Chapter 19 Flashcards
2.Long-term complications of diabetes mellitus include
a. arthritis, rheumatism, and osteoporosis.
b. retinopathy, nephropathy, and neuropathy.
c. impaired immunity and opportunistic infections.
d. dermatitis, nephrotic syndrome, and detached retina.
ANS:B
Long-term complications of diabetes mellitus include retinopathy, nephropathy, and neuropathy. Diabetes mellitus can increase risk and severity of infection indirectly due to poor circulation and high blood glucose levels, but immunity is not impaired. Arthritis, rheumatism, osteoporosis, dermatitis, nephritic syndrome, and detached retina are not associated with diabetes.
1.A person is diagnosed as having diabetes mellitus if his or her fasting blood glucose level on two occasions is greater than _____ mg/dL.
a. 90
b. 120
c. 126
d. 156
ANS:
ANS:C
Diabetes mellitus is diagnosed as fasting blood glucose level >126 mg/dL on two occasions.
3.The type of diabetes therapy that seems to be most effective in decreasing and delaying the complications of diabetes is
a. psychotherapy.
b. intensive therapy.
c. combined therapy.
d. conventional therapy.
ANS:B
Intensive therapy is most effective in decreasing and delaying the complications of diabetes because it allows better control of blood glucose levels. Psychotherapy may help patients cope with psychological concerns about their disease, but will not delay complications. Conventional therapy may help prevent complications if blood glucose levels are well controlled, but this is less likely than with intensive therapy. Combined therapy is not a recognized term.
4.The three main symptoms of untreated type 1 diabetes mellitus are
a. polyphagia, polyuria, and polydipsia.
b. neuropathy, nephropathy, and retinopathy.
c. confusion, loss of coordination, and headaches.
d. fatigue, loss of appetite, and frequent infections.
ANS:A
Polyphagia, polyuria, and polydipsia are hallmarks of untreated type 1 diabetes mellitus. Neuropathy, nephropathy, and retinopathy are long-term complications associated with diabetes mellitus. Confusion, loss of coordination, headaches, fatigue, and loss of appetite are not associated with diabetes mellitus. Patients with diabetes may be more susceptible to infection and make take longer to heal if their blood glucose levels are elevated and if they have impaired circulation.
5.The cause of type 1 diabetes mellitus is
a. excessive intake of simple sugars.
b. destruction of pancreatic beta cells.
c. inability of cells to respond to insulin in the bloodstream.
d. inability of the pancreas to keep up with the body’s demands for insulin.
ANS:B
Type 1 diabetes mellitus is caused by autoimmune destruction of pancreatic beta cells. Excessive sugar intake does not cause any kind of diabetes mellitus. Type 2 diabetes is caused by inability of cells to respond to insulin in the bloodstream. In type 1 diabetes the pancreas is not able to keep up with the body’s demands for insulin, but the cause of this is destruction of beta cells.
6.The two strongest risk factors for type 2 diabetes are
a. obesity and family history.
b. recurrent viral infections and stress.
c. male gender and upper body obesity.
d. preference for sweet foods and sedentary lifestyle.
ANS:A
The two strongest risk factors for type 2 diabetes are obesity and family history. Upper body obesity and sedentary lifestyle may also contribute to the disease. Male gender, preference for sweet foods, recurrent viral infections, and stress are not risk factors for type 2 diabetes.
7.In individuals with type 2 diabetes, insulin production is generally
a. absent.
b. normal.
c. decreased.
d. increased.
ANS:D
Insulin production is generally increased in individuals with type 2 diabetes. The body produces more insulin in an attempt to lower elevated blood glucose levels, but the insulin is not effective because the cells fail to respond to the insulin.
8.Type 2 diabetes is becoming more prevalent in children, largely because of
a. increased intakes of refined sugar.
b. increased awareness and diagnosis.
c. the increasing prevalence of overweight children.
d. inheritance of a dominant gene that causes the disease.
ANS:C
Type 2 diabetes is becoming more prevalent in children because of the increasing prevalence of overweight children. This is related to decreased activity levels and increased intake of kcals in general, not just from refined sugar. Increased awareness and diagnosis may account for a small portion of the increase in prevalence, but this is not the major cause. There is no specific dominant gene that causes type 2 diabetes in children.
9.For individuals with diabetes mellitus, glycosylated hemoglobin (HgbA1c) levels should be less than
a. 6%.
b. 7%.
c. 8%.
d. 10%.
ANS:B
For individuals with diabetes mellitus, glycosylated hemoglobin levels should be less than 7%. This indicates overall maintenance of acceptable blood glucose levels.
10.The ethnic group that has the lowest prevalence of type 2 diabetes mellitus is
a. Native Americans.
b. African Americans.
c. Hispanic Americans.
d. non-Hispanic whites.
ANS:D
Prevalence of type 2 diabetes mellitus is lowest among non-Hispanic whites. Native Americans, African Americans, Hispanic Americans all have a relatively high prevalence of type 2 diabetes mellitus.
11.Exogenous insulin is a required part of treatment for all individuals with
a. type 1 diabetes mellitus.
b. type 2 diabetes mellitus.
c. gestational diabetes.
d. impaired glucose tolerance.
ANS:A
All individuals with type 1 diabetes mellitus require treatment with exogenous insulin. Many individuals with type 2 diabetes are treated with diet and exercise or diet, exercise, and oral hypoglycemic medications; only the most severe cases require exogenous insulin. Insulin is sometimes, but not always, prescribed for individuals with gestational diabetes. Impaired glucose tolerance is treated with diet and exercise only.
12.The main difference between the different types of exogenous insulin is
a. their shelf life.
b. the concentration of the preparation.
c. the type of solvent used to carry the insulin.
d. the length of time they take to act in the body.
ANS:D
The main difference between the different types of exogenous insulin is the length of time they take to act in the body. Their shelf life, concentration, and type of solvent are standard for all types of insulin.
13.Sulfonylureas and meglitinides decrease blood glucose levels by
a. stimulating insulin secretion.
b. slowing the rate of absorption of glucose.
c. providing an exogenous source of insulin.
d. improving insulin sensitivity.
ANS:A
Sulfonylureas and meglitinides decrease blood glucose levels by stimulating insulin secretion. Alpha-glucosidase inhibitors and biguanides slow the rate of absorption of glucose. No oral drugs provide an exogenous source of insulin. Biguanides and thiazolidinediones improve insulin sensitivity.
14.Patients with diabetes mellitus should exercise at times when their blood glucose level is _____ mg/dL.
a. between 90 and 110
b. between 100 and 160
c. between 100 and 200
d. less than 250
ANS:C
Ideally, patients with diabetes mellitus should exercise when their blood glucose level is between 100 and 200 mg/dL.
15.To prevent hypoglycemia after exercise, patients with type 1 diabetes should
a. decrease their insulin dose.
b. omit a scheduled insulin dose.
c. increase their intake of protein-based foods.
d. increase their intake of carbohydrate-based foods.
ANS:D
To prevent hypoglycemia after exercise, patients with type 1 diabetes should increase their intake of carbohydrate-based foods. Decreasing or omitting an insulin dose would essentially starve cells and could be dangerous. Increasing intake of protein-based foods would not prevent a decrease in blood glucose level as effectively as carbohydrate-based foods.
16.Patients with type 2 diabetes are most likely to maintain good metabolic control if they
a. avoid all sources of simple carbohydrates.
b. avoid eating during the evening or at night.
c. space their meals evenly throughout the day.
d. eat one large meal and two small meals each day.
ANS:C
Patients with type 2 diabetes are most likely to maintain good metabolic control if they space their meals evenly throughout the day. Avoiding all sources of simple carbohydrates does not address other dietary excesses of kcals, fat, and complex carbohydrate. Avoiding eating during the evening and at night may help control kcal intake, but would not help control blood glucose levels. Eating one large meal and two small meals each day would result in uneven metabolic control.
17.Glycosylated hemoglobin level is used to indicate
a. the effect of meals on blood glucose level.
b. day-to-day variations in blood glucose level.
c. iron deficiency anemia in patients with diabetes.
d. overall blood glucose control over several weeks.
ANS:D
Glycosylated hemoglobin level is used to indicate overall blood glucose control throughout the previous 100 to 120 days. The effect of meals on blood glucose level is determined using self-monitoring of blood glucose levels. Glycosylated hemoglobin level does not show day-to-day variations in blood glucose level. Iron deficiency anemia is diagnosed by measuring total hemoglobin level in patients with and without diabetes.
18.A young man with type 1 diabetes runs 3 miles, falls asleep on the sofa, and forgets to eat his next meal. He is likely to experience
a. nephropathy.
b. hypoglycemia.
c. hyperglycemia.
d. diabetic ketoacidosis.
ANS:B
A young man who exercises and forgets to eat his next meal is likely to experience hypoglycemia because he used up his available blood glucose and glycogen stores while exercising but still has exogenous insulin in his bloodstream. Hyperglycemia would occur if he ate extra carbohydrate without using extra insulin. Diabetic ketoacidosis would occur if he omitted insulin doses. Nephropathy is a long-term complication of diabetes mellitus.
19.An individual with a blood glucose level of 40 mg/dL would have
a. hypoglycemia.
b. a normal blood glucose level.
c. hyperglycemia.
d. impaired glucose tolerance.
ANS:A
Hypoglycemia occurs when blood glucose level falls below 50 mg/dL; therefore 40 mg/dL is hypoglycemia. Normal blood glucose levels are about 80 to 100 mg/dL, although levels may increase to 140 mg/dL after meals. Blood glucose levels above 180 mg/dL would be considered hyperglycemia. Impaired glucose tolerance is diagnosed when fasting blood glucose levels are >100 mg/dL but <126 mg/dL.
20.Diabetic ketoacidosis may occur in a patient with type 1 diabetes who
a. gets caught in traffic and misses a meal.
b. participates in an all-day sporting event.
c. accidentally takes a double dose of insulin.
d. goes away for the weekend and forgets to take his or her insulin.
ANS:D
Diabetic ketoacidosis may occur in a patient with type 1 diabetes who goes away for the weekend and forgets to take his or her insulin. Missing a meal would cause hypoglycemia. Participation in an all-day sporting event could cause hypoglycemia if he or she did not eat extra food. Accidentally taking a double dose of insulin would cause hypoglycemia.
21.Ketones accumulate in the blood during diabetic ketoacidosis because of increased metabolism of _____ and decreased metabolism of _____.
a. fatty acids; glucose
b. glucose; fatty acids
c. amino acids; glucose
d. glucose; amino acids
ANS:A
Ketosis occurs because of an abnormal accumulation of ketones caused by metabolism of fatty acids for energy with decreased metabolism of glucose due to lack of insulin. Amino acid metabolism is not generally involved in diabetic ketoacidosis.
22.If someone with type 1 diabetes has nausea and vomiting, weakness and fatigue, as well as excessive hunger and thirst, but does not have a fruity or acetone odor on their breath, they may have
a. hepatic encephalopathy.
b. diabetic ketoacidosis (DKA).
c. hyperglycemic hyperosmolar nonketotic syndrome (HHNS).
d. hypoglycemia.
ANS:C
Nausea and vomiting, weakness, fatigue, polyphagia, and polydipsia can all be symptoms of both HHNS and DKA. However, with DKA the breath smells fruity because of ketones. If this is absent, the patient has HHNS. Hypoglycemia would be characterized by hunger, confusion, trembling, and erratic behavior. Hepatic encephalopathy is not associated with diabetes.
23.If a young man with type 1 diabetes wants to eat cake for dessert after a meal of roast chicken, mashed potatoes, gravy, green beans, and dinner rolls, he should eat less
a. potatoes and/or rolls.
b. chicken and gravy.
c. green beans.
d. of everything.
ANS:A
Foods containing sucrose (such as cake or other desserts) should be substituted for other carbohydrate foods in the meal plan, so he should eat less potatoes and/or rolls. Chicken, gravy, and green beans are low in carbohydrate so he does not need to eat less if he wants to eat dessert.
24.Patients with type 1 diabetes should be taught to regulate the _____ meal and snacks.
a. kcal content of
b. total amount of sugars in
c. total amount of dietary fiber in
d. total amount of carbohydrates in
ANS:D
Patients with type 1 diabetes should learn to regulate the total amount of carbohydrates in meals and snacks. The overall kcal content and amount of dietary fiber are less important. The amount of sugar is important only as it contributes to total carbohydrate.
