MS Diabetes Mellitus

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?

"I'll know if I have sores or lesions on my feet because they will be painful"

Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the *best* response by the nurse?

"That is a good range for your glucose levels"

The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient (select all that apply)?

- Erectile dysfunction - Vomiting undigested food - Painless myocardial infarction

The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level (select all that apply)?

- Headache - Abdominal cramps - Increase in urination - Weakness and fatigue

The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)?

- Maintain a healthy weight - Monitor for polyuria, polyphagia, and polydipsia

The patient with type 2 diabetes is being put on acarbose (Precose) and wants to know about taking it. What should the nurse include in this patient's teaching (select all that apply)?

- Take it with the first bit of each meal - Effectiveness is measured by 2-hour postprandial glucose - It delays glucose absorption from the GI tract

What are manifestations of diabetic ketoacidosis (DKA) (select all that apply)?

- Thirst - Ketonuria - Dehydration - Metabolic acidosis - Kussmaul respirations - Sweet, fruity breath

What characterizes type 2 diabetes (select all that apply)?

- β-cell exhaustion - Insulin resistance - Genetic predisposition - Altered production of adipokines - Inherited defect in insulin receptors - Inappropriate glucose production by the liver

The patient with diabetes is brought to the ER by his family members, who say that he has had an infection, is not acting like himself, and he is more tired than usual. Number the nursing actions in the order of priority for this patient. A. Establish IV access B. Check blood glucose C. Ensure patent airway D. Begin continuous regular insulin drip E. Administer 0.9% NaCl solution at 1 L/hr F. Establish time of last food and medication(s)

1. Ensure patent airway 2. Check blood glucose 3. Establish IV access 4. Administer 0.9% NaCl solution at 1 L/hr 5. Begin continuous regular insulin drip 6. Establish time of last food and medication(s)

Which patient should the nurse plan to teach how to prevent or delay the development of diabetes?

A 34-year-old woman whose parents both have type 2 diabetes

When caring for a patient with metabolic syndrome, the nurse should give the *highest* priority to teaching the patient about which treatment plan?

Achieving a normal weight

A patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medication. The patient tells the nurse she would rather control her blood sugar with herbal therapy. Which action should the nurse take?

Advise the patient to discuss using herbal therapy with her HCP before using it

The nurse should observe the patient for symptoms of ketoacidosis when

An insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy

Which class of 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?

Biguanide

The following interventions are planned for a patient with diabetes. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP)?

Check that the bath water is not too hot

The nurse assesses the technique of the patient with diabetes for self-monitoring of blood glucose (SMBG) 3 months after initial instructions. Which error in the performance of SMBG noted by the nurse requires intervention?

Cleaning the puncture site with alcohol before the puncture

When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient?

Consistently use the same size of insulin syringe to avoid dosing errors

Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to

Eat regular meals at regular times

A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included?

FPG for all individuals at age 45 and then every 3 years

Which laboratory results would indicate that the patient has prediabetes?

Fasting blood glucose result of 120 mg/dL (6.7mmol/L)

The patient with type 2 diabetes has had trouble controlling his blood glucose with several OA but wants to avoid the risks of insulin. The HCP told him a medication will be prescribed that will increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying. The nurse knows this is which medication that will have to be injected?

Glucogon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)

The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has

Impaired glucose tolerance

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do?

Increases amino acid transport into cells and protein synthesis

A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult?

It is more difficult to achieve strict glucose control than in younger patients

Which statement *best* describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes?

It occurs with a higher frequency and earlier onset than in the nondiabetic population

The home care nurse should intervene to correct a patient whose insulin administration includes

Mixing an evening dose of regular insulin with insulin glargine in one syringe for administration

A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last 5 mornings. What should the nurse advise the patient to do *first*?

Monitor the glucose level at bedtime, between 2:00 AM and 4:00 AM, and on arising

What should the goals of nutrition therapy for the patient with type 2 diabetes include?

Normal serum glucose and lipid levels

To prevent hyperglycemia of hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the *best* time for exercise?

Plan activity and food intake related to blood glucose levels

In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose?

Polydipsia

Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones?

Stimulate glucose output by the liver

When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump?

Tight glycemic control can be maintained

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?

Withdraws the NPH dose into the syringe first

During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results (select all that apply)?

- A1C of 7.5% - FPG ≥ 127 mg/dL (7.0 mmol/L)

Which tissues require insulin to enable movement of glucose into the tissue cells (select all that apply)?

- Adipose - Skeletal muscle

What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)?

- Coronary artery disease - Ulceration and amputation of the lower extremities

A patient with type 1 diabetes uses 20 U of Novolin 70/30 (NPH/regular) in the morning and at 6:00 PM. When teaching the patient about this regimen, what should the nurse emphasize?

A set meal pattern with a bedtime snack in necessary to prevent hypoglycemia

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 should the nurse advise the family member to do?

Administer glucagon 1 mg intramuscularly (IM) or subcutabeously

A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the *best* for this patient?

Administer the usual insulin dose

Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered?

At mealtime or within 15 minutes of meals

What describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)?

HHS requires greater fluid replacement to correct the dehydration

The nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as the *priority* by the nurse?

Rapid respirations with deep inspiration