UNIT 5 DIABETES CHAPTER 59

Question 1

Which Diabetes in modifiable

Type 1 diabetes or Type 2 diabetes

Answer 1

Type 2 diabetes

Question 2

Rapid-Acting Insulin (bolus)

Answer 2

• Examples:
• Human Lispro (Humalog), Insulin Aspart (Novolog) & Insulin Glulisine (Apidra)
• Onset within 5-15 minutes
• Peak in about one hour
• Given just prior to meal, during meal or within 20 minutes after meal.

Question 3

Short-Acting Insulin

Answer 3

Examples:
* Regular Human Insulin(Humulin R, Novolin R)
* Onset-30-60 minutes
* Peak 2-4 hours
* Duration 5-7 hours
* *Only kind of insulin to be used IV
* USES SLIDING SCALE
* Used to treat DKA emergencies (will be discussed in later course)

Question 4

Does a person with type 2 Diabetes produce insulin

Answer 4

Yes

Insulin Resistance)the body
does not use insulin
properly.

Question 5

Intermediate-Acting Insulin

Answer 5

• Examples:
  *NPH (Humulin N, Novolin N)
• Onset-1-2 hours
• Peak 4-12 hours
• Duration 18-24 hours
• Between meal snacks may be ordered for patients to prevent hypoglycemia

Question 6

What are you most concerned about during the peak time of Insulin

Answer 6

manifestation of hypoglycemia

during the peak time of insulin, that’s when its the highest concentration in the blood, which indicates the blood sugar will be the lowest.

Question 7

Long-Acting Insulin – basal

Answer 7

Long-Acting Insulin – basal
Examples:
*Insulin Glargine (Lantus)
Onset- 2-4 hours
Peaks-relatively constant slow release
Duration 24 hours
Used with Basal/Bolus protocol

Insulin glargine is a long-acting insulin injected once daily and provides a basal insulin level throughout the day

BASAL INSULIN THERAPY
* Insulin Glargine (Lantus)
* Cannot be mixed with any other insulin
* May be ordered twice a day, but needs to be given within 30 minutes of the same time each day.
* Optimum dose will not cause hypoglycemia even when NPO

NEVER MIX WITH ANY INSULIN

Question 8

Type 2 Diabetic Patient Manifestation

Answer 8

Type II
* Hyperglycemia
* 3 P’s
-Polyphagia: EXTREME HUNGER
-Polydypsia: EXTREME THIRST
-Polyuria: EXCESSIVE URINATION
* Weight gain
* Symptoms are not always
as obvious

Question 9

The nurse reviewing the preadmission testing laboratory values for a 62- year-old client scheduled for a total knee replacement finds an A1C value of 6.2%. How will the nurse interpret this finding?
A. The client’s A1C is completely normal.
B. The client has type 1 diabetes mellitus.
C. The client has type 2 diabetes mellitus.
D. The client has prediabetes mellitus.

Answer 9

D. The client has prediabetes mellitus.

Question 10

The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result?
1. This result is below normal levels.
2. This result is within acceptable levels.
3. This result is above recommended levels.
4. This result is dangerously high.

Answer 10

3. This result is above recommended levels.

Question 11

Dawn Phenomenon what is it used to prevent

Answer 11

In the early morning hours your body starts to release hormones to get you up and going (think circadian rhythm). Plus, you release the necessary glucagon to handle the “get up and
go”.
If you are a diabetic, you don’t have enough insulin to keep up with that release and the person experiences hyperglycemia.

Treatment:
Increase insulin or change administration time

used to prevent hyperglycemia

Question 12

The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement?
1. Ensure the client eats the bedtime snack.
2. Determine how much food the client ate
at lunch.
3. Perform a glucometer reading at 0700.
4. Offer the client protein after administering
insulin.

Answer 12

1. Ensure the client eats the bedtime snack.

Humulin N peaks in FOUR (4) to TWELVE
(12) hours, making the client at risk for hypoglycemia around midnight, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia.

Question 13

Somogyi effect what is it used to prevent

Answer 13

Usually due to taking too much insulin before
bed or when miss the nighttime snack.
So, the blood sugar drops during the night.
Body react to the low sugar by releasing
glucagon.
Release of glucagon without insulin leads to
hyperglycemia.
Treatment:
Give bedtime snack or reduce insulin at
bedtime

use to prevent hypoglycemia

Question 14

The nurse is assessing the feet of a client with long-term type 2 diabetes. Which assessment data warrant immediate intervention by the nurse?
1. The client has crumbling toenails.
2. The client has athlete’s foot.
3. The client has a necrotic big toe.
4. The client has thickened toenails.

Answer 14

3. The client has a necrotic big toe.
4. A necrotic big toe indicates “dead” tissue. The client does not feel pain, does not realize the injury, and does not seek treat- ment. Increased blood glucose levels de- crease the oxygen supply needed to heal the wound and increase the risk for devel- oping an infection.

Question 15

The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included in the plan of care?
1. Assess the client’s ability to read small print.
2. Monitor the client’s serum prothrombin time
(PT) level.
3. Teach the client how to perform a hemoglobin
A1c test daily.
4. Instruct the client to check the feet weekly.

Answer 15

1. Assess the client’s ability to read small print.

Age-related visual changes and diabetic retinopathy could cause the client to have difficulty in reading and drawing up insulin dosage accurately.

Question 16

Glycosylated hemoglobin
(A1C) test

Normal Range, Prediabetic range , Diabetic Range

Answer 16

Levels >6% indicate diabetes.

Levels >8% indicate poor diabetes control and need for adherence to regimen or changes in therapy.

Question 17

Type 1 Diabetic Patient Manifestation

Answer 17

Type I
* Hyperglycemia
* 3P’
-Polyphagia: EXTREME HUNGER
-Polydypsia: EXTREME THIRST
-Polyuria: EXCESSIVE URINATION
* Weight loss (NONOBESE)
* Symptoms are
pronounced

Question 18

1. An 18-year-old female client, 5′4′′ tall, weighing 113 kg, comes to the clinic for a nonhealing wound on her lower leg, which she has had for two (2) weeks. Which disease process should the nurse suspect the client has developed?
2. Type 1 diabetes.
3. Type 2 diabetes.
4. Gestational diabetes.
5. Acanthosis nigricans.

Answer 18

2. Type 2 diabetes.

Type 2 diabetes is a disorder usually occur- ring around the age of 40, but it is now be- ing detected in children and young adults as a result of obesity and sedentary life- styles. Nonhealing wounds are a hallmark sign of type 2 diabetes. This client weighs 248.6 pounds and is short.

Question 19

Sick Days for diabetic patient

Answer 19

Notify your primary health care provider or diabetes health care provider that you are ill.
* Monitor your blood glucose at least every 4 hours.
* Test your urine for ketones when your blood glucose level is greater than 240 mg/dL (13.8 mmol/L).
* Continue to take insulin or other antidiabetic agents, unless instructed otherwise by your primary health care provider.
* To prevent dehydration, drink 8 to 12 ounces (240 to 360 mL) of sugar-free liquids every hour that you are awake. If your blood glucose level is below your target range, drink fluids that contain sugar.
* Continue to eat meals at regular times.
* If unable to tolerate solid food because of nausea, consume more easily tolerated foods or liquids equal to the carbohydrate content of your usual meal.
* Call your diabetes health care provider for any of these problems:
* Persistent nausea and vomiting
* Moderate or high ketones
* Blood glucose elevation after two supplemental doses of insulin
* High (101.5°F [38.6°C]) temperature or increasing fever; fever for
more than 24 hours
* Treat diarrhea, nausea, vomiting, fever as directed by your diabetes health care provider.
* Get plenty of rest.

Question 20

Foot Care diabetic patient

Answer 20

Inspect your feet daily, especially the area between the toes.
* Wash your feet daily with lukewarm water and soap. Dry thoroughly.
* Apply a moisturizer to your feet (but not between your toes) after bathing.
* Change into clean co tton socks every day.
* Do not wear the same pair of shoes 2 days in a row and wear only shoes made of breathable materials, such as leather or cloth.
* Check your shoes for foreign objects (nails, pebbles) before putt ing them on. Check inside the shoes for cracks or tears in the lining.
* Buy shoes that have plenty of room for your toes. Buy shoes later in the day, when feet are normally larger. 1/2 to 5/8 larger
LARGER Break in new shoes gradually.
* Wear socks to keep your feet warm.
* Trim your nails straight across with a nail clipper and smooth them with an emery board.
* See your diabetes health care provider immediately if you have blisters, sores, or infections. Protect the area with a dry, sterile dressing. Do not use tape to secure dressing to the skin.
* Do not treat blisters, sores, or infections with home remedies.
* Do not smoke or use nicotine products.
* Do not step into the bathtub without checking the temperature of the water with your wrist or thermometer.
* Do not use very hot or cold water. Never use hot-water bo les, heating pads, or portable heaters to warm your feet.
* Do not treat corns, blisters, bunions, calluses, or ingrown toenails yourself.
* Do not go barefooted.
* Do not wear sandals with open toes or straps between the toes.
* Do not cross your legs or wear garters or tight stockings that constrict blood flow.
* Do not soak your feet.

Question 21

Does a person with type 1 Diabetes produce insulin

Answer 21

No

the body does not produce
insulin.

Question 22

Risk Factors for type 1 diabetes

Answer 22

Family History
* Genetics
* Geography
* Less than 30 years of age
* Issue with beta cells which
produce insulin
* Post viral infection
* Usually not obese
* Abrupt onset

Question 23

Risk Factors for type 2 diabetes

Answer 23

Weight
* Family history
* Inactivity
* Peaks around age 50
* Usually insulin resistant and but
can have some dysfunctional
beta cells
* Obesity
* Insidious onset
* Certain cultures – Hispanic,
African Americans, Native
American, Asian American, and
Pacific Islanders
* Has history of gestational
diabetes

Question 24

Drug and lifestyle therapy for type 1 diabetes

Answer 24

Insulin
* Diet
* Blood sugar monitoring
* Education of Client

Patients with type 1 DM require insulin therapy for blood glucose control and may use other antidiabetic drugs, as well.

Question 25

Drug and lifestyle therapy for type 2 diabetes

Answer 25

Diet * exercise * Possible medication * Frequent blood sugar monitoring * Education of Client Drug therapy. Drug therapy is indicated when a patient with type 2 DM does not achieve blood glucose control with diet changes, regular exercise, and stress management.

Question 26

Definition of Diabetes Mellitus

Answer 26

Diabetes mellitus (DM) is a common, chronic, complex disorder of impaired nutrient metabolism, especially glucose, that can affect the function of every body system Glucose regulation is the process of maintaining optimal blood glucose levels, also known as glycemic control

Question 27

Does Diabetes affect all major body organs

Answer 27

yes * Chronic hyperglycemia thickens basement membranes, which causes organ damage. * Glucose toxicity directly or indirectly affects functional cell integrity. * Chronic ischemia in small blood vessels causes tissue hypoxia and microischemia

Question 28

Importance of Alpha Cells and Beta cells

Answer 28

Pancreas – * Alpha cells – secretes glucagon (prevents HYPOglycemia) * Beta cells – produces insulin and amylin (prevents HYPERglycemia)

Question 29

Kussmaul respiration.

Answer 29

The excess acids caused by absence of insulin increase hydrogen ion (H+) and carbon dioxide (CO2) levels in the blood, causing anion-gap metabolic acidosis. These products trigger the brain to increase the rate and depth of respiration in an atempt to “blow off” carbon dioxide and acid. This type of breathing is known as Kussmaul respiration. Acetone is exhaled, giving the breath a “rotting citrus fruit” odor. When the lungs can no longer offset acidosis, the blood pH drops. Arterial blood gas studies show a metabolic acidosis (decreased pH with decreased arterial bicarbonate [HCO3− ] levels) and compensatory respiratory alkalosis (decreased partial pressure of arterial carbon dioxide [PaCO 2]). Kussmaul respiration A deep and rapid respiratory pattern triggered by acidosis to reduce blood hydrogen ion concentration by “blowing off” carbon dioxide.

Question 30

Diabetic peripheral neuropathy

Answer 30

Diabetic peripheral neuropathy (DPN) is a progressive deterioration of nerve function that results in loss of sensory perception . It is a common complication of DM and often involves all body areas. Damage to sensory nerve fibers results first in pain, which is eventually followed by loss of sensation. Damage to motor nerve fibers results in muscle weakness. The onset is slow, affects both sides of the body, progresses, and is permanent. Late complications include foot ulcers and deformities. Damage to nerve fibers in the autonomic nervous system can cause dysfunction in every organ. The combination of factors leading to the nerve damage in diabetic neuropathy consists of: * Hyperglycemia, long duration of DM, hyperlipidemia * Damaged blood vessels leading to reduced neuronal oxygen and other nutrients * Increased genetic susceptibility to nerve damage * Smoking, nicotine, and alcohol use

Question 31

Health Promotion and Maintenance of Diabetes

Answer 31

Adopting a healthy lifestyle that includes a low-calorie diet and increasing physical activity with weight loss improves metabolic and cardiac risk factors ( and can prevent or delay the onset of type 2 DM (ADA, 2019k). These improvements include reducing hypertension, increasing heart rate variability between resting rate and exercise rate, lowering triglyceride levels, increasing high- density lipoprotein cholesterol (“healthy” or “good” cholesterol) levels, and reducing low-density lipoprotein cholesterol (“lousy” or “bad” cholesterol) levels. Smoking cessation and avoidance of excess alcohol consumption also are important in preventing complications of DM. Encourage daily foot inspection and the prompt reporting of ulcers or open areas to the primary health care provider to reduce the risk for deep wounds or the need for amputation. Teach patients with DM that keeping their blood glucose levels within prescribed target ranges can prevent or delay complications. Urge them to regularly follow up with their primary health care provider or diabetes health care provider, to have their eyes and vision tested yearly by an ophthalmologist, and to have urine albumin levels assessed yearly. Early detection of changes in the eye or kidney allows adjustments in treatment plans that can slow or halt progression of retinopathy and nephropathy. Urge adults to maintain an appropriate weight range for height and body build and to engage in physical activity at least 150 minutes per week

Question 32

Risk factors for Diabetes continued

Answer 32

* Testing for diabetes is considered at any age in adults with a BMI greater than 25 of kg/m2 (or greater than 23 kg/m2 in Asian Americans) with one or more these additional risk factors: Have a first-degree relative with diabetes Are physically inactive Are members of a high-risk ethnic population (e.g., African American, Hispanic American, American Indian, or Pacific Islander) * Give birth to a baby weighing more than 9 lb (4.1 kg) or have been diagnosed with GDM * Are hypertensive (>140/90 mm Hg) * Have a high-density lipoprotein (HDL) cholesterol level less than 35 mg/dL (0.90 mmol/L) and/or a triglyceride level greater than 250 mg/dL (2.82 mmol/L) * Have polycystic ovary syndrome * Have A1C greater than 5.7%, or IFG or IGT on previous testing * Have a history of vascular disease * If the tested adult has normal glucose values at this time but other conditions and risk factors remain the same, testing should be repeated at 3-year intervals.

Question 33

Does the patient with Diabetes require Interprofessional Care?

Answer 33

The Patient With Diabetes Mellitus The complicated and chronic nature of DM requires the coordination of an interprofessional team approach for optimum outcomes. The interprofessional team members to help patients achieve desired outcomes include primary health care providers, endocrinologists, diabetes health care providers, certified diabetes educators, ophthalmologists, other medical practitioners, registered nurses, pharmacists, registered dietitian nutritionists (RDNs), podiatrists, physical therapists, and wound care specialists.

Question 34

A1C testing

Answer 34

Measurement of A1C shows the average blood glucose level during the previous 120 days—the life span of red blood cells. A1C testing can help assess long-term glycemic control and predict the risk for complications. Unlike the fasting blood glucose test, A1C test results are not altered by the eating habits on the day before the test. This testing is performed at diagnosis and at specific intervals to evaluate the treatment plan. A1C testing is recommended at least twice yearly in patients who are meeting expected treatment outcomes and have stable blood glucose control. Quarterly assessment is recommended for patients whose therapy has changed or who are not meeting prescribed glycemic levels (ADA, 2019d). Table 59.7 shows the correlation between A1C and mean blood glucose levels.

Question 35

Can a patient disregard a healthy diet when taking anti-diabetic medications?

Answer 35

Patients with type 1 DM require insulin therapy for blood glucose control and may use other antidiabetic drugs, as well.

Question 36

Are anti diabetic medications harsh on the liver? A. No B. Yes

Answer 36

B. Yes To avoid drug interactions, teach the patient who is taking an antidiabetic drug to consult with his or her diabetes health care provider or pharmacist before using any over-the-counter drugs.

Question 37

Should metformin an anti diabetic medication be used with a patient with kidney disease?

Answer 37

Metformin can cause lactic acidosis in patients with kidney impairment and should not be used by anyone with kidney disease

Question 38

Insulin injection

Answer 38

Absorption is fastest in the abdomen, which is, except for a 2-inch radius around the navel, the preferred injection site. Rotating injection sites allows each injection site to heal completely before the site is used again. Rotation within one anatomic site is preferred to rotation from one area to another to prevent day-to-day variability in absorption. Absorption rate is determined by insulin properties. Longer duration of action makes absorption less reliable. Larger doses prolong the absorption. Factors that increase blood flow from the injection site, such as applying heat locally, massaging the area, and exercising the injected area, increase insulin absorption. Scarred areas are less sensitive to pain, but these sites usually slow insulin absorption. Injection depth changes insulin absorption. Usually injections are made into the subcutaneous tissue. IM injection has a faster absorption and is not used for routine insulin use. Most patients lightly grasp a fold of skin and inject at a 90-degree angle; however, a 45-degree angle is used for frail older adults and those who are very thin. Aspiration for blood is not needed. Patients who are overweight can use 4-mm or 5-mm needles to inject insulin at a 90-degree angle without pinching a skinfold before injection.

Question 39

Dawn Phenomenon

Answer 39

Dawn phenomenon results from a nighime release of adrenal hormones that causes blood glucose elevations at about 5 to 6 a.m. It is managed by providing more insulin for the overnight period (e.g., giving the evening dose of intermediate-acting insulin at 10 p.m. instead of with the evening meal). Dawn Phenomenon In the early morning hours your body starts to release hormones to get you up and going (think circadian rhythm). Plus, you release the necessary glucagon to handle the “get up and go”. If you are a diabetic, you don’t have enough insulin to keep up with that release and the person experiences hyperglycemia. Treatment: Increase insulin or change administration time

Question 40

Smoygi

Answer 40

Somogyi phenomenon is morning hyperglycemia from the counterregulatory response to nighime hypoglycemia. It is managed by ensuring adequate dietary intake at bedtime and evaluating the insulin dose and exercise programs to prevent conditions that lead to hypoglycemia. Somogyi Effect Usually due to taking too much insulin before bed or when miss the nighttime snack. So, the blood sugar drops during the night. Body react to the low sugar by releasing glucagon. Release of glucagon without insulin leads to hyperglycemia. Treatment: Give bedtime snack or reduce insulin at bedtime

Question 41

Insulin Storage

Answer 41

Insulin storage varies by use. Teach patients to refrigerate insulin that is not in use to maintain potency, prevent exposure to sunlight, and inhibit bacterial growth. Insulin in use may be kept at room temperature for up to 28 days to reduce injection site irritation from cold insulin.

Question 42

Prefilled syringes

Answer 42

Teach patients to always have a spare supply of each type of insulin used. Prefilled syringes are stable for up to 30 days when refrigerated. Store prefilled syringes in the upright position, with the needle pointing upward or flat, so insulin particles do not clog it. Teach patients to roll prefilled syringes between the hands before using to gently mix and warm the dose.

Question 43

Insulin Temperature

Answer 43

To prevent loss of drug potency, teach the patient to avoid exposing insulin to temperatures below 36°F (2.2°C) or above 86°Fo (30°C), to avoid excessive shaking, and to protect insulin from direct heat and light. Insulin should not be allowed to freeze. Teach patients to discard any unused insulin after 28 days.

Question 44

Proper dose preparation for Insulin

Answer 44

Proper dose preparation is critical for insulin effectiveness and safety. Teach patients that the person giving the insulin needs to inspect the vial before each use for changes (e.g., clumping, frosting, precipitation, or change in clarity or color) that may indicate loss in potency. Preparations containing NPH insulin are uniformly cloudy after gently rolling the vial between the hands. Other insulins should be clear. If potency is questionable, another vial or pen of the same insulin type should be used. Disposable needles are used only once. Teach the patient to discard the syringe and needle after one use. I

Question 45

Patient education: blood glucose monitoring

Answer 45

Patient education: blood glucose monitoring. Self-monitoring of blood glucose (SMBG) provides a means to assess effectiveness of the management plan and assists the patient in self-care decisions. Results of SMBG are useful in preventing hypoglycemia and hyperglycemia by adjusting drug therapy, diet therapy, and physical activity. Teach patients to assess blood glucose frequently for these situations: * Symptoms of hypoglycemia or hyperglycemia * Hypoglycemic unawareness * Periods of illness * Before and after exercise * Gastroparesis * Adjustment of antidiabetes drugs * Evaluation of other drug therapies (e.g., steroids) * Pregnancy

Question 46

Subcutaneous Insulin Administration With Vial and Syringe

Answer 46

Subcutaneous Insulin Administration With Vial and Syringe * Wash your hands. * Inspect the bole for the type of insulin and the expiration date. * Gently roll the bole of intermediate-acting insulin in the palms of your hands to mix the insulin. * Clean the rubber stopper with an alcohol swab. * Remove the needle cover and pull back the plunger to draw air into the syringe. The amount of air should be equal to the insulin dose. Push the needle through the rubber stopper and inject the air into the insulin bole. * Turn the bole upside down and draw the insulin dose into the syringe. * Remove air bubbles in the syringe by tapping on the syringe or injecting air back into the bole. Redraw the correct amount. * Make certain the tip of the plunger is on the line for your dose of insulin. Magnifiers are available to assist in measuring accurate doses of insulin. * Remove the needle from the bole. Recap the needle if the insulin is not to be given immediately. * Select a site within your injection area that has not been used in the past month. * Clean your skin with an alcohol swab. Lightly grasp an area of skin and insert the needle at a 90-degree angle. * Push the plunger all the way down. This will push the insulin into your body. Release the pinched skin. * Pull the needle straight out quickly. Do not rub the place where you gave the shot.

Question 47

Subcutaneous Insulin Administration With a Pen Device

Answer 47

With a Pen Device * Wash your hands. * Check the drug label to be sure it is what was prescribed. * Remove the cap. * Look at the insulin to be sure it is evenly mixed if it contains NPH and that there is no clumping of particles. * Wipe the tip of the pen where the needle will aach with an alcohol swab. * Remove the protective pull tab from the needle and screw it onto the pen until snug. * Remove both the plastic outer cap and inner needle cap. * Look at the dose window and turn the dosage knob to the appropriate dose. * Holding the pen with the needle pointing upward, press the buon until at least a drop of insulin appears. This is the “cold shot,” “air shot,” or “safety shot.” Repeat this step if needed until a drop appears. * Dial the number of units needed. * Hold the pen perpendicular to and against the intended injection site with your thumb on the dosing knob. * Press the dosing knob slowly all the way to dispense the dose. * Hold the pen in place for 6 to 10 seconds, then withdraw from the skin. * Replace the outer needle cap; unscrew until the needle is removed, and dispose of the needle in a hard plastic or metal container. * Replace the cap on the insulin pen.

Question 48

4. When preparing to administer a prescribed subcutaneous dose of NPH insulin from an open vial taken from a medication drawer to a client with diabetes, the nurse notes the solution is cloudy. What action will the nurse perform to ensure client safety? A. Warm the vial in a bowl of warm water until it reaches normal body temperature. B. Return the vial to the pharmacy and open a fresh vial of NPH insulin. C. Roll the vial between the hands until the insulin is clear. D. Check the expiration date and draw up the insulin dose.

Answer 48

D. Check the expiration date and draw up the insulin dose.

Question 49

5. While making rounds the nurse finds a client with type 1 diabetes mellitus pale, sweaty, and slightly confused; the client can swallow. The client’s blood glucose level check is 48 mg/dL (2.7 mmol/L). What is the nurse’s best first action to prevent harm? A. Call the pharmacy and order a STAT does of glucagon. B. Immediately give the client 30 g of glucose orally. C. Start an IV and administer a small amount of a concentrated dextrose solution. D. Recheck the blood glucose level and call the Rapid Response Team.

Answer 49

B. Immediately give the client 30 g of glucose orally.

Question 50

Patient and family teaching for diabetes management

Answer 50

Teach the patient and family to check blood glucose levels every 4 to 6 hours as long as symptoms such as anorexia, nausea, and vomiting are present and as long as glucose levels exceed 250 mg/dL (13.8 mmol/L). Teach them to check urine ketone levels when blood glucose levels exceed 300 mg/dL (16.7 mmol/L). Teach the patient to prevent dehydration by maintaining food and fluid intake. Suggest that he or she drink at least 2 L of fluid daily and increase this amount when infection is present. When nausea is present, instruct the patient to take liquids containing both glucose and electrolytes (e.g., regular sugar-sweetened soda pop, diluted fruit juice, and sports drinks [Gatorade]). Small amounts of fluid may be tolerated even when vomiting is present. When the blood glucose level is normal or elevated, the patient should take 8 to 12 ounces (240 to 360 mL) of calorie-free and caffeine-free liquids every hour while awake to prevent dehydration.

Question 51

The nurse is discussing the oral hypoglycemic medication Micronase with the client diagnosed with Type 2 diabetes. Which information should the nurse discuss with the client? 1. Instruct the client to take the oral hypoglycemic medication with food. 2. Explain that hypoglycemia will not occur with oral medications. 3. Tell the client to notify the HP if a headache, nervousness, or sweating occurs. 4. Recommend the client check the ketones in the urine every morning.

Answer 51

1. Instruct the client to take the oral hypoglycemic medication with food.

Question 52

The nurse is caring for the client diagnosed with Type 2 diabetes. The client is complaining of a headache, jitteriness, and nervousness. Which action should the nurse implement first? 1. Check the client's serum blood glucose level. 2. Give the client a glass of orange juice. 3. Determine when the last antidiabetic medication was administered. 4. Assess the client's blood pressure and apical pulse.

Answer 52

2. Give the client a glass of orange juice.

Question 53

A patient with Type 2 Diabetes is started on the medication Glyburide. Which of the following statements by the patient causes concern?* A. "I will monitor my blood glucose regularly because I know this medication can cause a low blood sugar." B. "I will consume no more than 8 oz. of alcohol per week." C. "I will continue monitoring my diet and participating in exercise while taking this medication." D. "This medication works by stimulating the beta cells in the pancreas to make insulin."

Answer 53

B. "I will consume no more than 8 oz. of alcohol per week."

Question 54

A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct?* A. Administer the medication as ordered. B. Hold the dose and notify the doctor for further orders. C. Administer the medication as ordered but hold the next day's dose. D. Check the patient's blood glucose prior to administering the medication

Answer 54

B. Hold the dose and notify the doctor for further orders.

Question 55

A patient has a blood glucose of 400. Which of the following medications could be the cause of this?* A. Glyburide B. Atenolol C. Bactrim D. Prednisone

Answer 55

D. Prednisone

Question 56

The nurse administered 25 units of Humulin N to a client with Type 1 diabetes at 1600. Which intervention should the nurse implement? 1. Assess the client for hypoglycemia around 1800. 2. Ensure the client eats the nighttime snack. 3. Check the client's serum blood glucose level. 4. Serve the client the supper tray.

Answer 56

2. Ensure the client eats the nighttime snack.

Question 57

The nurse is teaching the client with Type 1 diabetes how to use an insulin pen injector. Which information should the nurse discuss with the client? 1. Instruct the client to dial in the number of insulin units needed to inject. 2. Demonstrate the proper way to draw up the insulin in an insulin syringe. 3. Discuss that the insulin pen injector must be used in the abdominal area only. 4. Explain that the traditional insulin syringe is less painful than the injector pen.

Answer 57

1. Instruct the client to dial in the number of insulin units needed to inject.

Question 58

The nurse is teaching a client with newly diagnosed Type 1 diabetes about insulin therapy. Which statement indicates the client needs more teaching concerning insulin therapy? 1. "If I have a headache or start getting nervous. I will drink some orange juice." 2. "If I pass out at home, a family member should give me a glucagon injection." 3. "Because I am taking my insulin daily I do not have to adhere to a diabetic diet." 4."I will check mv blood alucose with mv alucometer at least once a dav."

Answer 58

3. "Because I am taking my insulin daily I do not have to adhere to a diabetic diet."

Question 59

The nurse administered 12 units of regular insulin to the patient with Type 1 diabetes at 0700. Which meal would prevent the client from experiencing hypoglycemia? 1. Breakfast. 2. Lunch. 3. Supper. 5. HS snack.

Answer 59

1. Breakfast.

Question 60

The client diagnosed with Type 1 diabetes is complaining of a dry mouth, extreme thirst, and increased urination. Which action should the nurse implement? 1. Administer one amp of intravenous 50% glucose. 2. Prepare to administer intravenous regular insulin. 3. Inject Humulin N subcutaneously in the abdomen. 4. Hang an intravenous infusion of D5W at a keep open rate.

Answer 60

2. Prepare to administer intravenous regular insulin.

Question 61

The nurse in the medical department is preparing to administer Humalog, a rapidacting insulin, to a client diagnosed with Type 1 diabetes. Which intervention should the nurse implement? 1. Ensure the client is wearing a MedicAlert bracelet. 2. Administer the dose according to the regular insulin sliding scale. 3. Assess the client for hyperosmolar, hyperglycemic, nonketotic coma. 4. Make sure the client eats the food on the meal tray that is at the bedside.

Answer 61

4. Make sure the client eats the food on the meal tray that is at the bedside.

Question 62

Which assessment data best indicate the client with Type 1 diabetes is adhering to the medical treatment regimen? 1. The client's fasting blood glucose is 100 mg/dL. 2. The client's urine specimen has no ketones. 3. The client's glycosylated hemoglobin is 5.8% 4. The client's glucometer reading is 120 mg/dL.

Answer 62

3. The client's glycosylated hemoglobin is 5.8%

Question 63

The nurse is discussing storage of insulin vials with the client. Which statement indicates the client understands the teaching concerning the storage of insulin? 1. "I will keep my unopened vials of insulin in the refrigerator." 2. "I can keep my insulin in the trunk of my car so I will have it at all times." 3. "It is all right to put my unopened insulin vials in the freezer." 4. "If I prefill my insulin syringes, I must use them within 1-2 days."

Answer 63

1. "I will keep my unopened vials of insulin in the refrigerator."

Question 64

18. Which of the following insulins can be administered intravenously? * A.NPH B. Lantus C. Humulin R D. Novolog

Answer 64

C. Humulin R

Question 65

15. Which of the following insulins has no peak but a duration of 24 hours? A. NPH B. Novolog C. Lantus v D. Humulin N

Answer 65

C. Lantus v

Question 66

17. When is a patient most susceptible to hypoglycemic symptoms after the administration of insulin? A. Onset B. Peak v C. Duration D. Duration & Peak

Answer 66

B. Peak v

Question 67

1. Which of the following symptoms do NOT present in hyperglycemia? 
A. Extreme thirst 
B. Hunger
' C. Blood glucose <60 mg/dL 
D. Glycosuria

Answer 67

C. Blood glucose <60 mg/dL

Question 68

2. Type 1 diabetics typically have the following clinical characteristics: 
A. Thin, young with ketones present in the urine 
B. Overweight, young with no ketones present in the urine 
C. Thin, older adult with glycosuria 
D. Overweight, adult-aged with ketones present in the urine


Answer 68


The answer is A.

Question 69

3. A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important?
A. Recheck the glucose level
 B. Give the patient ½ cup (4 oz) of fruit juice
 C. Call the doctor 
D. Keep the patient nothing by mouth


Answer 69

B. Give the patient ½ cup (4 oz) of fruit juice


Question 70

4. Which of the following patients is at most risk for Type 2 diabetes? 
A. A 6 year old girl recovering from a viral infection with a family history of diabetes. 
B. A 28 year old male with a BMI of 49. 
C. A 76 year old female with a history of cardiac disease.
D. None of the options provided.

Answer 70


B. A 28 year old male with a BMI of 49. The answer is B. Remember Type 2 diabetes risk factors are related to lifestyle….being obese is a risk factor (BMI >30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for Type 2.

Question 71

The _____ ______ secrete insulin which are located in the _______. 
A. Alpha cells, liver 
B. Alpha cells, pancreas 
C. Beta cells, liver 
D. Beta cells, pancreas

Answer 71

The answer is D.

Question 72

6. A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially? 
A. Diet and exercise regime
 B. Metformin BID by mouth
 C. Regular insulin subcutaneous 
D. None, monitoring at this time is sufficient enough
\

Answer 72

The answer is A.

Question 73

9. A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be to:
 A. Administer Dextrose 50% IV per protocol
 B. Continue to monitor the glucose 
C. Give the patient 4 oz of fruit juice 
D. None, this is a normal blood glucose reading

Answer 73

A. Administer Dextrose 50% IV per protocol
 The answer is A. This question requires critical thinking because the patient is NPO for surgery and can NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However, the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50% IV per protocol to help increase the blood glucose and recheck the glucose level.

Question 74

16. A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak? A.      1300 B.      0930 C.      1100 D.      1700

Answer 74

C.      1100

Question 75

14. True or False: The Somogyi effect causes the patient to experience an increase in their blood glucose during the hours of 2-3 am.; False True

Answer 75

False

Question 76

13. A patient with diabetes is experiencing a blood glucose of 275 when waking. What is a typical treatment for this phenomenon? A.      None, this is a normal blood glucose reading. B.      The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia. C.      A bedtime snack may prevent this phenomenon. D.      This is known as the Somogyi effect and requires decreasing the bedtime dose of insulin.

Answer 76

B.      The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia.

Question 77

12. A patient newly diagnosed with diabetes is about to be discharged home. You are watching the patient administer insulin. Which of the following actions causes you  to re-educate them? A.      They massaged the site after administering the insulin. B.      They injected into the fat of their thighs. C.      They used an opposite side for injection compared to the last insulin injection. D.      They engaged the safety after administering the medication.

Answer 77

A.      They massaged the site after administering the insulin.

Question 78

11. A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins? A.      These insulins cannot be mixed, therefore, should be drawn up in different syringes. B.      Draw-up the Humulin R insulin first and then the NPH insulin. C.      Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D.      Draw-up the NPH insulin first and then the Humulin R insulin.

Answer 78

B.      Draw-up the Humulin R insulin first and then the NPH insulin.

Question 79

4. A patient has a blood glucose of 45 and is sweating, cold, and clammy. The patient is conscious. What is your next nursing intervention? A. Recheck the blood glucose in 5 minutes. B. Give the patient 15 grams of a complex carbohydrate. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 15 grams of a simple carbohydrate.

Answer 79

D. Give the patient 15 grams of a simple carbohydrate.

Question 80

Complications of Diabetes

Answer 80

Potential Complications * Macrovascular/microvascular problems * Renal * Infection * Amputation * Heart attack * Stroke

Question 81

DIABETES EFFECTS ON BODY SYSTEMS

Answer 81

Other issues that occur with Diabetes to assess for * SKIN * Breaks in skin, infection * Diabetic dermopathy * Unhealed injection sites * EYES * Cataracts and/or retinal problems * PERIPHERAL * Hair loss on extremities * Skin is shiny, thin, pale and cool * Pulses are weak or absent * Nails are thick * Erectile disorder * CARDIAC * Angina * MI * RESPIRATORY * Dyspnea * Kidneys * Edema, GU * UTI, * urinary retention GI * Dental caries, * Periodontal disease, * Candidiasis

Question 82

Labs and diagnostics for diabetes

Answer 82

* Blood glucose * Hemoglobin A1C * Glucose tolerance test * Postprandial * Urine screening

Question 83

The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth

Answer 83

A. Hypoglycemia

Question 84

Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330

Answer 84

B. 1330 and 1930

Question 85

A nurse went to a patient’s room to do routine vital signs monitoring and found out that the patient’s bedtime snack was not eaten. This should alert the nurse to check and assess for: A. Elevated serum bicarbonate and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Symptoms of hyperglycemia during the peak time of NPH insulin D. Sugar in the urine

Answer 85

B. Signs of hypoglycemia earlier than expected