Diabetes

24 July 2022
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question
Which statement is true regarding gestational diabetes? a) It occurs in most pregnancies. b) Onset usually occurs in the first trimester. c) A glucose challenge test should be performed between 24 and 28 weeks. d) There is a low risk for perinatal complications.
answer
C. A glucose challenge test should be performed between 24 and 28 weeks.
question
NPH is an example of which type of insulin? a) Short-acting b) Intermediate-acting c) Rapid-acting d) Long-acting
answer
B. Intermediate-acting
question
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? a) "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." b) "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." c) "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." d) "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
answer
d) "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
question
The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? a) Autonomic neuropathy b) Retinopathy c) Sensory neuropathy d) Nephropathy
answer
c) Sensory neuropathy Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The feet are inspected on each visit to insure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.
question
A patient who is diagnosed with type 1 diabetes would be expected to: a) Be restricted to an American Diabetic Association diet. b) Have no damage to the islet cells of the pancreas. c) Need exogenous insulin. d) Receive daily doses of a hypoglycemic agent.
answer
c) Need exogenous insulin Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.
question
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? a) Polyuria, headache, and fatigue b) Polyphagia and flushed, dry skin c) Polydipsia, pallor, and irritability d) Nervousness, diaphoresis, and confusion
answer
d) Nervousness, diaphoresis, and confusion Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.
question
A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? a) Metformin b) Glyburide c) Repaglinide d) Glipizide
answer
a) Metformin Metformin is a biguanide and along with the thiazolidinediones (rosiglitazone and pioglitazone) are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.
question
A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? a) 1/2 cup fruit juice or regular soft drink b) 4 oz of skim milk c) 1/2 tbsp honey or syrup d) three to six LifeSavers candies
answer
a) 1/2 cup fruit juice or regular soft drink In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.
question
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? a) Onset most common during adolescence b) Insufficient insulin production c) Less common than type 1 diabetes d) Little relation to prediabetes
answer
b) Insufficient insulin production Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence; although, it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Prediabetes can lead to type 2 diabetes.
question
A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? a) How to self-inject insulin b) How to monitor ketones daily c) How to recognize signs of diabetic ketoacidosis d) How to control blood glucose through lifestyle modification with diet and exercise
answer
d) How to control blood glucose through lifestyle modification with diet and exercise Persons at high risk for type 2 diabetes receive standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo, or an intensive program of lifestyle modifications. The 16-lesson curriculum of the intensive program of lifestyle modifications focuses on reducing weight by more than 7% of initial body weight and moderate-intensity physical activity. It also includes behavior modification strategies designed to help clients achieve the goals of weight reduction and participation in exercise. These findings demonstrate that type 2 diabetes can be prevented or delayed in persons at high risk for the disease.
question
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? a. They have no effect. b. They decrease the need for insulin. c. They increase the need for insulin. d. They cause wide fluctuations in the need for insulin.
answer
c. They increase the need for insulin Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.
question
Which instruction about insulin administration should a nurse give to a client? a. "Always follow the same order when drawing the different insulins into the syringe." b. "Shake the vials before withdrawing the insulin." c. "Store unopened vials of insulin in the freezer at temperatures well below freezing." d. "Discard the intermediate-acting insulin if it appears cloudy."
answer
a. "Always follow the same order when drawing the different insulins into the syringe." The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.
question
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? a. Sweating, tremors, and tachycardia b. Dry skin, bradycardia, and somnolence c. Bradycardia, thirst, and anxiety d. Polyuria, polydipsia, and polyphagia
answer
a. Sweating, tremors, and tachycardia Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.
question
The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? a. Provides best information on the body's ability to maintain normal blood functioning b. Best indicator for the nutritional state of the client c. Is less costly than performing daily blood sugar test d. Reflects the amount of glucose stored in hemoglobin over past several months.
answer
d. Reflects the amount of glucose stored in hemoglobin over past several months. Hemoglobin A1c tests reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. This test provides a more accurate picture of overall glucose control in a client. Glycosylated hemoglobin test does not indicate normal blood functioning or nutritional state of the client. Self-monitoring with a glucometer is still encouraged in clients who are taking insulin or have unstable blood glucose levels.
question
A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: a. 90 mg/dL before meals. b. 120 mg/dL, 1 hour postprandial. c. 80 mg/dL, 1 hour postprandial. d. 138 mg/dL, 2 hours postprandial.
answer
d. 138 mg/dL, 2 hours postprandial. The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.
question
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? a. Coma, anxiety, confusion, headache, and cool, moist skin b. Kussmaul's respirations, dry skin, hypotension, and bradycardia c. Polyuria, polydipsia, hypotension, and hypernatremia d. Polyuria, polydipsia, polyphagia, and weight loss
answer
a. Coma, anxiety, confusion, headache, and cool, moist skin Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mf/dl) include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul's respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.