Question 1

Diabetes is a heterogeneous group of chronic disorders characterized by ____________

Accepted Answer

Hyperglycemia

Question 2

Alterations in metabolism of fats, carbs, and proteins are caused by

Accepted Answer

Insufficient insulin supply and/or action

Question 3

Fats and proteins are metabolized for energy if _______

Accepted Answer

No insulin is available or given

Question 4

Transport and metabolism of glucose for use as energy is the job of _______

Accepted Answer

Insulin

Question 5

Insulin stimulates storage of glucose in the _____________ & ____________ as glycogen

Accepted Answer

Liver and muscles

Question 6

What is polyuria

Accepted Answer

Excessive urination

Question 7

Polyuria leads to diuresis (severe water loss) and excretion of

Accepted Answer

Sodium, chloride, and potassium

Question 8

What is polydipsia

Accepted Answer

Excessive thirst

Question 9

Polydipsia and polyuria are caused by excessive sugar in the blood, causing your kidneys to work harder by _______

Accepted Answer

Excreting excess sugar into the urine dragging fluids along, causing frequent urination and subsequent thirst

Question 10

In order to move glucose into most body systems you need

Accepted Answer

Insulin

Question 11

What causes polyphagia

Accepted Answer

Cells are starved for glucose causing excessive appetite

Question 12

What is polyphagia

Accepted Answer

Excessive eating

Question 13

What are the three types of diabetes

Accepted Answer

Type I and II and gestational ( pregnancy induced)

Question 14

Type 1 is caused by ___________________ causing insulin deficiency, onset is ___

Accepted Answer

beta cell destruction Juvenile (

Question 15

Type 2 is caused by a lack of _______ or resistance to the action. Onset is _______

Accepted Answer

Insulin, adult onset

Question 16

What are some signs and symptoms of type 1 diabetes

Accepted Answer

Fatigue, weakness, vision changes, numbness/tingling in hands and feet, dry skin, wounds slow to heal, recurrent infections and sudden weight loss may occur.

Question 17

What are some signs and symptoms of type 2 diabetes

Accepted Answer

Fatigue, weakness, vision changes, numbness/tingling in hands and feet, sexual dysfunctions, dry skin, wounds slow to heal, recurrent infections, weight loss, vaginal infections.

Question 18

Objective assessment symptoms include

Accepted Answer

Weight loss ( type 1 ) Obesity ( type 2) Elevated fasting serum glucose Glycosuria Peripheral, neuro, and sensory changes

Question 19

Ketones/ketones bodies are produced by

Accepted Answer

Abnormal breakdown of fatty acids or fat

Question 20

Excess acids caused by lack of insulin increase hydrogen and carbon dioxide causing

Accepted Answer

Acidosis

Question 21

What are Kussmaul respirations

Accepted Answer

Deep gasping hyperventilation associated with severe diabetic acidosis

Question 22

What other assessment of breathing would lead you to believe a case of diabetic acidosis

Accepted Answer

Fruity breath odor

Question 23

What blood test is used for long term glucose control

Accepted Answer

Hemoglobin A1c/ glycosylated hemoglobin

Question 24

How does exercise help

Accepted Answer

Lowers blood sugar, aids in weight loss, lowers risk for cardiovascular problems

Question 25

what glucose related problem can occur because of exercise

Accepted Answer

Post work out hypoglycemia

Question 26

Moderate exercise can _____________blood sugar Strenuous exercise can temporarily _____________blood sugar

Accepted Answer

Lower, Raise

Question 27

What are some of the risks associated with diabetes mellitus

Accepted Answer

Macrovascular ( large blood vessels) Microvascular ( small blood vessels) Diabetic ketoacidosis ( DKA) HHS ( hyperosmolar hyperglycemic state- high glucose levels over 400)

Question 28

What is Hypoglycemia

Accepted Answer

Low blood glucose levels

Question 29

Macrovascular complications of diabetes can include:

Accepted Answer

Macro: stroke, heart disease, hypertension, PVD, foot problems.

Question 30

Microvascular complications of diabetes can include:

Accepted Answer

Diabetic eye disease (retinopathy and cataracts) Renal disease Neuropathy Foot problems

Question 31

What additional factors increase risk for macrovascular complications

Accepted Answer

Smoking, physical inactivity, increased body weight, hypertension, hyperlipidemia

Question 32

Knowing that gluconeogenesis helps to maintain blood levels, a nurse should A   Document weight changes because of fatty acid mobilization B   Evaluate the patient\'s sensitivity to low room temperatures because of decreased adipose tissue insulation C   Protect the patient from sources of infection because of decreased cellular protein deposits D  Do all of the above

Accepted Answer

D Do all of the above

Question 33

Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except: A   Hypoglycemia B   Hyponatremia C   Ketonuria D   Polyphagia

Accepted Answer

A Hypoglycemia

Question 34

The lowest fasting plasma glucose level suggestive of a diagnosis of DM is A   90mg/dl B   115mg/dl C   126mg/dl D   180mg/dl

Accepted Answer

C 126mg/dl

Question 35

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: A   Third day B   Week C   2-3 weeks D   2-4 weeks

Accepted Answer

C  2-3 weeks    To prevent lipodystrophy

Question 36

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A   Blurred vision B   Diaphoresis C   Nausea D   Weakness

Accepted Answer

B Diaphoresis

Question 37

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except: A   Integumentary inspection for the presence of brown spots on the lower extremities B   Observation for paleness of the lower extremities C   Observation for blanching of the feet after the legs are elevated for 60 seconds D   Palpation for increased pulse volume in the arteries of the lower extremities

Accepted Answer

D Palpation for increased pulse volume in the arteries of the lower extremities

Question 38

The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively: A   10-20% B   25-40% C   50-60% D   85-90%

Accepted Answer

C 50-60%

Question 39

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

Accepted Answer

B 1330 and 1930

Question 40

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: A   6-8 hours B   10-14 hours C   16-20 hours D   24-28 hours

Accepted Answer

C 16-20 hours

Question 41

Albert refuses his bedtime snack. This should alert the nurse to assess for: A   Elevated serum bicarbonate and a decreased blood pH. B   Signs of hypoglycemia earlier than expected. C   Symptoms of hyperglycemia during the peak time of NPH insulin. D   Sugar in the urine

Accepted Answer

B Signs of hypoglycemia earlier than expected

Question 42

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A   2-4 hours after administration B   6-14 hours after administration C   16-18 hours after administration D   18-24 hours after administration

Accepted Answer

B 6-14 hours after administration  NPH is intermediate acting insulin. The onset of action is 1-2 hours, it peaks in 6-14 hours, and it\'s duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

Question 43

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A   Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B   Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C   Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D   Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels

Accepted Answer

A Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.  An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as neede4. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

Question 44

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? A   Elevated blood glucose level and a low plasma bicarbonate B   Decreased urine output C   Increased respirations and an increase in pH D   Comatose state

Accepted Answer

A Elevated blood glucose level and a low plasma bicarbonate  In diabetic acidiosis the arterial pH is less than 7.35. plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmauls respirations would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis

Question 45

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client\'s anxiety would be to: A   Administer a sedative B   Make sure the client knows all the correct medical terms to understand what is happening C   Ignore the signs and symptoms of anxiety so that they will soon disappear D   Convey empathy, trust, and respect toward the client

Accepted Answer

D Convey empathy, trust, and respect toward the client  The most appropriate intervention is to address the client\'s feelings related to the anxiety. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client\'s anxious feelings. A client will not relate to medical terms, particularly when anxiety exists

Question 46

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: 1. High risk for d A   High risk for deficient fluid volume B   Deficient knowledge: disease process and treatment C   Imbalanced nutrition: less than body requirements D   Disabled family coping: compromised

Accepted Answer

A High risk for deficient fluid volume  Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options B, C, and D are not related specifically to the issue of the question.

Question 47

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: A   Administer regular insulin intravenously B   Administer 5% dextrose intravenously C   Correct the acidosis D   Apply an electrocardiogram monitor

Accepted Answer

A Administer regular insulin intravenously  lack (absolute or relative) of insulin is the primary cause of DK1. Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority action.

Question 48

A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse? A   Pulse B   BP C   Respiration D   Temperature

Accepted Answer

D Temperature  An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis

Question 49

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? A   \"The best time for me to exercise is every afternoon.\" B   \"The best time for me to exercise is right after I eat.\" C   \"The best time for me to exercise is after breakfast.\" D   \"The best time for me to exercise is after my morning snack.\"

Accepted Answer

A \"The best time for me to exercise is every afternoon.\"  A hypoglycemic reaction may occur in the response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication. Options B, C, and D do not address peak action times.

Question 50

A client with diabetes mellitus visits a health care clinic. The client\'s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? A   Prednisone (Deltasone) B   Atenolol (Tenormin) C   Phenelzine (Nardil) D   Allopurinol (Zyloprim)

Accepted Answer

A Prednisone (Deltasone)  Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

Question 51

Glucose is an important molecule in a cell because this molecule is primarily used for: A   Extraction of energy B   Synthesis of protein C   Building of genetic material D   Formation of cell membranes

Accepted Answer

A Extraction of energy  Glucose catabolism is the main pathway for cellular energy production.

Question 52

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse\'s priority is to provide: A   Oxygen B   Carbohydrates C   Fluid replacement D   Dietary instruction

Accepted Answer

C Fluid replacement  As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin.

Question 53

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. A   Thirst B   Palpitations C   Diaphoresis D   Slurred speech E   Hyperventilation

Accepted Answer

B- Palpitations   C- Diaphoresis   D- Slurred speech  Palpitations, an adrenergic symptom, occur as the glucose levels fall; the sympathetic nervous system is activated and epinephrine and norepinephrine are secreted causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.

Question 54

When a client is in diabetic ketoacidosis, the insulin that would be administered is: A   Human NPH insulin B   Human regular insulin C   Insulin lispro injection D   Insulin glargine injection

Accepted Answer

B Human regular insulin  Regular insulin (Humulin R) is a short-acting insulin and is administered via IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood glucose becomes ;13.9 mmol/L (;250 mg/dL). At this point, insulin dose should be decreased by half, to 0.1 units/kg every 2 hours, until the resolution of DKA.

Question 55

The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says: A   \"I need to rub my forearm vigorously until warm before testing at this site.\" B   \"The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.\" C   \"I have to make sure that my current glucose monitor can be used at an alternate site.\" D   \"Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.\"

Accepted Answer

B The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.  The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected

Question 56

Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to exhibit? Select all that apply: A   Sweating B   Low PCO2 C   Retinopathy D   Acetone breath E   Elevated serum bicarbonate

Accepted Answer

B- Low PCO2   C- Retinopathy  Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a lowered PCO2. A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis.

Question 57

A client\'s blood gases reflect diabetic acidosis. The nurse should expect: A   Increased pH B   Decreased PO2 C   Increased PCO2 D   Decreased HCO3

Accepted Answer

D Decreased HCO3  The bicarbonate-carbonic acid buffer system helps maintain the pH of the body fluids; in metabolic acidosis there is a decrease in bicarbonate because of an increase of metabolic acids.

Question 58

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it: A   Inhibits gluconeogenesis B   Stimulates the release of insulin C   Increases blood glucose levels D   Provides more storage of glucose

Accepted Answer

C Increases blood glucose levels  Glucagon, an insulin antagonist produced by the alpha cells in the islets of langerhans, leads to the conversion of glycogen to glucose in the liver.

Question 59

A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should: A   Call the physician B   Encourage the intake of fluids C   Administer the insulin as ordered D   Give the client Â½ c. of orange juice

Accepted Answer

C Administer the insulin as ordered  A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered.

Question 60

The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order. 1. Inject air equal to NPH dose into NPH vial 2. Invert regular insulin bottle and withdraw regular insulin dose 3. Inject air equal to regular dose into regular dose 4. Invert NPH vial and withdraw NPH dose. A   1, 2, 3, 4. B   1, 4, 3, 2. C   1, 4, 2, 3, D   1, 3, 2, 4

Accepted Answer

D 1, 3, 2, 4.

Question 61

The insulin that has the most rapid onset of action would be: A   Lente B   Lispro C   Ultralente D   Humulin N

Accepted Answer

B Lispro  Lispro has an immediate onset, a peak of 30-90 minutes, and duration of 2-4 hours

Question 62

A client with DM states, \"I cannot eat big meals; I prefer to snack throughout the day.\" The nurse should carefully explain that the: A   Regulated food intake is basic to control B   Salt and sugar restriction is the main concern C   Small, frequent meals are better for digestion D   Large meals can contribute to a weight problem

Accepted Answer

A Regulated food intake is basic to control  An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two-between meals snacks needs to be tailored to the client\'s specific needs, with due regard for activity, diet, and therapy.

Question 63

A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse\'s primary responsibility to: A   Check the client\'s serum glucose level B   Assist the client out of bed to the chair C   Place the client in a high-fowlers position D   Ensure that the client\'s residual limb is elevated

Accepted Answer

A Check the client\'s serum glucose level  Because the client has diabetes, it is essential that the blood glucose level be determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage.

Question 64

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? A   Give subcutaneous insulin and monitor blood glucose B   Monitor blood glucose closely, and look for signs of hypoglycemia D   Monitor blood glucose, and assess for signs of hyperglycemia

Accepted Answer

B Monitor blood glucose closely, and look for signs of hypoglycemia  When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemic. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Giving insulin would also lower the glucose levels, causing hypoglycemic. The client wouldn\'t have hyperglycemia if the glyburide was absorbed.

Nursing 137 Diabetes – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards