b. 10 to 15 g of a simple carbohydrate. To reverse hypoglycemia, American Diabetes Association recommends ingesting 10-15 g of simple carb, such as 3-5 pieces of hard candy, 2-3 packets of sugar (4-6 tsp), or 4 oz fruit juice. If necessary, this treatment can be repeated in 15 mins. Ingesting only 2-5 g of a simple carb may not raise blood glucose level sufficiently. Ingesting >15 g may raise it above normal, causing hyperglycemia.
An agitated, confused female pt arrives in ER. Her hx includes type 1 diabetes mellitus, HTN, & angina pectoris. Assessment reveals pallor, diaphoresis, HA, & intense hunger. A stat blood glucose measures 42 mg/dl, & pt is treated for acute hypoglycemic reaction. After recovery, nurse teaches pt to treat hypoglycemia by
ingesting:
a. 2 to 5 g of a simple carbohydrate.
b. 10 to 15 g of a simple carbohydrate.
c. 18 to 20 g of a simple carbohydrate.
d. 25 to 30 g of a simple carbohydrate.
b. At least three times a week
Diabetic clients must exercise at least 3x/week to meet goals of planned exercise — lowering blood glucose,
reducing/maintaining proper weight, increasing serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing BP, & minimizing stress. Exercising once/week wouldn’t achieve these goals. Exercising more than 3x/week, although beneficial, would exceed minimum requirement.
During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the
clients to exercise how often to meet the goals of planned exercise?
a. At least once a week
b. At least three times a week
c. At least five times a week
d. Every day
c. “It tells us about your sugar control for the last 3 months.”
The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test
helps identify trends or practices that impair glycemic control, & it doesn’t require fasting period before blood is drawn. The nurse can’t conclude that the result occurs from poor dietary management or inadequate insulin coverage.
Pt w/type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing result w/pt, the nurse would be most accurate in stating:
a. “The test needs to be
repeated following a 12-hour fast.”
b. “It looks like you aren’t following prescribed diabetic diet.”
c. “It tells us about your sugar control for the last 3 months.”
d. “Your insulin regimen needs to be altered significantly.”
d. Consuming a low-carbohydrate, high-protein diet and avoiding fasting. To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn’t help control hypoglycemia.
Nurse Kate is providing dietary instructions to a male pt w/hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:
a. Increasing saturated fat intake and fasting in the afternoon.
b. Increasing intake of vitamins B and D and taking
iron supplements.
c. Eating a candy bar if light-headedness occurs.
d. Consuming a low-carbohydrate, high-protein diet and avoiding fasting.
b. has type 2 diabetes.
Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren’t effective in type 1 diabetes. Pregnant and lactating women aren’t prescribed oral antidiabetic agents
because the effect on the fetus is uncertain.
A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:
a. prefers to take insulin orally.
b. has type 2 diabetes.
c. has type 1 diabetes.
d. is pregnant and has type 2 diabetes.
a. sulfisoxazole (Gantrisin)
Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn’t cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.
When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?
a. sulfisoxazole (Gantrisin)
b. mexiletine (Mexitil)
c. prednisone (Orasone)
d. lithium carbonate (Lithobid)
b. Switch pt to
a different oral antidiabetic agent.
Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldn’t be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent.
After taking glipizide (Glucotrol) for 9 months, a male
client experiences secondary failure. Which of the following would the nurse expect the physician to do?
a. Initiate insulin therapy.
b. Switch pt to a different oral antidiabetic agent.
c. Prescribe an additional oral antidiabetic agent.
d. Restrict carbohydrate intake to less than 30% of the total caloric intake.
A. Lower blood glucose levels
The primary function of insuln is to:
A. Lower blood glucose levels
B. Produce melanin
C. regulate the bodys metabolic rate
D. stimulate release of digestive enzymes
Which nursing action is most appropriate for a client in ketoacidosis?
a. admin of carbs
b. admin of IV fluids
c. applying cold compress
d. giving glucagon IV
The nurse smells a sweet
fruity odor on the breath of a client admitted with DM. This odor may be associated with?
a. alcohol intoxication
b. insulin shock
c. ketoacidosis
d. macrovacular complications
a. blood sugar lvl's over a 6-10 week period
A client asks what the purpose of the Hb A1c test is. The nurses best explanation would be that the test measures the average: a. blood sugar lvl's over a 6-10 week period b. hemoglobin lvl's over a 6 - 10 week period c. protien lvl over a 3 month period d. vanillylmandelic acid lvl's
A nurse is caring for a client in the late stage of Ketoacidosis. The nurse notices that the clients breath has a characteristic fruity odor. Which of the following substances is responsible for the fruity smell in the breath? a. iodine b. acetone c. alcohol d. glucose
A nurse is assigned to care for and monitor any complications in a 40 yr client with chronic diabetes. Which of the following is a macrovascular complication of diabetes. a. neuropathy b. retinopathy c. nephropathy d. arteriosclerosis
c. inform client about the type of syringe to use
A nurse is instructing a 50yr diabetic client about the steps to be followed for self admin of insulin. Which of following instructions should be included in teaching? a. instruct client to avoid injections to abdomen b. encourage client to always inject insulin in the same site c. inform client about the type of syringe to use d. encourage client to do active exercise after injection
c) how do you feel about your progress? Open-ended questions allow the client to take the lead in the conversation. Options A and B denote judgment and may block communication. Option D allows the client to answer with a yes or no response and does not provide the client an opportunity to share feelings. Option C is open-ended and focuses on the subject of the question, the client's degree of adaptation to the disorder.
A clinic nurse is performing an assessment on a client recently diagnosed with diabetes mellitus. Which assessment question is appropriate when assessing the client's degree of adaptation to this disorder? a) you really don't think you caused your disorder, do you? b) your family is helping you stick to your diet, aren't they? c) how do you feel about your progress? d) are you feeling anxious?
A.Report changes in urinary pattern.
Glucophage
(metformin) can cause renal complications. The client should be monitored for changes in renal function. In answer B, the medication begins working immediately, so it is incorrect. In answer C, the amount of carbohydrates should be regulated with a diabetic diet, so it is incorrect. The use of lotions in answer D is unnecessary, so it is incorrect.
A diabetic client has been maintained on Glucophage (metformin) for regulation of his blood glucose levels. Which teaching should be included in plan of care?
A.Report changes in urinary pattern. B.Allow six weeks for optimal effects. C.Increase amount of carbohydrates in your diet. D.Use lotions to treat itching.
D.Eat a protein and carbohydrate snack at bedtime
Somogyi’s is characterized by a drop in glucose levels at approximately 2 a.m. or 3 a.m. followed by a false
elevation. Eating a protein and carbohydrate snack before retiring prevents the hypoglycemia and rebound elevation. Answers A, B, and C are incorrect because they do not prevent Somogyi’s effect.
A client with diabetes experiences Somogyi’s effect. To prevent this complication, the nurse should instruct the client to:
A.Take his insulin each day at 1400 hours B.Engage in physical activity daily C.Increase the amount of regular insulin D.Eat a protein and carbohydrate snack at bedtime
B. At night
This insulin, unlike others, is most frequently administered at night. Its duration is 24–36 hours. A, C, and D are incorrect they are incorrect times to administer Lantus insulin.
A diabetic client is taking Lantus insulin for regulation of his blood glucose levels. The nurse should know that this insulin will most likely be administered:
A.Prior to each meal B.At night C.Midday D.Prior to the evening meal
B.Hyperglycemia
The client with hyperglycemia will exhibit polyuria, polydipsia, or increased thirst, and polyphagia, or increased hunger. A, C, and D are incorrect because they are not signs of hypoglycemia.
A client with polyuria, polydipsia, and polyphagia is diagnosed with diabetes mellitus. The nurse would expect that these symptoms are related to
A.Hypoglycemia B.Hyperglycemia C.Hyperparathyroidism D.Hyperthyroidism
C.Hgb A-1C
The Hgb A-1C indicates that the client has been compliant for approximately three months. Answers A, B, and D tell the nurse the
client’s blood glucose at the time of the test, so they are incorrect.
Which laboratory test conducted on the client with diabetes mellitus indicates compliance?
A.Fasting blood glucose B.Two-hour post-prandial C.Hgb A-1C D.Dextrostix
B. Somogyi effect
The Somogyi effect is when blood sugar drops too low in the morning causing rebound
hyperglycemia in the morning. The hypoglycemia at 2am is highly indicative. The Dawn phenomenon is similar but would not have the hypoglycemia at 2am.
The nurse is caring for a client who has normal glucose levels at bedtime, hypoglycemia at 2am and hyperglycemia in the morning. What is this client likely experiencing?
A. Dawn phenomenon
B. Somogyi effect
C. An insulin spike
D. Excessive corticosteroids
C. Administer 10-15 grams of a carbohydrate
The client has low hypoglycemia. This is generally treated with a small snack.
The nurse is caring for a patient whose blood glucose level is 55mg/dL. What is the likely nursing response?
A. Administer a glucagon injection
B. Give a small meal
C. Administer 10-15 grams of a carbohydrate
D. Give a small snack of high protein food
E. Regular insulin The only insulin that can be given by IV is regular insulin.
What insulin type can be given by IV? Select all that apply:
A. Glipizide (Glucotrol)
B. Lispro (Humalog)
C. NPH insulin
D. Glargine (Lantus)
E. Regular insulin
B. Expect hyperglycemia
The body's natural reaction to illness is to release glucose. As such, diabetics can expect to face increased hyperglycemia in addition to their illness.
A client with type II diabetes is being educated about what to do if he catches the flu or a cold. What is something he should be informed of?
A. Discontinue Metformin
(glucophage)
B. Expect hyperglycemia
C. Add 2-3 more snacks to diet
D. Come into the hospital for monitoring
A. High blood glucose damages capillaries
High blood glucose damages capillaries which prevent proper healing.
In educating a client about Type II Diabetes, what would be a proper explanation for poor wound healing?
A.
High blood glucose damages capillaries
B. Swings in blood sugar prevent proper clotting
C. The pancreas fails to secrete the proper chemicals
D. Ketosis prevents proper healing
D. 2-3 hours
The exact details depend on various factors, but 2-3 hours for peak action of regular insulin is an accepted range.
When does regular insulin generally have peak action after application?
A. 30-45 minutes
B. 45-60 minutes
C. 1-2 hours
D. 2-3 hours
C. I should not go more than 3 days without washing my feet
The recommended self-care routine is to wash feet on a daily basis without soaking and carefully cleaning.
In educating a client with diabetes, what response would reveal need for further education?
A. I should avoid tights
B. I should take good care of my toe nails
C. I should not go more than 3 days without washing my feet
D. I should avoid going barefoot and should wear clean socks
B. Pioglitazone (Actos)
Cardiac safety of diabetes meds is a very complex subject. That said, pioglitazone is known to possibly have issues.
A client with diabetes and coronary heart disease is being evaluated for treatment. In light of the heart condition, which medication option is more likely to be an issue?
A. Metformin (Glucophage)
B. Pioglitazone (Actos)
C. Insulin
D. Sitagliptin (Januvia)
D. In HHNS, blood pH tends to drop
In HHNS, you tend to avoid the decrease
in pH and ketosis (hence nonketotic) that often occurs in diabetic ketoacidosis. Remember that the two are very similar otherwise.
What is NOT true of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) compared to diabetic ketoacidosis (DKA)?
A. HHNS is found mainly in Type II Diabetes
B. Both have high levels of hyperglycemia
C. Both typically are treated with insulin
D. In HHNS, blood pH tends to drop
A. Alternating insulin injection sites
Alternating insulin injection sites helps avoid lipodystrophy, which is a lump or dent in the skin that can be caused by using the same site for injections.
Insulin lipodystrophy should be treated in part by:
A. Alternating insulin injection sites
B. Balancing diet and snack routine
C.
Reduction of insulin dose
D. Adding an oral glycemic medication
a.Diet
Type 1 diabetes is a primary failure of pancreatic beta cells to produce insulin. It primarily affects children and young adults and is unrelated to diet.
The risk factors for type 1 diabetes include all of the following except: a.Diet
b.Genetic
c.Autoimmune
d.Environmental
c.90-95%
Type 2 diabetes accounts for the overwhelming majority of cases diagnosed in adults. It develops gradually, beginning with insulin resistance and as the requirement for insulin increases, the pancreas becomes progressively less able to produce it.
Type 2 diabetes accounts for approximately what percentage of all cases of diabetes in adults?
a.55%-60%
b.35%-40%
c.90-95%
d.25-30%
c.Smoking
Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.
Risk factors for type 2 diabetes include all of the following except:
a.Advanced age
b.Obesity
c.Smoking
d.Physical inactivity
b.5%-10%
African-American, Hispanic/Latina and Native American women are at greater risk of developing gestational diabetes than
are white women. Women who experience gestational diabetes are at increased risk of developing diabetes during the decade following pregnancy.
What percentage of women with gestational diabetes is diagnosed with type 2 diabetes following pregnancy?
a.25%-30%
b.5%-10%
c.<5%
d.20%-25%
d.Tinnitus
Untreated diabetes also may result in loss of lower limbs to amputation and death.
Untreated diabetes may result in all of the following except:
a.Blindness
b.Cardiovascular disease
c.Kidney disease
d.Tinnitus
d.Increased risk of developing type 1 diabetes
Persons with elevated glucose levels that do not yet meet the criteria for diabetes are considered to have prediabetes and are at increased risk of developing type 2 diabetes. Weight loss and increasing physical activity can help people with prediabetes prevent or postpone the onset of type 2 diabetes.
Prediabetes is associated with all of the following except:
a.Increased risk of developing type 2 diabetes
b.Impaired glucose tolerance
c.Increased risk of heart disease and
stroke
d.Increased risk of developing type 1 diabetes
a.Smoke
Diabetics who smoke are at greater risk of developing heart disease because both diabetes and smoking act to narrow blood vessels. Smoking also is associated with increased risk of eye problems and may compromise circulation to the legs.
Diabetics are at increased risk of heart disease if they also:
a.Smoke
b.Have high HDL cholesterol levels
c.Take aspirin
d.Consume a high-fiber diet
a.Below 7%
A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the two to three months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.
Blood sugar is well controlled when Hemoglobin A1C is:
a.Below 7%
b.Between 12%-15%
c.Less than 180 mg/dL
d.Between 90 and 130 mg/dL
c.Genital candidiasis
The signs and symptoms that suggest type 1 diabetes include excessive thirst, hunger, urination, weight loss, fatigue, irritability,
blurred vision, and infection with candida albicans (also known as yeast infections).
Among female children and adolescents, the first sign of type 1 diabetes may be:
a.Rapid weight gain
b.Constipation
c.Genital candidiasis
d.Insomnia
bVitiligoExcessively high blood sugar or prolonged hyperglycemia can cause DKA, the condition in which the body breaks down fat for energy & ketones spill into urine. HHNS occurs when blood sugar is excessively high & available insulin is ineffective. In this case, the body cannot use glucose or fat for energy & glucose is excreted in urine. Without immediate medical attention, both conditions may result in coma or death.
Untreated hyperglycemia may lead to all of the following complications except:
a.Hyperosmolar syndrome (HHNS)
bVitiligo
c.Diabetic ketoacidosis
d.Coma
a.The U.S. prevalence of diabetes is decreasing
The prevalence of diabetes is increasing dramatically. The CDC reports an increase of more than three million cases in the two years from 2006 to 2008. By 2008, an estimated 8% of the U.S. population had diabetes.
Which statement about diabetes is false?
a.The U.S. prevalence of diabetes is decreasing
b.Diabetes is the seventh leading cause of death in the United States
c.Diabetes is the leading cause of blindness among persons age 20 to 74
d.Diabetes is the leading cause of kidney failure
c.Eliminating all carbohydrates from the diet
There is no evidence
that eliminating all sugar from the diet benefits people with diabetes. It is more important for diabetics to manage and control total carbohydrate intake so that their blood glucose levels remain on target. Controlling blood glucose, blood pressure, and blood lipid levels can aid in the prevention of complications associated with diabetes.
Which of the following measures does not help to prevent diabetes complications?
a.Controlling
blood glucose
b.Controlling blood pressure and blood lipids
c.Eliminating all carbohydrates from the diet
d.Prompt detection of diabetic eye and kidney disease
c.Biguanides
Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels
Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?
a.Sulfonylureas
b.Meglitinides
c.Biguanides
d.Alpha-glucosidase inhibitors
d.They help with weight loss
Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.
The benefits of using an insulin pump include all of the following except:
a.By continuously providing insulin they eliminate the need for injections of
insulin
b.They simplify management of blood sugar and often improve A1C
c.They enable exercise without compensatory carbohydrate consumption
d.They help with weight loss
d.Three or four injections per day of different types of insulin.
Because persons with type 1 diabetes do not produce insulin, they require insulin and cannot be treated with oral anti-diabetic drugs. Several injections of
insulin per day, calibrated to respond to measured blood glucose levels, offer the best blood glucose control and may prevent or postpone the retinal, renal, and neurological complications of diabetes.
Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes?
a.A single anti-diabetes drugs
b.Once daily insulin injections
c.A combination of oral anti-diabetic
medications
d.Three or four injections per day of different types of insulin.
d.Minnesota Mutiphasic Personality inventory (MMPI) Nerve conduction studies assess transmission of electrical signals through nerves & electromyography evaluates nerve transmission to muscles. Ultrasound can assess responsivity & function of internal organs that may be compromised by neurological damage. Foot exams help to assess peripheral neuropathy & ensure integrity of skin. The MMPI is a psychological test & is not used to assess diabetic neuropathy.
Diabetic neuropathies are diagnosed using all of the following except:
a.Nerve conduction studies or electromyography
b.Ultrasound
c.Foot examinations
d.Minnesota Mutiphasic Personality inventory (MMPI)
a. irritability
signs of hypoglycemia include irritability, shaky feeling, hunger, headache, dizziness.
Drowsiness, abdominal pain, nausea, and vomiting are signs of HYPERglycemia.
Which symptom is indicative of hypoglycemia?
a. irritability
b. drowsiness
c. abdominal pain
d. N & V
300 mg / dl
DKA determined by BG of 300 or greater. Accompanied by acdetone breath, dehydration, weak and rapid pulse, and decreased level of consciousness.
A nurse should understand that hyperglycemia associated with diaabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than?
D. Frequent Urination
Polyphagia, polyuria, polydipsia, and weight loss are cardinal signs of DM. Other signs include irritability, shortened attention span, lowered frustration tolerance, fatigue, dry skin, blurred vision, sores that are slow to heal, and flushed skin.
A nurse shoud recognize which symptom as a cardinal sign of diabetes mellitus?
a. Nausea
b. Seizure
c. Hyperactivity
d. Frequent urination
C. Better management of diabetes
BG monitoring improves diabetes management and is used successfully from the onset of their diabetes. By testing your own blood, you are able to change insulin regimen to maintain their glucose level in the normoglycemic range of 80 - 120 mg / dl. This allows better management of their diabetes.
Why is blood glucose monitoring needed?
a. easier
method of testing
b. less expensive
c. better management of diabetes
d. greater sense of control over diabetes
a. Withdrawing NPH insulin first.
Regular insulin is ALWAYS withdrawn first so it won't become contaminated w/NPH insulin. The client is instructed to inject air into NPH insulin bottle equal to amt of insulin to be withdrawn because there will be regular insulin in syringe and
won't be able to inject air when he needs to withdraw NPH. It's necessary to remove air bubbles to ensure a correct dosage before drawing up the second insulin.
A client is learning to mix regular insulin & NPH insulin in the same syringe. Which action, if performed by client, would indicate need for FURTHER teaching?
a. Withdrawing the NPH insulin first
b. Injecting air into the NPH insulin bottle first
c. After drawing up
first insulin, removing air bubbles
d. Injecting an amt of air equal to the desired dose of insulin
b. 1/2 hour to 1 hour
Regular insulin's onset is 1/2 to 1 hr. peak is 2-4 hours, and duration is 3-6 hours.
Lispro insulin has an onset within 5 minutes
NPH has onset within 2-4 hrs
Ultralente insulin is the longest acting with an onset of 6-10 hrs
A client is diagnosed with diabetes type 1. The primary health care provider prescribes an insulin regimen of regular insluin and NPH insulin administered subcutaneously each morning. How soon after administration will the onset of regular insulin begin?
a. within 5 minutes
b. 1/2 hr to 1 hr
c. 1 - 1 1/2 hrs
d. 4-8 hrs
a. Polydispisa, polyuria, and weight
loss
Symptoms of hyperglycemia include polydipsia, polyuria, and weight loss. Metformin and sulfonylureas are commonly ordered medications.
Weight gain, tiredness, and bradycardia are symptoms of hypothyroidism.
Irritability, diaphoresis, and tachycardia are symptoms of hypoglycemia.
Symptoms of Crohn's disease include diarrhea, abdominal pain, and weight loss.
A client who is started on metformin and glyburide would have initially presented with which symptoms?
a. Polydispisa, polyuria, and weight loss
b. weight gain, tiredness, & bradycardia
c. irritability, diaphoresis, and tachycardia
d. diarrhea, abdominal pain, and weight loss
a. check blood glucose level and administer carbohydrates
The client is experiencing symptoms of hypoglycemia. Checking the blood glucose level and administering
carbs will elevate blood glucose. ECG and nitroglycerin are treatments for MI. O2 won't correct low blood glucose level.
Restricting salt, admin diuretics, and performing paracentesis are tx for ascites.
A client presents with diaphoresis, palpitations, jitters, and tachycardia approx 1.5 hrs after taking his reg morning insulin. Which treatment is appropriate for this client?
a. check blood glucose level and administer
carbohydrates.
b. give nitroglycerin and perform an ECG
c. check pulse oximetery & administer O2 therapy
d. Restrict salt, administer diuretics and perform a paracentesis.
a. take on-half of usual daily dose of intermediate acting insulin
If pt takes full daily dose of intermediate-acting insulin when he isn't allowed anything orally before surgery, he'll become hypoglycemic. 1/2 insulin
dose will provide all that is needed. Clients w/ type 1 don't take oral anti-diabetic agents. IV insulin infusions aren't standard for routine surgery; used in the management of clients undergoing stressful procedures - such as transplants or coronary artery bypass surgery
Which nursing consideration must be taken into account for a client with type 1 diabetes mellitus on the morning of surgery?
a. take on-half of usual daily dose
of intermediate acting insulin
b. receive an oral antidiabetic agent
c. receive an IV insulin infusion
d. take his full daily insulin dose with no dextrose infusion
Diabetes Mellitus type II
Which type of diabetes is controlled primarily through diet, exercise, and oral antidiabetic agents?
c. African-American woman.
Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
Which of the following persons would most likely be diagnosed with diabetes mellitus? A 44-year-old: a. Caucasian woman. b. Asian woman. c. African-American woman. d. Hispanic male.
a. Age over 45 years b. Overweight with a waist/hip ratio >1 d. Maintaining a sedentary lifestyle
Which of the following factors are risks for the development of diabetes mellitus? (Select all that apply.) a. Age over 45 years b. Overweight with a waist/hip ratio >1 c. Having a consistent HDL level above 40 mg/dl d. Maintaining a sedentary lifestyle
a. Fasting Plasma Glucose (FPG) b. Two-hour Oral Glucose Tolerance Test (OGTT)
Which laboratory test should a nurse anticipate a physician would order when an older person is identified as high-risk for diabetes mellitus? (Select all that apply.) a. Fasting Plasma Glucose (FPG) b. Two-hour Oral Glucose Tolerance
Test (OGTT) c. Glycosylated hemoglobin (HbA1C) d. Finger stick glucose three times daily
d. Perineal itching
Older women might complain of perineal itching due to vaginal candidiasis.
Of which of the following symptoms might an older woman with diabetes mellitus complain? a. Anorexia b. Pain intolerance c. Weight loss d. Perineal itching
d. All of the above.
The principal goals of therapy for older persons with diabetes mellitus and poor glycemic control are enhancing quality of life, decreasing the chance of complications, improving self-care through education, and maintaining or improving general health status.
The principal goals of therapy for older patients who have poor glycemic control are: a. Enhancing quality of life. b. Decreasing the chance of complications. c. Improving self-care through education. d. All of the above.
a. Physical exercise can slow the progression of diabetes mellitus.
Physical exercise slows the progression of diabetes mellitus, because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity.
Strenuous exercise can cause retinal damage, and can cause hypoglycemia. Insulin and foods both must be adjusted to allow safe participation in exercise.
Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus? a. Physical exercise can slow the progression of diabetes mellitus. b. Strenuous exercise is beneficial when the blood glucose is high. c. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia. d. Adjusting insulin regimen allows for safe participation in all forms of exercise.
b. Somogyi phenomenon
Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and increase in ketones.
A diabetic patient experiencing a reaction of alternating periods of nocturnal hypoglycemia and hyperglycemia might be manifesting which of the following? a. Uncontrolled diabetes b. Somogyi phenomenon c. Brittle diabetes d. Diabetes insipidus
c. Stimulate the beta cells of the pancreas to secrete insulin.
Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. These drugs
stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin.
The primary purpose for sulfonylureas, such as long-acting glyburide (Micronase), is to: a. Induce hypoglycemia by decreasing insulin sensitivity. b. Improve insulin sensitivity and decrease hyperglycemia. c. Stimulate the beta cells of the pancreas to secrete insulin. d. Decrease insulin sensitivity by enhancing glucose uptake.
b. Release insulin evenly throughout the day and control basal glucose levels.
One of the benefits of Glargine (Lantus) insulin is its ability to: a. Release insulin rapidly throughout the day to help control basal glucose. b. Release insulin evenly throughout the day and control basal glucose levels. c. Simplify the dosing and better control blood glucose levels during the day. d. Cause hypoglycemia with other manifestation of other adverse reactions.
d. Hyperglycemic hyperosmolar non-ketotic coma
Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNC. Insulin resistance usually is
indicated by a daily insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly decreased amounts of insulin.
A frail elderly patient w/diagnosis of type 2 diabetes mellitus has been ill w/pneumonia. The client's intake has been very poor, & she is admitted to hospital for observation & management as needed. What is the most likely problem with this patient? a. Insulin resistance has developed. b. Diabetic ketoacidosis is occurring. c. Hypoglycemia unawareness is developing. d. Hyperglycemic hyperosmolar non-ketotic coma