NUR 239 Final (last chapter)
A nurse educator is explaining the pathophysiology of diabetes to a newly diagnosed patient. The patient does not understand why she had a "constant, insatiable thirst" in the months preceding her diagnosis. What phenomenon should the nurse describe?
"Excess glucose pulled more water through your kidneys and the increased urination caused thirst."
A patient in his mid-30s has received a diagnosis of type 2 diabetes. Following his diagnosis, he has been meeting with a nurse regularly as well as performing extensive online research. Which of the patient's statements should prompt the nurse to perform further teaching?
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."
During a teaching session on the care of the diabetic patient, a family member asks why her daughter has a different insulin than her best friend. The nurse should make which of the following statements to explain the differences in insulin?
"Insulins have different onsets and durations of action."
A diabetic client presents to a clinic for routine visit. Blood work reveals a HbA1C of 11.0% (high)? Which response by the patient may account for this abnormal lab result?
"My meter broke so I have not been checking my blood glucose levels for a while."
A patient asks the nurse why a quick-acting sugar given by mouth is better in the regulation of insulin than the use of intravenous glucose for a low blood sugar. Which of the following statements by the nurse represents the most appropriate response to this question?
"The ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins."
A client's primary care provider has ordered an oral glucose tolerance test (OGTT) as a screening measure for diabetes. Which of the following instructions should the client be given?
"The lab tech will give you a sugar solution and then measure your blood sugar levels at specified intervals."
A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be:
"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."
A hospital patient is to receive 4 units of regular insulin prior to lunch. The nurse knows that the lunch trays are usually distributed at approximately 12:15. The nurse should plan to administer the patient's insulin at what time?
11:45
A hospital client has been complaining of increasing fatigue for several hours, and his nurse has entered his room to find him unarousable. The nurse immediately checked the client's blood glucose level (and reverified with a second blood glucose meter), which is 22 mg/dL (1.2 mmol/L). The nurse should prepare to administer which of the following?
A 50% glucose solution intravenously
A 69-year-old woman has been taking metformin for the treatment of type 2 diabetes for several years. Which of the following changes in the woman's laboratory values may demonstrate a need to discontinue the medication?
A decrease in glomerular filtration rate
Which of the following clients would be considered to be exhibiting manifestations of "prediabetes"?
A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL.
A client is admitted in the ICU with diagnosis of hyperglycemic hyperosmolar state (HHS). The nurse caring for the client knows that the client's elevated serum osmolality has pulled water out of this brain cells based on which of the following assessment findings? Select all that apply.
All but, Increase in urine output in proportion to the increase in blood glucose Weakness one side of the body After the sole of the foot has been firmly stroked, the toes flex and flare out Unable to respond verbally to questions Uncontrollable twitching of a muscle group
A patient is to be administered glipizide (Glucotrol). Which of the following factors would contraindicate the administration of glipizide (Glucotrol) to this patient?
Allergy to sulfonamides
A client with a history of diabetes presents to the emergency department following several days of polyuria and polydipsia with nausea/vomiting. On admission, the client labs show a blood glucose level of 480 mg/dL and bicarbonate level of 7.8 mEq/dL. The nurse suspects the client has diabetic ketoacidosis (DKA). The priority intervention should include:
Begin a loading dose of IV regular insulin followed by a continuous insulin infusion.
The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which of the following pathophysiologic processes underlies the client's new diagnosis?
Beta cell exhaustion due to long-standing insulin resistance
A hospital patient with a diagnosis of type 1 diabetes is ordered Humulin R on a sliding scale. Based on the patient's blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse recognizes the need to follow up this intervention and will reassess the patient's blood glucose level when the insulin reaches peak efficacy. The nurse should consequently check the patient's blood glucose level at what time?
Between 09:45 and 10:45
Which of the following comorbidities represent the greatest risk for the development of foot ulcers in a diabetic client? Select all that apply.
Bilateral distal loss of pain sensation Motor neuropathy related to improperly fitted shoes Smoking history averaging 2 packs/day
A diabetic client presents to the clinic. He is concerned his lower legs are "feeling funny." Which of the following assessment findings lead the health care provider to suspect the client may have developed somatic neuropathy? Select all that apply.
Both legs appear to be the same as far as numbness is involved. Bilateral cool ankles and feet. With eyes closed, the client cannot identify where the HCP is touching his feet.
A client with type 1 diabetes has started a new exercise routine. Knowing there may be some increase risks associated with exercise, the health care provider should encourage the client to:
Carry a snack with carbs to prevent profound hypoglycemia
Impaired and delayed healing in a person with diabetes is caused by long-term complications that include:
Chronic neuropathies
While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which of the following accurate information?
In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.
A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing:
Dawn phenomenon
A diabetic client's most recent blood work indicated a decreased glomerular filtration rate and urine testing revealed + microalbuminuria. Which priority self-care measures should the client's care team prescribe for this client?
Diet, exercise, and prescriptions to lower blood pressure below 140/80 mm Hg
A patient is diagnosed with type 1 diabetes. What distinguishing characteristic is associated with type 1 diabetes?
Exogenous insulin is required for life.
A patient of Italian descent has been prescribed antidiabetic medications. Heavy intake of which of the following herbs should be avoided by this patient?
Garlic
Which of the following assessment findings of a male client constitutes a criterion for a diagnosis of metabolic syndrome? The client:
Has blood pressure that is consistently in the range of 150/92 mm Hg
A patient's medication administration record specifies that the patient is to receive 20 units of NPH insulin at 08:00. Before administering this medication, the nurse must do which of the following?
Have a colleague confirm the dosage.
Diabetic retinopathy, the leading cause of acquired blindness in the United States, is characterized by retinal:
Hemorrhages
While working on the med-surg floor, the nurse has a client who is experiencing an insulin reaction. The client is conscious and can follow directions. The most appropriate intervention would be:
Immediately administer 15 g of glucose (preferably via oral route if the client is alert enough to swallow) and wait for 15 minutes. Then repeat this if necessary.
A newly diagnosed type 2 diabetic client has been prescribed metformin. When explaining the actions of this medication, the nurse should include which statement? This medication:
Inhibits hepatic glucose production and increases the sensitivity of peripheral tissues to the actions of insulin
Which of the following insulin administration regimens is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes?
Intermediate-acting insulin at 8:00 AM and 8:00 PM with rapid-acting insulin before each meal
Which of the following pregnant women likely faces the greatest risk of developing gestational diabetes? A client who:
Is morbidly obese defined as greater than 100 pounds over ideal weight
A patient has been prescribed acarbose (Precose). What is the advantage of acarbose over alternative drugs?
It delays the digestion of complex carbohydrates.
An 8-month-old infant is admitted to the pediatric floor of the community hospital with a new diagnosis of diabetes. The patient is to receive 1 unit of regular insulin subcutaneously. How will that 1 unit be administered?
It is administered as U-10.
A patient with a diagnosis of diabetes is prescribed pramlintide (Symlin). How will this drug assist in controlling the patient's blood sugar?
It slows gastric emptying.
Sitagliptin (Januvia) is prescribed for a patient who has been diagnosed with type 2 diabetes. What is the action of sitagliptin (Januvia)?
It slows the rate of inactivation of the incretin hormones.
A patient who regularly takes metformin has developed a severe infection. How will the infection change his diabetic regimen?
Metformin is contraindicated in the presence of an infection.
A diabetic client was visiting the endocrinologist for annual checkup. The client's blood work reveals an increased level of which lab result that reveals early signs of diabetic nephropathy?
Microalbuminuria
A 58-year-old patient who has been living with diabetes since age 14 states he has pain in his feet and hands. What is this pain most likely a result of?
Peripheral neuropathy
A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following effects will result from the action of insulin?
Promotion of glucose uptake by target cells
A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600 mg/dL. The physician has ordered the patient to receive an initial dose of 25 units of insulin intravenously. What type of insulin will most likely be administered?
Regular insulin
A patient has suffered from hypoglycemia twice in the past week. She states she eats one meal per day and snacks the rest of the day. What patient education will you provide for this patient?
She should not eat at sporadic times.
A patient will soon begin treatment for diabetes using glyburide. Which of the following conditions must be met in order for treatment to be effective?
The patient must have functioning pancreatic beta cells.
A client with long-standing type 2 diabetes is surprised at his high blood sugar readings while recovering from an emergency surgery. Which of the following factors may have contributed to the client's inordinately elevated blood glucose levels?
The stress of the event caused the release of cortisol.
A client with type 2 diabetes has routine lab work, which reveals elevated free fatty acids (FFA). The client asks, "Why is this significant?" The most accurate response would be: Select all that apply.
This may increase the amount of triglyceride (a form of fat) stored in your liver or around your heart. Your pancreas is affected by increased fat (lipotoxicity), which causes beta cell dysfunction, leading to the need for insulin.
