Diabetes Exam Flashcards
Glucose in the urine is called ______
glycosuria
_______ is too much sugar in the blood
Hyperglycemia
______ is too little sugar in the blood
Hypoglycemia
Deep, sighing respirations from diabetic acidosis are called ______ respirations
Kussmaul’s
Excessive hunger is called ?
Polyphagia
Excessive thirst is called ?
Polydipsia
The patient who gets up to urinate at night has _____
nocturia
The time when insulin is working its hardest after injection is called its ____ action time
peak
The length of time insulin works is called its _____
duration
Symptoms of hyperglycemia
Polydipsia, polyuria, lethargy, fruity breath, abdominal pain
Symptoms of hypoglycemia
Tremor, irritability, sweating
Impaired vision
Retinopathy
Burning pain in legs and feet
Neuropathy
Profound hyperglycemia without ketonemia
Hyperosmolar hyperglycemia
Ketones in the blood and urine
DKA
Food intolerance
Gastroparesis
Which of the following is an acceptable pre-meal blood sugar range for a patient with diabetes?
a) 46 to 98
b) 70 to 130
c) 180 to 250
d) 350 to 600
b) 70 to 130 mg/dL
Before giving insulin, the nurse always checks which test result?
a) Recent potassium level
b) Blood sugar level
c) Urine ketones
d) White blood cell count
b) Blood sugar level
At what point after injection does the peak action of regular insulin occur?
a) 30 to 60 minutes
b) 1 to 2 hours
c) 2 to 5 hours
d) 8 to 12 hours
c) 2 to 5 hours
Which of the following are symptoms of hypoglycemia?
a) Nausea and vomiting
b) Glycosuria
c) Cold sweat and tremor
d) Polyuria and polydipsia
c) Cold sweat and tremor
In addition to stimulating insulin production, glyburide (Micronase) has which of the following effects?
a) Stimulates gluconeogenesis
b) Promotes fat breakdown
c) Increases tissue sensitivity to insulin
d) Enhances appetite
c) Increases tissue sensitivity to insulin
A 26-year-old patient is admitted to the hospital with a new diagnosis of diabetes, a blood glucose of 680 mg/dL, and ketones in the blood and urine. Which type of diabetes should the nurse suspect?
a) Type 1
b) Type 2
c) Prediabetes
d) Gestational
a) Type 1
A 45-year-old with diabetes forgot to take a daily dose of glyburide (Micronase). For which of the following symptoms should the nurse be vigilant?
a) Cold, clammy sweat
b) Tachycardia, nervousness, hunger
c) Chest pain, shortness of breath
d) Fatigue, thirst, blurred vision
d) Fatigue, thirst, blurred vision
By which routes can insulin be administered? (Select all that apply)
a) Oral
b) Topical
c) Intravenous
d) Subcutaneous
e) Intramuscular
c, d, e
While providing discharge instructions to a patient newly taking NPH insulin every morning, the nurse recognizes that teaching has been effective if the patient knows to observe for signs and symptoms of low blood sugar level at which of the following times?
a) 1 hour after administration of insulin
b) 6 to 12 hours after administration of insulin
c) 24 to 36 hours after administration of insulin
d) NPH insulin does not cause low blood sugar level
b) 6 to 12 hours after administration of insulin
A patient with newly diagnosed diabetes asks the nurse what to take for low blood sugar. Which of the following would be most appropriate for the nurse to suggest?
a) Raisins
b) Cheese
c) acetaminophen (Tylenol)
d) Beef jerky
a) Raisins
The nurse recognizes that teaching is effective if a patient with diabetes knows to use subcutaneous glucagon for an emergency episode of which of the following conditions?
a) Hyperglycemia
b) Ketonuria
c) DKA
d) Hypoglycemia
d) Hypoglycemia
A patient on an American Diabetes Association diet receives a breakfast tray and does not care for the oatmeal. Which of the following foods can the nurse substitute for a half cup of oatmeal?
a) 4 oz of orange juice
b) Two strips of bacon
c) 1 oz of cheese
d) A slice of wheat toast
d) A slice of wheat toast
Which of the following is the best definition of diabetes mellitus?
a) It is a disease in which high blood glucose results from defective insulin secretion or action
b) It is a disease that causes polyuria and polydipsia
c) It is a disease characterized by macrovascular and microvascular complications
d) It is a complex disease of protein and fat metabolism
a) It is a disease in which high blood glucose results from defective insulin secretion or action
Which of the following is a risk factor for type 2 diabetes mellitus?
a) Cardiovascular disease
b) Obesity
c) Age younger than 40 years
d) Virus exposure
b) Obesity
Diabetes is diagnosed when the fasting blood glucose is greater than ___ mg/dL
126
Place the steps for mixing insulin in correct sequential order?
a) Draw up cloudy insulin
b) Draw up clear insulin
c) Roll cloudy vial
d) Inject air into cloudy insulin
e) Inject air into clear insulin
f) Clean vial tops with alcohol
c) Roll cloudy vial
f) Clean vial tops with alcohol
d) Inject air into cloudy insulin
e) Inject air into clear insulin
b) Draw up clear insulin
a) Draw up cloudy insulin
Which of the following symptoms is most commonly associated with hyperglycemia?
a) Tremor
b) Flank pain
c) Sweating
d) Polyuria
d) Polyuria
Protein in the urine is a sign of which long-term complication of diabetes?
a) Nephropathy
b) Neuropathy
c) Retinopathy
d) Gastroparesis
a) Nephropathy
What is the best way for patients to avoid long-term complications of diabetes?
a) See the doctor for a complete checkup every 6 months
b) Check feet daily
c) Maintain premeal blood glucose levels under 130 mg/dL
d) Follow a strict meal plan for diabetes
c) Maintain premeal blood glucose levels under 130 mg/dL
Which breakfast menu is most appropriate for a patient with diabetes?
a) Two eggs, two strips bacon, orange juice, coffee
b) Oatmeal with artificial sweetener, whole-grain toast, tea
c) One half grapefruit, cranberry juice, bagel with sugar-free jelly
d) One slice whole-grain toast with peanut butter, skim milk, orange juice
d) One slice whole-grain toast with peanut butter, skim milk, orange juice
For which of the following blood glucose results would the nurse administer a fast sugar?
a) 48
b) 80
c) 126
d) 223
a) 48
A patient who is preparing for surgery asks the nurse why his physician took him off his oral hypoglycemic and placed him on sliding-scale insulin. Which response by the nurse is the best?
a) “It helps us maintain better control of your blood glucose during surgery. You will most likely be back on your pills before you go home.”
b) “The stress of surgery often exacerbates diabetes. We will teach you how to give insulin before you go home.”
c) “Oral hypoglycemic are ineffective during times of stress. Insulin is the only way to keep your blood glucose under control.”
d) “The oral agents must not be controlling your blood glucose any longer. I will check and see which insulin you will be going home on.”
a) “It helps us maintain better control of your blood glucose during surgery. You will most likely be back on your pills before you go home.”
Which meal plan is best for the patient with reactive hypoglycemia?
a) High-carbohydrate meals
b) Small, frequent meals
c) Avoidance of fats and proteins
d) Three medium to large meals daily
b) Small, frequent meals
Cells and body tissues use ____ for energy
glucose
____ is a simple sugar provided by the foods we eat
Glucose
_____ provide most of the glucose for the cells in the body
Carbohydrates
_____ and _____ work together to maintain blood glucose levels
insulin, glucagon
When glucose cannot be utilized properly, _____ is diagnosed
diabetes
Glucose can only enter cells with help of _____
insulin
The hormone insulin is produced by beta cells in ____ ___ ______ of the pancreas
islets of Langerhans
Some insulin is made by the pancreas, but not enough. Sometimes the pancreas makes enough insulin but the cells are resistant to it. Characterized by hyperglycemia on lab value (blood and urine)
Type 2 diabetes
Defined as carbohydrate intolerance occurring during pregnancy. It is due to extra metabolic demands that pregnancy triggers
Gestational Diabetes Mellitus (GDM)
______ refers to blood glucose levels that are above normal, but do not meet the criteria for diagnosing diabetes
Prediabetes
Develops due to another chronic illness that damages the islet cells such as pancreatitis and cystic fibrosis. May be the result of medication use (most commonly steroids)
Secondary diabetes
When a patient has 3 or more of the following metabolic abnormalities: HTN, increased cholesterol, low HDL (below 40), increased triglycerides, obesity, fasting glucose greater than 100
Metabolic Syndrome or Syndrome X
Classic signs and symptoms of Diabetes
Polyuria, polydipsia, polyphagia
Below 100 mg/dL for a nondiabetic, or for a diabetic with good glucose control
Normal fasting blood glucose
This is when the blood is checked with no regards to the last meal. It is done randomly. Diabetes is diagnosed if this level is 200 or above and have signs and symptoms of diabetes with it
Casual plasma glucose
A loading dose of carbohydrates are given and the blood glucose is measured at intervals afterwards. This test evaluates insulin response to glucose loading. If diabetic, the patient will have greatly elevated glucose levels for 1-5 hours after glucose load
OGTT - Oral glucose tolerance test
What are the patient considerations for fasting lab draws?
- For fasting glucose pt must fast from any caloric intake for at least 8 hours (overnight) sips of water are allowed
- Advise patient to refrain from smoking before the glucose sampling
- Hold insulin or oral anti-hyperglycemic medications
- For postprandial test, advise patient that no food should be eaten during the 2 hour interval
- Check lab results before administering medication or food
Normal HbA1C is _ to _ %
4 to 5
This better determines the average blood glucose, rather than one single fasting blood sugar would
Blood glucose attaches itself to hemoglobin and forms glycohemoglobin
AKA: Glycated hemoglobin, Glycohemoglobin, Glycosylated hemoglobin
**This test will be inaccurate with those patients that have anemia
HbA1C
Capillary blood glucose values obtained by ___ ___ samples tend to be higher than values in venous samples
finger stick
Do you aspirate or rub sire after an injection of insulin
NO!
Injection sites are to be ____ in order to avoid injury to the tissues
rotated
This medication is used for type 2 diabetes
The action is to either increase the production of insulin, or decreases glucose production by the liver.
Also used in conjunction with insulin.
Most need to be administered before a meal
Oral hypoglycemics
Block enzymes that digest starches
Alpha-Glucose Inhibitors
Slow the rate at which the liver releases glucose
Biguanides
Make the pancreas release more insulin in a more rapid manner than other oral agents
Meglitinides
Stimulate the pancreas to produce more insulin. They assist insulin in moving glucose into cells
Sulfonylureas
Assist muscle utilization of insulin produced by the body
Tiazolidinediones (TZDs)
Usually referred to when blood glucose is below 50
Hypoglycemia
What are some fast carbohydrates to give someone when they have low blood sugar (hypoglycemia)
4 oz OJ, hard candy, soda, raisins, glucose tablets, milk
______ _____ is an acute complication of diabetes mellitus (usually type 1) characterized by hyperglycemia, ketonuria, acidosis, dehydration, hyperkalemia
Diabetic ketoacidosis (DKA)
This is a complication of diabetes type 2
It also primarily occurs in the elderly
As the blood glucose rises, polyuria causes dehydration producing the hyperosmolar (concentrated) state
Signs and symptoms: extreme thirst, lethargy and confusion
Hyperosmolar-Hyperglycemia-Nonketotic Syndrome (HHNK)
Due to vascular complications, neuropathy and infection risk, diabetics are at extreme high risk for ____ complications
foot
This type of hypoglycemia occurs in the patient that is not diabetic. It is believed to be caused by the overreaction of the pancreas to eating. The pancreas senses a rise in blood glucose and produces more insulin than is necessary
Reactive hypoglycemia
what 2 insulins cannot be mixed with other insulins?
Glargine (Lantus) and detemir (Levemir)
Insulin lispro (Humalog) Insulin aspart (Novolog) Insulin glulisine (Apidra)
Very short acting insulin
Regular (Humulin R, Novolin R)
Short acting insulin
NPH (Humulin N, Novolin N)
Intermediate acting insulin
Insulin glargine (Lantus AE) Insulin detemir (Levemir)
Basal insulin
When mixing insulins, remember ___ to ____
clear to cloudy
What is basal-bolus insulin?
This consists of an injection of a basal insulin (such as Lantus) once a day, often at bedtime, to provide a constant small amount of insulin in the bloodstream
____-_____ of ____ ___ (SMBG) usually is done before meals and at bedtime by the person on insulin who wants to maintain tight control of blood glucose
self-monitoring of blood glucose
______ ________ (DKA) occurs when blood glucose levels become very high and insulin is deficient
diabetic ketoacidosis
The combination of vascular disease, neuropathy, and risk for infection makes patients with diabetes prone to ____ problems
foot
Tiny amounts of protein in the urine
microalbuminuria
