B. Family history C. Working in a low-stress environment D. Maintaining ideal body weight E. Maintaining adequate physical activity F. Lack of exercise
D. Maintaining ideal body weight E. Maintaining adequate physical activity F. Lack of exercise
The nurse would observe the patient with untreated hyperglycemia for which condition? A. Respiratory acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Metabolic acidosis
D. Metabolic acidosis
Early treatment of diabetic ketoacidosis (DKA) and hyperglycemic-hyperosmolar (HHS) state includes IV administration of which fluid? A. Glucagon B. Potassium C. Bicarbonate D. Saline
D. Saline
Which class of antidiabetic medication is MOST LIKELY to cause hypoglycemia even when hyperglycemia is not present? A. Alpha-glucosidase inhibitors, which include miglitol B. Biguanides, which include metformin C. Meglitinides, which include nateglinide D. Second-generation sulfonylureas, which include glipizide
D. Second-generation sulfonylureas, which include glipizide
A patient with type II DM, usually controlled with a second-generation sulfonylurea, develops a urinary tract infection. Due to the stress of the infection, the patient must be treated with insulin. What additional information about this treatment does the nurse explain to the patient? A. The sulfonylurea must be discontinued and insulin taken until the infection clears. B. Insulin will now be necessary to control the patient's diabetes for life. C.The sulfonylurea dose must be reduced until the infection clears. D. The insulin is necessary to supplement the second-generation sulfonylurea until the infection clears.
D. The insulin is necessary to supplement the second-generation sulfonylurea until the infection clears.
Which are signs and symptoms of mild hypoglycemia? (Select all that apply.) a. Headache b. Weakness c. Cold, clammy skin d. Irritability e. Pallor f. Tachycardia
a. Headache b. Weakness d. Irritability
SMBG levels is most important in which patients? (Select all that apply.) a. Patients taking multiple daily insulin injections b. Patients with mild type 2 diabetes c. Patients with hypoglycemic unawareness d. Patients using a portable infusion device for insulin administration e. Patients with acute illnesses f. Pregnant patients
a. Patients taking multiple daily insulin injections c. Patients with hypoglycemic unawareness d. Patients using a portable infusion device for insulin administration e. Patients with acute illnesses f. Pregnant patients
Along with exercise, what is the recommended calorie reduction for a patient with diabetes who must lose weight? a. 100-200 calories/day b. 250-500 calories/day c. 501-600 calories/day d. 601-750 calories/day
b. 250-500 calories/day
