WEEK 10 DIABETES Chapter 51 + Karch Ch 38

The nurse transcribes an order for chlorpropamide (Diabinese). What is an appropriate dosage range for this medication? A) 0.25 to 3 g per day B) 2 mg per day C) 100 to 250 mg per day D) 5 mg orally daily

Ans: C Feedback: The appropriate dosage range for oral chlorpropamide is 100 to 250 mg/d. Tolbutamide is 0.25 to 3 g/d. Glimepiride is 1 to 4 mg/d. Glipizide is taken 5 mg PO daily. 35.

The nurse is caring for a postoperative patient whose diabetes has been well controlled on acarbose (Precose). The patient is not allowed to take anything orally following abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer IV to control the patients blood glucose level? A) Glyburide B) Acarbose C) NPH insulin D) Regular insulin

Ans: D Feedback: Only regular insulin can be administered IV. No other insulins or oral antidiabetic medications can be given IV.

A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur? A) Patients who are obese and who have no known history of diabetes B) Patients with type 1 diabetes and poor dietary control C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes

Ans: D Feedback: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes.

A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the body's need for insulin? A) Adequate sleep B) Low stimulation C) Exercise D) Low-fat diet

Ans: C Feedback: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patient's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A) Fasting plasma glucose greater than or equal to 126 mg/dL B) Random plasma glucose greater than 150 mg/dL C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D) Random plasma glucose greater than 126 mg/dL

Ans: A Feedback: Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.

The nurse is performing diabetes screening and recognizes what ethnic group is at higher risk for diabetes but is also predisposed to a higher normal range of blood glucose? A) Native Americans B) Japanese Americans C) African Americans D) Caucasian Americans

Ans: A Feedback: Certain ethnic groups tend to have a genetically predetermined variation in blood glucose levels, possibly caused by a variation in metabolism. For example, Native Americans, Hispanic Americans, and Japanese Americans have higher blood glucose levels than white Americans do. Groups that are more likely to develop diabetes mellitus include African Americans, Native Americans, and Hispanic Americans.

The nurse is caring for a patient taking Bromocriptine (Cycloset). What is an advantage of this medication? A) Reduces risk of heart attack or stroke B) Has no adverse effects C) Is taken four times a day D) Long-term studies needed

Ans: A Feedback: Bromocriptine-therapy patients had improved HbA1c levels, showing better glycemic control, and were less likely to have a heart attack or stroke or to die of heart disease. All drugs have adverse effects. Taking the medication four times a day and the need for long-term studies are not advantages of the drug.

An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A) Administration of antihypertensive medications B) Administering sodium bicarbonate intravenously C) Reversing acidosis by administering insulin D) Fluid and electrolyte replacement

Ans: D Feedback: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe? A) "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." B) "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it." C) "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." D) "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."

Ans: D Feedback: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not "make" glucose.

A diabetes nurse is assessing a patient's knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patient's knowledge of nutritional therapy in diabetes? A) ask the patient to describe an optimally healthy meal B) ask the patient to keep a food diary and review it with the nurse C) ask the patient's family what he typically eats. D) ask the patient to describe a typical day's food intake.

ANS: B Feedback: Reviewing the patient's actual food intake is the most accurate method of gauging the patient's diet.

A nurse is teaching basic "survival skills" to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address? A) Signs and symptoms of diabetic nephropathy B) Management of diabetic ketoacidosis C) effects of surgery and pregnancy on blood sugar levels D) Recognition of hypoglycemia and hyperglycemia

ANS: D Feedback: It is imperative that newly diagnosed patients know the signs and symptoms and management of hypo/hyperglycemia. The other listed topics are valid points for education, but are not components of the patient's immediate "survival skills" following a new diagnosis.

When the nurse administers an oral combination drug called Metaglip, what doses of the two medications are being administered? A) 2.5 mg glipizide, 500 mg metformin B) 1.25 mg glyburide, 250 mg metformin C) 5 mg glipizide, 250 mg metformin D) 4 mg rosiglitazone, 500 mg metformin

Ans: A Feedback: Metaglip is a combination of 2.5 mg glipizide with 250 or 500 mg metformin or 5 mg glipizide and 500 mg metformin. Glucovance is a combination of 1.25 mg glyburide with 250 mg metformin, 2.5 mg glyburide with 500 mg metformin, and 5 mg glyburide with 500 mg of metformin. Avandamet is a combination of 1, 2, or 4 mg rosiglitazone with 500 mg metformin.

The nurse is caring for a patient with polycystic ovary syndrome. What antidiabetic drug would the nurse anticipate will be ordered? A) Metformin B) Acarbose C) Insulin D) Glyburide

Ans: A Feedback: Metformin and pioglitazone have proven effective in increasing insulin sensitivity and decreasing androgen and luteinizing hormone levels to break the cycle and allow ovulation to occur if pregnancy is desired. A fertility drug is often used with the antidiabetic agent. Other options are not appropriate because they are not indicated for treating polycystic ovary syndrome.

The nurse is preparing patient teaching for a diabetic patient who is to begin pramlintide acetate (Symlin) therapy, which will be taken in addition to insulin. What is the priority nursing instruction to include in this teaching plan? A) The drug is injected subcutaneously immediately before a major meal. B) The drug has a rapid onset of action. C) Inject the drug at least 2 inches away from any insulin injection site. D) Do not combine the drug with insulin in the same syringe.

Ans: A Feedback: Pramlintide works to modulate gastric emptying after a meal, so correct timing of administration of this drug is essential to its function. All options are appropriate instructions for this drug. However, making sure that the patient understands that injecting the medication immediately before eating a major meal is most important because it has a dramatic effect on the therapeutic action of the drug. If the medication is not given at the correct time, the other options would be insignificant.

The nurse will question what medication order for a diabetic patient who takes insulin to control his blood sugar level? A) Propranolol (Inderal) 10 mg orally t.i.d. B) Furosemide (Lasix) 60 mg/d orally C) Cefaclor (Ceclor) 250 mg orally every 8 hour D) Metoclopramide (Reglan) 20 mg PO

Ans: A Feedback: Propranolol is a beta-blocker and should be avoided in combination with insulin. The blocking of the sympathetic nervous system also blocks many of the signs and symptoms of hypoglycemia, hindering the patients ability to recognize problems. If propranolol must be taken, the nurse will need to teach this patient other ways to recognize hypoglycemia. Furosemide, cefaclor, and metoclopramide do not cause drugdrug interactions with insulin.

A patient with type 1 diabetes takes 12 units of regular insulin and 34 units of NPH insulin in the morning. How would the nurse explain why two different types of insulin are required to control the patients blood sugar? A) Different onsets and peak effects extends blood glucose control. B) The mixture makes each drug work more effectively. C) The combination reduces the adverse effects experienced. D) Patients are less likely to experience hypoglycemia.

Ans: A Feedback: Regular insulin will begin working within 30 to 60 minutes and peak within 2 to 4 hours and a 6- to 12-hour duration of action whereas NPH insulin has an onset of 60 to 90 minutes and peaks in 4 to 12 hours, with a 24-hour duration of action. By giving both drugs at once, the patient gets rapid blood glucose control within 30 minutes from the regular insulin and the control lasts 24 hours due to NPHs long duration of action. The combination does not make the drugs work more effectively, it does not reduce adverse effects, and patients are more likely to experience hypoglycemia if they do not eat properly.

The nurse is caring for an obese woman who was just diagnosed with type 2 diabetes. When developing this patients plan of care, what is the priority nursing diagnosis? A) Imbalanced nutrition: more than body requirements related to obesity B) Risk for unstable blood glucose related to ineffective dosing of antidiabetic agents C) Disturbed sensory perception related to glucose levels D) Ineffective coping related to diagnosis and therapy

Ans: A Feedback: The priority with this patient is to address her obesity because losing weight may eliminate the problem. Depending on the agent that is ordered, there may be risk for unstable blood glucose and the patient may need support to cope with the diagnosis but these are not the priority concern. Disturbed sensory perception is not indicated to be a problem at this time.

The nurse is caring for a patient with renal dysfunction who requires an oral antidiabetic agent. What drug will the nurse expect to see ordered? A) Tolbutamide B) Chlorpropamide C) Tolazamide D) Chlorpromazine

Ans: A Feedback: Tolbutamide is preferred for patients with renal dysfunction, who may not be able to excrete chlorpropamide, because it is more easily cleared from the body. Tolbutamide, chlorpropamide, and tolazamide are all first-generation sulfonylureas, but tolazamide is used less frequently and is usually tried after the first two drugs have been shown to be ineffective. Chlorpromazine (Thorazine) is an antipsychotic agent.

The nurse is caring for an adolescent newly diagnosed with type 1 diabetes. The patient says, I cant believe Im going to spend the rest of my life sticking myself with needles. What future possibilities for insulin delivery can the nurse share with this patient? (Select all that apply.) A) Implantable insulin pump B) Insulin patch C) Inhaled insulin D) Oral insulin E) Pancreas transplant

Ans: A, B, C Feedback: Research is ongoing to obtain approval for an implantable insulin pump, an insulin patch, and inhaled insulin. Insulin cannot be taken orally because it is destroyed by gastric secretions and transplanting a pancreas for treatment for diabetes is not likely.

The nurse is caring for a 3-year-old child newly diagnosed with type 1 diabetes. When developing the plan of care for this child, the nurse incorporates challenges the child faces that the adult does not, which includes what? (Select all that apply.) A) Children have a faster metabolic rate. B) Growth must be balanced with diet and activity. C) Insulin dose may be so small it is hard to calibrate accurately. D) Increased resistance by child to dietary restrictions is common. E) Changing metabolism makes regulating insulin difficult.

Ans: A, B, C Feedback: Treatment of diabetes in children is a difficult challenge of balancing diet, activity, growth, stressors, and insulin requirements. Children need to be carefully monitored for any sign of hypoglycemia or hyperglycemia and treated quickly because their fast metabolism and lack of body reserves can push them into a severe state quickly. Insulin dosage, especially in infants, may be so small that it is difficult to calibrate. Insulin often needs to be diluted to a volume that can be detected on the syringe. It is usually during adolescence when increased resistance to dietary restrictions and changing metabolism makes regulating insulin difficult so this would not be part of the plan of care for a 3-year-old.

The nurse is teaching the patient about the newly prescribed external insulin pump. What are priority teaching points for the nurse to include? (Select all that apply.) A) Watch for signs and symptoms of infection. B) Check blood glucose frequently. C) Change tubing frequently. D) Have pump calibrated weekly. E) Added insulin requires separate injection site.

Ans: A, B, C, D Feedback: This pump device can be worn on a belt or hidden in a pocket and is attached to a small tube inserted into the subcutaneous tissue of the abdomen. The device slowly leaks a base rate of insulin into the abdomen all day; the patient can pump or inject booster doses throughout the day to correspond with meals and activity. The device does have several disadvantages. For example, it is awkward, the tubing poses an increased risk of infection and requires frequent changing, and the patient has to frequently check blood glucose levels throughout the day to monitor response. There is no need to calibrate the pump.

The nurse admits a patient to the emergency department and recognizes the patient is in diabetic ketoacidosis (DKA) when what manifestations are assessed? (Select all that apply.) A) Fruity breath B) Edema C) Dehydration D) Agitation E) slow and deep respirations

Ans: A, C, E Feedback: Signs of impending dangerous complications of hyperglycemia such as DKA include the following: fruity breath as the ketones build up in the system and are excreted through the lungs; dehydration as fluid and important electrolytes are lost through the kidneys; slow and deep respirations (Kussmauls respirations) as the body tries to rid itself of high acid levels; loss of orientation and coma rather than agitation are to be expected. Edema is not a sign of DKA.

The nurse suspects the diabetic patient may be having a hypoglycemic reaction when what manifestation is assessed? A) Dry, flaky skin B) Diaphoresis C) Flushing of the face D) Fruity breath

Ans: B Feedback: Diaphoresis and cool clammy skin are signs of hypoglycemia. A fruity breath is seen with ketoacidosis. Flushing of the face is associated with hyperglycemia.

The patient with diabetes asks the nurse why different oral antidiabetic agents are ordered instead of just one drug. What is the nurses best explanation of the benefit of combining different agents? A) Maximum effects B) Additive effects C) Minimalistic effects D) Synergistic effects

Ans: B Feedback: Five types of oral antidiabetic agents exist, all of which may be used to treat type 2 diabetes when diet and exercise alone fail to control the disorder. The drugs lower blood sugar by different mechanisms and may be used in various combinations for additive effects.

What instructions would be important to give to a 50-year-old patient with type 2 diabetes who has been switched from glyburide (DiaBeta) to repaglinide? A) It is less potent, so you will need to take a larger dose. B) It stimulates insulin production, so you need to eat soon after taking the medication. C) It is more potent and longer lasting, so you should take it every other day. D) The two medications are virtually the same.

Ans: B Feedback: Glyburide is a second-generation sulfonylurea that stimulates insulin release from the beta cells in the pancreas with a 2- to 4-hour onset of action. Repaglinide has an onset of action within 30 minutes with peak effect in 1 hour, and duration of action is approximately 3 to 4 hours. Because repaglinide has a much faster onset of action, it is important the patient eats within15 to 30 minutes after taking the drug to avoid hypoglycemia. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same.

The home care nurse is caring for an older adult patient with visual impairment who cannot see the numbers on the syringe when preparing insulin for administration and cannot afford the increased cost of prefilled auto syringes. What strategy might the nurse use to help this patient comply with insulin needs between visits? A) Change the patient to oral antidiabetics. B) Prepare a weeks supply of syringes and refrigerate. C) Have the patient use a magnifying glass. D) Ask a neighbor to come over every day to prepare the medication.

Ans: B Feedback: Older adults can have many underlying problems that complicate diabetic therapy. Poor vision and/or coordination may make it difficult to prepare a syringe. A weeks supply of syringes can be prepared and refrigerated for the usual dose of insulin. If the patient is using insulin it is most likely because oral antidiabetic medications dont work. A magnifying glass is impractical because drawing up medication requires two hands and a magnifying glass will not help the patient to see well enough to be safe. It is a big imposition to expect a neighbor to be constantly available and this would not be the best choice.

A patient with type 2 diabetes presents at the clinic for a routine follow-up appointment. The patient asks the nurse whether she can take the herbal supplement ginseng. What is the correct response by the nurse? A) It increases the risk for high blood glucose levels. B) It increases the risk for low blood glucose levels. C) There is no research to indicate what effect it will have. D) There is no reason ginseng cannot be taken by people with diabetes.

Ans: B Feedback: Patients being treated with antidiabetic therapies are at an increased risk of developing hypoglycemia if they use herbals containing juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, or celery. If a patient uses these therapies, blood glucose levels should be monitored closely and appropriate dose adjustment made in the prescribed drug.

An type 1 (insulin-dependent) diabetic reports recurrent hypoglycemia late in the morning. After collecting his health history what finding would the nurse suspect is causing the late morning hypoglycemia? A) The patient likes to nap after work before his evening meal. B) The patient jogs 2 miles in the morning before he goes to work. C) The patient likes to have an early lunch with his girlfriend. D) The patient eats oatmeal early in the morning for breakfast.

Ans: B Feedback: Physical exercise, such as jogging, changes insulin requirements and may result in a delayed hypoglycemic reaction. The fact that he likes to nap before dinner and has an early lunch is unrelated to his hypoglycemia. The patient eating oatmeal early in the morning would help stabilize his blood sugars until later in the morning, but the jogging would have a dramatic effect.

The diabetes nurse educator describes type 1 diabetes with what statement? A) Blood glucose level can be controlled with diet. B) Exogenous insulin is required for life. C) Oral agents can help to control blood glucose levels. D) It is always diagnosed in early childhood.

Ans: B Feedback: Type 1 diabetes results from an autoimmune disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes because pancreatic beta cells are unable to secrete endogenous insulin and metabolism is severely impaired. In type 1 diabetes, blood glucose levels cannot be controlled with diet, oral agents cannot control the disease process because they stimulate insulin production, and the patient with type 1 diabetes does not produce insulin. It can be diagnosed at other stages of the life span than just in early childhood.

What is the maximum daily dosage of metformin the nurse can administer to a child aged 10 to 16 years? A) 500 mg B) 850 mg C) 2,000 mg D) 2,550 mg

Ans: C Feedback: Children should not receive more than 2,000 mg/d whereas adults should not receive more than 2,550 mg/d. The normal dosage for children is 500 mg/d and for adults is 500 to 850 mg/d.

A diabetic patient is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall patient response to the insulin therapy? A) Blood pressure B) Bilirubin level C) Glycosylated hemoglobin (HbAlc) levels D) Fasting blood glucose levels

Ans: C Feedback: HbAlc levels provide a 3-month average of glucose levels, which provides the best evaluation tool to measure the overall patient response to the treatment plan. Blood pressure readings would be used to evaluate a patients response to an antihypertensive drug. Bilirubin could indicate liver function. Fasting blood glucose levels provide only a baseline blood sugar and no historical overview. Comparing fasting blood glucose levels with HbAlc is like comparing a picture to a video because the HbAlc looks back across a period of 3 months whereas a blood glucose test result only tells you about the exact moment the blood was drawn.

The nurse is caring for a pregnant patient diagnosed with pregnancy-induced diabetes. What antidiabetic agent is best suited for administration to this patient? A) Metformin B) Acarbose C) Insulin D) Glyburide

Ans: C Feedback: Insulin therapy is the best choice for patients with diabetes during pregnancy and lactation, which are times of high stress and metabolic demands. Oral antidiabetic medications are contraindicated during pregnancy so metformin, acarbose, and glyburide are not the best choices.

A patient is brought to the emergency department with severe hypoglycemia. What drug would the nurse prepare to administer intravenously? A) Diazole (Hyperstat) B) Glyburide (DiaBeta) C) Glucagon (GlucaGen) D) Insulin (Humulin R)

Ans: C Feedback: This patient will need a glucose-elevating agent. Glucagon (GlucaGen) is given parenterally only and is the preferred agent for emergency situations. Diazole is also a glucose-elevating agent but is only administered so it would take longer to take effect. Insulin would be administered for hyperglycemia. Glyburide is an oral antidiabetic agent, which is a second-generation sulfonylurea, and is administered for hyperglycemia.

A patient comes to the diabetes educator and asks about changing his insulin. The patient explains that his occupation takes him on long international flights and he does not want to administer insulin on the plane. What kind of insulin would the diabetic nurse educator seek an order for? A) Lispro (Humalog) B) Glulisine (Apidra) C) Ultralente (Humulin U Ultralente) D) Aspart (NovoLog)

Ans: C Feedback: Ultralente has a duration of 20 to 36 hours and a peak time of 10 to 30 hours. This would prevent him having to administer insulin on the airplane. Lispro has a duration of 2 to 5 hours and a peak time of 30 to 90 minutes. Glulisine has a duration of 1 to 2.5 hours and a peak time of 30 to 90 minutes. Aspart has a duration of 3 to 5 hours and a peak time of 1 to 3 hours. The last three insulin types mentioned in this Rationale would likely require administration on long plane flights.

The nurse is instructing a patient how to mix NPH insulin with regular insulin in one syringe. The nurse tells the patient the mixture must be administered within how long after it is prepared? A) 5 minutes B) 10 minutes C) 15 minutes D) 20 minutes

Ans: C Feedback: Use caution when mixing types of insulin. Administer mixtures of regular and NPH or regular and lente insulins within 15 minutes after combining them to ensure appropriate suspension and therapeutic effect.

What type of insulin would the nurse administer if the fastest therapeutic effects are needed? A) Lispro (Humalog) B) Aspart (NovoLog) C) Regular (Humulin R) D) Glulisine (Apidra)

Ans: D Feedback: Glulisine has an onset of 2 to 5 minutes and peaks in 30 to 90 minutes so it has the fastest onset of action. Lispro has an onset in <15 minutes and also peaks at 30 to 90 minutes. Aspart takes 10 to 20 minutes for onset and peeks in 1 to 3 hours. Regular insulin has a 30 to 60 minute onset and peaks in 2 to 4 hours.

With what patient would the nurse question the administration of human insulin? A) Gestational diabetes B) Type 2 diabetes controlled on oral antidiabetic agents with systemic infection C) Type 1 diabetes of many years D) Type 2 diabetes controlled by diet

Ans: D Feedback: Insulin is recommended for treatment of type 2 diabetes in patients whose diabetes cannot be controlled by diet or other pharmacotherapeutic agents. If the diabetes can be controlled by diet, the pancreas is still functioning and releasing insulin. Human insulin can be used in gestational diabetes, patients with type 2 diabetes controlled on oral antidiabetic agents with systemic infection, or patients with type 1 diabetes of many years standing.

A patient is admitted to the emergency department in diabetic ketoacidosis (DKA) with a blood glucose level of 485 mg/dL. The physician orders an initial dose of 25 U insulin IV. Which type of insulin will be administered? A) NPH insulin B) Humulin L insulin C) Humulin N insulin D) Regular insulin

Ans: D Feedback: Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia resulting from DKA, which is a life-threatening complication that occurs with severe insulin deficiency. Furthermore, only regular insulin can be given IV and is the drug of choice in emergency situations. Humulin N, Humulin L, and NPH are intermediate-acting forms.

The patient, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurses best response? A) Inability of cells in the eye to reproduce B) Increase of aqueous humor in the eye C) Decrease of nerve innervations throughout the eye D) Oxygen cannot diffuse rapidly across the membrane to tissues in the eye

Ans: D Feedback: The bodys inability to effectively cope with carbohydrate, fat, and protein metabolism over a long period of time results in a thickening of the basement membrane in large and small blood vessels. This thickening leads to changes in oxygenation of the lining of the vessels causing damage and narrowing of the vessels. The decreased blood flow through the vessels results in the inability of oxygen to rapidly diffuse across the membrane to the tissues of the eye. The tiny vessels of the eye are narrowed and closed, which causes loss of vision. Increase of aqueous humor is seen in glaucoma. Inability of cell replication and decrease in nerve innervations throughout the eye is not associated with retinopathy.

What outcome would best indicate the nurses teaching was effective and that drug therapy was appropriate? A) The patient can explain how to take the medication. B) The patient demonstrates the correct procedure for monitoring blood sugar. C) The patient follows an appropriate diet. D) Blood glucose level is stable with no diabetic complications.

Ans: D Feedback: The single best indicator, and the goal of treatment, is to help the patient maintain a stable blood glucose level so as to be able to avoid any complications. For the patient to maintain a stable blood glucose level, he needs to understand how to take his medication, to check his blood sugar level, and to follow an appropriate diet, but the best indicator is the stable glucose level.

The nurse, working in the emergency department, receives a patient following a motor vehicle accident whose medical history is unknown with a blood glucose level of 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level? A) The patients accident was caused by diabetic ketoacidosis (DKA). B) The patient has not been taking the antidiabetic agent as prescribed. C) The patient most likely just finished a meal. D) The stress reaction caused an increase in blood sugar.

Ans: D Feedback: The stress reaction elevates the blood glucose concentration above the normal range. In severe stress situations, the blood glucose level can be very high (300 to 400 mg/dL). The body uses that energy to fight the insult or flee from the stressor. The patient may or may not be diabetic so this is not DKA, not an indication of medication noncompliance, and not an indication the patient had just eaten.

What antidiabetic agent is approved for the nurse to administer to children 10 years old and older with type 2 diabetes? A) Pioglitazone B) Repaglinide C) Liraglutide D) Metformin

Ans: D Feedback: Metformin is the only oral antidiabetic drug approved for children. It has established dosage for children 10 years of age and older. With the increasing number of children being diagnosed with type 2 diabetes, the use of other agents in children is being tested. Because metformin is the only drug approved for use with children, pioglitazone, repaglinide, and liraglutide would not be appropriate.

A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the child's pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes? A) Type 1 diabetes B) Type 2 diabetes C) Non-insulin-dependent diabetes D) Prediabetes

Ans: A Feedback: Beta cell destruction is the hallmark of type 1 diabetes. Non-insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.

A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A) Infection B) Acute pain C) Acute confusion D) Impaired urinary elimination

Ans: A Feedback: Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function.

A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer? A) "If you are going to use up the vial within 1 month it can be kept at room temperature." B) "If a vial of insulin will be used up within 21 days, it may be kept at room temperature." C) "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature." D) "If a vial of insulin will be used up within 1 week, it may be kept at room temperature."

Ans: A Feedback: If a vial of insulin will be used up within 1 month, it may be kept at room temperature.

A patient has been brought to the emergency department by paramedics after being found unconscious. The patient's Medic Alert bracelet indicates that the patient has type 1 diabetes and the patient's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? A) IV administration of 50% dextrose in water B) Subcutaneous administration of 10 units of Humalog C) Subcutaneous administration of 12 to 15 units of regular insulin D) IV bolus of 5% dextrose in 0.45% NaCl

Ans: A Feedback: In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate and insulin would exacerbate the patient's condition.

A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is likely to have minimal contact with the health care system. In order to ensure that the patient maintains adequate blood sugar control over the long term, the nurse should recommend which of the following? A) Participation in a support group for persons with diabetes B) regular consultation of websites that address diabetes management C) Weekly telephone "check-ins" with and endocrinologist D) participation in clinical trials relating to antihyperglycemics.

Ans: A Feedback: Participation in support groups is encouraged for patients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on patients' circumstances.

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A) Always carry a form of fast-acting sugar. B) Perform exercise prior to eating whenever possible. C) Eat a meal or snack every 8 hours. D) Check blood sugar at least every 24 hours.

Ans: A Feedback: The following teaching points should be included in information provided to the patient on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.

A diabetes nurse educator is teaching a group of patients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic patient? A) Do not eliminate insulin when nauseated and vomiting. B) Report elevated glucose levels greater than 150 mg/dL. C) Eat three substantial meals a day, if possible. D) Reduce food intake and insulin doses in times of illness.

Ans: A Feedback: The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what? A) "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." B) "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." C) "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." D) "I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine."

Ans: A Feedback: The nurse must explanation the "sick day rules" again to the patient who plans to stop taking insulin when sick. The nurse should emphasize that the patient should take insulin agents as usual and test one's blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60 minutes to prevent dehydration.

A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient about self-administration of insulin in the home setting. The nurse should teach the patient to do which of the following? A) Avoid using the same injection site more than once in 2 to 3 weeks. B) Avoid mixing more than one type of insulin in a syringe. C) Cleanse the injection site thoroughly with alcohol prior to injecting. D) Inject at a 45º angle.

Ans: A Feedback: To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90º angle. Cleansing the injection site with alcohol is optional.

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? A) Teach the patient about actions to slow the progression of nephropathy. B) Ensure that the patient receives a comprehensive assessment of liver function. C) Determine whether the patient has been using expired insulin. D) Administer a fluid challenge and have the test repeated.

Ans: A Feedback: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the patient's liver function is not likely affected. There is no indication for the use of a fluid challenge.

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes? A) "I've always been a fan of sweet foods, but lately I'm turned off by them." B) "Lately, I drink and drink and can't seem to quench my thirst." C) "No matter how much sleep I get, it seems to take me hours to wake up." D) "When I went to the washroom the last few days, my urine smelled odd."

Ans: B Feedback: Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment? A) Alterations in bile metabolism and release have likely caused hyperglycemia. B) Stress has likely caused an increase in the patient's blood sugar levels. C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures. D) The patient's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

Ans: B Feedback: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The patient's need for insulin is unrelated to the action of bile, the patient's overestimation of previous blood sugar control, or fluid imbalance.

A diabetic patient calls the clinic complaining of having a "flu bug." The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient? A) "Make sure to stick to your normal diet." B) "Try to eat small amounts of carbs, if possible." C) "Ensure that you check your blood glucose every hour." D) "For now, check your urine for ketones every 8 hours."

Ans: B Feedback: For prevention of DKA related to illness, the patient should attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours.

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patient's initial phase of treatment? A) Monitoring the patient for dysrhythmias B) Maintaining and monitoring the patient's fluid balance C) Assessing the patient's level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism

Ans: B Feedback: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.

The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address what topic during this dialogue? A) The need for frequent eye examinations for patients with diabetes B) The fact that patients with diabetes have an elevated risk of myocardial infarction C) The relationship between kidney function and blood glucose levels D) The need to monitor urine for the presence of albumin

Ans: B Feedback: Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and renal function are considered to be microvascular.

A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the patient's ability to prepare and self-administer insulin? A) Ask the patient to describe the process in detail. B) Observe the patient drawing up and administering the insulin. C) Provide a health education session reviewing the main points of insulin delivery. D) Review the patient's first hemoglobin A1C result after discharge.

Ans: B Feedback: Nurses should assess the patient's ability to perform diabetes related self-care as soon as possible during the hospitalization or office visit to determine whether the patient requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the patient about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.

A medical nurse is caring for a patient with type 1 diabetes. The patient's medication administration record includes the administration of regular insulin three times daily. Knowing that the patient's lunch tray will arrive at 11:45, when should the nurse administer the patient's insulin? A) 10:45 B) 11:15 C) 11:45 D) 11:50

Ans: B Feedback: Regular insulin is usually administered 20-30 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.

A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient? A) A sulfonylurea B) A biguanide C) A thiazolidinedione D) An alpha glucosidase inhibitor

Ans: B Feedback: Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

17. An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient? A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. D) Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.

Ans: B Feedback: The nurse recognizes that providing information on the long-term complications—especially foot and eye problems—associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs administered for diabetes.

A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply. A) Leukocytosis B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia

Ans: B, C, D, E Feedback: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.

A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients at this class? A) Low fat generally indicates low sugar. B) Protein should constitute 30% to 40% of caloric intake. C) Most calories should be derived from carbohydrates. D) Animal fats should be eliminated from the diet.

Ans: C Feedback: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient? A) Examine feet weekly for redness, blisters, and abrasions. B) Avoid the use of moisturizing lotions. C) Avoid hot-water bottles and heating pads. D) Dry feet vigorously after each bath.

Ans: C Feedback: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.

A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A) Increased caloric intake during the first trimester B) Changes in osmolality and fluid balance C) The effects of hormonal changes during pregnancy D) Overconsumption of carbohydrates during the first two trimesters

Ans: C Feedback: Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality.

A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A) A combination of protein and carbohydrates, such as a small cup of yogurt B) Two teaspoons of sugar dissolved in a cup of apple juice C) Half of a cup of juice, followed by cheese and crackers D) Half a sandwich with a protein-based filling

Ans: C Feedback: Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may result in a sharp rise in blood sugar that will last for several hours.

A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what? A) "I read that a pancreas transplant will provide a cure for my diabetes." B) "I will take my oral antidiabetic agents when my morning blood sugar is high." C) "I will make sure to follow the weight loss plan designed by the dietitian." D) "I will make sure I call the diabetes educator when I have questions about my insulin."

Ans: C Feedback: Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.

A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? A) The patient should withhold his next scheduled dose of insulin. B) The patient should promptly eat some protein and carbohydrates. C) The patient's insulin levels are inadequate. D) The patient would benefit from a dose of metformin (Glucophage).

Ans: C Feedback: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patient's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurse's best response? A) "Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years." B) "The cause is not known for sure but it is thought to have something to do with ketoacidosis." C) "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." D) "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels."

Ans: C Feedback: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.

Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control? A) a patient who skips breakfast when his glucose reading is greater than 220 mg/dL B) a patient who never deviates from her prescribed dose of insulin C) a patient who adheres closely to a meal plan and meal schedule D) a patient who eliminates carbohydrates from his daily intake.

Ans: C Feedback: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin t help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for a person with type 1 diabetes.

A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse should question the patient about what sign or symptom that would suggest the possible development of peripheral neuropathy? A) Persistently cold feet B) Pain that does not respond to analgesia C) Acute pain, unrelieved by rest D) The presence of a tingling sensation

Ans: D Feedback: Although approximately half of patients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication.

A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the patient and will implement a program of health education. What is the nurse's priority action? A) Ensure that the patient understands the basic pathophysiology of diabetes. B) Identify the patient's body mass index. C) Teach the patient "survival skills" for diabetes. D) Assess the patient's readiness to learn.

Ans: D Feedback: Before initiating diabetes education, the nurse assesses the patient's (and family's) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.

A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADA's recommendations include? A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

Ans: D Feedback: Currently the ADA and the Academy of Nutrition and dietetics recommend that for all levels of caloric intake, 50-60% of calories come from carbohydrates, 20-30% from fat, and the remaining 10-20% from protein.

A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patient's daily dose of metformin, the nurse should prioritize which of the following assessments? A) Monitoring the patient's neutrophil levels B) assessing the patient for signs of impaired liver function C) Monitoring the patient's level of consciousness and behavior D) Reviewing the patient's creatinine and BUN levels

Ans: D Feedback: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patient's renal function. This drug does not typically affect patients' neutrophils, liver function or cognition.

A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individual's risk for developing diabetes? A) Have blood glucose levels checked annually. B) Stop using tobacco in any form. C) Undergo eye examinations regularly. D) Lose weight, if obese.

Ans: D Feedback: Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.