NUR 112 - IGGY Med Surg I Ch 67.txt

  1. Who is mostly affected by the macro & micro vasular disease complications of diabetes?
  2. How to assess HHS and what is it? How to treat?
    Pt will have difficulty breathing (hyperglycemia). Give insulin and fluids.
  3. If DKA Pt is hyperkalemic and insulin has not driven it back into the cells, what is the next thing to try, why, and after that?
    Must get it out before it causes heart dysrhythmias, so KAYEXELATE - out in diarrheia. After that dialysis.
  4. Secondary diabetes can be induced by many things, among them drugs such as AAAA. It can also result from BBBB.
    • a. steroids
    • b. inflammation of the pancreas
  5. Gestational diabetes usually results in AAAA and is diagnosed at BBBB. Babies will often have health probems.
    • a. large babies
    • b. 28 weeks
  6. What do you give in Hyperglycemic-hyperosmotic (HHS) state?

    Similar to DKA except there are no ketones. Blood sugars are always way over 500, 900, 1200.
    Insulin and fluid replacement in HHS is to increase blood volume. In shock and severe hypotension, give normal saline. Otherwise, use half-normal saline because it more rapidly corrects the water deficit. Infuse fluids at 1 L/hr until central venous pressure or pulmonary capillary wedge pressure begins to rise or until blood pressure and urine output are adequate. The rate is then reduced to 100 to 200mL/hr.
  7. Hypoglycemia: AKA- Insulin shock: What would you see when you walk into a patients room?
    • Confusion
    • Cold, clamey skin
    • Diaphoresis (sweating)
    • Very irritable
    • Tremors/shakey
  8. Wright seems to think that shallow and rapid respiration is a sign of respiratory alkalosis and a type of Kussmaul respiration.
  9. Metabolic acidosis, resulting from DKA, leads to AAAA that are BBBB.
    • a. Kussmaul respirations
    • b. deep and rapid
  10. Neuropathy causes AAAA, resulting in dry, thinning skin. Skin cracks and fissures increase the risk for infection.
    a. loss of normal sweating and skin temperature regulation
  11. Leading cause of amutation worldwide?
  12. Most common complication of diabetes leading to hospitalization?
    Foot injury
  13. Guidelines for exercise are based on blood glucose levels and urine ketone levels. The patient checks AAAA levels before exercise. Patients with type BBBB diabetes should perform vigorous exercise only if blood glucose levels are CCCC and DDDD. The absence of urine ketones indicates that enough insulin is available for glucose transport and that exercise should be effective in lowering blood glucose levels. When urine ketones are present the patient should not exercise. Ketones indicate that current insulin levels are not adequate and that exercise would elevate blood glucose levels.
    • a. blood glucose
    • b. 1
    • c. 80 to 250 mg/dL
    • d. no ketones are present in the urine
  14. Exercise in the presence of long-term complications of diabetes often requires some adjustment. Vigorous aerobic or AAAA may be contraindicated in the presence of BBBB or severe non-PDR (NPDR). Teach the patient with PDR or NPDR to avoid the Valsalva maneuver (breath holding while bearing down) and activities that increase blood pressure. Heavy lifting, rapid head motion, or jarring activities can cause CCCC.
    • a. resistance exercise
    • b. proliferative diabetic retinopathy (PDR)
    • c. vitreous hemorrhage or retinal detachment
  15. Regular exercise decreases the risk for cardiovascular disease. It decreases AAAA and increases BBBB. Exercise decreases blood pressure and improves cardiovascular function. Regular vigorous physical activity prevents or delays type 2 diabetes by reducing body weight, CCCC, and DDDD.
    • a. most blood lipid levels
    • b. high-density lipoproteins (HDLs)
    • c. insulin resistance
    • d. glucose intolerance
  16. Regular exercise is an essential part of diabetic management. It has beneficial effects on AAAA and BBBB.
    • a. carbohydrate metabolism
    • b. insulin sensitivity
  17. Because of the potential for alcohol-induced AAAA, instruct the patient to ingest alcohol BBBB. Alcohol raises plasma triglycerides. Thus reducing or abstaining from alcohol is important for patients with CCCC. One alcoholic beverage is substituted for DDDD fat exchanges when calculating caloric intake.
    • a. hypoglycemia
    • b. only with or shortly after meals
    • c. hyperlipidemia
    • d. two
  18. One alcoholic beverage equals?
    • 12 ounces of beer
    • 5 ounces of wine
    • 1-1/2 ounces of distilled spirits
  19. Dietary sucrose does not increase blood glucose more than AAAA. Intake of sucrose and sucrose-containing foods by patients with diabetes does not need to be restricted out of a concern for causing hyperglycemia. Sucrose can be included in the meal plan as long as it is adequately covered with insulin or other glucose-lowering agents.
    a. equal amounts of other starches
  20. An increase in AAAA should accompany increased fiber intake. The nurse and the patient should pay careful attention to blood glucose levels because BBBB can result when dietary fiber intake increases significantly.
    • a. fluid intake
    • b. hypoglycemia
  21. Teach the patient to select a variety of fiber-containing foods such as AAAA because they provide vitamins, minerals, and other substances important for good health.
    • legumes
    • fiber-rich cereals (more than5 g fiber / serving)
    • fruits
    • vegetables
    • whole-grain products
  22. AAAA improves carbohydrate metabolism and lowers cholesterol levels.
  23. Dietary fat and cholesterol, especially saturated fatty acids and trans fatty acids are restricted to reduce the risk for AAAA.
    cardiovascular disease
  24. What nutrient has the greatest impact on after-meal blood glucose levels?
    Carbohydrates - amount & type
  25. Carbohydrate recommendation for the diabetic patient is a diet containing AAAA of calories from carbohydrate, with a minimum intake of BBBB g carbohydrate per day. The diet should include carbohydrates from CCCC. Diets restricting total carbohydrate to less than BBBB g/day are not recommended in the management of diabetes.
    • a. 45% to 65%
    • b. 130
    • c. fruit, vegetables, whole grains, legumes, and low-fat milk
  26. Protein intake of AAAA of total daily calories is appropriate for diabetic patients with BBBB. In patients with microalbuminuria, reduction of protein to CCCC may slow progression of renal failure, and a reduction to not more less 0.8 g/kg body weigh tin later stages of chronic kidney disease may improve function.
    • a. 15% to 20%
    • b. normal kidney function
    • c. 10% of calories (0.8 to 1.0 g/kg)
  27. AAAA are common side effects of pramlintide (injectable) therapy. It should not be used for patients with symptomatic gastroparesis. Pramlintide carries a black box warning for BBBB. The hypoglycemic risk is higher in patients with CCCC diabetes and usually occurs within 3 hours of injection.
    • a. Nausea, vomiting, and anorexia
    • b. insulin-induced severe hypoglycemia
    • c. type 1
  28. Teach the patient to prepare and self-administer pramlintide. A U-100 syringe is used to administer the drug. However, it is necessary to convert the microgram dosage to insulin syringe unit increments, e.g. AAAA. Pramlintide and insulin are NOT to be mixed in the same syringe because BBBB. Teach the patient to inject pramlintide into a site CCCC.
    • a. 15 mcg is equal to 2.5 units
    • b. the pH of the two drugs is not compatible
    • c. different from where insulin is injected
  29. Pramlintide alters gastric uptake. Therefore instruct patients to take oral drugs in which AAAA either BBBB hour before or CCCC hours after eating.
    • a. rapid onset of action is important (e.g., analgesics)
    • b. 1
    • c. 2
  30. The initial dose of pramlintide is AAAA before meals with BBBB. It can be given up to 4 times per day. Dosage is increased in 15-mcg increments to a target doseage of CCCC.
    • a. 15 mcg subcutaneously
    • b. at least 250 calories or 30 grams of carbohydrate
    • c. 30 mcg or 60 mcg
  31. What is Pramlintide and how does it work?
    It is an injectable diabetes drug (an amylin analogue) that works by three mechanisms:

    • 1) delaying gastric emptying
    • 2) reducing after-meal blood glucose levels
    • 3) triggering satiety (in the brain), which leads to decreased caloric intake and weight loss
  32. Amylin analogues are drugs similar to amylin, a naturally occurring AAAA produced by BBBB in the pancreas, that works with and is co-secreted with CCCC in response to blood glucose elevation. Amylin levels are deficient in patients with type DDDD diabetes who are also deficient in insulin. EEEE, an analogue of amylin, is approved for patients with FFFF diabetes treated with insulin. It is indicated as adjunct therapy for patients who use mealtime insulin delivery and have not achieved desirable glucose control despite optimum insulin therapy.
    • a. hormone
    • b. beta cells
    • c. insulin
    • d. 1
    • e. Pramlintide (Symlin)
    • f. either type 1 or type 2
  33. Another reason to not reuse AAAA needles is that even with one injection, the needle tip can become bent to form a hook, which can BBBB.
    • a. smaller (30- and31-gauge)
    • b. lacerate tissue or break off to leave needle fragments in the skin
  34. AAAA insulins contain products that inhibit the growth of bacteria commonly found on the skin. However, many diabetic patients are at an increased risk for infection.
  35. AAAA needles are not used for BBBB patients because of poor insulin absorption.
    • a. Short
    • b. obese
  36. Insulin syringe needles are measured in AAAA-gauge and in lengths of BBBB.
    • a. 28-, 29-, 30-, and 31
    • b. 1/2-inch and 5/16-inch
  37. The unit scale on the barrel of the syringe differs with the AAAA and BBBB.
    • a. syringe size
    • b. manufacturer
  38. Syringes are the most commonly used method to adminis-ter insulin. The standard insulin syringes are marked in insulin units. They are available in AAAA sizes.
    • 1-mL (100-U)
    • 1/2-mL (50-U)
    • 3/10-mL (30-U)
  39. Dose preparation is critical for insulin effectiveness and patient safety. Teach patients that the person giving the insulin needs to inspect the insulin before each use for changes (e.g.,AAAA) that may indicate loss in potency.
    • clumping
    • frosting
    • precipitation
    • change in clarity or color
  40. Teach patients to always have a spare bottle of each type of insulin used. A slight loss in potency may occur after the bottle has been in use for more than AAAA days, even when the expiration date has not passed.
  41. Dawn phenomenon results from a nighttime release of AAAA that causes blood glucose elevations at about BBBB. It is managed by providing more insulin for the overnight period (e.g. giving the evening dose of intermediate-acting insulin at 10 pm).
    • a. growth hormone
    • b. 5 to 6 am
  42. AAAA is an increased swelling of fat that occurs at the site of repeated insulin injections. The overlying skin has decreased sensitivity, and the area can become large and unsightly. Treatment consists of rotating the injection site among different body areas.
  43. AAAA is a loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in insulin. Treatment consists of injection of insulin at the edge of the atrophied area.
  44. No other insulin should be mixed with insulin AAAA or insulin BBBB.
    • a. glargine
    • b. detemir
  45. Short-acting and NPH insulins may be used AAAA when mixed, or they BBBB.
    • a. immediately
    • b. may be stored
  46. When rapid-acting (Humalog or NovoLog) or short-acting (regular) insulin is mixed with a longer-acting insulin, draw the AAAA dose into the syringe first, which prevents contamination of the AAAA insulin vial with the BBBB insulin.
    • a. shorter-acting
    • b. longer-acting
  47. Mixing insulins can change the time of peak action. Mixtures of short- and intermediate-acting insulins produce a more normal blood glucose response in AAAA patients than does a singledose.
  48. When blood glucose levels are below the target range, injection of regular insulin should be AAAA until BBBB eating and injection of rapid-acting insulin should be delayed until CCCC eating the meal.
    • a. delayed
    • b. immediately before
    • c. sometime after
  49. When blood glucose levels are above the target range, the lag time should be AAAA to permit insulin to begin to have an, effect sooner. Rapid-acting insulin analogues can be given BBBB minutes before and regular insulin CCCC minutes before eating a meal.
    • a. increased
    • b. 15
    • c. 30 to 60
  50. Regular insulin should be given at least AAAA minutes before eating when glucose levels are within the target range.
    20 to 30
  51. Insulin AAAA, insulin BBBB, and insulin CCCC have rapid onsets of action and should be given within DDDD minutes before mealtime when blood glucose is in the target range. If hyperglycemia or hypoglycemia is not present, these insulins can be given at any time from DDDD minutesbefore mealtime to just before eating or even immediately after eating.
    • a. lispro
    • b. aspart
    • c. glulisine
    • d. 10
  52. Timing of injection affects blood glucose levels. The interval between premeal injections and eating, known as "AAAA," affects blood glucose levels after meals.
    lag time
  53. Injection depth changes insulin absorption. Usually, injections are made into the AAAA or BBBB.
    • a. subcutaneous tissue
    • b. IV
  54. Scarred sites often become favorite injection sites because they are AAAA, but these areas usually slow the rate of insulin absorption.
    less sensitive to pain
  55. Factors that increase blood flow from the injection site, such as AAAA, BBBB, and CCCC, increase insulin absorption.
    • a. local application of heat
    • b. massage of the area
    • c. exercise of the injected area
  56. The abdomen (except for a 2 inch radius around the navel) is the preferred site because ...
    it provides the most rapid insulin absorption
  57. Rotation within one anatonic site is preferred to rotation from one site to another to ...
    prevent day-to-day changes in absorption.
  58. Rotating injection sites prevents AAAA and BBBB
    • a. lipohypertrophy (increased fat deposits in the skin)
    • b. lipoatrophy (loss of fatty tissue, leaving an uneven appeaiance).
  59. Absorption is fastest in this order:
    • abdomen
    • deltoid
    • thigh
    • buttocks
  60. Many factors affect insulin absorption and availability including AAAA; BBBB, CCCC; and DDDD.
    • a. injection site
    • b. timing
    • c. type, or dose of insulin used
    • d. physical activity
  61. How do diabetic Pts will deal with insulin peaks?
    with a snack
  62. Insulin glargine injection
    Type, Brand, Onset, Peak, Duration
    • Type: Long-acting
    • Brand: Lantus
    • Onset: 2-4
    • Peak: None
    • Duration: 24

    Never mix; Given at bedtime
  63. Isophane Insulin NPH injection
    Type, Brand, Onset, Peak, Duration
    • Type: Intermediate-acting
    • Brand: Humulin N (anything N)
    • Onset: 1.5
    • Peak: 4-12
    • Duration: 16-24+
  64. Regular human insulin injection
    Type, Brand, Onset, Peak, Duration
    • Type: Short-acting
    • Brand: Humulin R (anything R)
    • Onset: 0.5
    • Peak: 2-4
    • Duration: 5-7
  65. Human lispro injection
    Type, Brand, Onset, Peak, Duration
    • Type: Rapid-acting
    • Brand: Humalog
    • Onset: 0.25
    • Peak: 0.5-1.5
    • Duration: 5
  66. Insulin aspart
    Type, Brand, Onset, Peak, Duration
    • Type: Rapid-acting
    • Brand: Novolog
    • Onset: 0.25
    • Peak: 1-3
    • Duration: 3-5
  67. Usual starting dose for insulin?
    Between 0.5 and 1 unit/kg of body weight per day.
  68. What do insulin regimens seek to accomplish: A, and how: B?
    A. Try to duplicate the normal insulin release pattern from the pancreas.

    B. The pancreas produces a constant (basal) amount of insulin that balances liver glucose production with glucose use and maintains normal blood glucose levels between meals. The pancreas also produces additional (prandial) insulin to prevent blood glucose elevation after meals.
  69. Longer-acting oral antidiabetic agents (e.g., glyburide, glimepiride) with once-a-day dosing are better for AAAA.
    a. adherence
  70. Shorter-acting oral diabetic agents (e.g., glipizide) are preferable for?
    • older patients
    • those with irregular eating schedules
    • those with liver, kidney, or cardiac dysfunction,
  71. The choice of oral antidiabetic drug is based on AAAA, the patients ability to BBBB, CCCC, and DDDD.
    • a. cost
    • b. manage multiple drug doses
    • c. age
    • d. response to the drugs
  72. AAAA drugs are not a substitute for dietary modification and exercise. Teach the patient about the need for continuing dietary restrictions and regular exercise while taking AAAA drugs. To avoid adverse drug interactions, teach the patient to consult with the primary care provider or pharmacist before using any over-the-counter drugs.
    a. Antidiabetic
  73. a. What is Glucovance?

    b. When is it used?

    c. Nursing considerations
    a. An oral diabetes drug that is a combination of: glyburide and metformin which have different mechanisms of action.

    b. Metformin added to regimen when blood glucose is inadequately controlled on glyburide therapy alone.

    c. Teach patients how to prevent and treat hypoglycemia because hypoglycemia may occur when metformin is given in combination with sulfonylurea agent.
  74. Nursing interventions for Pioglitazone (Actose)?
    Emphasize the need for liver function tests as recommended. Instruct patients to report symptoms of unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, or dark urine.

    RATIONALE: Rare cases of liver failure have occurred with pioglitazone. Liver function tests are measured at the start of therapy and at regular intervals thereafter. Not recommended for moderate to severe liver impairment or in patients with jaundice.

    Advise women of the need for effective contraception during therapy.

    RATIONALE: Administration of pioglitazone with certain oral contraceptives may reduce the plasma concentration of the oral contraceptive. Post-menopausal women with insulin resistance may resume ovulation during therapy.

    Monitor weight; assess for edema and shortness of breath.

    RATIONALE: Fluid retention can lead to weight gain and can cause or exacerbate congestive heart failure.
  75. Pioglitazone (Actose)
    a. What is it?
    b. How does it act?
    c. What is the usual dose?
    • a. oral diabetes drug
    • b. Improves tissue sensitivity to insulin in the treatment of type 2 diabetes.
    • c. Usual dose: 15 mg or 30 mg once daily without regard to meals
  76. Nursing interventions: Nateglinide (Starlix)
    Teach patients to take the drug 3 times daily, 1 -30 min before meals which is most effective

    Teach patients to omit the drug when skipping a meal, and instruct them to add a dose if an extra meal is eaten. Hypoglycemia may occur shortly after dosing when the meal is delayed or omitted.
  77. Nateglinide (Starlix)
    a. What is it?
    b. How dos it act?
    c. What is the usual dose?
    • a. oral diabetes drug
    • b. Increase insulin secretion in the treatment of type2 diabetes; and Short-acting agent used to prevent postmeal blood glucose elevation.
    • c. Usual dose 60-120 mg before meals
  78. While AAAA do not cause secondary diabetes, they shouldn’t be taken when treating diabetes orally with BBBB agents because they can lower their effectiveness and THAT can lead to CCCC.
    • a. NSAIDs
    • b. sulfonylurea
    • c. hyperglycemia
  79. Side effects of sulfonylurea agents include AAAA and BBBB.
    • a. weight gain
    • b. hypoglycemia
  80. AAAA (oral) agents are classified as insulin BBBB and are used for patients with some remaining pancreatic beta-cell function. These drugs stimulate insulin secretion from pancreatic beta cells and CCCC. The overall effect of sulfonylurea therapy is lowering of fasting plasma glucose levels.
    • a. Sulfonylurea
    • b. secretagogues
    • c. increase the number or sensitivity of cell receptor sites for interaction with insulin
  81. AAAA glucose testing is an indirect measurement of blood glucose and is much less precise than blood glucose testing. Fluid intake, urine elimination patterns, and certain drugs affect the results. This test may be appropriate for a quickscreening but should not be used for monitoring diabetes management.
    a. Urine
  82. Tests for kidney function are important because the presence of AAAA without kidney symptoms may indicate BBBB changes in the kidney. Urine albumin excretion rates of 20 to 200 g/min indicate CCCC. Even minor elevations of albumin are associated with increased mortality.
    • a. urine protein
    • b. microvascular
    • c. microalbuminuria
  83. AAAA testing also is recommended for diabetic patients participating in a weight-loss program. BBBB without hyperglycemia suggests that weight loss is occurring without disrupting blood glucose control.
    • a. Ketone
    • b. Hyperketonuria
  84. Urine testing for AAAA should be performed during acute illness or stress, when blood glucose levels consistently exceed BBBB mg/dL, during , or when any symptoms of DDDD are present.
    • a. ketones
    • b. 300
    • c. pregnancy
    • d. ketoacidosis
  85. Hyperketonuria in the presence of AAAA is a medical emergency that, when detected early, can be treated with BBBB and careful monitoring.
    • a. hyperglycemia
    • b. insulin
  86. Ketone bodies are a product of AAAA metabolism.The presence of moderate to high urine ketones (hyperketonuria) indicates a severe lack of insulin.
    a. fat
  87. Glycosylated hemoglobin assays are useful because blood glucose permanently attaches to hemoglobin. The higher the blood glucose level is over time, the more glycosylated hemoglobin becomes. Thus glycosylated hemoglobin (HbAlc) is a good indicator of the average blood glucoselevels. Measurement of HbAlc shows the average blood glucoseWpI Hnrino the nrevious AAAA days—the life span of red blood.
    a. 120
  88. Screening to detect pre-diabetes and diabetes should be considered in patients older than AAAA years and those defined as overweight (BMI greater than BBBB kg/m2). It is considered also for patients who are younger than AAAA years and are overweight if they have additional risk factors for diabetes. If OGTT is used instead of FPG (fasting plasma glucose) is done, it uses a CCCC glucose load.
    • a. 45
    • b. 25
    • c. 75g
  89. Measurement of AAAA levels indicates beta secretory function of the pancreas. AAAA levels correlate well with insulin levels and are used to diagnose BBBB diabetes.
    • a. C-peptide
    • b. type 1
  90. Type 1 diabetes is an autoimmune diseasewith the presence of autoantibodies to proteins. The presence of AAAA is an indicator for type 1 diabetes.
    a. islet cell antibodies (ICA)
  91. The diagnosis of gestational diabetes mellitus (GDM) is based on the AAAA
    a. oral glucose tolerance test (75-g, 2-hr test or 100-g, 3-hr test)
  92. Oral glucose tolerance testing (OGTT) is the most sensitive test for the diagnosis of diabetes. It is AAAA used in the diagnosis of diabetes because the test is inconvenient to patients, costly, and time consuming compared with fasting blood glucose measures.
    a. not routinely
  93. Factors that adversly affect an oral glucose tolerance test?
    • Carbohydrate restriction
    • bedrest
    • acute illness
    • Phenytoin (Dilantin)
    • anovulatory drugs - one's that treat no ovulation
    • diuretics
    • nicotinic acid
    • glucocorticoids
  94. Fasting Blood Glucose test prep?
    No food or liquid for at least 8 hours.
  95. Normal and abnormal Glycosylated hemoglobin (HbAlc)
    • Normal: 4-6%
    • Anbormal: >8% indicate poor diabetic control and need for adherence to regimen or changes in therapy.
  96. Normal and abnormal Glucose tolerance test (2-hr post-load result)?
    Normal: < 140mg/dL

    Abormal: >140 mg/dL and<200 mg/dL indicate impaired glucose tolerance (IGT).

    Levels >200 mg/dL indicate provisional di-agnosis of diabetes. (Sim rslt on a subsequent day, sim circumstances confirms.)
  97. Normal and abnormal fasting blood glucose test results?
    • Normal: < 100mg/dL
    • Abnormal: > 100mg/dL but < 126 mg/dL
    • indicate impaired fasting glucose (IFG).
    • > 126mg/dL obtained on at least two occasions are diagnostic of diabetes, even in older adults.
  98. Diabetes is a significant health problem for AAAA. The prevalence rates for this disease can be from BBBB times higher than the rate for white patients.
    • a. African Americans, American Indians, Hispanic Americans, Asian Americans, and Pacific Islanders
    • b. 1.6 to 1.9
  99. Type 2 diabetes can be prevented or delayed by weight loss and increased physical activity. Encourage people to maintain weight within an appropriate range for height and body build. Teach them that strategies to reduce the AAAA risk factors of BBBB also reduce the incidence of type 2 diabetes and its long-term complications.
    • a. cardiovascular
    • b. tobacco use, hypertension, and high blood lipidlevels (triglycerides)
  100. Urge all patients with diabetes to regularly follow-up with their health care provider or endocrinologist, have their eyes and vision tested AAAA by an ophthalmologist, and have BBBB assessed yearly. Early diagnosis of changes allows adjustments in treatment regimens to be made that slow progression of eye and kidney problems.
    • a. yearly
    • b. urine microalbumin levels
  101. Health promotion for patients with type 1 diabetes focuses on controlling AAAA to reduce its long-term complications. Teach all patients with diabetes that tight control of blood glucose levels can prevent BBBB.
    • a. hyperglycemia
    • b. life-shortening complications
  102. The fact that diabetes is a common disorder and causes many preventable but devastating complications makes the disease a AAAA. Control of diabetes and its complications is a major focus for BBBB.
    • a. major public health problem
    • b. health promotion activities
  103. Heredity plays a major role in the development of type 2 diabetes. Offspring of patients with type 2 diabetes have a AAAA chance for developing the disease and a BBBB risk for having impaired glucose tolerance.
    • a. 15%
    • b. 30%
  104. Risk for type 1 diabetes is determined by inheritance of genes coding for the AAAA. However, although inheritance of these genes increases the risk, most people with these genes do not develop type 1 diabetes.
    a. HLA-DR and HLA-DQ tissue types
  105. Type 1 diabetes is an autoimmune disorder in which beta cells are destroyed in a genetically susceptible person. The immune system fails to recognize normal body cells as "self" and takes destructive actions against them. In type 1 diabetes, AAAA attack and detroy insulin secreting cells in the islets.
    a. immune system cells, mediators, and antibodies
  106. Serum potassium levels in diabetes, then, may be low (AAAA), high (BBBB), or normal, depending on hydration, the severity of acidosis, and the patients response to treatment.
    • a. hypokalemia - with dehydratuion
    • b. hyperkalemia - with acidosis
  107. Insulin lack causes potassium AAAA. Because of the increased fluid loss with hyperglycemia, excessive potassium is excreted in the urine, leading to low serum potassium levels. However, BBBB may occur in acidosis because of the shift of potassium from inside the cells to the blood.
    • a. depletion
    • b. high serum potassium levels
  108. When the lungs can no longer offset acidosis, the AAAA drops. Arterial blood gas studies show a BBBB and CCCC.
    • a. blood pH
    • b. metabolic acidosis(decreased pH with decreased arterial bicarbonate [HCO3]levels)
    • c. compensatory respiratory alkalosis (decreased partial pressure of arterial carbon dioxide [PacoJ).
  109. The excess acids caused by absence of insulin increase AAAA and BBBB levels in the blood, causing CCCC. These products trigger the respiratory centers of the brain to increase the rate and depth of respiration in an attempt to excrete more carbon dioxide and acid. This type of breathing is known as DDDD. EEEE is exhaled, giving the breath a "fruity" odor.
    • a. hydrogen ion (H+)
    • b. carbon dioxide (C02)
    • c. metabolic acidosis
    • d. Kussmaul respiration
    • e. Acetone
  110. Frequent eating

    C. Polyphagia
  111. Frequent fluid intake

    A. Polydipsia
  112. Frequent urination

    A. Polyuria
  113. Why is glucose vital to the body's cells?

    A. It is used by cells to produce energy.
  114. Which statement is true about insulin?

    B. It is necessary for glucose transport across cell membranes. (except in brain, liver, and blood cells)
  115. Usually abrupt onset of thirst and weight loss.

    C. Type 1
  116. Most who suffer with this type of dibetes are obese adults.

    A. Type 2
  117. Carbohydrate intolerance is first recognized during pregnancy.

    A. Gestational
  118. Autoimmune process is causing beta cell destruction.

    B. Type 1
  119. Cells have a reduced ability to respond to insulin.

    A. Type 2
  120. Diagnosis based on results of 100G glucose tolerance test.

    C. Gestational
  121. Glucagon is used primarily to treat the patient with which disorder?

    B. Severe hypoglycemia
  122. The insulin-dependent diabetic patient is planing to travel by air and asks the nurse about preparations for the trip. What does the nurse tell the patient to do?

    D. Carry all necessary diabetes supplies in a clearly identified pack aboard the plane.
  123. What is a secondary source of acid-base problems that result from insufficienr insulin and how does it occur?
    Lactic acid increases, causing more metabolic acidosis. It results from the dehydration that occurs with diabetes that leads to hemo-concentration, hypovolemia, hyperviscosity, hypoperfusion of tissues, and hypoxia, especially to the brain. Hypoxic cells do not metabolize glucose efficiently, the Krebs' cycle is blocked, and lactic acid results from the anerobic metabolism of glucose in cells that do not need insulin to get glucose acroos the cell membrane. (Remember - not all cell types require insulin, e.g. brain, liver & blood.)
  124. What acid-base problem arises from insulin deficiency and how does it occur?
    Fats break down, releasing free fatty acids. Conversion of fatty acids to ketone bodies (small acids) provides a backup energy source. Because ketone bodies, or "ketones," are abnormal breakdown products of fatty acids, they collect in the blood when insulin is not available.This collection causes metabolic acidosis.
  125. Polyuria is frequent and excessive urination and results from an AAAA caused by excess glucose in the urine. As a result of diuresis, BBBB are excreted in the urine and water loss is severe. CCCC results, and DDDD, which is excessive thirst, occurs.
    • A. osmotic diuresis
    • B. sodium, chloride, and potassium
    • C. Dehydration
    • D. polydipsia
  126. Hyperglycemia causes AAAA, leading to the classic symptoms of diabetes: BBBB.
    • A. fluid and electrolyte imbalances
    • B. polyuria, polydipsia, and polyphagia
  127. Without insulin, glucose builds up in the blood, causing AAAA, which BBBB.
    • A. hyperglycemia
    • B. is high blood glucose levels
  128. This type of insulin should not be diluted or mixed with any other insulin or solution.

    A. Insulin glargine (Lantus)
  129. This type of insulin should be given 30minutes before meals.

    C. Regular insulin
  130. When mixing insulins, this type is always drawn up first.

    B. Regular insulin
  131. This type of insulin is a long-acting insulin analogue given once daily at bedtime for basal insulin coverage.

    A. Insulin glargine (Lantus)
  132. This type of insulin is used in most regimens for basal insulin coverage.

    B. NPH insulin
  133. Place the injection sites in order of speed of absorption using the numbers 1 through 4, with 1 having the fastest absorption and 4 having the slowest absorption.

    _ a. Buttocks
    _ b. Abdomen
    _ c. Deltoid
    _ d. Thigh
    4, 1, 2, 3
  134. The patient has been receiving insulin in the abdomen for 3 days. On day 4, where does the nurse give the insulin injection?

    C. Abdomen, but in an area different from the previous day s injection
  135. The patient with diabetes has signs and symptoms of hypoglycemia. The patient has a blood glucose of 56 mg/dL, is not alert but responds to voice, and is confused and is unable to swallow fluids. What does the nurse do next?

    C. Administer D50 IV push.
  136. The patient with diabetes has signs and symptoms of hypoglycemia. The patient is alert and oriented with a blood glucose of 56 mg/dL. What does the nurse do next?

    D. Give a glass of orange or other type of juice and continue to monitor the patient.
  137. The patient with type 2 diabetes is taking a mixture of NPH and regular insulin at home.The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patients morning dose of insulin?

    a. Administer the dose that is routinely prescribed at home because the patient has type 2 diabetes and needs the insulin.
    b. Administer half the dose because the patient is NPO.
    C Hold the insulin with all the other medications because the patient is NPO and there is no need for insulin.
    d. Contact the health care provider for an order regarding the insulin.
    d. Contact the health care provider for an order regarding the insulin.
  138. The patient with type 1 diabetes is taking a mixture of NPH and regular insulin at home.The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patient's morning dose of insulin?

    A. Contact the health care provider for an order regarding the insulin.
  139. Which are signs and symptoms of mild hypoglycemia? (Select all that apply.)

    a. Headache
    b. Weakness
    c. Cold, clammy skin
    d. Irritability
    e. Pallor
    f. Tachycardia
    • a. Headache
    • b. Weakness
    • d. Irritability
    • e. Pallor
  140. The patient has been diagnosed with diabetes. Which aspects does the nurse consider informulating the teaching plan for this patient? (Select all that apply.)

    a. Covering all needed information in one teaching session
    b. Assessing visual impairment regarding insulin labels and markings on syringes
    c. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe
    d. Assessing patient motivation to learn and comprehend instructions
    e. Assessing the patient's ability to read printed material
    • b. Assessing visual impairment regarding insulin labels and markings on syringes
    • c. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe
    • d. Assessing patient motivation to learn and comprehend instructions
    • e. Assessing the patient's ability to read printed material
  141. The patient with type 2 diabetes often has which laboratory value?

    D. Elevated triglycerides
  142. The 50-year-old patient seen in the emergency department (ED) reported nausea, vomiting, and dehydration. When admitted to the hospital, the patient's fasting blood glucose was over500 mg/dL, and a blood gas showed a pH of 7.38. The patient was diagnosed with diabetes and treated with insulin and fluids. What do these events tell the nurse about the patient?

    C. The pancreas is producing enough insulin to prevent ketoacidosis.
  143. After a 2-hour glucose challenge, which result demonstrates impaired glucose tolerance?

    D. Greater than 140 mg/dL
  144. Which statement by the diabetic patient indicates an understanding of the principles of self-care?

    A. "I plan to get my spouse to exercise with me to keep me company"
  145. Which statement about sexual intercourse for diabetic patients is true?

    D. Impotence is associated with diabetes mellitus in male patients.
  146. Self-monitoring of blood glucose levels is most important in which patients? (Select all that apply.)

    • D. Patients taking multiple daily insulin injections
    • c. Patients with hypoglycemic unawareness
    • d. Patients using a portable infusion device for insulin administration
    • e. Ill patients
    • f. Pregnant patients
  147. The 25-year-old female patient with type 1 diabetes tells the nurse, "I have two kidneys and I'm still young. I expect to be around for a longtime, so why should I worry about my bloodsugar?" What is the nurses best response?

    B. "Keeping your blood sugar under control now can help to prevent damage to both kidneys."
  148. The nurse is teaching the diabetic patient about proper foot care. Which instruction does the nurse include?

    A. Apply moisturizing cream to the feet after bathing, but not between the toes
  149. The diabetic patient who swims for exercise is taught to administer insulin in which area of the body?

    D. Abdomen
  150. What is the recommended calorie reduction for the diabetic patient who must lose weight?

    D. 3500 calories/week
  151. What is the recommended protocol for type 2 diabetic patients who must lose weight?

    a. Participate in an aerobic program twice a week for 20 minutes each session.
    b. Slowly increase insulin dosage until mild hypoglycemia occurs.
    c Reduce calorie intake moderately and increase exercise.
    d. Reduce daily calorie intake to 1000 calories and monitor urine for ketones.
    c Reduce calorie intake moderately and increase exercise.
  152. Which statement about dietary concepts for the diabetic patient is true?

    B. Carbohydrate counting is emphasized when adjusting dietary intake of nutrients.
  153. What is the basic principle of meal planning for the patient with type 1 diabetes mellitus?

    C. Considering the effects and peak actiontimes of the patients insulin
  154. In developing an individualized meal plan for the diabetic patient, which goals are the focus of the plan? (Select all that apply.)

    a. Maintaining blood glucose levels at or as close to the normal range as possible
    b. Patient food preferences
    c. Allowing patients to eat as much as they desire
    d. Patient cultural preferences
    e. Limiting food choices only when guided by scientific evidence
    • a. Maintaining blood glucose levels at or as close to the normal range as possible
    • b. Patient food preferences
    • d. Patient cultural preferences
    • e. Limiting food choices only when guided by scientific evidence
  155. Turning of the great toe.

    A. Hallux valgus
  156. Deformity where the foot is warm, swollen, painful, and walking causes the arch to collapse, giving the foot a"rocker bottom" shape.

    A. Charcot foot
  157. Hyperextended toes causing increased pressure on the ball of the foot.

    A. Claw toe deformity
  158. According to the Diabetes Control and Complication Trial (DCCT) study of type 1 diabetes mellitus patients, intensive therapy with good glucose control resulted in delays in which complications? (Select all that apply.)

    a. Macrovascular disease
    b. Cardiovascular disease
    c. Retinopathy
    d. Nephropathy
    e. Neuropathy
    All of them.
  159. Loss of pain, pressure, and temperature sensation in the foot increases the risk for injury.

    a. True
    b. False
    a. True
  160. Very few patients with diabetic foot ulcers have peripheral sensory neuropathy.

    a. True
    b. False
    b. False - 60-90% have peripheral sensory neuropathy
  161. Sensory neuropathy, ischemia, and infection are the leading causes of foot disease among diabetics.

    a. True
    b. False
    a. True
  162. Healing of foot wounds is reduced because of impaired sensation.

    a. True
    b. False
    b. False - because of impaired circulation
  163. Which pathophysiology corresponds with this diabetic complication: Permanent blindness

    C. Retinopathy
  164. Which pathophysiology corresponds with this diabetic complication:
    Hard exudates on fundus

    C. Retinopathy
  165. Which pathophysiology corresponds with this diabetic complication:
    Pain or numbness

    A. Neuropathy
  166. Which pathophysiology corresponds with this diabetic complication:
    Hemorrhage into the eye

    B. Retinopathy
  167. Which pathophysiology corresponds with this diabetic complication:

    B. Nephropathy
  168. Which pathophysiology corresponds with this diabetic complication:
    Muscle weakness

    A. Neuropathy
  169. Which pathophysiology corresponds with this diabetic complication:
    End-stage renal disease

    C. Nephropathy
  170. Which pathophysiology corresponds with this diabetic complication: Neovascularization

    B. Retinopathy
  171. The patient with type 2 diabetes mellitus, usually controlled with a sulfonylurea, develops a urinary tract infection. Due to the stress of the infection, the patient must be treated with insulin. What additional information about this treatment does the nurse relay to the patient?

    C. The insulin is necessary to supplement the sulfonylurea until the infection clears.
  172. The diabetic patient has just returned from surgery with stable blood glucose levels between 120 and 180 mg/dL. Which IV solution will promote adequate hydration and stable blood glucose levels?

    A. D51/2NS at 125 mL/hr
  173. Which insulins are considered to have a rapid onset of action? (Select all that apply.)

    • D. Glulisine
    • d. Aspart
    • e. Lispro
  174. What is the earliest clinical sign of nephropathy?

    A. Microalbuminuria
  175. Which laboratory test is the best indicator of the patients average blood glucose level and/or compliance with the diabetes mellitus regimen over the last 3 months?

    C. Glycosylated hemoglobin (HbA 1 c)
  176. The 47-year-old patient with a history of type 2 diabetes mellitus and emphysema who reports smoking three packs of cigarettes per day is admitted to the hospital with a diagnosis of acute pneumonia. The patient is placed on the regular oral antidiabetic agents, sliding scale insulin, and antibiotic medications. On day 2of hospitalization, the health care provider orders prednisone therapy. What does the nurse expect the blood glucose to do?

    D. Increase
  177. The patient will be using an external insulin pump. What does the nurse tell the patient about the pump?

    C. The needle site must be changed every 1 to 3 days.
  178. The patient will be using an external insulin pump. What does the nurse tell the patient about the pump?

    A. The insulin supply must be replaced every 3 days.
  179. The diabetic patient is on a mixed-dose insulin protocol of 8 units regular insulin and 12 units NPH insulin at 7 am. At 10:30 am, the patient reports feeling uneasy, shaky, and has a headache. Which is the probable explanation for this?

    D. The regular insulins action is peaking, and there is an insufficient blood glucose level.
  180. Which statement about insulin administration is correct?

    D. Rotating injection sites improves absorption and prevents lipohypertrophy.
  181. Which statement about insulin is true?

    C. Insulins effectiveness depends on the individual patient's absorption of the drug.
  182. Which oral agent may cause lactic acidosis?

    B. Metformin
  183. Give drug with first bite of each main meal.

    A. Miglitol (Glyset)
  184. Hypoglycemic episodes are more likely to occur because of its long duration of action.

    B. Chlorpropamide (Diabinese)
  185. Hold drug for 48 hours if having x-ray with IV contrast dye (renal).

    D. Metformin (Glucophage)
  186. Give drug just before meals.

    C. Nateglinide (Starlix)
  187. Which is considered the earliest sign of diabetic nephropathy?

    D. Microalbuminuria
  188. The frequency with which the patient should monitor capillary blood glucose levels depends on levels of which element?

    D. Serum glucose
  189. The diabetic patient is scheduled to have a blood glucose test the next morning. What does the nurse tell the patient to do before coming in for the test?

    D. Eat the usual diet but have nothing aftermidnight.
  190. Which are preventive measures for diabetes mellitus?

    A. Maintaining ideal body weight
  191. What type of diabetes mellitus corresponds with this etiologic factor: Decreased Physical Activity

    B. Type 2
  192. What type of diabetes mellitus corresponds with this etiologic factor: Viral Infection

    B. Type 1
  193. What type of diabetes mellitus corresponds with this etiologic factor: Pregnancy

    A. Gestational
  194. What type of diabetes mellitus corresponds with this etiologic factor: Heredity

    A. Type 2
  195. What type of diabetes mellitus corresponds with this etiologic factor: Obesity

    A. Type 2
  196. What type of diabetes mellitus corresponds with this etiologic factor: Islet Cell Antibodies

    B. Type 1
  197. What type of diabetes mellitus corresponds with this etiologic factor: Autoimmune Process

    A. Type 1
  198. What type of diabetes mellitus corresponds with this etiologic factor: Aging Process

    A. Type 2
  199. When glucagon is administered, what does it do?

    B. Frees glucose from hepatic stores of glycogen
  200. Why is glucagon given in a dextrose solution?

    B. Dextrose increases blood sugar levels at a controlled rate.
  201. Early treatment of DKA and HHNS includes IV administration of which fluid?

    B. Normal saline
  202. What type of insulin is used in the emergency treatment of DKA and hyperglycemic-hyperosmolar nonketotic syndrome (HHNS)?

    D. Regular
  203. The patient is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin area dministered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dL. Which complication is the patient most at riskfor developing?

    A. Hypoglycemia
  204. Which factors differentiate DKA from HHS? (Select all that apply.)

    a. Level of hyperglycemia
    b. Amount of ketones produced
    c. Potassium levels
    d. Amount of volume depletion
    e. Dosage of insulin needed
    • a. Level of hyperglycemia
    • b. Amount of ketones produced
  205. In determining if the patient is hypogiycemic, the nurse looks for which characteristics in addition to checking the patient's blood glucose? (Select all that apply.)

    a. Nausea
    b. Hunger
    c. Irritability
    d. Palpitations
    e. Profuse perspiration
    f. Rapid deep respirations
    • b. Hunger
    • c. Irritability
    • d. Palpitations
    • e. Profuse perspiration
  206. The client with type 2 diabetes admitted for surgery has these results of today's laboratory testing: FPG = 122 mg/dL, after-meal blood glucose level = 182 mg/dL, and HbA1c = 5.8%. How should these values be interpreted with regard to the client's glucose control?

    A. Short-term values elevated, long-term values normal, overall good glucose control
    B. Short-term values elevated, long-term values elevated, overall poor glucose control
    C. Short-term values normal, long-term values normal, overall good glucose control
    D. Short-term values normal, Long-term values elevated, overall poor glucose control
    • ANS: A
    • Rationale: The American Diabetes Association (ADA) has proposed these treatment goals for glycosylated hemoglobin (HbA1c) and blood glucose levels (ADA, 2007c):
    • - HbA1c levels should be maintained at 7% or below.
    • - The majority of premeal (preprandial) blood glucose levels should be 90 to 130 mg/dL (5.0 to 7.2 mmol/L).
    • B is incorrect. The long-term value is the HbA1c, which is normal. Because this value is not affected by carbohydrate intake within the previous 48 hours, a normal value represents overall good glucose control.
    • C is incorrect. The short-term values are the FPG and the postmeal levels, which are both high.
    • D is incorrect. The short-term values are the FPG and the postmeal levels, which are both high; the long-term value is the HbA1c, which is normal. Because the long-term value is not affected by carbohydrate intake within the previous 48 hours, a normal value represents overall good glucose control.
  207. Insulins that are cloudy/clear?
    • Clear: rapid-acting, short-acting & glargine (long-acting)
    • Cloudy: All intermediate-acting
  208. Steps for insulin dose with mixed types?
    • 1. Inject air-dose into NPH (intermediate-acting) [all cloudy]
    • 2. Inject air-dose into regular, short-acting [all non-NPH are "clear"*]
    • 3. Withdraw regular short-acting (clear) first.
    • 4. Withdraw [all coudy insulins] last without injecting any of the first draws into the bottle.

    Air to Cloudy then Clear. Draw Clear then Cloudy.

    *glargine is clear, but is never mixed, and is usually given at hs
  209. Which of the following four laboratory findings is most indicative of diabetes mellitus?

    D. 2-hour glucose tolerance blood glucose =210 mg/dL
  210. Greatest risk for developing type 2 diabetes mellitus?

    B. 56-year-old Hispanic woman
  211. Untreated hyperglycemia results in which condition?

    C. Metabolic acidosis
  212. Which complications of diabetes mellitus are considered emergencies? (Select all that apply.)

    a. Diabetic ketoacidosis (DKA)
    b. Hypoglycemia
    c. Diabetic retinopathy
    d. Hyperglycemic-hyperosmolar state (HHS) e. Diabetic neuropathy
    • a. Diabetic ketoacidosis (DKA)
    • b. Hypoglycemia
    • d. Hyperglycemic-hyperosmolar state (HHS)
  213. Which electrolyte is most affected by hyperglycemia?

    B. Potassium
  214. What is the respiratory pattern of the patient with untreated hyperglycemia?

    C. Rapid and deep (Kussmaul respiration)
  215. What is NPH insulin?
    NPH insulin (or neutral protamine Hagedorn) (also known as Humulin N, Novolin N, Novolin NPH, NPH Iletin II, and isophane insulin), is an intermediate-acting insulin given to help control the blood sugar level of those with diabetes. NPH was created in 1936 when Nordisk formulated "isophane" porcine insulin by adding neutral protamine to regular insulin
Card Set
NUR 112 - IGGY Med Surg I Ch 67.txt
Care of Patients with Diabetes Millitus