MedSurg Exam #2 DIABETES

"With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased."

A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? "With type 2 diabetes, the body of the pancreas becomes inflamed." "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

Pre-diabetes

impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or both. It is an intermediate stage between normal glucose homeostasis and diabetes where the blood glucose levels are elevated, but not high enough to meet the diagnostic criteria for diabetes.

Two hours postprandial

two hours after your meal you blood surgar can rise. So they should take their blood surgar after meals

Diabetes

What is do these labs tell you about the pt? A1C is : 6.5 or above Fasting Plasma Glucose is : 126 or above Oral Glucose tolerance test is: 200 or above

normal no diabetes

What is do these labs tell you about the pt? A1C is : about 5 Fasting Plasma Glucose is : 99 or below Oral Glucose tolerance test is: 139 or below

roll gently, do not shake vigorously to mix suspension

What should we do with NPH and Lente?

Lose potassium, sodium and water, severely dehydrated.

What three things happen when there is too much insulin?

A wound that will not heal

Which symptom reported by a 50-year-old patient would lead the nurse to suspect early undiagnosed type 2 diabetes? Blurred vision Gradual weight gain A wound that will not heal Insomnia

Type 2 diabetes

With this type of diabetes the pancreas usually continues to produce some endogenous (self made) insulin. But the insulin that is made is either insufficient for the needs of the body or is poorly used by the tissues, or both.

Diabetic Ketoacidosis

Without insulin, the pt will develop _________________, a life threatening condition resulting in metabolic acidosis.

oral glucose tolerance test (OGTT)

Women with an average risk for gestational diabetes are screened using an __________________________ at 24-28 weeks of gestation.

Glucagon

________ is given if blood surgar is really low. this is produced in the alpha cells of the pancreas.

Lantus

____________ is never mixed with other insulins

Herperglycemia

____________ promotes the unresponsiveness of the pancreatic B cell.

Ketoacidosis

a complication most common in those with untreated type 1 diabetes, is associated with additional clinical manifestations and is discussed later in this chapter.

Diabetes Mellitus

Is a chronic multi system disease related to abnormal insulin production, impaired insulin utilization or both.

Polyphagia

Is a consequence of cellular malnourishment when insulin deficiency prevents utilization of glucose for energy.

Idiopathic diabetes

Is a form of type 1 diabetes that is strongly inherited and not related to autoimmunity. It occurs only in a small # of people with type 1 diabetes, most often of hispanic, african, or asian ancestry.

Insulin

Is a hormone produced by the B cells in the islets of Langerhans of the pancreas. Is continuously released into the bloodstream in small pulsatile increments, with increase release when food is ingested,

Type 1 Diabetes

Is an immune mediated disease, caused by autoimmune destruction of the pancreatic B cells, the site of insulin production. Total absence of insulin production.

A1C

Measures the amount of glycosylated hemoglobin as a percentage of total hemoglobin.

C-peptide

Measuring _____ in serum and urine is a useful clinical indicator of pancreatic B cell function.

counter-regulatory hormones.

Other hormones (glucagon, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are referred to as ________________________.

glycogenolysis and gluconeogenesis

Overproduction of glucagon stimulates _______________ & _________________.

Insulin resistance

less than normal drop in blood sugar in response to insulin secretion. Message doesn't get to the cells, so the body produces more insulin in an effort to get the blood sugar down. As a results there is a hyperinsulinemia.

Midnight before the test

A 51-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 am. The nurse instructs the patient to only drink water after what time?

Check the patient's blood sugar at 3 AM.

A patient diagnosed with diabetes type 1 has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse should be performed initially? Check the patient's blood sugar at 3 AM. Provide the patient with an evening snack. Rotate insulin injection sites between the abdomen, thigh, and arm. Contact the health care provider to increase the evening insulin dose.

D. "It is important that I take my blood pressure medication to help prevent kidney damage."

After discussing prevention of diabetes type 1 complications with the nurse, the patient is correct when making which statement? A. "I must limit fats in my diet to help prevent neuropathy." B."I should use a hot water bottle on my feet when they feel cold." C,"I should have an eye examination at least once every two years for glaucoma screening." D. "It is important that I take my blood pressure medication to help prevent kidney damage."

"I will need to be medicated with insulin for the rest of my life."

After a teaching session with the registered nurse, the newly diagnosed patient with Type 1 diabetes mellitus is correct when he or she makes which statement? "If I lose weight, I will be able to stop taking insulin." "My pancreas will produce more insulin as I recover." "I will need to be medicated with insulin for the rest of my life." "I will be able to take insulin pills once my blood sugar is stabilized.

Side-lying

After administering glucagon to an unconscious patient, the nurse should place the patient in which position? Supine Side-lying High-Fowler Semi-Fowler

Establish an intravenous (IV) access

After admitting a patient with diabetic ketoacidosis (DKA) to the emergency department, which nursing intervention is a priority? Administer insulin Administer oxygen Insert a Foley catheter Establish an intravenous (IV) access

"The body produces autoantibodies that destroy beta cells in the pancreas."

An 18-year-old patient, admitted with type 1 diabetes, asks the nurse what "type 1" means. What is the nurse's best response? "There is decreased insulin secretion, cellular resistance to insulin that is produced, or both." "An increased amount of adipose tissue has led to an insufficient amount of insulin being produced." "The body produces autoantibodies that destroy beta cells in the pancreas." "The insulin being made is not used by the tissues properly, leading to high blood sugar."

metabolic syndrome

An individual with ________________ has an increased risk of the development of type two diabetes.

abdomen, arms, thighs, and then buttocks

Fastest absorption is in the ____________, then _____, _________, then ___________.

Short acting.

Regular insulin is categorized as what type of insulin?

Adipokines

Secreted by adipose tissue appear to play a role in glucose and fat metabolism and are likely to contribute to the pathophysiology of type two diabetes.

polyuria, polydipsia, and polyphagia

The 3 classic symptoms for type 1 diabetes are ?

counter-regulatory hormones and insulin

The ___________________ and __________ usually maintain blood glucose levels within the normal range by regulating the release of glucose for energy during food intake and periods of fasting.

40-50U or 0.6U/kg

The average amount of insulin secreted daily by an adult is approx. ___-___ U. (or _____U/kg of body weight.)

intensive insulin therapy

The basal-bolus regimen is ____________________________, consisting of multiple daily insulin injections together with frequent self-monitoring of blood glucose.

D. A 62-year-old type 1 diabetic with a bedside glucose meter reading of 285 who is due for sliding scale coverage

The charge nurse is making assignments for the day shift. An appropriate assignment to the Licensed Practical Nurse (LPN) would be: A. A 45-year-old type 1 diabetic who is nothing by mouth (NPO) for an endoscopy at noon. B. A 28-year-old who is a type 1 diabetic being admitted with diabetic ketoacidosis (DKA) C. An 8-year-old newly diagnosed type 1 diabetic who is being discharged D. A 62-year-old type 1 diabetic with a bedside glucose meter reading of 285 who is due for sliding scale coverage

Acanthosis nigricans

The elevated insulin levels in the body activates insulin receptors in the skin, forcing it to grow abnormally. Reducing the circulating insulin by dieting or medication can lead to improvement of the skin problem.

exogenous insulin

The individual with type 1 diabetes requires insulin from an outside source called __________ to sustain life.

basal-bolus regimen

The insulin regimen that most closely mimics endogenous insulin production is the ______________ , which uses rapid- or short-acting insulin before meals and intermediate- or long-acting background insulin once or twice a day.

C. Decreases rate of hepatic glucose production; augment glucose uptake by tissues, especially muscles

The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works? A. Increases insulin production from the pancreas B. Slows the absorption of carbohydrate in the small intestine C. Decreases rate of hepatic glucose production; augment glucose uptake by tissues, especially muscles D. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying

Glycosylated hemoglobin level

The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? Prealbumin level Urine ketone level Fasting glucose level Glycosylated hemoglobin level

Humalog, Novalog, Apidra (glulisine)

What are three examples of rapid acting insulin?

Intitial diagnosis Missed dose of insulin Illness or infection

What are three major causes of too much insulin?

"When my blood sugar is less than 70mg/dL, I will take 15 grams of a fast-acting carbohydrate, such as orange juice, and re-check in 15 minutes."

The nurse is evaluating the teaching session on nutrition for the newly diagnosed diabetic patient. Which statement indicates an understanding of the teaching? "When my blood sugar is less than 70mg/dL, I will take 15 grams of a fast-acting carbohydrate, such as orange juice, and re-check in 15 minutes." "When my blood sugar is less than 70mg/dL I will drink 8 ounces of milk and recheck in 15 minutes." "I will eat a few hard candies when my blood sugar is less than 70 and recheck in 15 minutes." "When my blood sugar is less than 70 mg/dL, I will take 3 to 4 sugar tablets and recheck in 30 minutes."

Dairy products

The nurse would encourage a patient with diabetes mellitus and coronary artery disease to limit intake of which of the following foods to help reduce the percentage of saturated fat in the diet? Chicken and turkey Frozen and canned vegetables Enriched flour products Dairy products

Absence of ketones

The nurse, reviewing hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) and diabetic ketoacidosis recalls that with HHNKS, which condition occurs? Hyperglycemia Absence of ketones High serum osmolarity Decreased in serum potassium

Immediately before meals

The patient has a prescription for repaglinide (Prandin). The nurse instructs the patient to take the medication at which time? Immediately before meals When blood sugar levels are greater than 250 mg/dL Two hours after meals At bedtime

10:30 pm to 1:30 am

The patient received regular insulin 10 units subcutaneously at 8:30 pm for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? 8:40 pm to 9:00 pm 9:00 pm to 11:30 pm 10:30 pm to 1:30 am 12:30 am to 8:30 am

1100 and 1200

The patient received regular insulin eight units subcutaneously (subQ) at 0900. The nurse plans to monitor this patient for signs of hypoglycemia during which time? 1000 and 1100 1100 and 1200 1200 and 1300 1300 and 1500

Polyuria Polydipsia Polyphagia Weight loss (less severe in T2DM)

What are three signs of diabetes?

25 to 30 g/day

The patient with diabetes should consume fiber as part of a healthy diet. The current recommendation for persons with diabetes is 25 to 30 g/day 20 to 25 g/day 40 to 50 g/day 10 to 20 g/day

Adiponectin and leptin

The two main adipokines believed to affect insulin sensitivity are ______________ and _________.

Pre-diabetes

What is do these labs tell you about the pt? A1C is : 5.7 to 6.4 Fasting Plasma Glucose is : 100-125 Oral Glucose tolerance test is: 140 - 199

T1DM

This diabetes is more prone to ketoacidosis

A. Documented morning hyperglycemia C. May be avoided by consuming a bedtime snack D. Treatment is a lower dose of insulin in the evening E. Documented hypoglycemia between 2:00 AM and 4:00 AM

To demonstrate an understanding of Somogyi effect, the nurse correctly identifies which defining characteristics? Select all that apply. A. Documented morning hyperglycemia B. Caused by not rotating insulin injection sites C. May be avoided by consuming a bedtime snack D. Treatment is a lower dose of insulin in the evening E. Documented hypoglycemia between 2:00 AM and 4:00 AM F. Requires an adjustment of administration time of evening insulin

Glycosylated hemoglobin

To determine how well a patient's diabetes mellitus has been controlled over the past 2 to 3 months, what assessment parameter should the nurse review? Fasting blood glucose Oral glucose tolerance Glycosylated hemoglobin Random fingerstick blood glucose

Lantus (glargine), Levemir (detemir)

Two types of Long (Basal)?

1. elevated glucose levels 2. abdominal obesity 3. elevated BP 4. High levels of triglycerides 5. Decreased levels of HDLs

What are the five components metabolic syndrome has?

insulin, oral agents (OAs) and non-insulin agents.

What are the three major types of glucose-lowering agents used in the treatment of diabetes are?

Hyperglycemia

When insulin is not properly used, the entry of glucose into the cell is impeded, resulting in _____________________.

3 AM

When should the nurse instruct the patient to monitor the blood sugar if dawn phenomenon is suspected? 1 AM 3 AM 5 AM Upon arising

ketoacidosis

When there is too much insulin production with Type 1 they will develop _______________ because of increased lipolysis and conversion to ketone bodies

hyperosmolar coma

When there is too much insulin production with Type 2 the will develop ______________ is more common because endogenous insulin suppresses ketone formation

A glycoslated hemoglobin level

Which laboratory test is the best indicator of glucose control and long-term diabetes management in the patient with type 2 diabetes mellitus? a. Urine microalbumin b. Oral glucose tolerance test c.A glycoslated hemoglobin level d. Fasting blood sugar

- overweight or obese - being older - family history of type 2 diabetes

What are three risk factors for developing type 2 diabetes?

Fructosamine

Can also be used to assess glucose control. This is formed by a chemical reaction of glucose with plasma protein.

Hangs the arm in the dependent position for one minute before puncturing.

The nurse has been teaching a patient newly diagnosed with diabetes mellitus to test his or her own blood glucose level. During evaluation of his or her technique, the nurse determines adequate teaching when the patient performs which task? Reports control of diabetes is present when blood sugars are less than 65 Chooses a puncture site in the center of the finger pad. Runs the hand under cool water for 30 seconds to cleanse the site. Hangs the arm in the dependent position for one minute before puncturing.

T1DM

- Absolute insulin deficiency due to pancreatic cell failure due to autoimmune process - Most commonly between 5 and 20 years, most before age 30 - About 5-10% of all persons with diabetes - Requires insulin

T1DM

- Beta cells of the pancreas are destroyed - Long pre-clinical period - No insulin production - Rapid onset of symptoms

T2DM

- Relative insulin deficiency - Insulin resistance: Decreased tissue sensitivity to insulin, Decreased number of insulin receptors. - Decreased production of insulin in pancreas - Inappropriate glucose production by liver

T2DM

- Relative insulin deficiency - Risk factors: Aging (18.4% over 65) Sedentary lifestyle Obesity (abdominal and visceral adiposity) Genetics - Onset: gradual

Insulin

- Transports and metabolizes glucose - Stimulates glucose storage in liver (glycogen) - Enhances storage of fat in adipose tissue - Accelerates transport of amino acids into cells

140-199

A diagnosis of impaired glucose tolerance (IGT) is made if the 2 hr oral glucose tolerance test (OGTT) values are _______ to _______mg/dl

A. Exercise after meals. B. Have a warm-up and cool-down period. D. Carry glucose tablets or hard candies when exercising.

A nurse caring for a patient with type 2 diabetes encourages the patient to exercise regularly as part of diabetes management. What precautions should the patient take when exercising? Select all that apply. A. Exercise after meals. B. Have a warm-up and cool-down period. C. Avoid carbohydrate snacks during exercise. D. Carry glucose tablets or hard candies when exercising. E. Avoid exercise if blood glucose is equal to 120 mg/dL.

Decreased secretion of potassium through the kidneys secondary to nephropathy.

A 62-year-old patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.8 mEq/L. The nurse understands that a possible cause of hyperkalemia would be: A. Retention of potassium related to inadequate nutrition. B. The body's attempt to fight off the infection caused by cellulitis. C. Excess insulin administration causing potassium to leak out of the cells. D. Decreased secretion of potassium through the kidneys secondary to nephropathy.

C. Cardiac monitoring to detect potassium changes

A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI C. Cardiac monitoring to detect potassium changes D. Administer intravenous (IV) fluids rapidly to correct dehydration

genetic predisposition and virus

A ___________________ and exposure to a ________ are factors that may contribute to the pathogenesis of immune related type 1 diabetes.

Eat 15 g of simple carbohydrates

A college student is newly diagnosed with type 1 diabetes. The patient now has a headache, changes in vision, and is anxious, but does not have the portable blood glucose monitor with him or her. Which action should the campus nurse advise the patient to take? Eat a piece of pizza Drink some diet soft drink Eat 15 g of simple carbohydrates Take an extra dose of rapid-acting insulin

Insulin resistance

A condition in which body tissues do not respond to the action of insulin because insulin receptors are unresponsive, are insufficient in number, or both.

100-125

A diagnosis of impaired fasting glucose (IFG) when fasting blood glucose levels are ____ to _____ mg/dL

Test blood glucose whenever hypoglycemia is suspected. Test blood glucose before and after exercise. Take a blood sample from the side of the finger pad.

A nurse in the outpatient setting is teaching a patient about the importance of self-monitoring of blood glucose (SMBG) using a glucometer. What should the nurse tell the patient? Select all that apply. Test blood glucose whenever hypoglycemia is suspected. Test blood glucose before and after exercise. Take a blood sample immediately after a meal. Take a blood sample from the side of the finger pad. Wash hands in cold water when preparing to puncture.

Check the blood glucose level.

A patient hospitalized with diabetes mellitus has become shakey, anxious, and diaphoretic. Which action should the nurse implement first? Administer a 15 g snack. Notify the health care provider. Check the blood glucose level. Administer the prescribed insulin dose.

Dry skin and ketonurea

A patient is admitted with diabetic ketoacidosis. Which signs/symptoms would the nurse expect to find upon physical examination? Blood sugar 200 mg/dL and bradypnea Hypotension and blood sugar 68 mg/dL Diaphoresis and extreme hunger Dry skin and ketonurea

Rehydration through intravenous fluid replacement

A patient presents with diabetic ketoacidosis (DKA). The nurse initiates the collaborative plan of care with the understanding that the initial goal of the treatment plan is: Treatment for hypokalemia Rapid reduction of elevated blood glucose Rehydration through intravenous fluid replacement Reduction of ketosis by encouraging oral nourishment

Hemoglobin A1C of 5.5%

A patient who had been diagnosed with pre-diabetes six months ago is following up in the outpatient diabetes clinic. The nurse is reviewing the assessment data and understands the best reflection of good management of this condition is A 20-pound weight loss Hemoglobin A1C of 5.5% Reduction of total cholesterol to 200 mg/dL Decrease in polyuria, polydipsia, and polyphagia

"If I become ill, I will need to check my blood sugar more frequently."

A patient who was recently diagnosed with Type 2 diabetes mellitus completed a teaching session about disease management. Which statement by the patient indicates understanding of Type 2 diabetes mellitus? "I will always be able to manage my diabetes with pills." "As I get older, I will be able to decrease my diabetes medicine." "If I become ill, I will need to check my blood sugar more frequently." "As long as I take my medication, I do not have to follow a diabetic diet."

At least eight hours

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8 AM. The nurse instructs the patient to fast for what period of time? At least eight hours 4 AM on the day of the test After dinner the evening before the test 7 AM on the day of the test

Lessened ability to sense hypoglycemia

A patient with type 1 (insulin-dependent) diabetes mellitus has received a prescription for propranolol (Inderal). What does the nurse recognize as the major concern for this patient? A. Frequent night sweats B. Lessened ability to sense hypoglycemia C. More frequent episodes of hyperglycemia D. The need for an increased basal insulin dosage

"When was the last time you took your metformin?"

A patient with type 2 diabetes who takes metformin daily to manage blood sugar is scheduled for an intravenous pyelogram (IVP). Which question by the nurse is most important to ask the patient when preparing for the procedure? "Have you ever skipped a dose of metformin?" "When was the last time you took your metformin?" "How many times a day do you take your metformin?" "How long have you been taking metformin for diabetes?

Kussmaul respirations

A patient, who is admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? Central apnea Hypoventilation Kussmaul respirations Cheyne-Stokes respirations

Latent Autoimmune Diabetes in adults (LADA)

A slowly progressing autoimmune form of type 1 diabetes, usually occurs in people who are over the age of 35 who are not obese.

The infection increases the glucose level, resulting in a need for more insulin

A type 2 (non-insulin-dependent) diabetic patient who takes oral hypoglycemics is admitted to the hospital with a urinary tract infection (UTI). The patient asks why insulin injections have been prescribed. What explanation should the nurse provide? A. The infection increases the glucose level, resulting in a need for more insulin B. Oral hypoglycemic medications are contraindicated in patients with UTIs. C.Insulin should have been prescribed for the patient to take at home D.Insulin acts synergistically with the antibiotic that was prescribed.

Dehydration Hyperglycemia Ketosis

Diabetic ketoacidosis (DKA) is caused by a profound deficiency of insulin and is characterized by: Select all that apply. Hypoglycemia Dehydration Hyperglycemia Absence of ketones Ketosis

Pancreas

In the early stages of insulin resistance, the __________ responds to high blood glucose by producing greater amount of insulin (if b cell function is normal).

proinsulin

Insulin is synthesized from a precursor ___________.

70-120

Insulin lowers blood glucose and facilitates a stable, normal glucose range of approximately ___ to ____ mg/dL

obesity, chronically elevated insulin levels, low HDL and high blood pressure.

Insulin resistance syndrome refers to a combination of risk factors for T2DM, including ____________, ________________, ______________, __________________. People with insulin resistance get sleepy after a CHO meal.

Exogenous Insulin

Is needed when a pt has inadequate insulin to meet specific metabolic needs. People with type 1 diabetes need this to survive and may need multiple daily injections or continuous infusion of this type of insulin

skeletal muscle, fat, and liver cells.

Most insulin receptors are located on ___________, ____, and ____________.

Intermediate

NPH insulin is an example of what type of insulin?

Chooses a puncture site in the center of the finger pad

The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? Chooses a puncture site in the center of the finger pad Washes hands with soap and water to cleanse the site to be used Warms the finger before puncturing it to obtain a drop of blood Tells the nurse that the result of 110 mg/dL indicates good control of diabetes

"I should look at the condition of my feet every day."

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? "I should only walk barefoot in nice dry weather." "I should look at the condition of my feet every day." "I am lucky my shoes fit so nice and tight because they give me firm support." "When I am allowed up out of bed, I should check the shower water with my toes."

"Taking a hot bath every day will help with my circulation."

The nurse has taught a patient who was admitted with diabetes, cellulitus, and osteomyelitis about the principles of foot care. The nurse determines that additional teaching is necessary when the patient makes which statement? "Taking a hot bath every day will help with my circulation." "I should avoid walking barefoot at all times." "I should look at the condition of my feet every day." "I need a podiatrist to treat my ingrown toenails."

A. The variability in mealtime or insulin administration D. Measurement of bedtime and morning fasting blood glucose levels on several occasions E. Measurement of blood glucose levels between 2:00 and 4:00 AM on several occasions

The nurse is assessing a diabetic patient with complaints of night sweats, hyperglycemia, and headache on awakening. What should the nurse's assessment include? Select all that apply. A.The variability in mealtime or insulin administration B.Measurement of 2-hour oral glucose tolerance test (OGTT) C. Measurement of glycemic index (GI) D.Measurement of bedtime and morning fasting blood glucose levels on several occasions E. Measurement of blood glucose levels between 2:00 and 4:00 AM on several occasions

Assess the patient's understanding of the disease

The nurse is assigned to care for a 76-year-old patient with type 2 diabetes. To encourage the patient to become an active participant in his or her care, the nurse must first: Assess the patient's understanding of the disease Make a list of food restrictions for proper diabetes management Refer the patient to a nutritionist Set long-term goals to decrease the risk of complications

Assess patient's perception of what it means to have diabetes.

The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention? Assess patient's perception of what it means to have diabetes. Ask the patient to write down current knowledge about diabetes. Set goals for the patient to actively participate in managing diabetes. Assume responsibility for all of the patient's care to decrease stress level.

Cheese

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? Cheese Broccoli Chicken Oranges

Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include? A. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. C. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. D. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.

Autoimmune destruction of pancreatic β-cells

The nurse is caring for a 10-year-old admitted to the health care facility with type 1 diabetes. What leads to type 1 diabetes? Autoimmune destruction of pancreatic β-cells Presence of unresponsive insulin receptors Decrease in the production of insulin Inappropriate glucose production by the liver

Use the Credé maneuver to completely empty the bladder. (the Credé maneuver involves mild downward massage over the lower abdomen and bladder.)

The nurse is caring for a diabetic patient with neurogenic bladder. What should the nurse tell the patient about emptying the bladder? Empty the bladder every 5 hours. Relax abdominal muscles during voiding. Massage the lower abdomen horizontally. Use the Credé maneuver to completely empty the bladder.

Polydipsia, polyuria, and polyphagia

The nurse is caring for a patient with newly diagnosed type 2 (non-insulin-dependent) diabetes mellitus. Which symptoms indicate that the patient is experiencing hyperglycemia? Polydipsia, polyuria, and polyphagia Weight gain, fatigue, and bradycardia Irritability, diaphoresis, and tachycardia Loss of appetite, abdominal pain, and oliguria

Controlling blood sugar and blood pressure will reduce the risk of kidney injury.

The nurse is conducting a teaching session about nephropathy as a complication of diabetes. Which information would be appropriate for the nurse to include in the session? Vessels may begin to bleed, resulting in permanent blindness. Controlling blood sugar and blood pressure will reduce the risk of kidney injury. Organ damage resulting from changes in large and medium-sized blood vessels can be prevented by careful glucose control. This will not occur if one does not require insulin to control diabetes.

Rotate the injection within one anatomic site for a week.

The nurse is educating a diabetic patient about the use of premixed insulin neutral protamine hagedorn (NPH)/regular 70/30. What should the nurse inform the patient about using this insulin? Shake the bottle thoroughly to mix the insulin. Rotate the injection within one anatomic site for a week. Inject insulin at a 15 to 30 degree angle. Inform that the fastest subcutaneous absorption is from the thigh.

"I will administer my aspart within 15 minutes of eating my meal."

The nurse is educating the patient regarding administration of meal-time insulin, aspart (NovoLog). Which statement by the patient indicates correct knowledge of the onset of action of this medication? "I will administer my aspart 30 minutes before mealtime." "I will administer my aspart 60 minutes before mealtime." "I will administer my aspart within 15 minutes of eating my meal." "I will administer my aspart 30 minutes after the conclusion of my meal."

Excessive thirst

The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? Excessive thirst Gradual weight gain Overwhelming fatigue Recurrent blurred vision

Cushing's syndrome

The nurse is evaluating the patient who has developed diabetes as a result of another medical condition. The nurse knows that which condition can be linked to diabetes?

A. Fatigue B. Polyuria D. Visual changes E. Recurrent infections

The nurse is preparing an educational session on Type 2 diabetes for the public. Which symptoms of type 2 diabetes would the nurse include in the presentation? Select all that apply. A. Fatigue B. Polyuria C. Weight loss D. Visual changes E. Recurrent infections

A. Sitting to void B. Using the Credé maneuver when voiding D. Tightening the abdominal muscles when voiding

The nurse is providing discharge instructions to a patient who has a neurogenic bladder. Which self-care activities would the patient identify to facilitate bladder emptying to help prevent urinary stasis and infection? Select all that apply. A. Sitting to void B. Using the Credé maneuver when voiding C. Emptying the bladder at least three times a day D. Tightening the abdominal muscles when voiding E. Maintaining a fluid restriction of 1200 mL per day

Proper nutrition Regular physical activity Maintenance of recommended body weight

The nurse is providing education on managing type 2 diabetes with lifestyle modification to a group of patients. Which of the following topics should the nurse include in the education session? Proper nutrition Regular physical activity Drug therapy with insulin Maintenance of recommended body weight Drug therapy with oral agents

"To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath."

The nurse is reviewing diabetic self-care management with a patient newly diagnosed with diabetes. The patient is in need of further education when stating to the nurse: "To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath." "I have scheduled an eye examination with an ophthalmologist for next week. I will need to have an annual eye exam." "I am going to check my feet for pressure areas every morning before I take a bath."

Increased low-density lipoproteins

The nurse is reviewing laboratory results for the patient with diabetes and coronary artery disease. Which laboratory result would help predict possible macrovascular disease as a complication of diabetes? Increased low-density lipoproteins Decreased blood urea nitrogen Increased white blood cell count Decreased C-reactive protein

"I should have no more than 60 grams of carbohydrates in each meal."

The nurse is teaching a patient with diabetes about proper dietary recommendations. The nurse determines the patient understands the teaching when he or she makes which statement? "I should increase my daily intake of saturated fat to decrease my blood sugar." "I need more protein now that I have diabetes." "I do not need to limit my alcohol intake as long as it is low in sugar." "I should have no more than 60 grams of carbohydrates in each meal."

"I will take a brisk 30-minute walk five days per week and do resistance training three times a week."

The nurse is teaching a patient with type 2 diabetes about exercise as a method to control blood glucose levels. The nurse knows the patient understands when the patient elicits which exercise plan? "I want to go fishing for 30 minutes each day. I will drink fluids and wear sunscreen." "I will go running each day when my blood sugar is too high to bring it back to normal." "I will plan to keep my job as a teacher because I get a lot of exercise every school day." "I will take a brisk 30-minute walk five days per week and do resistance training three times a week."

Nervousness and tremors

The nurse is teaching the caregiver about the manifestations of hypoglycemia in the diabetic patient. What should the caregiver identify as a manifestation of hypoglycemia? Increase in urination Abdominal cramps Nervousness and tremors Nausea and vomiting

Withdrawing the NPH insulin first

The nurse observes a return demonstration by a patient who is learning how to mix regular insulin and NPH insulin in the same syringe. Which action by the patient indicates the need for further teaching? Withdrawing the NPH insulin first Injecting air into the NPH insulin bottle first Removing air bubbles after drawing up the first insulin Injecting an amount of air equal to the desired dose of insulin

"If I go over my calories, I can just increase my insulin."

The nurse provides dietary instructions to a patient with type 1 (insulin-dependent) diabetes mellitus. Which statement made by the patient indicates a need for further teaching? "If I go over my calories, I can just increase my insulin." "I'll need a bedtime snack, because I take an evening dose of NPH insulin." "I can have an occasional low-calorie dessert as long as I include it in my meal plan." "I should eat meals at the scheduled times, even if I'm not hungry, to prevent hypoglycemia."

"If I skip breakfast, I can hold my insulin until noon."

The nurse provides education to a patient with newly diagnosed type 1 (insulin-dependent) diabetes mellitus. Which statement made by the patient indicates a need for further instruction? "If I skip breakfast, I can hold my insulin until noon." "I'll have some options when it comes to food choices." "If I feel sweaty, shaky, or dizzy, my blood sugar might be low." "If I have to urinate a lot, feel thirsty all of the time, or have blurred vision, my blood sugar might be high."

Give four units of Humalog insulin intravenous (IV) push for blood sugar greater than 200.

Which of the following prescriptions should the nurse question? Give 70 units of Lantus insulin subcutaneously at bedtime. Give four units of Humalog insulin intravenous (IV) push for blood sugar greater than 200. Have the patient program the insulin pump to deliver basal rate of 0.5 units per hour. Administer 25 units of Humulin-N and 10 units of Humulin-R insulin subcutaneously before breakfast and supper.

"It is especially important that I exercise if my blood sugar is above 250mg/dL and my urine is positive for ketones."

Which statement by the patient with diabetes mellitus indicates that further education regarding exercise is required? "I should exercise about 30 minutes five days a week." "Because I take insulin daily, I should exercise about one hour after eating a meal." "Exercise will help me to lose weight, which will help my body to better use insulin." "It is especially important that I exercise if my blood sugar is above 250mg/dL and my urine is positive for ketones."

Gestrational Diabetes

develops during pregnancy and occurs in about 2% to 10% of pregnancies in US. Women with this have a higher risk for cesarean delivery and their babies have increased risk for perinatal death, birth injury, and neonatal complications.

Pharmacologic therapy Nutritional management Exercise Monitoring Education

five things to manage the pts diabetes?

T2DM

may not have the classic symptoms; more prone to hyperglycemic hyperosmolar coma.

Human leukocyte antigens (HLAs)

predisposition to type 1 diabetes is related to ______________________.

Glucagon

produced in the alpha cells of the pancreas

Growth hormone

produced in the pituitary glands