ch 37 study guide

Question 1

the nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. which information accurately explains why the type 1 diabetic does not produce adequate insulin?

Answer 1

the body’s immune system destroyed beta cells.

*rationale: in type 1 diabetes mellitus, the beta cells on the islets of langerhans are destroyed by an autoimmune reaction.

Question 2

type 2 diabetes cases compose approximately what percentage of all known cases of diabetes?

Answer 2

95%

*rationale: type 2 diabetes comprises 90-95% of all known cases.

Question 3

the nurse is educating a patient with gestational diabetes. which statement indicates that the patient needs additional teaching?

Answer 3

“this problem goes away completely once i give birth.”

*rationale: giving birth does not automatically resolve gestational diabetes. of the women who have gestational diabetes, 5-10% go on to develop type 2 diabetes.

Question 4

a patient asks the nurse if stress can be a potential cause of type 2 diabetes. which response is most appropriate for the nurse to make?

Answer 4

“Periods of stress cause increases in glycogen production by the adrenal cortex.”

*rationale: stress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia.

Question 5

the nurse is counseling an overweight, non compliant, 30 year old female with type 2 diabetes. which change is most important for the nurse to suggest?

Answer 5

begin an exercise program to lose weight.

*rationale: in the type 2 diabetic, weight reduction and increased physical activity can restore blood glucose to normal levels and maintain it.

Question 6

the nurse is educating the patient about the significance of islet cell antibodies. which statement accurately describes islet cell antibodies?

Answer 6

islet cell antibodies cause beta cells to quit producing insulin and lead to type 1 diabetes mellitus

*rationale: the antibodies cause the beta cells to quit producing insulin

Question 7

the nurse is educating a 50 year old patient about diabetes monitoring. which statement reinforces the american diabetes association (ADA’s) recommendation?

Answer 7

obtain regularly scheduled fasting blood glucose levels.

*rationale: the ADA recommends screening with a fasting blood glucose.

Question 8

a patient recently diagnosed with type 1 diabetes mellitus asks why she is experiencing increased thirst. which explanation is most appropriate?

Answer 8

high glucose levels in the blood pull cellular water into circulating volume and increase thirst.

*rationale: polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling intracellular fluid into the circulating volume

Question 9

the nurse is caring for a patient with ketosis. which statement indicates that the patient correctly understands the phenomenon?

Answer 9

“the condition resulted when my body tried to break down and use my stores of fats.”

*rationale: people with type 1 diabetes are prone to a serious complication, ketosis, associated with an excess production of ketone bodies leading to ketoacidosis (metabolic acidosis)

Question 10

the nurse is caring for a patient with type 1 DM who is diaphoretic and clammy. the patient complains of hunger but denies pain. the nurse performs a bedside blood glucose check. what should the nurse do next ?

Answer 10

give 6 ounces of orange juice

*rationale: findings are consistent with hypoglycemia
- manifestations of hypoglycemia:
- tremulousness, hunger, headache, pallor, sweating, blurred vision, and weakness

Question 11

which laboratory values are consistent with a patient in ketoacidosis?

Answer 11

Blood urea nitrogen (BUN) of 35 mg/dL

*rationale: diabetic ketoacidosis results when the body attempts to metabolize proteins and fats, which results in high BUN readings. (BUN 5-20)

Question 12

the patient comes to the ED complaining of abdominal pain. the nurse assesses dry, hot skin, fruity breath, and deep respirations. to which problem should the nurse attribute these findings?

Answer 12

ketoacidosis

*rationale: these are the manifestations of ketoacidosis. Kaussmaul respirations are fast deep breathing

Question 13

which reason best explains why diabetics are prone to infection?

Answer 13

Atherosclerotic vascular changes decrease blood supply to tissues

*rationale: the primary cause for increased risk of infection in diabetic patients is the hyperglycemic environment.

Question 14

the nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%. what can the nurse infer with these findings?

Answer 14

the patient’s blood glucose control has improved over the last several months.

Question 15

the nurse is caring for an older adult patient who is diabetic. the nurse cautions against the technique of “tight control” of hyperglycemia. which statement explains why this management method is not recommended?

Answer 15

older adults may experience cardiovascular problems from hypoglycemia.

*rationale: older adults experience hypoglycemia more quickly than younger people and are more prone to these episodes. Hypoglycemia can progress in older adults before signs and symptoms become obvious

Question 16

which goal is the primary objective of a diabetic diet?

Answer 16

adequate nutrition with weight control

*rationale: the primary goal of the current diabetic diet includes adequate nutrition with weight and cholesterol control. the diets also allow for some sweets and fast foods

Question 17

the patient takes his NovoLog 70/30 at 0700. when should the nurse suggest that the patient schedule exercise?

Answer 17

1300

*rationale: exercise should occur after peak action time to prevent hypoglycemia. NovoLog is a rapid acting insulin that peaks 1-3 hours after administration.

Question 18

the nurse is discussing insulin administration with an assigned patient. the patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites. which response by the nurse is most appropriate?

Answer 18

“rotating injection sites helps enhance insulin absorption.”

Question 19

a long term diabetic patient reports that he has been diagnosed with early cardiovascular disease. how does diabetes predispose the patient to cardiovascular complications?

Answer 19

Hyperglycemic periods cause thickening of the basement membranes in vessels, which causes atherosclerosis.

*rationale: the basement membrane (thin layer of connective tissue under the epithelium)
the vessels of the retina, renal glomeruli, peripheral nerves, muscles, and skin are affected.

Question 20

the nurse is caring for a patient who struggles to maintain glycemic control at night and during the early morning hours. which statement correctly explains the reason for this problem?

Answer 20

counterregulatoy hormones produce hyperglycemia

*rationale: dawn phenomenon is produced in the morning by the circadian release of growth hormones, epinephrine, and glucagon during the night. rebound hyperglycemia (Somogyi effect) follows a period of hypoglycemia, often during sleep

Question 21

a patient with type 1 DM is preparing for a moderate 30 m minute exercise period. which action best indicates that the patient understands condition management?

Answer 21

the patient consumes a simple carbohydrate snack after 30 minutes of activity.

*rationale: during moderate exercise (brisk walking, bowling, vacuuming) 5g of simple carbs should be consumed at the end of 30 minutes and at 30 minute intervals during the continued activity. ex: 1 tsp of honey

Question 22

the nurse is reviewing the patient’s prescribed insulin regimen. the nurse notes that the physician has ordered a long acting insulin. which medication best meets this criteria?

Answer 22

Lantus

Question 23

which genetic factors increase the risk of a person developing DM? (select all)

Answer 23

• number of relatives with DM
• genetic closeness of relatives with DM
• race

Question 24

which factors may cause DM? (select all)

Answer 24

• genetic
• microbiologic
• metabolic
• immunologic

Question 25

which statements explain a reason for weight loss in type 1 diabetics? (select all)

Answer 25

• loss of body fluid
• metabolization of body fats

Question 26

which requirements are part of the criteria for “tight control” of hyperglycemia? (select all)

Answer 26

• administer insulin injections three times a day based on glucometer readings
• maintain fasting glucose within normal limits
• maintain normal weight for height and age
• maintain cholesterol within normal limits

Question 27

when discussing exercise programs with the diabetic, which instructions are important for the nurse to include? (select all)

Answer 27

• delay exercise until glucose controlled
• keep a quick source of glucose readily available while exercising
• begin slowly and build up to 30-45 minutes
• only use the abdominal injection site for insulin

Question 28

the nurse is caring for a patient suspected of having ketoacidosis. which manifestations are characteristic with early ketoacidosis? (select all)

Answer 28

• fruity breath
• polyuria
• thirst

Question 29

the nurse watches a patient perform an insulin injection. which observations indicate that the patient needs additional instruction? (select all)

Answer 29

• the patient rubs the injection site after administration of the insulin injection
• the patient draws up the cloudy insulin and then the clear insulin
• the patient shakes the insulin bottle before administration