Diabetes

Which of the following persons would most likely be diagnosed with diabetes mellitus? A 44-year-old:

Your Answer:

African-American woman.

  Rationale: 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.

Nursing Process: AssessmentClient Need: Health Promotion and MaintenanceTaxonomic Level: Analysis

2.

Which of the following factors are risks for the development of diabetes mellitus? (Select all that apply.)

Your Answer: Age over 45 years

Overweight with a waist/hip ratio >1

Having a consistent HDL level above 40 mg/dl

Maintaining a sedentary lifestyleCorrect

Answers:Age over 45 years

Overweight with a waist/hip ratio >1

Maintaining a sedentary lifestyle  Rationale: Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.

Nursing Process: AssessmentClient Need: Physiologic Integrity, Reduction of Risk PotentialTaxonomic Level: Comprehension

Rationale: Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.

Nursing Process: AssessmentClient Need: Physiologic Integrity, Reduction of Risk PotentialTaxonomic Level: Comprehension

Rationale: Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.

Nursing Process: AssessmentClient Need: Physiologic Integrity, Reduction of Risk PotentialTaxonomic Level: Comprehension

Rationale: Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.

Nursing Process: AssessmentClient Need: Physiologic Integrity, Reduction of Risk PotentialTaxonomic Level: Comprehension

3.

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.)

Your Answer: Fasting Plasma Glucose (FPG)

Glycosylated hemoglobin (HbA1C)Correct

Answers:Fasting Plasma Glucose (FPG)

Two-hour Oral Glucose Tolerance Test (OGTT)  Rationale: When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.

Nursing Process: PlanningClient Need: Physiologic IntegrityTaxonomic Level: Comprehension

Rationale: When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.

Nursing Process: PlanningClient Need: Physiologic IntegrityTaxonomic Level: Comprehension

4.

Of which of the following symptoms might an older woman with diabetes mellitus complain?

Your Answer: Pain intoleranceCorrect

Answer:Perineal itching

  Rationale: Older women might complain of perineal itching due to vaginal candidiasis.

Nursing Process: AssessmentClient Need: Health Promotion and Maintenance Taxonomic Level: Application

5.

When an older adult is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the gerontology nurse should anticipate which of the following secondary medical diagnoses?

Your Answer: Gestational diabetes mellitusCorrect

Answer:Pancreatic tumor

  Rationale: The onset of hyperglycemia in the older adult can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumor.

Nursing Process: AssessmentClient Need: Physiologic Integrity, Reduction of Risk PotentialTaxonomic Level: Evaluation

6.

The principal goals of therapy for older patients who have poor glycemic control are:

Your Answer:

All of the above.

  Rationale: 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.

Nursing Process: PlanningClient Need: Safe, Effective Care EnvironmentTaxonomic Level: Comprehension

7.

Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus?

Your Answer:

Physical exercise can slow the progression of diabetes mellitus.

  Rationale: 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.

Nursing Process: ApplicationClient Need: Physiologic IntegrityTaxonomic Level: Analysis

8.

A diabetic patient experiencing a reaction of alternating periods of nocturnal hypoglycemia and hyperglycemia might be manifesting which of the following?

Your Answer:

Somogyi phenomenon

  Rationale: Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and increase in ketones.

Nursing Process: AnalysisClient Need: Physiologic IntegrityTaxonomic Level: Analysis

9.

The primary purpose for sulfonylureas, such as long-acting glyburide (Micronase), is to:

Your Answer:

Stimulate the beta cells of the pancreas to secrete insulin.

  Rationale: 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.

Nursing Process: AnalysisClient Need: Physiologic Integrity, Pharmacologic TherapyTaxonomic Level: Knowledge

10.

One of the benefits of Glargine (Lantus) insulin is its ability to:

Your Answer:

Release insulin evenly throughout the day and control basal glucose levels.

  Rationale: Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.

Nursing Process: EvaluationClient Need: Physiologic Integrity, Pharmacologic TherapyTaxonomic Level: Evaluation

11.

A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client's intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient?

Your Answer:

Hyperglycemic hyperosmolar non-ketotic coma

  Rationale: 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.

Nursing Process: AnalysisClient Need: Physiologic IntegrityTaxonomic Level: Analysis

Patients with Type 1 diabetes mellitus may require which of the following changes to their daily routine during periods of infection?

a. No changes.b. Less insulin.c. More insulin.d. Oral diabetic agents.

C  During periods of infection or illness, patients with Type 1 diabetes may need even more insulin to compensate for increased blood glucose levels.

LEHNE 6th---Edition: NCLEX-Style questions for Diabetes Mellitus

9 questions total

1) A nurse administers oral medications that enhance insulin action to a

patient with diabetes. Which type of diabetes does this patient have?

a) Type I Diabetes

b) Type II Diabetes

c) Diabetes insipidus

d) Ketosis

Ans:B; oral agents are effective ONLY with Type II diabetes

2) When administering 30 Units of Regular Insulin and 70 Units of NPH

insulin, a nurse will:

a) Draw up the Regular Insulin into the syringe first, followed by the

cloudy NPH insulin

b) Inform the patient that mixing insulin helps increase insulin

production

c) Rotate sites at least once a week and label the sites used on a

diagram

d) Use a 23-25 gauge syring with a 1-inch needle for maximum

absorption

Ans:A; drawing up the regular insulin into the syringe first prevents

accidental mixture of NPH insulin into the vial of regular insulin,

which could cause an alteration in the onset of action of the

regular insulin

3) Which long-acting insulin mimics natural basal insulins with its duration

of 24 hours?

a) Insulin Glargine (Lantus)

b) Insulin aspart (NovoLog)

c) Regular Insulin (Humulin R)

d) Ultralente insulin (Humulin U)

Ans:A; Insulin glargine has a duration of action of 24 hours with NO

peaks, which mimics the natural basal insulin secretion of the

pancreas

4) An operating room nurse prepares a patient with Type II diabetes for

surgery. Which types of insulin will the surgical nurse have available?

a) Regular Insulin (Humulin R)

b) Isophane insulin suspension (NPH insulin)

c) Insulin zinc suspension (Lente insulin)

d) Insulin Glargine (Lantus)

Ans:A; Regular insulin is the ONLY insulin that can be given

Intravenously

5) For the most consistent absorption, into which site should the insulin be

injected?

a) Abdomen

b) Deltoid

c) Vastus Lateralis

d) Gluteus maxius

Ans:A ; the abdomen provides the most consistent absorption

because the blood flow to subcutaneous tissue typically is not as

affected by muscular movements. The other options are all

intramuscular sites and should not be used for insulin administration.

6) A patient receives NPH insulin at 8 am. The patient eats breakfast at

830 am, lunch at noon and dinner at 6 pm. At what time is this patient

at the highest risk for hypoglycemia?

a) 10 AM

b) 2 PM c) 5 PM d) 8 PM

Ans: C; Breakfast eaten at 8:30am would cover the onset of NPH

insulin, and lunch covers the 2 PM time frame. However, if the

patient does not eat a midafternoon snack, the NPH insulin may be

peaking just before dinner, without sufficient glucose on hand to

prevent hypoglycemia.

7) A nurse would include which statement when teaching a patient about

insulin Glargine (Lantus)?

a) “You should inject this insulin just before meals because it is very

fast acting.”

b) “The duration of action for this insulin is about 8-10 hours, so

you’ll need to take it twice a day.”

c)“You can mix this insulin with Lente insulin to enhance its effects.”

d) “You cannot mix this insulin in the same syringe with Regular

insulin.”

Ans:D; Insulin Glargine is a long-acting insulin with a duration of up

to 24 hours. It should not be mixed with any other insulin.

8) A patient newly diagnosed with diabetes asks, “How does insulin

normally work in my body?” The Nurses response should be based on

which understanding of the action f insulin? Normal Insulin:

a) Stimulates the pancreas to reabsorb glucose

b) Promotes synthesis of amino acids into glucose

c) Stimulates the liver to convert glycogen into glucose

d) Promotes the passage of glucose into cells for energy

Ans:D; Insulin promotes the passage of glucose into the cells, where

it is metabolized for energy.

9) To achieve the most beneficial effect, the nurse plans to administer

glipizide (Glucotrol);

a) With food

b) 30 minutes before a meal

c) 15 minutes postprandial

d) At bedtime

Ans: B; Food inhibits the absorption of Glipizide. It is the ONLY

sulfonylurea agent that should be given 30 Minutes before a meal.

Which symptom is indicative of hypoglycemia?

a. irritabilityb. drowsinessc. abdominal paind. N & V

A. Irritability: signs of hypoglycemia include irritability, shaky feeling, hunger, headache, dizziness.

Drowsiness, abdominal pain, nausea, and vomiting are signs of HYPERglycemia.

A nurse should understand that hyperglycemia associated with diaabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than?

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 shoud recognize which symptom as a cardinal sign of diabetes mellitus?

a. Nauseab. Seizurec. Hyperactivityd. Frequent urination

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.

Why is blood glucose monitoring needed? C. Better management.

a. easier method of testingb. less expensivec. better management of diabetesd. greater sense of control over 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.

A client is learning to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, would indicate the need for FURTHER teaching?

a. Withdrawing the NPH insulin firstb. Injecting air into the NPH insulin bottle firstc. After drawing up first insulin, removing air bubblesd. Injecting an amt of air equal to the desired dose of insulin

a. Withdrawing NPH insulin first.

Regular insulin is ALWAYS withdrawn first so it won't become contaminated with NPH insulin.

The client is instructed to inject air into the NPH insulin bottle equal to the amt of insulin to be withdrawn because there will be regular insulin in the syringe and he won't be able to inject air when he needs to withdraw the NPH.

It's necessary to remove the air bubbles to ensure a correct dosage before drawing u p the second insulin.

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 minutesb. 1/2 hr to 1 hrc. 1 - 1 1/2 hrsd. 4-8 hrs

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 who is started on metformin and glyburide would have initially presented with which symptoms?

a. Polydispisa, polyuria, and weight lossb. weight gain, tiredness, & bradycardia

a. Polydispisa, polyuria, and weight loss

Symptoms of hyperglycemia include polydipsia, polyuria, and weight loss. Metformin and sulfonylureas are commonly

c. irritability, diaphoresis, and tachycardiad. diarrhea, abdominal pain, and weight loss

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 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 and administer O2 therapy

d. Restrict salt, administer diuretics and perform a paracentesis.

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 lovw blood glucose level.

Restricting salt, admin diuretics, and performing paracentesis are tx for ascites.

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

receive an IV insulin infusion

take his full daily insulin dose with no dextrose infusion

a. take on-half of usual daily dose of intermediate acting insulin

If the client takes his full daily dose of intermediate-acting insulin when he isn't allowed anything orally before surgery, he'll become hypoglycemic. On-half the insulin dose will provide all that is needed.

Clients with type 1 don't take oral anti-iabetic 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 type of diabetes is controlled primarily through diet, exercise, and oral antidiabetic agents?

Diabetes Mellitus type II

Which nursing intervention should be taken for a client who complains of N & V 1 hour after taking his morning glyburide?

a. give glyburide again

b. give subQ insulin and monitor BG

c. Monitor blood glucose closely, and look for signs of hypoglycemia

d. monitor BG and assess for symptoms of hyperglycemia

c. Monitor blood glucose closely, and look for signs of hypoglycemia

When a client who has taken an oral antidiabetic agent vomits, the nurse should monitor glucose and assess him frequently for signs of hypoglycemia.

Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day.

giving insulin also will lower glucose levels, causing hypoglycemia

client wouldn't have hyperglycemia if they glyburide was absorbed.

When teaching a newly diagnosed diabetic dclient about diet and exercise, it's important to include which directive?

a. use of fiber laxatives and bulk-forming agents

b. management of fluid, protein, and electrolytes

c. reduction of calorie intake before exercising

d. caloric goals, food consistency, and physical activity

d. caloric goals, food consistency, and physical activity

Diabetic clients must be taught the relationship among caloric goals, consistency of food composition, and physical activity.

Fiber lax and bluk forming agents are treatments for constipation

management of fluids, proteins, and electorlytes is important for client wit hacute renal failure

diabetic client may need to intake additional calories before exercising

Nurse is teaching a client with DM about chronic complications associated with the disease. Which info should she include in her teaching?

a. buy shoes that are a half size larger

b. annual eye exams are recommended

c. excessive exercise increases insulin resistance

d. podiatry visits are necessary every 5 years

b. annual eye exams are recommended

Retinopathy is a chronic complication of DM. Therefore yearly eye exams are recommended.

Because of the risk of serious foot injuries, shoes should fit properly and be the correct size.

Exercise decreases insulin resistance

A podiatrist should be seen on a yearly basis

Rotating injection sites when administering insulin prevents which complication?

a. insulin edemab. insulin lipodystrophyc. insulin resistanced. systemic allergic reactions

b. insulin lipodystrophy

Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into those sites.

Insulin edema is generalized retention of fluid, sometimes seen after normal blood glucose levels are established in a client with prolonged hypergylecemia

Insulin resistance occurs mostly in overweight clients and is due to insulin binding with antibodies, decreasing the amt of absorption.

systemic allergic reactions range from hives to anaphylaxis; rotating injection sites won't prevent these.

Which test allows a RAPID measurement of glucose in whole blood?

a. Capillary blood glucose testb. serum keton testc. serum T4 test

a. Capillary blood glucose test

This test is a rapid test used to show BG levels.

ketone test is used to document diabetic

d. urine glucose test

ketoacidosis by titration and may allow determination of serum ketone concentration

a serum T4 test is used to diagnosis thyroid disorders. Most of the time, however neither serum ketone levesls nor T4 levels are useful in determining BG levels

urine glucose test monitors glucose levels in urine and is influenced by both glucose and water excretion. Therefore, results correlate poorly with BG levels

How long does the peak effect last for Novolin NPH, an intermediat-acting insulin?

a. 15 min - 1 hrb. 2-6 hrsc. 6-16 hrsd. 14-26 hrs

c. 6-16 hrs

Novolin NPH has a peak effect of 6-16 hrs.

the peak effect of rapid-acting insulin is 2-6 hrs

long -acting insulin has a peak effect of 14-26 hrs

onset of rapid acting insulin is 15 min - 1 hr

The polydipsia and polyuria related to diabetes mellitus are primarily caused by

A. the release of ketones from cells during fat metabolism.

B. fluid shifts resulting from the osmotic effect of hyperglycemia.

C. damage to the kidneys from exposure to high levels of glucose.

D. changes in RBCs resulting from attachment of excessive glucose to hemoglobin.

B. fluid shifts resulting from the osmotic effect of hyperglycemia.

When a patient with type 2 diabetes mellitus is admitted to the hospital with pneumonia, the nurse recognizes that the patient

D. may have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar

A. must receive insulin therapy to prevent the development of ketoacidosis.

B. has islet cell antibodies that have destroyed the ability of the pancreas to produce insulin.

C. has minimal or absent endogenous insulin secretion and requires daily insulin injections.

D. may have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar hyperglycemic nonketotic syndrome.

hyperglycemic nonketotic syndrome.

Effective collaborative management of diabetes includes

A. using insulin with all patients to achieve glycemic goals.

B. relying on the health care provider as the central figure in the program for good control.

C. relying solely on nutritional therapy as the initial treatment modality for all patients with diabetes.

D. aiming for a balance of diet, activity, and medications together with appropriate monitoring and patient and family teaching.

D. aiming for a balance of diet, activity, and medications together with appropriate monitoring and patient and family teaching.

The nurse assists the patient with nutritional therapy of diabetes with the knowledge that a “diabetic diet” is designed

A. to be used only for type 1 diabetes.

B. for use during periods of high stress.

C. to normalize blood glucose by elimination of sugar.

D. to help normalize blood glucose through a balanced diet.

D. to help normalize blood glucose through a balanced diet.

In teaching a newly diagnosed type 1 diabetic “survival skills,” the nurse includes information about

D. self-monitoring of blood glucose.

A. weight loss measures.

B. elimination of sugar from diet.

C. need to reduce physical activity.

D. self-monitoring of blood glucose.

An appropriate teaching measure for the patient with diabetes mellitus related to care of the feet is to

A. use heat to increase blood supply.B. avoid softening lotions and creams.C. inspect all surfaces of the feet daily.D. use iodine to disinfect cuts and abrasions.

C. inspect all surfaces of the feet daily.

A diabetic patient has a serum glucose level of 824 mg/dl (45.7 mmol/L) and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic nonketotic syndrome based on the finding of

A. polyuria.B. severe dehydration.C. rapid, deep respirations.D. decreased serum potassium.

C. rapid, deep respirations.

Although the primary function of insulin is to promote glucose transport from the blood into the cell, insulin also:

a. enhances breakdown of adipose tissue for energy

b. stimulates hepatic glycogenolysis and gluconeogenosis

c. prevents transport of tryglycerides into adipose tissue

d. accelerates the transport of amino acids into cells and their synthesis into protein

d. accelerates the transport of amino acids into cells and their synthesis into protein

Tissues that require insulin for glucose transport are: adipose & skeletal muscle

During developement of type 1 diabetes, the beta

Proinsulin C-peptides

cell response to the hyperglycemia can be identified in the blood and urine by the presence of:

Two hormones released during physical and emotional stress that are conterregulatroy to insulin are:

Cortisol & Epinephrine

The type of diabetes that is strongly related to human leukocyte antigen type is:

Type 1

Type 1 or 2?

Inherited defect in insulin receptors:

Type 2

Type 1 or 2?

Production of islet cell antibodiesType 1

Typer 1 or 2?

Genetic susceptibility for antibody production?

Type 1

Type 1 or 2?

Inappropriate glucose production by the liver

Type 2

Type 1 or 2?

Beta Cell destructionType 1

Describe process occurring withPOLYURIA

High glucose levels cause loss of glucose in urine with osmotic diuresis

Describe process occurring withPOLYDYPSIA

Thirst caused by fluid loss of polyuria

Describe process occuring with POLYPHAGIA

Cellular starvation from lack of glucose and use of fat and protein for energy

The nurse identifies that the risk for developing diabetes is highes in:

a. 62 yr old obese white manb. obese, 50 yr old hispanic womanc. child whose father has type 1 diabetesd. 34 yr old woman whose parents both have type 2 diabetes

d. 34 yr old woman whose parents both have type 2 diabetes

Type 2 diabetes has STRONG influence, 15%-45% of dvlpt.

Type 1 genetic susceptibility is only 6-9%. Is more related to HLA

Lower risks include the obesity / age / and race of the other answers

When caring for a patient with insulin resistance syndrome, the nurse plans teaching to decrease the patients risk for:

a. hypertensionb. hypoglycemiac. cardiovascular diseased. hyperglycemic hyperosmolor nonketosis

c. cardiovascular disease

52 yr old patient admitted to hospital with vomiting and diarrhea has a fasting BS of 512 and pH 7.38. Diagnosed with diabetes M and treated with insulin and IV. The ruse recognizes that it is most likely that this patient:

a. will require insulin treatment only during stress

b. is demonstrating abrupt onset of type 1 diabetes

c. will require long-term insulin therapy to control diabetes

d. has enough endogenous insulin to prevent diabetic ketoacidosis with the hyperglycemia

d. has enough endogenous insulin to prevent diabetic ketoacidosis with the hyperglycemia

during a routine health screening a patient has a fasting plasma Glucose of 132. AT following visit diabetes would be diagnoses based on:

a. glucosuria of 3+b. FPG of 126c. random plasma glucose of 210d. OGTT of 190

c. random plasma glucose of 210

On at least two testings, diabetes is diagnosed with a random plasma glucose over 200

a fasting plasma glucose over 126

or a OGTT over 200

fasting plasma glucose testing preferred

Nurse determines that a patient with a 2-hour OGTT of 152 has:

a. diabetesb. impaired fasting glucose

c. impaired glucose tolerance

Between 140 - 200 is "Pre-diabetes"

OVer 200 = dx of diabetes

c. impaired glucose toleranced. elevated glycosolated hemoglobinWhen teaching patient about isulin administration, the nurse instructs the patient to:

a. pull back on plunger to check for blood

b. clean the skin at inj. site

c. consistently use the same size of the appropriate strength insulin syringe to avoid dosing errors

d. rotate inj. site from arms to thighs to abdomen

c. consistently use the same size of the appropriate strength insulin syringe to avoid dosing errors

A patient with type 1 diabetes uses 20U of 70/30 (NPH/regular) in the morning and at 6 pm. The nurse stresses what about meal plans?

A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia

20. A patient with newly diagnosed diabetes mellitus is learning to recognize the symptoms of hypoglycemia. Which of the following symptoms is indicative of hypoglycemia?

A. Polydipsia. B. Confusion. C. Blurred vision. D. Polyphagia.

20. Answer: B

Hypoglycemia in diabetes mellitus causes confusion, indicating the need for carbohydrates.

Type 1 Diabetes

Type 1 diabetes is an autoimmune disorder in which insulin producing cells are destroyed. Insulin is a hormone produced by the pancreas, that controls the level of glucose in the blood. Without insulin present glucose can not enter into the cells. There is no definite cause of type 1 diabetes; it is thought to stem from a combination of genetic, immunologic, and environment factors. Diabetes type 1 is also called juvenile diabetes because the onset is usually during childhood.

The symptoms include:increased urinationincreased thirsthungerblurred visionweight loss

The primary treatment for type 1 diabetes will be insulin injection. The insulin injections could range from 1-7 times a day with a combination of short and long acting insulin. This is important because if insulin is not available for energy consumption the body will burn fats. When fat breakdown occurs, the result is ketone production. If ketones are present in the body; clients are at risk for diabetic ketoacidosis.

Diabetic Ketoacidosis (DKA) is a life threatening condition that occurs when not enough insulin is present. The three main symptoms are:AcidosisDehydration/electrolyte lossHyperglycemia

The ketone production will create an acidotic state in the body. Dehydration will be caused by excessive urination, clients may lose up to 6 liters a day. Hyperglycemia is caused due to a lack of insulin.

Other signs of DKA: fruity breath, abdominal pain, nausea, vomiting, hyperventilation

Treatment for DKA will be IV fluid + electrolytes and Regular Insulin IV. The Insulin will reverse both the acidosis and hyperglycemia.

NCLEX Review Questions:

What is the primary way type 1 diabetes is controlled?What is the life threatening condition that can occur if type 1 diabetes is uncontrolled?If ketones are present in the body should the client exercise?What is the treatment for diabetic ketoacidosis?

**Remember if insulin injection is the primary mode of treatment for type 1 diabetes education will be the key. On NCLEX remember to teach about:

blood glucose monitoringdifferent types of insulingiving insulin with mealsprevention of diabetic complications

Answers:

InsulinDiabetic KetoacidosisNo-will cause more fat to be consumed for energy leading to more ketone productionIV fluids and insulin

Type 2 Diabetes

Type 2 diabetes occurs primarily because of two problems:

1)insulin resistance2)impaired insulin production

Normally, insulin binds to special receptors on the cell surface which initiate glucose metabolism however with type 2 diabetes insulin is not as effective in causing glucose metabolism. When the cells become resistant to the insulin bond the body tries harder by secreting more insulin. The cells still don't respond so now there is a ton of glucose floating around which leads to hyperglycemia. Eventually the body realizes that secreting all the extra insulin won't help; so the pancreas stops producing it.

Unlike Type 1 Diabetes there is still enough insulin in the body to prevent the breakdown of fats which leads to ketones. You will not see DKA in type 2 diabetes. However you may see another acute condition called Hyperglycemic Hyperosmolar NonKetotic Syndrome (HHNS). HHNS occurs when high blood sugar causes severe dehydraton in the client. The client's constant hyperglycemic state (blood sugar over 600) causes osmotic diuresis, resulting in water and electrolyte loss. Several events can cause HHNS:acute illness (pneumonia)medications (thiazides)dialysis

Treatment for HHNS is the same as for DKA: fluid/electrolyte replacement and regular insulin IV. This is the potential risk for type 2 diabetics.

There is no known cause for type 2 diabetes although clients can have predisposing factors such as:family historyobesityusually over 40 yrs oldphysically inactivehave high blood pressure

African American, Native American, or Hispanic American

Signs of type 2 diabetes include:

polyuriapolydipsiapolyphagia

Clients may also experience blurry vision, poor wound healing, or frequent vaginal infections.

Diagnostic tests for type 2 diabetes:

An abnormally high glucose level is the basic criteriaFasting glucose greater than 126 (fasting=no calorie intake for at least 8 hours)Hemoglobin A1c greater than 7%

**Hemoglobin A1c measures the blood sugar for the last 3 months

Treatment for type 2 diabetes is primarily weight loss along with exercise. Exercise increases the effective of insulin binding to the cells. Exercise also lowers the blood glucose in diabetics. Eating a well balanced meal will also be emphasized during treatment. If these things are not successful then clients may be started on oral antidiabetics . If oral agents are not effective then the client may need to advance to insulin SQ injections.

NCLEX Review Questions:

What is the primary way type 2 diabetes is controlled?Why must diabetics inspect their feet daily?Will exercise increase or decrease the need for insulin?Will stress increase or decrease the need for insulin?

Answers:

Diet and ExerciseDiabetics may have sores that go unnoticedDecrease; exercise may cause hypoglycemiaStress will increase the need for insulin

Basic Types of Insulin

The goal of insulin therapy is strict blood glucose control.

Rapid Acting Humalog, NovologOnset-15 minsPeak- 1 hourDuration- 3 hoursClient Teaching-Give with meals

Short ActingHumalog R, Novolin ROnset-1 hourPeak- 2 hoursOnset- 4 hoursClient Teaching- Clear appearanceOnly type that can be given IV

Intermediate ActingNPH, Humulin NOnset-4 hoursPeak-8 hoursDuration- 12 hoursClient Teaching- Cloudy appearanceWhen mixing insulin draw Regular before IntermediateThink "clear before cloudy"

Long ActingLantusOnset 1 hourPeak- No peak (continuous)Duration- 24 hoursClient Teaching- Taken at bedtime

General Insulin TeachingInject subcutaneously-do not aspirateDo not massage site after injectionRotate injection siteMay need to decrease insulin after exercise to prevent hypoglycemia

Oral Antidiabetic AgentsMust be used in conjunction with diet and exercise

comes in tablet formgive 30 minutes before mealsused to treat type 2 diabetes onlyDo not give to type 1 diabetics

Examples: Metformin, Byetta, Glucophage, Avandia

Side Effects:GI disturbance (diarrhea, nausea, etc.)HeadacheWeight gain

Client Teaching:-Several medications interfere with Oral antidiabetics:CoumadinOral ContraceptivesCorticosteriodsSymptoms of hyper/hypoglycemia

Diabetes Related Complications

In order to critically think for the NCLEX you need to have a basic understanding of these common diabetes related complications.

Hypoglycemia (Low Blood Sugar)Blood glucose is less than 65Signs:physical- trembling, tachy, shaking, hungry,weak, sweatingmental- incoherent, combative, belligerent, slurred speechCause: too much insulintoo much exercisetoo little foodTreatment: Give a fast acting sugar (candy, glucose tablet, 8 ounze skim milk)If client is unconscious give 50% Dextrose IV or Glucagon IM

Hyperglycemia (High Blood Sugar)Blood glucose is 200-800Signs: physical-3 P's, dehydration, weakness, tachymental-confusion, incoherent, stupor, lethargicCause: dehydrationillnessstressmissed dose of insulin

Other complications

Diabetic retinopathy is the result of changes of in the small vessels in the eyes due to poorly controlled blood sugar. Cataracts and blindness are common in diabetics, teach clients to get yearly eye exams.Atherosclerosis is the result of blood vessels becoming hard due to uncontrolled diabetes, proper diet and exercise should be emphasized during treatment.Infections are common in people with diabetes (foot, urinary tract, and yeast)Lipodystrophy is the result of fatty masses that are produced when insulin injections are giving in the same place repeatedly. Teach clients the importance of injection site rotation.DKA (please see link)HHNS (please see link)

Dawn Phenomenon occurs between 5-8 am. The client will wake up hyperglycemic. Think "I am hyper at dawn" Give bedtime insulin to prevent this from happening.

Somogyi phenomenon is rebound hyperglycemia. It starts around 2am; at first the client will be hypoglycemic so the body releases stored insulin but the effect is hyperglycemia by 7am. Teach the client to eat a snack at bedtime to prevent this from happening.

The ABC's of Diabetes Care

A1c less than 7%Blood pressure controlCholesterol controlDiabetes educationEye examFoot examGlucose monitoring

Gestational Diabetes

Gestational diabetes is glucose intolerance that begins during pregnancy. Hyperglycemia occurs because the placental hormones cause insulin resistance in the mother.

The risk factors for gestational diabetes include:25 years or olderOverweightFamily history of diabetesAfrican, Hispanic, or Native AmericanPrevious baby 9lbs or greater

Signs of gestational diabetes:

PolyuriaPolydipsiaPolyphagia

Diagnosis:Fasting glucose test greater 126 mg/dL (no calorie intake for 8 hrs)or3 hour glucose tolerance test

How gestational diabetes affects the baby:Born overweightExperience hypoglycemia after birth

Treatment includes:Blood glucose monitoringDietExerciseInsulin-last resort**Never give oral glycemics during pregnancy****On NCLEX always remember to check blood glucose level first before giving any treatment

NCLEX Review Questions:

What is the primary way to treat gestational diabetes?

How should clients with gestational diabetes deliver?

Answers:

Blood glucose monitoring and Diet

By C-section due to baby size and prevention of injury