Medications
After the home health nurse has taught a patient and family about how to use glargine and regular insulin safely, which action by the patient indicates that the teaching has been successful?
a. The patient disposes of the open insulin vials after 4 weeks.
b. The patient draws up the regular insulin in the syringe and then draws up the glargine.
c. The patient stores extra vials of both types of insulin in the freezer until needed.
d. The patient's family prefills the syringes weekly and stores them in the refrigerator
Answer: A
The patient disposes of the open insulin vials after 4 weeks.
Rationale: Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Freezing alters the insulin molecule and should not be done.
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about
a. use of low doses of regular insulin.
b. self-monitoring of blood glucose.
c. oral hypoglycemic medications.
d. maintenance of a healthy weight.
Answer: D
Maintenance of a healthy weight
Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.
A nurse is caring for a client with type 1 diabetes mellitus. which client complaint would alert the nurse to the presence of a possible hypoglycemic reaction?
A. Tremors
B. Anorexia
C. Hot, dry skin
D. Muscle cramps
Answer: A
Tremors
Rationale: decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 3 is more likely for hyperglycemia, and options 2 and 4 are unrelated to the signs of hypoglycemia.
A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what ""type 2"" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes:
a. The pt is totally dependent on an outside source of insulin
b. There is a decreased insulin secretion and cellular resistance to insulin that is produced
c. The immune system destroys the pancreatic insulin-producing cells
d. The insulin precurosr that is secreted by the pancreas is not activated by the liver
Answer: B
There is a decreased insulin secretion and cellular resistance to insulin that is produced
Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body's needs or the cells do not respond to the insulin appropriately. The other information describes the physiology of type 1 diabetes
Risk factors for type 2 diabetes include all of the following except:
a. Advanced age
b. Obesity
c. Smoking
d. Physical inactivity
Answer:C
smoking
Rationale: Additional risk factors for type 2 diabetes are a family history of diabetes,
impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.
A diabetic patient is started on intensive insulin therapy. The nurse will plan to teach the patient about mealtime coverage using _____ insulin.
a. NPH
b. lispro
c. detemir
d. glargine
Answer: B
Lispro
Rationale: Rapid or short acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
Blood sugar is well controlled when Hemoglobin A1C is:
a. Below 7%
b. Between 12%-15%
c. Less than 180 mg/dL
d. Between 90 and 130 mg/dL
Answer: A
Below 7%
Rationale: A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.
While hospitalized and recovering from an episode of diabetic ketoacidosis, the patient calls the nurse and reports feeling anxious, nervous, and sweaty. Based on the patient's report, the nurse should
a. obtain a glucose reading using a finger stick.
b. administer 1 mg glucagon subcutaneously.
c. have the patient eat a candy bar.
d. have the patient drink 4 ounces of orange juice.
Answer: A
Obtain a glucose reading using a finger stick.
Rationale:The patient's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the patient's symptoms become worse or if the patient is unconscious. Candy bars contain fat, which would slow down the absorption of sugar and delay the response to treatment.
The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of Type II Diabetes and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents?
a. Comply with medication regimen 100% for 6 months
b. Quit the use of any tobacco products by the end of three months
c. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily
d. Practice relaxation techniques for at least five minutes five times a day for at least five months
Answer: C
Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily.
Rationale:When type II diabetics lose weight through diet and exercise they sometimes have an improvement in insulin efficiency sufficient to the degree they no longer require oral hypoglycemic agents.
The risk factors for type 1 diabetes include all of the following except:
a. Diet
b. Genetic
c. Autoimmune
d. Environmental
Answer: A
Diet
Rationale:Type 1 diabetes is a primary failure of pancreatic beta cells to produce insulin. It primarily affects children and young adults and is unrelated to diet.
Amitriptyline (Elavil) is prescribed for a diabetic patient with peripheral neuropathy who has burning foot pain occurring mostly at night. Which information should the nurse include when teaching the patient about the new medication?
a. Amitriptyline will help prevent the transmission of pain impulses to the brain.
b. Amitriptyline will improve sleep and make you less aware of nighttime pain.
c. Amitriptyline will decrease the depression caused by the pain.
d. Amitriptyline will correct some of the blood vessel changes that cause pain.
Answer: A
Amitriptyline will help prevent the transmission of pain impulses to the brain.
Rationale: Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain. Tricyclics also improve sleep quality and are used for depression, but that is not the major purpose for their use in diabetic neuropathy. The blood vessel changes that contribute to neuropathy are not affected by tricyclics.
A diabetic patient is admitted with ketoacidosis and the health care provider writes all of the following orders. Which order should the nurse implement first?
a. Start an infusion of regular insulin at 50 U/hr.
b. Give sodium bicarbonate 50 mEq IV push.
c. Infuse 1 liter of normal saline per hour.
d. Administer regular IV insulin 30 U.
Answer: C
Infuse 1 liter of normal saline per hour.
Rationale: The most urgent patient problem is the hypovolemia associated with DKA, and the priority is to infuse IV fluids. The other actions can be accomplished after the infusion of normal saline is initiated.
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis (DKA). The nurse recognizes that this measure is important to identify
a. electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia.
b. fluid overload resulting from aggressive fluid replacement.
c. the presence of hypovolemic shock related to osmotic diuresis.
d. cardiovascular collapse resulting from the effects of hyperglycemia.
Answer: A
Electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia.
Rationale: The hypokalemia associated with metabolic acidosis can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Fluid overload, hypovolemia, and cardiovascular collapse are possible complications of DKA, but cardiac monitoring would not detect theses.
During a diabetes screening program, a patient tells the nurse, "My mother died of complications of type 2 diabetes. Can I inherit diabetes?" The nurse explains that
a. as long as the patient maintains normal weight and exercises, type 2 diabetes can be prevented.
b. the patient is at a higher than normal risk for type 2 diabetes and should have periodic blood glucose level testing.
c. there is a greater risk for children developing type 2 diabetes when the father has type 2 diabetes.
d. although there is a tendency for children of people with type 2 diabetes to develop diabetes, the risk is higher for those with type 1 diabetes.
Answer: B
The patient is at a higher than normal risk for type 2 diabetes and should have periodic blood glucose level testing.
Rationale: Offspring of people with type 2 diabetes are at higher risk for developing type 2 diabetes. The risk can be decreased, but not prevented, by maintenance of normal weight and exercising. The risk for children of a person with type 1 diabetes to develop diabetes is higher when it is the father who has the disease. Offspring of people with type 2 diabetes are more likely to develop diabetes than offspring of those with type 1 diabetes.
Which of the following factors are risks for the development of diabetes mellitus? (Select all that apply.)
a) Age over 45 years
b) Overweight with a waist/hip ratio >1
c) Having a consistent HDL level above 40 mg/dl
d) Maintaining a sedentary lifestyle
Answer: A,B,D
Age over 45 years, overweight, and fainting a sedentary lifestyle.
Rationale: Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.
A client is taking Humulin NPH insulin daily every morning. The nurse instructs the client that the mostlikely time for a hypoglycemic reaction to occur is:
A) 2-4 hours after administration
B) 4-12 hours after administration
C) 16-18 hours after administration
D) 18-24 hours after administration
Answer: B
4-12 hours after administration
Rationale: Humulin is an intermediate acting insulin. The onset of action is 1.5 hours, it peaks in 4-12 hours, and its duration is 24 hours. Hypoglycemic reactions to insulin are most likely to occur during the peak time.
A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may
a. require administration of insulin while taking prednisone.
b. develop acute hypoglycemia during the RA exacerbation.
c. have rashes caused by metformin-prednisone interactions.
d. need a diet higher in calories while receiving prednisone.
Answer: A
Require administration of insulin while taking prednisone.
Rationale: Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a complication of RA exacerbation or prednisone use. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient is likely to have an increased appetite when taking prednisone, but it will be important to avoid weight gain for the patient with RA.
A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral vascular disease evidenced by decreased peripheral pulses and dependent rubor. The nurse teaches the patient that
a. the feet should be soaked in warm water on a daily basis.
b. flat-soled leather shoes are the best choice to protect the feet from injury.
c. heating pads should always be set at a very low temperature.
d. over-the-counter (OTC) callus remover may be used to remove callus and prevent pressure.
Answer: B
Flat-soled leather shoes are the best choice to protect the feet from injury.
Rationale: The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided; the patient should see a specialist to treat these problems.
A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a swimming class every day at 1:00 PM. The clinic nurse teaches the patient to
a. delay eating the noon meal until after the swimming class.
b. increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the swimming class.
c. time the morning insulin injection so that the peak occurs while swimming.
d. check glucose level before, during, and after swimming.
Answer: D
Check glucose level before, during, and after swimming.
Rationale: The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.
Which of the following persons would most likely be diagnosed with diabetes mellitus? A 44-year-old..
A. Caucasian Woman
B. Asian Woman
C. African-American woman
D. Hispanic Male
Answer: C
African-American Woman
Rationale: Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with Type 1 diabetes at 1600. Which action should the nurse implement?
A. Ensure the client eats the bedtime snack.
B. Determine how much food the client ate at lunch.
C. Perform a glucometer reading at 0700.
D. Offer the client protein after administering insulin.
Answer: A
Ensure the client eats the bedtime snack.
Rationale: Humulin N peaks in 6-8 hours, making the client at risk for hypoglycemia around midnight, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia. The food intake at lunch will not affect the client's blood glucose level at midnight. The client's glucometer reading should be done around 2100 to assess the effectiveness of insulin at 1600. Humulin N is an intermediate-acting insulin that has an onset in 2-4 hours but does not peak until 6-8 hours.
A patient with type 2 diabetes is scheduled for an outpatient coronary arteriogram. Which information obtained by the nurse when admitting the patient indicates a need for a change in the patient's regimen?
a. The patient's most recent hemoglobin A1C was 6%.
b. The patient takes metformin (Glucophage) every morning.
c. The patient uses captopril (Capoten) for hypertension.
d. The patient's admission blood glucose is 128 mg/dl.
Answer: B
The patient takes metformin (Glucophage) every morning.
Rationale: To avoid lactic acidosis, metformin should not be used for 48 hours after IV contrast media are administered. The other patient data indicate that the patient is managing the diabetes appropriately.
A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which findings is the nurse most likely to observe in this client? Select all that apply:
1. Excessive thirst
2. Weight gain
3. Constipation
4. Excessive hunger
5. Urine retention
6. Frequent, high-volume urination
Answer: 1,4,6
Excessive thirst, excessive hunger, and frequent, high-volume urination
Rationale: Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia (excessive hunger), and polyuria (excessive urination). Because the body is starving from the lack of glucose the cells are using for energy, the client has weight loss, not weight gain. Clients with diabetes mellitus usually don't present with constipation. Urine retention is only a problem is the patient has another renal-related condition.
The nurse is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply.
a. Cakes, candies, cookies, and regular soft drinks should be avoided.
b. Gestational diabetes increases the risk that the mother will develop diabetes later in life.
c. Gestational diabetes usually resolves after the baby is born.
d. Insulin injections may be necessary.
e. The baby will likely be born with diabetes
f. The mother should strive to gain no more weight during the pregnancy.
Answer: A,B,C,D
Cakes, candies, cookies, and regular soft drinks should be avoided. Gestational diabetes increases the risk that the mother will develop diabetes later in life. Gestational diabetes usually resolves after the baby is born.Insulin injections may be necessary.
Rationale: Gestational diabetes can occur between the 16th and 28th week of pregnancy. If not responsive to diet and exercise, insulin injections may be necessary. Concentrated sugars should be avoided. Weight gain should continue, but not in excessive amounts.Usually, gestational diabetes disappears after the infant is born. However, diabetes can develop 5 to 10 years after the pregnancy.
The nurse is explaining to a nursing student what conditions occur in the body to cause the development of gestational diabetes in a pregnant mother. Which statement by the nurse is the most accurate pertaining to what causes gestational diabetes?
a. A decreased level of glucose in the blood cannot get into the cells because there is a decreased level of insulin. This condition in the body causes GDM.
b. An excessive level of glucose in the blood cannot get into the cells because there is not enough insulin to carry the high amount of glucose present. This condition in the body causes GDM.
c. A decreased level of glucose in the blood cannot get into the cells because there is an excessive level of insulin. This condition in the body causes GDM.
Answer: B
An excessive level of glucose in the blood cannot get into the cells because there is not enough insulin to carry the high amount of glucose present. This condition in the body causes GDM.