Diabetes General Information
Located posteriorly to the stomach, this organ influences carbohydrate metabolism, indirectly influence fat and protein metabolism, and produces insulin and glucagon
What is the Pancreas?
Saunders Comprehensive Review for the NCLEX-PN Examination 7th edition, page 561
A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise?
A. I should not exercise after lunch
B. I should not exercise after breakfast
C. I should not exercise in the late evening
D. I should not exercise in the late afternoon
What is...
D. A hypoglycemic reaction may occur in response to increased exercise. Client should avoid exercise during the peak time of insulin. Humilin N insulin peaks between 6-14 hours. Therefore, late-afternoon exercise would occur during the peak of the medication
Test taking strategy: Note the subject, the most likely time of a hypogylcemic reaction. Recalling the peak time of humulin N insulin will direct you to the option of late afternoon exercise. Review measures to prevent hypoyglcemia
Saunders Comprehensive Review for the NCLEX PN Exam, page 582
As the nurse teaching insulin administration, you would instruct your client to cleanse the skin with _________ prior to insulin injection.
What is alcohol?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 572
Time of onset for rapid acting insulin.
What is up to 30 minutes?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 591
Insulin Lispro 15-30 mins
Insulin aspart 10-20 mins
Insulin glulisine 10-15 mins
Excessive thirst
Polydipsia
This machine helps patients and health care providers know the amount of sugar in the blood at any given time. Ouch ! You hurt my finger !
What is a glucometer?
Often diagnosed in Children and Adolescents, this type of Diabetes results in absolute deficiency of insulin
What is Type 1 Diabetes?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 571
Your diabetic patient, should always carry this with him or her when going outside their home in case a hypoglycemic event occurs.
What is a form of fast-acting simple carbohydrate ?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 573
Examples:
4 tsp of sugar
4 sugar cubes
3 graham crackers
An unopened vial of insulin can be used up in 1 month when stored in this location.
What is the refrigerator?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 591
This is a life-threatening complication of Diabetes Mellitus Type 1.
What is Diabetic Ketoacidosis?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 575
*Nclex tip: The main clinical manifestations include hyperglycemia, dehydration, electrolyte imbalance, and acidosis. Only patients with Type 1 DM can have DKA
This disorder is a chronic disorder of impaired carbohydrate, protein, and lipid metabolism caused by a deficiency of insulin?
What is Diabetes Mellitus?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 571.
DOUBLE JEOPARDY !!! 600 points !!
A nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following factors can cause HHS? (Select all that apply)
A. Evidence of recent myocardial infarction
B. BUN 35 mg/dl
C. Takes a calcium channel blocker
D. Age 77 years
E. Fluid volume excess
What is...
A. The client who has type 2 DM and had a myocardial infarction 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 DM can 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 the several medications that increase the risk for HHS in a client who has type 2 DM
D. The older adult is at risk for developing type 2 DM and can be unaware of associated manifestations, increasing risk for HHA
A nurse understands that a diabetic client can have non-healing ulcers of the feet because of this condition.
What is Diabetic neuropathy?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 577
Abdomen, Arms (posterior surface), thighs (anterior surface), and hips
What are insulin injection sites?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 592
DOUBLE JEOPARDY !! 600 points !!
This hormone increases blood glucose levels by stimulating glycogenolysis in the liver. It can be administered Subcutaneously, intramuscularly, or intravenously.
What is Glucagon
Saunders Comprehensive Review for the NCLEX-PN Exam, page 593
This condition is a major risk factor for Diabetes Melitus (DM).
What is Obesity?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 571
DOUBLE JEOPARDY QUESTIONS = 800 points !
Explain why insulin may be needed during times of stress, surgery, or infection?
During stress, surgery, or infection, the stress response is initiated and is sustained by the adrenal glands. The adrenal glands produce cortisol (steroid hormone) and epinephrine (AKA Adrenaline) as part of the fight or flight response. A major side effect of cortisol is elevated blood sugar levels, thus the patient may require additional insulin or changes in current insulin regimen.
A nurse is assisting with a presentation about nutrition habits that prevent type 2 Diabetes Mellitus. Which of the following should the nurse include? (Select all that apply)
A. Eat less meat and processed foods
B. Decrease intake of saturated fats
C. Increase daily fiber intake
D. Limit unsaturated fat intake to 15% of daily caloric intake
E. Include omega-3 fatty acids in the diet
What is...
A. Healthy nutrition should include decreasing consumption of meats and processed foods, which can prevent diabetes and hyperlipidemia
B. Healthy nutrition should include lowering LDL by decreasing intake of saturated fats, which can prevent diabetes and hyperlipidemia
C. Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of diabetes and hyperlipidemia
E. Healthy nutrition should include omega-3 fatty acids for secondary prevention of diabetes and heart disease
True or False: Aspiration after insertion of the needle while administering Insulin is recommended with self-injection of insulin.
False: Aspiration after insertion of the needle is generally not recommended with self-injection of insulin.
Saunders Comprehensive Review for the NCLEX-PN Exam, page 592
True/False: Insulin plays a major role in the treatment of Hyperosmolar Hyperglycemic Syndrome (HHS).
False: Insulin plays a less critical role in the treatment of HHS than it does for DKA because ketosis and acidosis do not occur in HHS. Rehydration alone may decrease glucose levels
Saunders Comprehensive Review for the NCLEX-PN Exam, page 576
This syndrome is also known as syndrome X, and the individual will have co-existing risk factors for developing type 2 Diabetes Mellitus. The risk factors include: abdominal obesity, hyperglycemia, hypertension, high triglyceride level, and lowered high density lipoprotein (HDL) cholesterol level
What is Metabolic Syndrome?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 571
This phenomenon occurs when normal or elevated blood glucose levels are present at bedtime, then drops to hypoglycemic levels usually between 2AM and 3AM
What is Somogyi Phenomenon?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 573
*By 7AM, in response to counterregulatory hormones overnight, the bloods sugar rebounds significantly to hyperglycemic levels.
Jeopardy Bonus question +100 pts: what are possible treatments to combat the somogyi phenomenon?
A nurse is collecting data from a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect to instruct the clients family that which of the following findings could occur? (select all that apply)
A. Weight gain
B. Fruity Odor of breath
C. Abdominal pain
D. Kussmaul Respirations
E. Metabolic Acidosis
What is:
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 by glucose, protein, and fat breakdown, which produces ketones
ATI Content Mastery Series, page 503
This type of insulin must be rotated or rolled between palms to ensure that the insulin and ingredients are mixed well. Otherwise, an inaccurate dose will be drawn.
What is NPH insulin?
Saunders Comprehensive Review for the NCLEX-PN Exam, page 592
A patient in your acute care facility is experiencing an altered level of consciousness whose blood sugar is below 70mg/dL. The nurse would perform this intervention FIRST.
What is bypass oral treatment and start with injectable glucagon or 50% dextrose.
Saunders Comprehensive Review for the NCLEX-PN Exam, page 574