Unit 11 - Class Activities

Question 1

Frank has been noncompliant with his diabetic regimen in the past. What test will give the best information regarding his compliance?

A.random blood sugar
B.test urine for glucosuria
C.glycosylated hemoglobin Hgb A1C
D.glucose tolerance test

Answer 1

C.glycosylated hemoglobin Hgb A1C

*Hemoglobin A1c (HbA1c) provides an average of your blood sugar control over the past 2 to 3 months and is used along with home blood sugar monitoring/When glucose is high it combines with Hemoglobin, becoming “glycated.“

normal A1c test: 4% and 5.6%.
5.7% and 6.4% indicate increased risk of diabetes
6.5% or higher indicate diabetes
Goal for people with diabetes is less than: 7%

Question 2

Mrs. Bergstrum is a 60 year old client who has been newly diagnosed with noninsulin dependent diabetes ( Type II diabetes). She is 70 pounds overweight.What information should the nurse include in a teaching plan for Mrs. Bergstrum?

A.Emphasize controlling her weight through a high protein diet.
B.The role of exercise in improving blood glucose control.
C.Oral hypoglycemic agents are less effective than insulin in managing blood glucose levels.
D.Reaching her optimal weight will cure her disease.

Answer 2

B.The role of exercise in improving blood glucose control.

*Exercise will improve insulin resistance and assist in controlling her disease, in addition it will help with weight loss, and use excess glucose in her body.

Question 3

Metformin takes _____ weeks to take effect

Answer 3

4

Question 4

Which of the following is a desired outcome in evaluating a new diabetic’s understanding of teaching about insulin usage?

a. After drawing up insulin from a vial, he adds an air bubble so as to clear the needle after injection.
b. He carries some form of simple carbohydrate at all times.
c. He recognizes that hunger and tremor signal a need for additional insulin.
d. He knows that adding carbohydrate to the diet can produce an insulin reaction.

Answer 4

b. He carries some form of simple carbohydrate at all times.

Question 5

Polyuria in the client with diabetes is caused by

a. a high renal threshold.
b. osmotic diuresis.
c. increased thirst.
d. dehydration.

Answer 5

b. osmotic diuresis.
* diuresis due to a high concentration of osmotically active substance (Sugar)in the renal tubules, which limit the reabsorption of water. Kidneys can only reabsorb so much (sugar) rest is released and it pulls water with it.

Question 6

Which of the following is priority in patient education for all persons with diabetes regarding the prevention of hypoglycemia?

a. instructions in the use of glucagon
b. use of a fast acting carbohydrate
c. need to increase caloric consumption
d. peak time of glucose lowering medication/s

Answer 6

d. peak time of glucose lowering medication/s

Question 7

C.D., who is a diabetic, wears heavy, well constructed shoes. At work, he stepped on a nail and it pierced his foot right through his leather shoe. He didn’t notice the nail until later that evening when he was changing his shoes. What type of problem does this indicate?

a. retinopathy
b. nephropathy
c. neuropathy
d. peripheral vascular disease

Answer 7

c. neuropathy

* may present as numb, tingling, burning, pain sensation / feeling is stunted

Question 8

Robert Jacobsen is seen at a community clinic for complaints of a wound on his foot that will hot heal. Upon examination, the wound appears to be infected. He indicates that he didn’t even realize the wound was there until he removed his shoe and found his foot was bloody. Mr. Jacobsen is obese and is being treated for type 2 diabetes mellitus. Why is Mr. Jacobsen at risk for developing infections? Mark all that apply

a. Vascular changes reduce blood flow to lower extremities
b. Hyperglycemia promotes bacterial growth
c. Impaired function of WBC
d. . Hyperglycemia causes alterations in skin integrity
e. . Decreased peripheral sensation reduces early warning signs

Answer 8

Robert Jacobsen is seen at a community clinic for complaints of a wound on his foot that will hot heal. Upon examination, the wound appears to be infected. He indicates that he didn’t even realize the wound was there until he removed his shoe and found his foot was bloody. Mr. Jacobsen is obese and is being treated for type 2 diabetes mellitus. Why is Mr. Jacobsen at risk for developing infections? Mark all that apply

a. Vascular changes reduce blood flow to lower extremities
b. Hyperglycemia promotes bacterial growth
Impaired function of WBC
d. Decreased peripheral sensation reduces early warning signs

*D: not directly)/ they may have more skin rashes though

Question 9

A home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food or medication has been consumed for 36 hours. Which additional statement by the client indicates a need for further teaching?

a. “I need to stop my insulin.”
b. “I need to increase my fluid intake.”
c. “I need to call the physician because of these symptoms.“
d. “I need to monitor my blood glucose every 3 to 4 hours

Answer 9

a. “I need to stop my insulin.”

Question 10

Bobby Davies a 12 year old male is newly diagnosed with type 1 diabetes mellitus. Bobby’s pathophysiologic state is most probably the result of:

A. A familial, autosomal dominant gene defect
B. Obesity and lack of exercise
C. Immune destruction of the pancreas
D. Hyperglycemia from eating too may sweets

Answer 10

C. Immune destruction of the pancreas

Question 11

An adult client with type 2 diabetes is taking metformin (Glucophage) 1,000 mg two times every day. A nurse provides instructions regarding the interaction of alcohol and metformin. When the nurse evaluates the client’s understanding she notes that learning is evident because the client makes which of the following statements?

1. “ If I know I’ll be having alcohol, I must not take metformin: I could develop lactic acidosis.”
2. “ If my physician approves, I may drink alcohol with my metformin”
3. Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain and rapid heartbeat.”
4. “ If I feel bloated, I should call my physician”

Answer 11

1.“ If I know I’ll be having alcohol, I must not take metformin: I could develop lactic acidosis.”

Question 12

Susan less has type 1 diabetes mellitus. She is admitted to the hospital with the following lab values: serum glucose 500 mg/dl ( high) , urine glucose and ketones 4+, arterial ph 7.20. her parents state that she has been sick with the “flu”for a week. Which of the following statements best explains her state.

a. Increased insulin levels promote protein breakdown and ketone formation
b. Her uncontrolled diabetes has led to renal failure
c. low serum insulin promotes lipid storage and corresponding release of ketones
d. Insulin deficiency promotes lipid metabolism and ketone formation

Answer 12

d. Insulin deficiency promotes lipid metabolism and ketone formation

Question 13

A client with Type 1 DM has DKA. Which os the following findings has the greatest effect on fluid loss?

a. hypotension
b. decreased serum potassium level
c. rapid, deep respirations
d. warm, dry skin

Answer 13

c. rapid, deep respirations
* Due to the rapid, deep respirations, the client is losing fluid from vaporization form the lungs and skin (insensible fluid loss). Normally, about 900 ml of fluid is lost per day through vaporization .

Decreased serum potassium level has no effect on insensible fluid loss. Hypotension occurs due to polyurea and inadequate fluid intake. It may decrease the flow of blood to the skin, causing skin to be warm and dry.

Question 14

A client comes to the emergency department with diabetic ketoacidosis. The nurse should identify which of the following nursing diagnoses as a priority problem?

a. Insomnia
b. Ineffective health maintenance
c. Imbalanced nutrition: Less than body requirements
d. Deficient fluid volume

Answer 14

d. Deficient fluid volume
* Increased osmolality from glucose leads to a fluid shift form the intracellular to the extra cellular space. The fluid shift leads to increased renal excretion of glucose and fluid. Severe dehydration, possible hypovolemic shock is a medical emergency ….

Question 15

Jerry Green is a 13 year old who uses insulin to control his type 1 diabetes. During his gym class, he experiences hunger, light headedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is:

a. hyperglycemia resulting from incorrect administration.
b. dawn phenomenon caused by eating a snack before gym class.
c. hypoglycemia caused by increased exercise.
d. Somogyi effect caused by insulin sensitivity

Answer 15

c. hypoglycemia caused by increased exercise.

Question 16

Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus. Select all that apply

1. A major risk factor for complications is obesity and central abdominal obesity.
2. Supplemental insulin is mandatory for controlling the disease
3. Exercise increases insulin resistance
4. The primary nutritional source requiring monitoring in the diet is carbohydrates
5. Annual eye and foot examinations are recommended by the American Diabetes Association (ADA)

Answer 16

1. A major risk factor for complications is obesity and central abdominal obesity.
2. The primary nutritional source requiring monitoring in the diet is carbohydrates
3. Annual eye and foot examinations are recommended by the American Diabetes Association (ADA)

Question 17

Who of the following is at highest risk for Type II diabetes mellitus?

a. a nine year old boy with a history of repeated viral infections
b. a 20 year old man whose mother has Type II
c. a 32 year old woman in her third trimester of pregnancy
d. a 52 year old woman who is 30 pounds overweight

Answer 17

d. a 52 year old woman who is 30 pounds overweight

*Being overweight and having a large waist-hip ratio ( central abdominal obesity) increases insulin resistance, making control of diabetes more difficult.
The ADA recommends a yearly referral to an ophthalmologist and podiatrist.

Exercise and weight management decrease insulin resistance.

Question 18

Patricia Fowler, a 55 year old patient, is admitted to the medical unit for complications of long-term, poorly controlled type 2 diabetes mellitus (DM). In addition to alterations in the serum glucose, you would expect to see which of the following lab abnormalities?

A. Elevated serum lipids
B. Metabolic alkalosis
C. Elevated liver enzymes
D. Low red blood cells count

Answer 18

A. Elevated serum lipids

Question 19

A client with diabetes mellitus has a glycosylated hemoglobin level of 9%. Based on this result, the nurse plans to teach the client about the need to:

a) avoid infection
b) take in adequate fluids
c) prevent and recognize hypoglycemia
d) prevent and recognize hyperglycemia

Answer 19

d) prevent and recognize hyperglycemia
* A client with diabetes mellitus has a glycosylated hemoglobin level of 9%. Based on this result, the nurse plans to teach the client about the need to:a) avoid infectionb) take in adequate fluidsc) prevent and recognize hypoglycemiad) prevent and recognize hyperglycemia
- In the test result for glycosylated hemoglobin A1c, 7% or less indicates good control, 7% to 8% indicates fair control, and 8% or higher indicates poor control. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in the blood glucose level will cause elevations in the amount of glycosylation. Thus, the test is useful in identifying clients who have periods of hyperglycemia that are undetected in other ways. Elevations indicate continued need for teaching related to the prevention of hyperglycemic episodes.

Question 20

A nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client is ill by stating:

a) I will stop taking my insulin if I’m too sick to eat
b) I will decrease my insulin dose during times of illness and check my urine for WBC’s.
c) I will adjust my insulin dose according to the amount of food I eat
d) I will notify my physician if my blood glucose level is higher than 250 mg/dL and check my urine for ketones.

Answer 20

d) I will notify my physician if my blood glucose level is higher than 250 mg/dL and check my urine for ketones.
* - During illness, the client should monitor blood glucose levels and should notify the physician if the level is higher than 250 mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the physician’s advice and are usually adjusted based on blood glucose levels, not urinary glucose readings.