question

Diabetes mellitus is characterized by chornic ____ due to inadequate insul secretion and or the effectiveness of endogenous insulin (insulin resistance)

answer

hyperglycemia

question

Diabetes mellitus is a contributing factor to the development of ____, ___, ____, ___, ___, ___, and ____ (7) as individuals age

answer

cardiovascular disease hypertension kidney disease neuropathy retinopathy peripheral vascular disease stroke

question

Diabetes mellitus is more prevalent in __, ___, and ___ populations

answer

African Americans American Indians Hispanic

question

Type ___ diabetes mellitus is an autoimmune dysfunction involving the destruction of beta cells, which produce insulin

answer

1

question

Type ___ diabetes mellitus usually occurs at a young age, and there are no successful interventions to prevent the disease

answer

1

question

Type ___ diabetes mellitus is a progressive condition due to increasing inability of cells to respond to insulin (insulin resistance) and decreased production of insulin by the beta cells.

answer

2

question

Type ___ diabetes mellitus usually occurs later in a clients life due to obesity, inactivity and heredity.

answer

2

question

What are risk factors for diabetes mellitus?

answer

Inactivity obesity hypertension hyperlipidemia cigarette smoking genetic history elevated C-reactive protein ethnic group women who have delivered infants weight more than 9 lbs

question

The American Diabetes Association recommends screening a client who has a BMI greater than ___ and an age greater than ___-, or if a child is overweight and has additional risk factors

answer

BMI greater than 24 age greater than 45

question

You should instruct a client with diabetes mellitus to decrease total fat intake to ___% of total daily calories.

answer

30

question

You should encourage clients with DM to have a diet low in ____ fats and decrease _____

answer

saturated fats decrease LDLs

question

___, ___, ___ and ____ may lead to the development of insulin resistance and type 2 diabetes

answer

obesity physical inactivity high triglycerides (greater than 250

question

someone with triglycerides greater than ___- increase their risk for developing insulin resistance and type 2 diabetes mellitus

answer

250

question

Hyperglycemia is a blood glucose level usually greater than ___mg/dL

answer

250

question

What are clinical manifestations of DM?

answer

hyperglycemia polyuria polydipsia Polyphagia acetone/fruity breath odor

question

___ respirations occur with DM and are characterized by increased resp rate and epth in attempt to excrete carbon dioxide and acid due to metabolic acidosis

answer

Kussmaul respirations

question

Diagnostic criteria for DM include two findings on separate days of :(3)

answer

1. manifestations of diabetes plus casual blood glucose concentration greater than 200 (without regard to time of last meal) 2. Fasting blood glucose greater than 126 3. 2-hr glucose greater than 200mg/dL with an oral glucose tolerance test

question

Clients having a fasting blood glucose should not eat or drink for __ hrs before the etest

answer

8

question

What is an oral glucose tolerance test

answer

a fasting blood glucose is drawn then they are instructed to consme a specific amount of glucose and blood glucose levels are observed every 30 mins for two hours and the client is assessed for hypoglycemia throughout the procedure

question

for an oral glucose tolerance test the client should ast for ___ before the test

answer

10-12 hours

question

for an oral glucose tolerance test the client should eat a balanced diet for __before the test

answer

3 days

question

___ is the best indicator of the average blood glucose level for the past 120 days

answer

HbA1c

question

The expected reference range for HbA1c is __ -__%

answer

4-6

question

High ketone sin the urine is associated with hyperglycemia and if it exceeds ___mg/dL it is a medical emergency

answer

300

question

For clients with type 1 diabetes you should give ____ insulin

answer

more than 1 type of insulin

question

The needle on an insulin pump should be changed every __- to prevent infection

answer

2-3 days

question

Insulin pens are prefilled cartridges of __ -__ units of insulin with disposable needles

answer

150-300 units

question

insulin pens are used only if ___

answer

one insulin is given at a time

question

____ are used by clients who have type 2 diabetes along with diet and exercise to regulate their blood glucose.

answer

oral hypoglycemics

question

Give examples of rapid-acting insulin (3)

answer

Lispro insulin (Humalog) Aspart insulin (novolog) Glulistine insulin (Apidra)

question

Aspart insulin (novolog) is an example of ____ acting insulin

answer

rapid acting

question

____ insulin should be administered before meals to control postprandial rise in blood glucose

answer

rapid acting

question

Th eonset for rapid acting insulin is __- -___ depending on which insulin is administered

answer

10-30 mins

question

Give an example of short-acting insulin (2)

answer

Humalin R Novolin R

question

Humalin R is an example of ____ acting insulin

answer

short-acting insulin

question

___ insulin should be administered 30-60 mins before meals to control postprandial hyperglycemia

answer

30-60mins

question

You should administer ____ acting insulin to provide glycemic control between meals and at night.

answer

intermediate or long acting

question

___ acting insulin is available in two concentrations

answer

short acting

question

short acting insulin is available in two concentrations ___ and ___

answer

U100 U500

question

short acting insulin in ____ concentration is used for the client who has insulin resistance and is never administered IV

answer

U500

question

short acting insulin in ____ concentration is prescribed for most clients and may be administered IV

answer

U-100

question

What are some examples of Intermediate-acting insulin

answer

NPH insulin (Humulin N) Detemir Insulin (Levemir)

question

Detemir insulin (Levemir) is an example of ____ acting insulin

answer

intermediate

question

____ acting insulin is administered for glycemic control between meals and a t night it is not administered before meals

answer

Intermediate acting insulin

question

You should administer NPH insulin ____ only

answer

subcutaneous only

question

___ is th eonly insulin to mix with short acting insulin

answer

NPH

question

detemir insulin is administered __- and is never mixed with other insulins

answer

subcutaneous only

question

Give an example of long acting insulin

answer

Glargine Insulin (Lantus)

question

Glargine Insulin (Lantus) is an example of ___ acting insulin

answer

long

question

___ insulin forms microprecipitates that dissolves slowly over 24 hours and maintains a steady blood sugar level with no peaks or troughs

answer

GLargine insulin

question

when should you administer long acting insulin/

answer

once daily anytime during the day but always at the same tim each day

question

When injecting subcuteanous insulin injections you should inject at a ___ angle and aspiration is ___

answer

90 deg angle 45 if thin aspiration is not necessary

question

When mixing a rapid or short acting insulin with a long acting insulin draw up the ___ into th syringe first

answer

short acting

question

For a patient who has hypoglycemia their glcose is below __

answer

70

question

for a patient with hypoglycemia they should take 15-20 g of carbs, which snacks are appropriate

answer

4-6 oz fruit juice or soft drink 3-4 glucose tablets 8-10 hard candies 1tbsp honey

question

blood glucose increases approximately ___mg/dL over 30 mins following ingestion of 10g of absorbable carbohydrate

answer

40

question

for someone experiencing hypoglycemia, after having a snack they should recheck blood sugar in ___

answer

15 mins

question

If hypoglycemia occurs and patient is unconcscious or unable to swallow administer ___ subcuatenous or IM

answer

glucagon

question

If hypoglycemia occurs and client is unconscious, in acute care, the nurse should admin ___ IV if available and consciousness should occur within 20 mins

answer

50% dextrose IV

question

what skin changes will be evident with hyperglycemia

answer

hot, dry skin

question

restrict exercise when blood glucose levels exceed ___

answer

250

question

____ reduces the production of glucose by the liver and increases tissue sensitivity to insulin

answer

Biguanides Metoformin HCL (Glucophage)

question

What considerations need to be taken for someone on Biguanides Metoformin HCL (Glucophage)

answer

monitor GI effects monitor for lactic acidosis stop meds for 48 hrs before any type of radiographic test with iodinated contrast dye (may cause lactic acidosis)

question

What would you educate the client on taking Glucophage

answer

take with food take B12 and folic acid supplements contact provider if manifestations of lactic acidosis develop never crush or chew may take during pregnancy

question

What are clinical manifestations of lactic acidosis?

answer

myalgia sluggishness somnolence hyperventilation

question

_____ medications stimulates insulin release fromt eh pancrease causing a decrease in blood sugar levels and incrases tissue sensitivity to insulin

answer

Second-genernation sulfonylureas

question

Glucophage is a ____medication

answer

Biguanides

question

Give example of Second generation sulfonylureas

answer

Glipizide (Clucortrol) Blimepiride (Amaryl) Glyburide (Diabeta, Glynase Prestab)

question

Glipizide (Clucortrol) is an example of a ___ _ medication

answer

second generation sulfonylureas

question

What nursing considerations would you want to take for someone taking Second Generation Sulfonylureas

answer

monitor for hypoglycemia beta blockers can mask tachycardia typically seen during hypoglycemia

question

What client education would you need to give to a client taking second generation sulfonylureas

answer

admin 30 mins before meals monitor for hypoglycemia and report freq episodes to the provider instruct client to avoid alcohol due to disulfiram effect

question

___ medications stimulat einsul release from pancreas and administered for postmeal hyperglycemia

answer

Meglitinides

question

give an example of a Meglitinide medications

answer

repaglinide (Prandin) Nateglinide (Starlix)

question

Repaglinide (Prandin) is an example of a ____ medication

answer

Meglitinides

question

what nursing considerations would be require for a patient taking Meglitinides?

answer

monitor for hypoclycemia monitor HbA1c every 3 months to determine effectiveness

question

What client education should be included for a client taking Meglitinides?

answer

administer 15-30 mins before a meal omit the dose if skipped a meal to prevent hypoglycemic crisis

question

_____ medications reduces the production of glucose by the liver (gluconeogenesis) and increase tissue sensitivity to insulin

answer

Thiazolidinediones

question

Give an example of Thiazolidinediones

answer

Pioglitazone (Actos)

question

Pioglitazone (Actos) is an example of a ____ medication

answer

Thiazolidinediones

question

What nursing considerations are required for a patient taking Thiazolidinediones?

answer

monitor for fluid retention, esp in clients who have history of heart failure monitor for elevation of clients LDL and triglyceride levels

question

What client education should be included for a patient taking Thiazolidinediones?

answer

Report rapid weight gain, SOB, decreased exercise tolerance use additional contraception methods because the meds reduce th eblood levels of oral contraceptives and stimulate ovulation have liver function test every 2 months for the first year

question

____ medications slow carbohydrate absorption from the intestinal tract

answer

Alpha-Glucosidase Inhibitors

question

Give an example of an Alpha-Glucosidase inhibitor medication/

answer

Acarbose (Precose) Miglitol (Glyset)

question

Acarbose (Precose) is an example of a ____ medication

answer

Alpha-Glucosidase inhibitor

question

What nursing considerations should be implemented for a client taking an Alpha-Glucosidase inhibitor

answer

alert client that Gi discomfort is common with these meds monitor liver function every 3 months treat hypoglycemia with dextrose not table sugar

question

What client education should be included for a patient taking Alpha-Glucosidase inhibitors?

answer

have liver function test for 3 months take med with first bite of each meal in order for medication to be effective have available dextrose paste to treat hypoglycemia

question

____ medications aguments naturally occurring intestinal incretin hormones, which promote release of insulin and decrease secretion fo glucagon. These meds also lower fasting and postprandial glucose levels

answer

Dipeptidyl Peptidase-4 inhibitors

question

give examples of Dipeptidyl Peptidase-4 inhibitors medications

answer

Sitagliptin (Januvia) Saxagliptin (Onglyza)

question

Saxagliptin (Onglyza) is an example of a ____ medication

answer

Dipeptidyl Peptidase-4 inhibitors

question

What nursing considerations should be taken into account for a client taking Dipeptidyl Peptidase-4 inhibitors

answer

upper respiratory symptoms (nasal and throat inflammation) may be present alter the client of GI discomforts (N/V and diarrhea)

question

what client education should be included for a patient taking Dipeptidyl Peptidase-4 inhibitors

answer

instruct clien to report persistent upper respiratory symptoms medication only works when blood sugar is rising

question

_____ medications mimics the function of intestinal incretin hormone by decreasing glucagon secretion and gastric emptying and decreases insulin demand by reducing fasting and postprandial hyperglycemia

answer

Incretin mimetic

question

give an example of an Incretin mimetic

answer

Exenatide (Byetta)

question

Exenatide (byetta) is a ____ medication

answer

Incretin mimetic

question

What nursing considerations are required for a client taking an Incretin mimetic medication

answer

do not administer after a meal oral antibiotics, contraceptives, or Tylenol (acetominiphen) should never be given within 1 hour of oral exenatide or 2 hours of injection May have decreased appetite and weight loss wait fo rnext scheduled dose if the scheduled medication is missed

question

A client taking Incretin mimetics should not consume antibiotics, contraceptives, of acetominiphen (Tylenol) within ____ of an oral dose or ____ of an injected dose

answer

ORAL 1 hour INJECTION 2 hours

question

_____ medications are a synthetic amylin hormone found in the beta cells fo the pancreas, it suppresses glucagon secretion and controls postrandial blood glucose levels

answer

Amylin Mimetic

question

Give an example of an Amylin Mimetic medication

answer

Pramlintide (Symlin)

question

Pramlintide (Symlin) is an example of a ____ medication

answer

Amylin Mimetic

question

What nursing considerations are given to a patient taking an Amylin Mimetic medication

answer

administer subcuatenous immediately before each major meal. Do not administer if HbA1c is greater than 9% May administer with insulin therapy or oral hypoglycemic agent

question

What client education should be included for a client taking Amylin mimetic medication?

answer

monitor and report freq periods of hypoglycemia monitor for injection site reactions

question

____ is increased swelling of fat due to not rotating injection sties

answer

lipohypertrophy

question

____ is loss of fat tissue due to not rotating injection sites

answer

lipoatrophy

question

Clients with DM should inspect feet ___

answer

daily

question

Clietns with DM should wash feet daily with mild soap and warm water and test water temp with ___ before washing feet

answer

hands

question

patients with DM should avoid lotion ___

answer

between the toes

question

clients with DM with sweaty feet can use ___

answer

cornstarch (mild foot powder)

question

If a patient with DM has a clluses or a corn they should ___

answer

consult a podiatrist

question

clients should wear ___ shoes if possible, and use ____ if feet are cold

answer

leather cotton or wool socks not electric blankets ets

question

____g of carbohydrates are equal to 1 carbohydrate exhcnage

answer

15g

question

When sick, patients with DM should call the provider if: (8)

answer

blood glucose greater than 240 fever greater than 101.5 and doe snot respond to acetaminophen or lasts more than 24 hours feeling disoriented or confused rapid brething vomiting occurs more than once diarrhea occurs more than 5 times longer or for longer than 24 hours unable to tolerate liquids illness lasts longer than 2 days

question

A nurse is caring for a client who has blood glucose of 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. recheck blood glucose in 15 mins B. provide a carbohydrate and protein food C. Provide 4 oz grape juice D. Report findings to the provider.

answer

C. Provide 8 oz grapejuice (Hypoglycemia)

question

A nurse is preparing to administer a morning dose of aspart insulin (Novolog) to a client who has type 1 diabetes mellitus. Which of the following is an appropriate action by the nurse? A. Check the clients blood glucose immediately after breakfast B. Administer the insulin when breakfast arrives C. Hold breakfast for 1 hour after insulin administration D. Clarify the prescription because insulin should not be administered at this time

answer

B. Administer the insulin when breakfast arrives (aspart is rapid acting and should be administered 5-10 mins before breakfast)

question

A nurse is preparing to administer the morning doses of glargine (Lantus) insulin and regular (Humulin R) insulin to a client who has a blood glucose of 178mg/dL. Which of the following is an appropriate nursing action? A. draw up the regular insulin and then the glargine insulin in the same syringe. B. Draw up the glargine insulin then the regular insulin in the same syringe. C> Draw up and administer the regular and glargine insulin in separate syringes. D. Administer the regular insulin, wait 1 hour, then administer the glargine insulin.

answer

C. administer each insulin as a separate injection they are not compatible and should not be drawn up in same syringe.

question

A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? (select all that apply) A. Eat less meat and processed foods B> decrease intake of saturated fats C> Increase daily fiber intake D. Limit saturated fat intake to 15% of daily caloric intake E. Include omega-3 fatty acids in the diet

answer

A. eat less meat and processed foods B. decrease intake of saturated fats C. increase daily fiber intake E. include omega-3 fatty acids in diet

question

A nurse is teaching foot care to a client who has DM. Which of the following information should the nurse include in the teaching (Select all that apply) A. Remove calluses using over-the-counter remedies. B. Apply lotion between toes C. Perform nail care after bathing D> Trip toenails straight across E. Wear closed-toe shoes

answer

C. perform nail care after bathing D. trip toe nails straight across E. Wear closed-toed shoes

ATI: Chapter 83 Diabetes Mellitus Managment – Flashcards

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