DM Flashcards
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes?
a) A 48-yr-old woman with a hemoglobin A1C of 8.4%
b) A 58-yr-old man with a fasting blood glucose of 111 mg/dL
c) A 68-yr-old woman with a random plasma glucose of 190 mg/dL
da
d) A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
a
Criteria for a diagnosis of diabetes include a hemoglobin A1C of 6.5% or greater,
fasting plasma glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of 200 mg/dL or greater.
The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes?
a) Increased triglyceride levels
b) Increased high-density lipoproteins (HDL)
c) Decreased low-density lipoproteins (LDL)
d) Decreased very-low-density lipoproteins (VLDL)
a
Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.
The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse?
a) “I will discard any insulin bottle that is cloudy in appearance.”
b) “The best injection site for insulin administration is in my abdomen.”
c) “I can wash the site with soap and water before insulin administration.”
d) “I may keep my insulin at room temperature (75° F) for up to 1 month.”
a
Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (<32°F [0°C]). Rotating sites to different anatomic sites is no lo
A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively?
a) Avoid sick people and wash hands.
b) Obtain comprehensive dental care.
c) Maintain hemoglobin A1C below 7%.
d) Coughing and deep breathing with splinting
b
A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep breathing with splinting would be important for any type of surgery but are not the priority for this patient with mitral valve replacement.
The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan?
a) “I will go running when my blood sugar is too high to lower it.”
b) “I will go fishing frequently and pack a healthy lunch with plenty of water.”
c) “I do not need to increase my exercise routine since I am on my feet all day at work.”
d) “I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week.”
d
The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days/wk and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and walking at work are light activity, and running is considered vigorous activity.
The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet?
a) Cheese
b) Broccoli
c) Chicken
d) Oranges
a
Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.
Which patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness?
a) A 58-yr-old patient with diabetic retinopathy
b) A 73-yr-old patient who takes propranolol (Inderal)
c) A 19-yr-old patient who is on the school track team
d) A 24-yr-old patient with a hemoglobin A1C of 8.9%
b
Hypoglycemic unawareness is a condition in which a person does not have the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin’s peak action?
a) 8:40 PM to 9:00 PM
b) 9:00 PM to 11:30 PM
c) 10:30 PM to 1:30 AM
d) 12:30 AM to 8:30 AM
c
Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin’s onset is between 10 and 30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.
The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to explain how this medication works?
a )Increases insulin production from the pancreas.
b) Slows the absorption of carbohydrate in the small intestine.
c) Reduces glucose production by the liver and enhances insulin sensitivity.
d) Increases insulin release from the pancreas and inhibits glucagon secretion.
c
Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue’s insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.
A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise the patient to take?
a) Eat a piece of pizza.
b) Drink some diet pop.
c) Eat 15 g of simple carbohydrates.
d) Take an extra dose of rapid-acting insulin.
c
When a patient with type 1 diabetes is unsure about the meaning of the symptoms they are experiencing, they should treat for hypoglycemia to prevent seizures and coma from occurring. Have the patient check the blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.
The nurse has been teaching a patient with diabetes how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient’s technique, the nurse identifies a need for additional teaching when the patient does what?
a) Chooses a puncture site in the center of the finger pad.
b) Washes hands with soap and water to cleanse the site to be used.
c) Warms the finger before puncturing the finger to obtain a drop of blood.
d) Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.
a
The patient should select a site on the sides of the fingertips, not on the center of the finger pad because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.
The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement?
a) “I should only walk barefoot in nice dry weather.”
b) “I should look at the condition of my feet every day.”
c) “I will need to cut back the number of times I shower per week.”
d) “My shoes should fit nice and tight because they will give me firm support.”
b
Patients with diabetes need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Routine care includes regular bathing.
The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include?
a) Macroangiopathy only occurs in patients with type 2 diabetes who have severe disease.
b) Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin.
c) Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by most patients with diabetes.
d) Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.
b
Microangiopathy occurs in diabetes. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.
The nurse is assessing a patient newly diagnosed with type 2 diabetes. Which symptom reported by the patient correlates with the diagnosis?
a) Excessive thirst
b) Gradual weight gain
c) Overwhelming fatigue
d) Recurrent blurred vision
a
The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.
The nurse is assigned to care for a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in managing diabetes, what should be the nurse’s initial intervention?
a) Assess patient’s perception of what it means to have diabetes.
b) Ask the patient to write down current knowledge about diabetes.
c) Set goals for the patient to actively participate in managing his diabetes.
d) Assume responsibility for all of the patient’s care to decrease stress level.
a
For teaching to be effective, the first step is to assess the patient. Teaching can be individualized after the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient’s care will not facilitate the patient’s health.
