Exam 2: Chapter 24 Flashcards
A client is newly diagnosed with type 2 diabetes mellitus. Which diagnostic test will best
evaluate the management plan prescribed for this client?
a. A yearly funduscopic examination by an ophthalmologist
b. Regular foot examinations by a podiatrist
c. Quarterly hemoglobin A1C
d. Biannual cholesterol testing
ANS: C
Quarterly or biannual hemoglobin A1C (Hb A1C) is designed to provide information regarding
the averaged glucose levels for a 3-month period of time. The periodic measurement of a glycated hemoglobin test (Hb A1C) is the best measure of ongoing glycemic control. Eye
examinations are important, but proper blood sugar control will help prevent the damaging effects of diabetes to the eyes. Proper foot care is important, but good blood sugar control will
help prevent the damaging effects of diabetes on the feet. Biannual cholesterol testing is not relevant to the evaluation of type 2 diabetes mellitus.
Which is the most likely reason that type 2 diabetes mellitus is often difficult to diagnose in
older adults?
a. Presenting symptoms occur very quickly.
b. The disease rarely occurs in older adults.
c. The classic symptoms may not be present in older adults.
d. There are no recognizable symptoms; it is a “silent killer.”
ANS: C
The symptoms are also often masked by normal aging changes and conditions common in
older adults. Polydipsia often does not occur due to the decreased thirst mechanism in older
adults, polyphagia is often not recognized due to normal appetite declines associated with
aging, and polyuria is often not recognized due to frequent urinary tract infections in older
adults. Presenting symptoms usually occur very slowly. Type 2 diabetes mellitus is very
common in older adults. There are symptoms of diabetes mellitus in older adults; however,
they may be different than those seen in younger adults.
Hyperglycemia is harder to detect in older adults due to which of the following?
a. There is a higher tolerance for elevated levels of circulating glucose in older
adults.
b. Older adults tend to metabolize glucose at a faster rate than younger adults.
c. Fingerstick glucose monitoring is inaccurate in older adults.
d. The classic signs of elevated glucose levels, polyuria, polyphagia, and polydipsia
are rarely present in older adults.
ANS: A
Hyperglycemia in older adults is harder to detect than in a younger adult. With aging there is a
higher tolerance for elevated levels of circulating glucose. It is not unusual to find persons with fasting glucose levels of 200-600 mg/dL or higher. It is not true that older adults
metabolize glucose at a faster rate than younger adults or that fingerstick glucose monitoring
is inaccurate in older adults. While it is true that older adults usually do not have the classic
symptoms of elevated glucose levels, this does not explain why hyperglycemia is harder to
detect in older adults.
A nurse is caring for an older adult who is diagnosed with type 2 Diabetes. The patient is
prescribed oral medication for diabetes. The nurse can expect that which of the following medications is prescribed as a first-line therapy?
a. Insulin
b. Sulfonylureas
c. Metformin
d. Chlorpropramide
ANS: C
Metformin (Glucophage) is commonly prescribed as first-line therapy; it does not cause hypoglycemia or weight gain. Sulfonylureas were used for many years as first-line agents for
all persons with type 2 DM. However they are associated with hypoglycemia and can only be used in persons who can either be aware of the signs themselves or who have a caregiver
capable of doing so; therefore, Metformin is considered the first line of therapy. Insulin is
used for individuals with type 2 DM; however, it is not first-line therapy. Chlorpropramide is
contraindicated due to a long half-life and the fact that it can cause prolonged hypoglycemia.
An older adult with type 2 DM who is being treated with insulin wants to increase his activity
level and begin a walking program. What recommendations should the nurse provide to this
patient?
a. A walking program is not recommended for an older adult with diabetes.
b. The walking regimen needs to be done on a regularly scheduled basis.
c. Regular exercise should not exceed 30 minutes three times a week.
d. Insulin can most probably be discontinued if the individual adheres to the walking
program.
ANS: B
If the person is using insulin, exercise needs to be done on a regular rather than an erratic basis. Exercise is an important part of diabetes self-management. In some cases, exercise in
conjunction with an appropriate diet may be sufficient to maintain blood glucose levels within
normal levels; however, it is not likely that insulin will be able to be discontinued.
A nurse is educating an older adult with diabetes mellitus on minimizing the risk of cardiovascular disease. The nurse focuses on lipid levels. Which of the following are the recommended goals for lipid levels? (Select all that apply.)
a. Cholesterol <200
b. Low-density lipoprotein (LDL) >100
c. High-density lipoprotein (HDL) >40 (men), >50 (women)
d. Hb A1C value of 6.5%
e. Triglycerides <150
ANS: A, C, E
Goals for acceptable lipid levels include: Cholesterol <200, LDL <100, HDL >40 (men), >50, (women) and triglycerides <150. Hb A1C levels are not a measure of lipids.
An older patient asks a nurse: “I went to my diabetes doctor and everything was stable. The
nurse practitioner spent the entire time teaching me about decreasing my risks of heart
disease. It seemed odd that she did not focus on teaching me how to better control my
diabetes. Do you know why?” The nurse formulates a response based on the understanding
that: (Select all that apply.)
a. promoting cardiovascular health has the potential to minimize the complications of
DM.
b. there is little evidence that demonstrates that the course of DM can be altered in an
older adult.
c. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glycemic control.
d. older adults are less receptive to teaching about diabetes than they are to teaching
about cardiovascular disease.
e. diabetes is not a common chronic condition in older adults.
ANS: A, C
While glycemic control is important, more emphasis is now on the prevention and treatment of cardiovascular diseases. Research has indicated that it may take 8 years of glycemic control
before benefits are seen while the benefits of better control of blood pressure and lipids are
seen as early as 2-3 years. Promoting cardiovascular health has the potential to be the most
efficacious in the minimization of complications in the persons with DM. Education on
self-management of diabetes is important for patients of all ages. Diabetes is a common
chronic condition in older adults.
A nurse is caring for an older adult who has metabolic syndrome. The nurse knows that the
following conditions are common in persons with metabolic syndrome: (Select all that apply.)
a. Glucose levels that are higher than normal
b. Increased waist circumference
c. Blood pressure that is lower than normal
d. Increased blood cholesterol levels
e. Decreased triglyceride levels
ANS: A, B, D
Metabolic syndrome is characterized by higher than normal glucose levels, increased waist
size due to excess abdominal fat, high blood pressure, and abnormal levels of cholesterol and
triglycerides in the blood.
A nurse works in an outpatient diabetes clinic. The nurse knows that the minimum standard of
care for a patient with diabetes includes the following at each visit: (Select all that apply.)
a. Monitoring weight and BP
b. Inspecting the feet
c. Obtaining hemoglobin A1C
d. Reviewing self-management skills
e. Obtaining fasting lipid profile and serum creatinine
ANS: A, B, D
Minimum standards of care for an individual with diabetes include the following at each visit:
Monitoring weight and BP, inspecting feet, reviewing self-monitoring glucose record,
reviewing/adjusting medications as needed, reviewing self-management skills/goals, assessing
mood, counseling on tobacco and alcohol use. Obtaining hemoglobin A1C is recommended at
quarterly intervals and obtaining fasting lipid profile and serum creatinine is recommended
annually.
A nurse is educating an older adult with diabetes on glucose self-monitoring. When developing the teaching plan, the nurse includes which of the following goals in the teaching plan? The patient will: (Select all that apply.)
a. demonstrate the technique for obtaining a blood sample.
b. verbalize actions to take when results indicate an error on the machine.
c. state the correct timing of blood glucose monitoring.
d. state the signs and symptoms of both hyperglycemia and hypoglycemia.
e. demonstrate technique for storing and transporting insulin correctly.
ANS: A, B, C
Option D is important for an older person with diabetes; however, it is not directly related to glucose self-monitoring. Option E is important for a person who is taking insulin, however is
not directly related to glucose self-monitoring.
Which of the following statements is true about diabetes mellitus?
a. Type 2 diabetes is the result of the failure of the pancreas to produce insulin.
b. Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dl.
c. Noninsulin-dependent diabetes mellitus is another name for type 1 diabetes.
d. The incidence of diabetes mellitus does not increase with age.
B - Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dl.
Which laboratory results are goals for reducing a persons risk for diabetes and heart disease?
a. Triglycerides over 150 mg/dl
b. Cholesterol 250 mg/dl
c. High-density lipoprotein (HDL) over 40 mg/d
d. Fasting blood glucose under 150 mg/dl
C - High-density lipoprotein (HDL) over 40 mg/d
When teaching a patient about foods that do not increase blood glucose, which should the nurse include?
a. White bread
b. Baked beans
c. Broccoli
d. Corn
C - Broccoli
Which of the following statements is true about medications taken by individuals with diabetes mellitus?
a. Sitagliptin (Januvia) is indicated to treat type 1 diabetes mellitus.
b. Nateglinide (Starlix) increases the secretion of insulin.
c. Metformin (Glucophage) increases the secretion of insulin.
d. Rosiglitazone (Avandia) decreases glucose absorption.
B - Nateglinide (Starlix) increases the secretion of insulin.
An older man with diabetes mellitus complains to the nurse that his feet feel like they are burning. Which of the following interventions should the nurse recommend to this older adult to reduce his discomfort?
a. Wear well-fitting, leather shoes
b. Wear knee-high nylon stockings
c. Soak the feet in warm water
d. Apply antifungal powder on the feet
A - Wear well-fitting, leather shoes
