question

When instructing a patient regarding a urine study for free cortisol, it is most important for the nurse to tell the patient to A. Save the first voided urine in the am. B. Maintain a high-sodium diet 3 days before collection. C. Try to avoid stressful situations during the collection period. D. Complete at least 30 minutes of strenuous exercise before collecting the urine sample.

answer

C. Try to avoid stressful situations during the collection period. A urine study for free cortisol requires a 24-hour urine collection. The patient should be instructed to avoid stressful situations and excessive physical exercise that could unduly increase cortisol levels. The patient should also maintain a low-sodium diet before and during the urine collection period.

question

Which of the following assessment parameters is of highest priority when caring for a patient undergoing a water deprivation test? A. Serum glucose B. Patient weight C. Arterial blood gases D. Patient temperature

answer

B. Patient weight A patient is at risk for severe dehydration during a water deprivation test. The test should be discontinued and the patient rehydrated if the patient's weight drops more than 2 kg at any time. The other assessment parameters do not assess fluid balance.

question

A patient has sought care because of a loss of 25 lb over the past 6 months, during which the patient claims to have made no significant dietary changes. The nurse should assess the patient for potential A. Thyroid disorders. B. Diabetes insipidus. C. Pituitary dysfunction. D. Parathyroid dysfunction.

answer

A. Thyroid disorders. Hyperthyroidism is associated with weight loss. Alterations in pituitary function, such as diabetes insipidus, and parathyroid dysfunction are not commonly associated with this phenomenon.

question

The surgeon was unable to save a patient's parathyroid gland during a radical thyroidectomy. The nurse should consequently pay particular attention to which of the following components of the patient's laboratory values? A. Calcium levels B. Potassium levels C. Blood glucose levels D. Sodium and chloride levels

answer

A. Calcium levels The parathyroid gland plays a key role in maintaining calcium levels. Potassium, sodium, glucose, and chloride are not directly influenced by the loss of the parathyroid gland.

question

A patient's recent medical history is indicative of diabetes insipidus. The nurse would perform patient education related to which of the following diagnostic tests? A. Thyroid scan B. Fasting glucose test C. Oral glucose tolerance D. Water deprivation test

answer

D. Water deprivation test A water deprivation test is used to diagnose the polyuria that accompanies diabetes insipidus. Glucose tests and thyroid tests are not directly related to the diagnosis of diabetes insipidus.

question

A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2" means. Which of the following is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." C. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy b-cells in the pancreas."

answer

B. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin.

question

The nurse caring for a 54-year-old patient hospitalized with diabetes mellitus would look for which of the following laboratory test results to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level

answer

D. Glycosylated hemoglobin level A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months.

question

The nurse has been teaching a patient with diabetes how to perform self-monitoring of blood glucose. During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does which of the following? A. Chooses a puncture site in the center of the finger pad B. Washes hands with soap and water to cleanse the site to be used C. Warms the finger before puncturing to obtain a drop of blood D. Tells the nurse that the result of 120 mg/dl indicates good control of diabetes

answer

A. Chooses a puncture site in the center of the finger pad The patient should select a site on the sides of the fingertips, not on the center of the finger pad. This area contains many nerve endings and would be unnecessarily painful.

question

The nurse is teaching a 54-year-old patient with diabetes about proper composition of the daily diet. The nurse explains that the guideline for carbohydrate intake is which of the following? A. 80% of daily intake B. Minimum of 80 g/day C. Minimum of 130 g/day D. Maximum of 130 g/day

answer

C. Minimum of 130 g/day The recommendation for carbohydrate intake is a minimum of 130 g/day. Low-carbohydrate diets are not recommended for diabetes management.

question

The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, which of the following should be the nurse's initial intervention? A. Assess patient's perception of what it means to have diabetes. B. Ask the patient to write down current knowledge about diabetes. C. Set goals for the patient to actively participate in managing his diabetes. D. Assume responsibility for all of the patient's care to decrease stress level.

answer

A. Assess patient's perception of what it means to have diabetes. In order for teaching to be effective, the first step is to assess the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient.

question

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. Which of the following information would be appropriate for the nurse to include? A. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. C. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. D. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.

answer

B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Sexual impotency and slowed gastric emptying result from microangiopathy. Macroangiopathy can occur in either type 1 or type 2 diabetes.

question

The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which of the following symptoms reported by the patient is considered one of the classic clinical manifestations of diabetes? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision

answer

A. Excessive thirst The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger).

question

A 54-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 am. The nurse instructs the patient to only drink water after what time? A. 6:00 pm on the evening before the test B. 4:00 am on the day of the test C. Midnight before the test D. 7:00 am on the day of the test

answer

C. Midnight before the test Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 am should not have any food or beverages containing any calories after midnight.

question

A patient is admitted with diabetes mellitus, has a glucose level of 380 mg/dl, and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which of the following respiratory patterns would the nurse expect to find? A. Central apnea B. Hypoventilation C. Kussmaul respirations D. Cheyne-Stokes respirations

answer

C. Kussmaul respirations In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored.

question

The nurse is assisting a diabetic patient to learn dietary planning as part of initial management of diabetes. The nurse would encourage the patient to limit intake of which of the following foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges

answer

A. Cheese Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry.

question

Lab results are back for a 54-year-old patient with a 15-year history of diabetes. Which of the following lab results follows the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Decreased low-density lipoproteins C. ncreased high-density lipoproteins D. Decreased very-low-density lipoproteins

answer

A. Increased triglyceride levels Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. For this reason, the patient should limit the amount of fat in the diet.

question

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes which of the following statements? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I am lucky my shoes fit so nice and tight because they give me firm support." D. "When I am allowed up out of bed, I should check the shower water with my toes."

answer

B. "I should look at the condition of my feet every day." Patients with diabetes should inspect feet daily for broken areas prone to infection. Water temperature should be tested with the hands first. Properly fitted (not tight) shoes should be worn at all times.

question

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse considers that which of the following could be a contributing factor for this lab result (SELECT ALL THAT APPLY)? A. The level may be increased as a result of dehydration that accompanies hyperglycemia. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The level is consistent with renal insufficiency that can develop with renal nephropathy. D. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia.

answer

A, C, D A - The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. C - Kidneys may have difficulty excreting potassium if renal insufficiency exists. D - Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention; thus it is not a contributing factor to this patient's potassium level.

question

The patient received regular insulin 10 units subcutaneously at 8:30 pm for a blood glucose level of 253 mg/dl. The nurse plans to monitor this patient for signs of hypoglycemia at which of the following peak action times? A. 9:00 pm to 10:30 pm B. 10:30 pm to 11:30 pm C. 12:30 am to 1:30 am D. 2:30 am to 4:30 am

answer

B. 10:30 pm to 11:30 pm Regular insulin exerts peak action in 2 to 3 hours, making the patient most at risk for hypoglycemia between 10:30 pm and 11:30 pm.

question

Describe Type 1 Diabetes Mellitus

answer

Autoimmune dysfunction, a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy.

question

Describe Type 2 Diabetes Mellitus

answer

Type 2 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. It often occurs later in a client's life due to obesity, inactivity, and heredity.

question

Name 3 risk factors associated with Diabetes.

answer

- Obesity - Hypertension - Inactivity - Hyperlipidemia - Cigarette smoking, - Genetic history - Elevated C-reactive protein (CRP) - Ethnicity - Women who have delivered infants weighing more than 9 lb

question

When assessing for diabetes, test __________ and __________ during routine examinations to evaluate the need for further testing.

answer

Glucose & Ketones

question

What are some teaching points in the prevention of Diabetes?

answer

- Exercise - Diet low in saturated fats - Limit Calories - Decrease fat intake to 30% of daily calories

question

__________ and __________ are secondary causes of Diabetes.

answer

Pancreatitis and Cushing's Syndrome

question

Triglycerides higher than _______mg/dL may lead to the development of insulin resistant type 2 Diabetes.

answer

250 mg/dL

question

Diagnostic criteria for diabetes include two findings (on separate days) of one of three criteria. What are they?

answer

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

question

High ketones in the urine associated with hyperglycemia is a medical emergency. What is considered an excessive amount?

answer

When ketones exceed 300 mg/dL

question

How long does it take for Rapid-acting insulin to produce effects after administration?

answer

10 to 30 minutes

question

What are some examples of Rapid-acting insulin?

answer

Humalog Novalog Apidra

question

When should the client take Short-acting insulin?

answer

Administer 30 to 60 min before meals to control between-meal hyperglycemia.

question

What are some examples of Short-acting insulin?

answer

Regular insulin: Humulin R Novolin R

question

For which client would you give U-500 concentration insulin?

answer

The client with Type 2 Diabetes. U-500 is reserved for insulin resistance.

question

True or false? U-500 is administered intravenously.

answer

False! U-500 is never administered IV.

question

For which client would you give U-100 concentration insulin?

answer

U-100 is Humulin (short-acting) and prescribed for most diabetic clients

question

True or false? U-100 can be administered intravenously

answer

True! U-100 may be administered IV.

question

What are some examples of Intermediate-acting insulin?

answer

NPH insulin: Humulin N Levemir

question

When would you administer Intermediate-acting insulin?

answer

It is administered for glycemic control between meals and at night. Not administered before meals to control post-meal rise in blood glucose.

question

True or False? NPH Insulin can be mised with Regular Insulin.

answer

True!

question

What is an example of Long-acting insulin?

answer

Glargine insulin (Lantus)

question

When would you administer Long-acting insulin?

answer

Once daily, anytime during the day but always at the same time each day.

question

When would you administer Rapid-acting insulin?

answer

Administer in conjunction with intermediate- or long-acting insulin to provide glycemic control post-meals and at night.

question

True or False? Insulin Glargine can be given subcutaneous and IV.

answer

False! Administer glargine insulin subcutaneous only and never administer IV.

question

What are some client education tips when teaching about self-administration of Insulin?

answer

- Rotate injection sites to prevent lipohypertrophy, and prevent day-to-day changes in absorption rates - Inject at a 90° angle (45° angle if thin). Aspiration for blood is not necessary. - When mixing a rapid- or short-acting insulin with a longer-acting insulin, draw up the shorter-acting insulin into the syringe first and then the longer-acting insulin (this reduces the risk of introducing the longer-acting insulin into the shorter-acting insulin vial). - Advise the client to eat at regular intervals, avoid alcohol intake, and adjust insulin to exercise and diet to avoid hypoglycemia.

question

What are some teaching points for diabetic foot care? Name three.

answer

- Inspect feet daily. - Wash with mild soap and warm water. - Pat feet dry gently, especially between the toes, and avoid lotions between toes to decrease excess moisture and prevent infection. - Use mild foot powder (powder with cornstarch) on sweaty feet. - Consult a podiatrist. - Perform nail care after a bath when toenails are soft and easier to trim. - Avoid open-toe, open-heel shoes. - Wear shoes that fit correctly. - Wear slippers with soles. - Do not go barefoot. - Wear clean, absorbent socks or stockings made of cotton or wool - Avoid prolonged sitting, standing, and crossing of legs.

question

What are some teaching points for diabetic nutrition guidelines? Name three

answer

- Consult dietician on meal planning to include food intake, weight management, and lipid and glucose management. - Plan meals to achieve appropriate timing of food intake, activity, onset, and peak of insulin. Calories and food composition should be similar each day. - Eat at regular intervals, and do not skip meals. - Count grams of carbohydrates consumed for glycemic control. - Recognize that 15 g of carbohydrates are equal to 1 carbohydrate exchange. - Restrict calories and increase physical activity as appropriate to facilitate weight loss (for clients who are obese) or to prevent obesity. - Include fiber in the diet to increase carbohydrate metabolism and to help control cholesterol levels. - Use artificial sweeteners. - Read and interpret fat content information on food labels to keep saturated fats within 7% of the recommendations of the daily total caloric intake.

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 min. B. Provide a carbohydrate and protein food. C. Provide 4 oz grape juice. D. Report findings to the provider.

answer

C. The client's acute need for a rapidly absorbed carbohydrate, such as grape juice, takes priority when treating the blood glucose of 52 mg/dL.

question

A nurse is preparing to administer a morning dose of rapid acting 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 client's blood glucose immediately after breakfast. B. Administer the insulin when breakfast arrives. C. Hold breakfast for 1 hr after insulin administration. D. Clarify the prescription because insulin should not be administered at this time.

answer

B. Administer rapid acting insulin when breakfast arrives to avoid a hypoglycemic episode.Aspart insulin is rapid-acting, and should be administered 5 to 10 min 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 278 mg/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 regular and glargine insulin in separate syringes. D. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin.

answer

C. Administer each insulin as a separate injection. These insulins are not compatible and should not be drawn up in the 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. Limit meats and processed foods, which can prevent diabetes and hyperlipidemia. B. Lower LDL by decreasing intake of saturated fats, which can prevent diabetes and hyperlipidemia. C. Increase dietary fiber to control weight gain and decrease the risk of diabetes and hyperlipidemia. E. Include omega-3 fatty acids for secondary prevention of diabetes and heart disease.

question

A nurse is teaching foot care to a client who has diabetes mellitus. 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. Trim toenails straight across. E. Wear closed-toe shoes.

answer

C. Perform nail care after bathing, when toenails are soft and easier to trim. D. Trim toenails straight across to prevent injury to soft tissue of the toes. E. Wear closed-toe shoes to prevent injury to soft tissue of the toes and feet.

question

An acute, life-threatening condition characterized by hyperglycemia(greater than 300 mg/dL) resulting in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine.

answer

Diabetic Ketoacidosis

question

True or False? Diabetic Ketoacidosis has a slow onset and a high mortality rate.

answer

False! The onset is rapid, and the mortality rate of DKA is less than 5%.

question

An acute, life-threatening condition characterized by profound hyperglycemia (greater than 600 mg/dL), that leads to dehydration, and an absence of ketosis.

answer

Hyperglycemic-hyperosmolar state (HHS)

question

True or False? Hyperglycemic-hyperosmolar state (HHS) has a gradual onset over several days, and if left untreated can lead to coma and death.

answer

True!

question

What are some risk factors associated with Diabetic Ketoacidosis? Name three

answer

- Lack of sufficient insulin related to undiagnosed or untreated type 1 diabetes mellitus - Nonadherence to a diabetic regimen - Reduced or missed dose of insulin - Any condition that increases carbohydrate metabolism, such as physical or emotional stress, illness, infection (No. 1 cause of DKA), surgery, or trauma that requires an increased need for insulin - Increased hormone production (e.g., cortisol, glucagon, epinephrine) stimulates the liver to produce glucose and decreases the effect of insulin.

question

What are some risk factors associated with Hyperglycemic-hyperosmolar state (HHS)? Name three.

answer

- Old Age - Poor Kidney Function - Poor diabetes control - Poor Medication Management - Infection - Heart attack - Stroke - Congestive heart failure - Dehydration

question

What medications are associated with risk for Hyperglycemic-hyperosmolar state (HHS)?

answer

- Glucocorticoids - Diuretics - Calcium channel blockers. - Dilantin - Propranolol (Inderal)

question

What is the #1 cause of Diabetic Ketoacidosis?

answer

Infection

question

A nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following data confirms this diagnosis? (Select all that apply.) A. Evidence of recent myocardial infraction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years E. No insulin production

answer

A. The client who has type 2 diabetes mellitus and had a myocardial infraction is at risk for developing HHS. This is due to the increased hormone production during illness or stress, which can stimulate the liver to produce glucose and decrease the effects of insulin. B. The client who has type 2 diabetes mellitus may be at risk for developing HHS when the BUN is 35 mg/dL because it is an indication of decreased kidney function and inability of the kidney to filter high levels of blood glucose into the urine. C. A calcium channel blocker is one of several medications that increase the risk for HHS in a client who has type 2 diabetes mellitus. D. The older adult client is at risk for developing type 2 diabetes mellitus and may be unaware of associated symptoms, increasing the risk for HHS.

question

A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. Which of the following are expected findings? (Select all that apply.) A. Weight gain B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis

answer

B. Fruity odor of breath is a manifestation of elevated ketone levels that lead to metabolic acidosis. C. Abdominal pain is a GI manifestation of increased ketones and acidosis. D. Kussmaul respirations are an attempt to excrete carbon dioxide and acid when in metabolic acidosis. E. Metabolic acidosis is caused from glucose, protein, and fat breakdown, which produces ketones.

question

A nurse is reviewing laboratory reports of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following is an expected finding? A. Serum pH 7.2 B. Serum osmolarity 350 mOsm/L C. Serum potassium 3.8 mg/dL D. Serum creatinine 0.8 mg/dL

answer

B: A client who has HHS would have a serum osmolarity greater than 320 mOsm/L.

question

A nurse is preparing to administer IV fluids to a client who has diabetic ketoacidosis. Which of the following is an appropriate nursing action? A. Administer an IV infusion of regular insulin at 0.3 unit/kg/hr. B. Administer an IV infusion of 0.45% sodium chloride. C. Rapidly administer an IV infusion of 0.9% sodium chloride. D. Add glucose to the IV infusion when serum glucose is 350 mg/dL.

answer

C. The nurse should rapidly administer an IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain blood perfusion to vital organs. *I*sotonic stays where *I* put it Hyp*o*tonic goes *o*ut of the vessel Hyp*e*rtonic *e*nters the vessel

question

A nurse is providing discharge teaching to a client who experienced diabetic ketoacidosis. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Drink 3 L of fluids daily. B. Monitor blood glucose every 4 hr when ill. C. Administer insulin as prescribed when ill. D. Notify the provider when blood glucose is 200 mg/dL. E. Report ketones in the urine after 24 hr of illness.

answer

A. Drinking 3 L of fluids daily may prevent dehydration if the client develops diabetic ketoacidosis. B. Blood glucose tend to increase during illness. Blood glucose should be monitored every 4 hr. C. Illness often causes blood glucose to increase. Regular doses of insulin should be administered. E. The provider should be notified if there are ketones in the urine after 24 hr of illness.

question

A nurse is providing guidelines to a client who has type 1 diabetes mellitus. What information / teaching should the nurse include when describing the disease to the client?

answer

Your body no longer makes insulin because your immune system has attacked and destroyed the cells that make it. - Insulin injections - Oral medications - Making healthy food choices. - Being physically active. - Control blood pressure levels - Control cholesterol levels.

question

A nurse is providing guidelines to a client who has type 1 diabetes mellitus. What are some teaching points that the nurse can include when discussing how to control this disease?

answer

- Monitor blood glucose Q 3-4 hr. - Take insulin as prescribed. - Maintain adequate hydration - Call provider if unable to tolerate liquids. - Call provider if ill for longer than 2 days, - Call HCP if diarrhea lasts longer than 24 hr. - Call HCP fever > 101.5° longer than 24 hr. *GO FISH (glucose, OMG - diarrhea, fever, insulin, sick, hydration)

question

A nurse is planning care for a client who has diabetic ketoacidosis. What treatments should the nurse include in the plan of care, and what are some actions involved with each one?

answer

LIFE! *L*abs, *I*nsulin, *F*luids *E*lectrolytes *L*ab tests - - Monitor and replace potassium as prescribed. - Review BUN and creatinine levels for expected improvement. - Monitor serum osmolarity. - Evaluate blood glucose hourly. *I*nsulin administration - - Administer regular insulin IV bolus dose as prescribed. - Follow with regular insulin IV infusion as prescribed. *F*luid replacement - - Rapidly infuse IV 0.9% sodium chloride. - Follow with IV infusion of 0.45% sodium chloride (maintenance)

question

If glucose is a disorder of glucose metabolism, then why do we need Glucose?

answer

Glucose is needed for energy

question

What organ controls glucose Metabolism?

answer

Pancreas - Controls glucose by producing insulin and glucagon which are hormones.

question

When does Gestational Diabetes typically develop?

answer

24-25 weeks gestation, and usually resolves postpartum

question

What is Secondary Diabetes?

answer

Caused by other medical condition. Ie. Pancreatitis, Cushings (body makes too much cortisol or exposure to corticosteroids for a long time), TPN, Hyperthyroidism, etc. Usually resolves with tx of disorder.

question

What are the 3 P's of Diabetes Diagnosis? What are other s/sx?

answer

Polydypsia, Polyuria, Polyphagia Weight loss Weakness Fatigue Frequent infections

question

Which test in most useful in determining glycemic levels over time??

answer

HgA1c Most useful in measuring DM management over time.

question

What is the target range for HgA1c?

answer

6.5%

question

What is the current diagnostic criteria for Diagnosing DM?

answer

FBG > 126mg/dL Random Gl > 200mg/dL

question

Name that Insulin: What is an example of Rapid Acting Insulin? What is the onset? What is the Peak?

answer

Humalog (Lispro) Onset: 15 - 30 minutes Peak: 0.5 - 2.5 hours

question

Name that Insulin: What is an example of Short Acting Insulin? What is the onset? What is the Peak?

answer

Humulin R (Regular) Onset: 30 minutes Peak: 2.5 - 5 hours

question

Name that Insulin: What is an example of Intermediate Acting Insulin? What is the onset? What is the Peak?

answer

Humulin N (NPH) Onset: 1 - 2 hours Peak: 4 - 12 hours

question

Name that Insulin: What is an example of Long Acting Insulin? What is the onset?

answer

Lantus / Glargine Onset: 3-4 hours

question

Name that Insulin: What is an example of Premix Insulin? What is the onset? What is the Peak? How long does it last?

answer

70/30 Humalog Onset: 30 mins Peak: 2 - 12 hrs Lasts: 14 - 24 hours

question

Which category of drugs stimulates B-cell insulin production?

answer

Sulfonureas (Glyburide, glipizide)

question

Name a drug that decreases hepatic glucose production & improves glucose transport?

answer

Metformin

question

When should Metformin be held?

answer

HOLD FOR IV DYE, SURGERY, N/V/D

question

What are long term complications of DM involving the eyes?

answer

Retinopathy

question

What are long term complications of DM involving the heart?

answer

Macro-Vascular (ie Stroke, MI), HTN, PVD

question

What are long term complications of DM involving the kidneys?

answer

Nephropathy

question

What are long term complications of DM involving the nerves?

answer

Neuropathy

question

What are long term complications of DM involving the feet?

answer

Serious Infections, gangrene

question

Emma Martin, 76 has type 2 diabetes and was been admitted to the floor for compulsive gambling. Patient takes Glyburide 5 mg per day and Metformin 1000 twice daily. She is consuming ¾ of the food on her plate as observed by her nurses. You observe that she had had multiple hypoglycemic incidents over the previous week. What factor is probably most responsible for the hypoglycemia? a. Patient isn't eating all of her food. b. Patient is in renal failure and may have a prolonged hypoglycemia because the Glyburide is working in her body for a long time. c. Patient has elevated creatinine which contraindicates use of metformin.

answer

b. Patient is in renal failure and may have a prolonged hypoglycemia because the Glyburide is working in her body for a long time.

question

Emma Martin, 76 has type 2 diabetes and was been admitted to the floor for compulsive gambling. Patient takes Glyburide 5 mg per day and Metformin 1000 twice daily. She is consuming ¾ of the food on her plate as observed by her nurses. What is the best way to manage Emma's blood sugars moving forward? a. Transition to a basal/bolus insulin regimen immediately. b. Provide hydration in an effort to lower creatinine and raise GFR, then restart Glyburide. c. Stop oral anti-diabetes agents while carefully monitoring blood sugars. Order A1c, BMP and develop treatment plan based on results.

answer

c. Stop oral anti-diabetes agents while carefully monitoring blood sugars. Order A1c, BMP and develop treatment plan based on results.

question

Your patient is NPO and the MD has ordered Humalog using the Very Insulin Sensitive Correction Scale. When should you check her blood sugars? a. Before meals and bedtime b. Every 4 hours c. Every 6 hours d. There is not enough information to answer the question

answer

b. Every 4 hours

question

Which Statement about bolus insulin is false? a. Bolus insulin provides mealtime coverage b. Bolus insulin can be calculated using a correction scale c. Lantus is an example of bolus insulin d. Humalog is an example of bolus insulin

answer

c. Lantus is an example of bolus insulin

question

Emma Martin, 76 has type 2 diabetes and was been admitted to the floor for compulsive gambling. Patient takes Glyburide 5 mg per day and Metformin 1000 twice daily. She is consuming ¾ of the food on her plate as observed by her nurses. You are meeting Mrs. Jones for the first time tonight. Which of the following attributes about Mrs. Jones makes you think she may be at risk for hypoglycemia? a. Mrs. Jones takes 50 units of Lantus at bedtime b. Mrs. Jones has had blood sugars in the 50's at bedtime for the past 2 nights and her insulin regimen hasn't changed c. Mrs. Jones has peanut butter and crackers for a bedtime snack d. Mrs. Jones has had type 1 diabetes for 50 years

answer

b. Mrs. Jones has had blood sugars in the 50's at bedtime for the past 2 nights and her insulin regimen hasn't changed

question

Jackie Dubuque, 58 is scheduled for an MRI with contrast dye today. Jackie takes Metformin 1000 mg BID and glimepiride 4 mg BID. His serum creatinine is 0.9 mg/dL. a. Jackie's serum creatinine is at an acceptable level so he may restart the Metformin immediately. b. The glimepiride should be held for 48 hours so the contrast dye can clear the kidneys first. c. The metformin should be held for 48 hours so the contrast dye can clear the kidneys first. d. The glimepiride and metformin should both be held for 48 hours so the contrast dye can clear the kidneys first.

answer

c. The metformin should be held for 48 hours so the contrast dye can clear the kidneys first.

question

John Bellegarde, 22 - is newly diagnosed type 1 diabetes. He's asking questions whenever you enter his room. You are using your "cheat sheets" to guide conversations. However, some of his questions are out of your realm of expertise. What's the best way to proceed? a. Advise John you are asking the Hospitalist for referrals to an endocrinologist, CDE and visiting nurses to help answer his questions. Let John know that the hospital has a medical library that patients are welcome to utilize. b. Advise John that you want to help him, but don't know the answers to his questions. Write his questions down share them with his medical team. c. A and B d. Let him know that you aren't an expert in type 1 diabetes and spend as little time in his room as you can get away with.

answer

c. A and B

question

Which statement best describes why a patient with type 1 diabetes may develop DKA in the hospital? a. The patient doesn't feel like eating, skips sliding scale, but continues to take Lantus. b. The patient is eating with mealtime sliding scale ordered and he has started to take Lantus at bedtime. c. The patient is transitioning from IV dextrose to food, is on a sliding scale and NPH twice daily. d. The patient isn't eating much, the sliding scale starts at >200 and no long acting insulin has been ordered.

answer

d. The patient isn't eating much, the sliding scale starts at >200 and no long acting insulin has been ordered.

question

In which case would the patient be more likely to have DKA or HHS? a. Positive ketones b. Blood sugars >600 mg/dL c. Symptoms developed quickly over 24 hours

answer

A. DKA B. HHN C. DKA

question

Which of the following should be a component of hypoglycemia education for your patient with a history of hypoglycemia unawareness who was hospitalized after an automobile accident involving low blood sugars? (SELECT ALL THAT APPLY) a. Keep an emergency glucagon kit at home for family members to administer b. Purchase a medical identification bracelet that says patient has diabetes c. Avoiding hypoglycemia over several weeks can help improve the hyperglycemia unawareness d. It is important to avoid over-treatment because then the patient will have to contend with a rebound hyperglycemia

answer

A, B, C, D

question

Which would not be included in your foot care education plan for the patient with diabetes? a. Look for cuts and sign of infection daily. b. Soak feet in hot water for at least an hour every day. c. Do not go barefoot. d. A Podiatrist should trim toe nails. e. All of the information listed above should be included.

answer

b. Soak feet in hot water for at least an hour every day.

question

What lifestyle intervention suggestion is appropriate for the 85-year old patient with newly diagnosed type 2 diabetes who ambulates in a walker? a. Start jogging for 10-15 minutes per day b. Eat 3 meals per day, add protein to each meal c. There is no need to test blood sugars because you only have type 2 diabetes d. There is no need to continue the chair exercises suggested by your Physical Therapist after discharge

answer

b. Eat 3 meals per day, add protein to each meal

question

Ann Boyd, 60 was admitted with COPD. She was placed on a predisone taper this morning. Her A1c is 10.5 and blood sugars are in the 200's. She is 60 inches tall and weighs 250#. Which statement best describes the situation? a. Ann's has steroid-induced diabetes due to today's predisone taper and her sugars will go back to normal levels as soon as the taper has been discontinued. b.Ann has had type 2 diabetes for a while as evidenced by the elevated A1c. The COPD exacerbation has caused a further rise in blood sugars. The predisone will cause sugars to go up even further. c.Ann has type 1 diabetes d.There is not enough information to determine if Ann has diabetes

answer

b.Ann has had type 2 diabetes for a while as evidenced by the elevated A1c. The COPD exacerbation has caused a further rise in blood sugars. The predisone will cause sugars to go up even further.

question

Danny Hildreth is 55. He has type 2 diabetes and peripheral neuropathy with right foot cellulitis and is on IV Vancomycin. Danny takes his oral medications properly and tests blood sugars as ordered by his physician. What will be your diabetes educational focus? a. Neuropathy, foot care and complications. b. Insulin management - he will be on insulin sooner than later. c. Review oral medications and blood glucose monitoring. d. No teaching necessary - he seems to have mastered the basics.

answer

a. Neuropathy, foot care and complications.

question

Mary Barretto, 34 is on an insulin pump. Mary has type 1 diabetes and was admitted in DKA. What information is false and will not help her prevent future DKA hospitalizations? a. Illness causes blood sugars to go up - so a person with type 1 diabetes will need additional insulin during an illness. Call your physician for assistance with insulin pump adjustments when you get sick. b. Purchase ketostix and test urine if blood sugars >250, or if you have nausea or vomiting. c. Suspend insulin delivery on the pump if you aren't going to eat . d. Unexpected blood sugar elevations that do not decrease when you have administered a bolus of insulin may be caused by a kink in the tubing. Change the infusion set under those conditions to prevent DKA.

answer

c. Suspend insulin delivery on the pump if you aren't going to eat.

question

What are some common early s/sx of hyperglycemia?

answer

Frequent urination Increased thirst Blurred vision Fatigue Headache

question

What are some common later s/sx of hyperglycemia?

answer

If hyperglycemia goes untreated, it can cause toxic acids (ketones) to build up in your blood and urine (ketoacidosis). Signs and symptoms include: Fruity-smelling breath Nausea and vomiting Shortness of breath Dry mouth Weakness Confusion Coma Abdominal pain

question

What are some common s/sx of hypoglycemia?

answer

Confusion Abnormal behavior Visual disturbances Heart palpitations Shakiness Anxiety Sweating Hunger Tingling sensation around the mouth

question

What are some possible, but uncommon, s/sx of hypoglycemia?

answer

Seizures - uncommon Loss of consciousness - uncommon

question

Blood Glucose greater than _____mg/dl would signify DKA

answer

BG > 250mg/dL

question

+ or - Ketones would signify DKA

answer

+ Ketones

question

Urine pH < ______ would signify DKA

answer

pH <7.30

question

True or False? Severe Dehydration is not a symptom of DKA.

answer

False!

question

True or False? In HHN, there is an absence of Ketones in the urine.

answer

True!

question

True or False? In HHN, blood glucose levels are shown as being high.

answer

True!

question

A nurse is teaching a patient with Type 1 Diabetes who is beginning a complex regimen of glycemic control about the properties and actions of the various types of insulin. The nurse should explain that the type of insulin that has an onset of 60 - 120 minutes, peaks in 6 - 14 hours, and has a duration of 16 - 24 hours is known as: A. Regular Insulin (Humilin) B. Insulin Glargine (Lantus) C. NPH Insulin D. Insulin Detemir

answer

C. NPH has an onset of 60 - 120 minutes, peaks in 6 - 14 hours, and has a duration of 16 - 24 hours

question

A nurse instructing a patient about the use of an insulin pump should explain that the risk of DKA increases with the use of a pump because: A. The pump must be removed for bathing B. Insulin is injected continuously C. The pump uses intermediate acting insulin D. The tubing could become occluded

answer

D. Malfunctioning of the pump from low battery power, occlusion of tubing or needles, or lack of insulin in the pump increases the risk of DKA.

question

A nurse is instructing a patient newly diagnosed with type 2 DM about the biguanide she has been prescribed, which is Metformin. The nuse should explain that this type of medication acts by: A. Reducing hepatic glucose production B. Delaying carbohydrate digestion C. Increasing the cellular response to insulin D. Increasing insulin secretion by the pancreas

answer

A. Biguanides reduce hepatic glucose production while increasing insulin action on muscle glucose uptake

question

A nurse is reviewing self administration of insulin using a prefilled pen administration system with a patient who started using it the previous week. The patient asks what he can do to reduce discomfort. The nurse teaches: A. Agitate the syringe slightly before injection B. Store pens with needle pointing upward C. Insert needle slowly D. Keep pen at room temperature for a few minutes

answer

D. Injecting cold insulin can be painful

question

The nurse is reviewing results of a lab test performed as part of a 50yo woman's annual physical. The nurse notes a blood glucose level of 120 mg/dl. The nurse should determine this as an abnormal result for a: A. Casual bg measurement B. Fasting bg measurement C. Glycosylated Hemoglobin measurement D. 2 hour measurement for oral glucose

answer

B. This result exceeds the acceptable range of 70 - 105

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