Ignatavicius NCLEX Qs Flashcards
How is hypoglycemia prevented in the healthy person who does not have diabetes even after fasting for 8
hours?
A. Metabolism is so slow when a person sleeps without eating for 8 hours that blood glucose does not
enter cells to be used for energy. As a result, hypoglycemia does not occur.
B. Fasting for 8 hours triggers conversion of proteins into glycogen (glycogenesis) so that
hyperglycemia develops rather than hypoglycemia.
C. Lipolysis (fat breakdown) in fat stores occurs, converting fatty acids into glucose to maintain
blood glucose levels.
D. The secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage
sites.
D
Rationale: Glucagon is a counterregulatory hormone secreted by pancreatic alpha cells when blood
glucose levels are low, as they would be during an 8-hour fast. The body’s metabolic rate does decrease
during sleep (which is not stated in this question) but not sufficiently to prevent hypoglycemia. Glucagon
works on the glycogen stored in the liver, breaking it down to glucose (glycogenolysis) molecules that are
then released into the blood to maintain blood glucose levels and prevent hypoglycemia. Although
proteins can be broken down and converted to glucose, they are not converted to glycogen. Fat
breakdown through lipolysis can provide fatty acids for fuel, but this is not glucose, and lipolysis does not
occur until all stored glycogen is used.
Which health problems are considered results of microvascular complications from long-term or poorly
controlled diabetes mellitus?
A. Obesity and hyperglycemia
B. Systolic hypertension and heart failure
C. Retinal hemorrhage and male erectile dysfunction
D. Diabetic ketoacidosis and hyperglycemic-hyperosmolar state
C
Rationale: Both retinal hemorrhage and male erectile dysfunction are caused by microvascular
complications. Structural problems in retinal vessels include areas of poor retinal circulation, edema, hard
fatty deposits in the eye, and retinal hemorrhages. Microvascular changes cause hypoxia and death of the
nerves needed for male erection. Systolic hypertension and heart failure are considered macrovascular
complications. Obesity and hyperglycemia are causes of microvascular complications and are not caused
by them. Diabetic ketoacidosis and hyperglycemic-hyperosmolar state are problems of hyperglycemia but
are not caused by microvascular changes.
Which statement made by a client who is learning about self-injection of insulin indicates to the nurse that
clarification is needed about injection site selection and rotation?
A. “The abdominal site is best because it is closest to the pancreas.”
B. “I can reach my thigh best, so I will use different areas of the same thigh.”
C. “By rotating sites within one area, my chance of having skin changes is less.”
D. “If I change my injection site from the thigh to an arm, the inulin absorption may be different.”
A
Rationale: The abdominal site has the fastest and most consistent rate of absorption because of the blood
vessels in the area, not because of its proximity to the pancreas.
While assessing the client who has had diabetes for 15 years, the nurse finds that he has decreased
sensory perception in both feet. What is the nurse’s best first action?
A. Document the finding as the only action.
B. Examine the feet for manifestations of injury.
C. Test the sensory perception of the client’s hands.
D. Tell the client that he now has peripheral neuropathy.
B
Rationale: When reduced peripheral sensory perception is present, the likelihood of injury is high. Any
open area or other problem on the foot of a person with diabetes is at great risk for infection and must be
managed carefully and quickly. Checking for sensory perception on the hands and other areas is important
but can come after a thorough foot examination.
During a clinic visit, you are reviewing the records of a 39-year-old patient who was diagnosed 5 years
ago with type 2 diabetes. You discover that, although he has always been extremely near-sighted, he has
not seen an ophthalmologist for 4 years. He has gained 12 lbs since his last visit a year ago. His laboratory
values show a fasting blood glucose level of 96 mg/dL, an A1C of 8.2%, a total cholesterol of 322 mg/dL,
and an LDL of 190 mg/dL. When you ask him about ophthalmology follow-up and point out his
laboratory values, he replies that because he is taking prescribed antidiabetic medication, he believes that
he won’t have all the diabetes complications that his father had. He further tells you that he did have his
eyes checked by an optometrist to make sure his prescription was accurate but that because he was
younger than 40 years old, he does not need intraocular pressure measurements.
1. How should you interpret his laboratory values in terms of his personal glucose regulation?
assist this patient in managing his diabetes?
How should you interpret his laboratory values in terms of his personal glucose regulation?
His fasting blood glucose level is acceptable and indicates that he has controlled his diabetes during
the past 24 hours. However, his hemoglobin A1C is high, indicating that his overall control for the
past several months is poor. It is possible that the current medication regimen is not sufficient to
manage his disease. The fact that his weight is increasing rather than decreasing and that his blood
lipid levels are quite high hint that his nutrition therapy is probably not being followed.
During a clinic visit, you are reviewing the records of a 39-year-old patient who was diagnosed 5 years
ago with type 2 diabetes. You discover that, although he has always been extremely near-sighted, he has
not seen an ophthalmologist for 4 years. He has gained 12 lbs since his last visit a year ago. His laboratory
values show a fasting blood glucose level of 96 mg/dL, an A1C of 8.2%, a total cholesterol of 322 mg/dL,
and an LDL of 190 mg/dL. When you ask him about ophthalmology follow-up and point out his
laboratory values, he replies that because he is taking prescribed antidiabetic medication, he believes that
he won’t have all the diabetes complications that his father had. He further tells you that he did have his
eyes checked by an optometrist to make sure his prescription was accurate but that because he was
younger than 40 years old, he does not need intraocular pressure measurements.
2. Should you address his weight gain? Why or why not?
Should you address his weight gain? Why or why not?
Yes, you should address his weight. A major pathophysiological problem with type 2 diabetes is
insulin resistance. Increasing weight correlates to greater insulin resistance. Even modest weight loss
can improve the sensitivity of insulin receptors to insulin. The excess weight is contributing even
more to his risk for cardiovascular events, as evidenced by the high blood lipid levels.
During a clinic visit, you are reviewing the records of a 39-year-old patient who was diagnosed 5 years
ago with type 2 diabetes. You discover that, although he has always been extremely near-sighted, he has
not seen an ophthalmologist for 4 years. He has gained 12 lbs since his last visit a year ago. His laboratory
values show a fasting blood glucose level of 96 mg/dL, an A1C of 8.2%, a total cholesterol of 322 mg/dL,
and an LDL of 190 mg/dL. When you ask him about ophthalmology follow-up and point out his
laboratory values, he replies that because he is taking prescribed antidiabetic medication, he believes that
he won’t have all the diabetes complications that his father had. He further tells you that he did have his
eyes checked by an optometrist to make sure his prescription was accurate but that because he was
younger than 40 years old, he does not need intraocular pressure measurements.
- Is he correct in thinking that an ophthalmologist visit is not necessary at this time? Explain your
response.
Is he correct in thinking that an ophthalmologist visit is not necessary at this time? Explain your
response.
Even if he did not have a vision problem, his risk for ophthalmic complications leading to blindness is
high. Just having diabetes is a reason to been seen by an ophthalmologist rather than an optometrist
(who is not a medical doctor). Depending on the control of his disease (which right now is not very
controlled), coupled with long-standing vision problems, he should be seen yearly by an
ophthalmologist. The ophthalmologist can determine whether a less frequent evaluation cycle would
be appropriate.
During a clinic visit, you are reviewing the records of a 39-year-old patient who was diagnosed 5 years
ago with type 2 diabetes. You discover that, although he has always been extremely near-sighted, he has
not seen an ophthalmologist for 4 years. He has gained 12 lbs since his last visit a year ago. His laboratory
values show a fasting blood glucose level of 96 mg/dL, an A1C of 8.2%, a total cholesterol of 322 mg/dL,
and an LDL of 190 mg/dL. When you ask him about ophthalmology follow-up and point out his
laboratory values, he replies that because he is taking prescribed antidiabetic medication, he believes that
he won’t have all the diabetes complications that his father had. He further tells you that he did have his
eyes checked by an optometrist to make sure his prescription was accurate but that because he was
younger than 40 years old, he does not need intraocular pressure measurements.
- Is he correct in believing that taking antidiabetic medication will prevent complications of
diabetes? Explain your response.
Is he correct in believing that taking antidiabetic medication will prevent complications of diabetes?
Explain your response.
He is not correct in his thinking. Diabetes is a complex disorder and can only be controlled with a
combination of antidiabetic medications and life-style changes that include nutrition therapy,
maintenance of a healthy weight, blood pressure control, blood lipid control, and physical activity.
The drugs are only part of the management plan. The fact that he was diagnosed at an earlier age and
is taking medications is helpful, but without proper management, the complications of diabetes will
not even be delayed let alone prevented.
During a clinic visit, you are reviewing the records of a 39-year-old patient who was diagnosed 5 years
ago with type 2 diabetes. You discover that, although he has always been extremely near-sighted, he has
not seen an ophthalmologist for 4 years. He has gained 12 lbs since his last visit a year ago. His laboratory
values show a fasting blood glucose level of 96 mg/dL, an A1C of 8.2%, a total cholesterol of 322 mg/dL,
and an LDL of 190 mg/dL. When you ask him about ophthalmology follow-up and point out his
laboratory values, he replies that because he is taking prescribed antidiabetic medication, he believes that
he won’t have all the diabetes complications that his father had. He further tells you that he did have his
eyes checked by an optometrist to make sure his prescription was accurate but that because he was
younger than 40 years old, he does not need intraocular pressure measurements.
- How do you propose to assist this patient in managing his diabetes?
How do you propose to assist this patient in managing his diabetes?
The patient’s comments and the laboratory data indicate that he does not understand the disease, its
consequences, management techniques, and his role in the management plan. His issues are going to
require more than your intervention, although you can get this started. Patient-centered evaluation and
management with the entire diabetes management team is needed as soon as possible. He will need
further testing to assess for early-stage complications and possible changes to his medication regimen.
You should start by asking what he knows about the disease and correct any misunderstandings.
Bringing in a diabetes educator, the health care provider and registered dietitian is really needed now.
If classes are available, he should be strongly encouraged to start them. If he has a partner, try to
include her or him in this process. Essentially, this patient requires that the team treat him as if he had
just been newly diagnosed with diabetes.
The patient is a 60 year-old-woman who is 1 day postoperative after a total knee replacement. She has
type 2 diabetes and just recently was switched from oral antidiabetic drugs to an insulin regimen. She let
her nurse know that her on-demand lunch has been ordered. The nurse tests her blood and gives her the
prescribed short-acting insulin dose. An hour later, the physical therapist finds her pale, confused, and
clammy. Her lunch tray is on her table and appears totally untouched.
1. Is her condition consistent with hyperglycemia or hypoglycemia? Explain your choice.
Is her condition consistent with hyperglycemia or hypoglycemia? Explain your choice.
Her condition is consistent with hypoglycemia, especially because she received insulin about an hour
ago. Manifestations of hypoglycemia include weakness; difficulty thinking; confusion; sweating; and
cool, pale skin, and manifestations of hyperglycemia include warm, moist skin and possible fruity
breath odor. Hyperglycemia does not change level of consciousness until it is severe.
The patient is a 60 year-old-woman who is 1 day postoperative after a total knee replacement. She has
type 2 diabetes and just recently was switched from oral antidiabetic drugs to an insulin regimen. She let
her nurse know that her on-demand lunch has been ordered. The nurse tests her blood and gives her the
prescribed short-acting insulin dose. An hour later, the physical therapist finds her pale, confused, and
clammy. Her lunch tray is on her table and appears totally untouched.
2. What is your first action? Provide a rationale.
What is your first action? Provide a rationale.
Check her blood glucose level immediately because the methods to increase her blood glucose level
are dependent on how low the current level is.
a. As an alternative, if there is an easily digestible carbohydrate on her tray and she is able to
swallow, you could give that to her immediately and then obtain a blood glucose
measurement. However, this is less precise.
The patient is a 60 year-old-woman who is 1 day postoperative after a total knee replacement. She has
type 2 diabetes and just recently was switched from oral antidiabetic drugs to an insulin regimen. She let
her nurse know that her on-demand lunch has been ordered. The nurse tests her blood and gives her the
prescribed short-acting insulin dose. An hour later, the physical therapist finds her pale, confused, and
clammy. Her lunch tray is on her table and appears totally untouched.
3. What is the most likely cause leading to this problem?
What is the most likely cause leading to this problem?
Clearly, there was a delay in eating after receiving the insulin. The tray may have been delayed longer
than expected from food service, or perhaps she decided she was not hungry when it first arrived. She
could have been interrupted (possible phone call or visitor) before she had a chance to eat it. In
addition, it is possible because she has only recently been started on insulin that she did not
understand the necessity of eating soon after receiving insulin.
The patient is a 60 year-old-woman who is 1 day postoperative after a total knee replacement. She has
type 2 diabetes and just recently was switched from oral antidiabetic drugs to an insulin regimen. She let
her nurse know that her on-demand lunch has been ordered. The nurse tests her blood and gives her the
prescribed short-acting insulin dose. An hour later, the physical therapist finds her pale, confused, and
clammy. Her lunch tray is on her table and appears totally untouched.
4. What could be done on this nursing care unit to prevent such an incident from happening again?
What could be done on this nursing care unit to prevent such an incident from happening again?
The patient should receive more education about the relationship between insulin and eating. The unit
needs to establish guidelines or policies about premeal insulin administration. Perhaps it should not be
administered until the tray is actually in the patient’s possession and the patient is ready to eat it. Also,
whenever short-acting insulin is given, the nurse giving it should evaluate the patient within 20
minutes.
A client previously diagnosed with liver cirrhosis visits the medical clinic. What assessment findings does the nurse expect in this client? Select all that apply. A. Ecchymosis B. Soft abdomen C. Moist, clammy skin D. Jaundice E. Ankle edema F. Fever
A, D, E
Rationale: Clients with advanced cirrhosis often have symptoms such as gastrointestinal (GI) bleeding,
jaundice, ascites, and spontaneous bruising. They may also have dry skin, rashes, purpuric lesions (e.g.,
petechiae), warm and bright red palms of the hands, vascular lesions (spider angiomas), and peripheral
dependent edema of the extremities and sacrum.
The nurse is providing teaching for a client scheduled for a paracentesis. Which statement by the client
indicates the teaching has been successful?
A. “I must not use the bathroom prior to the procedure.”
B. “I will lie on my stomach while the procedure is performed.”
C. “I will not be allowed to eat or drink anything the night before surgery.”
D. “The physician will likely remove 2 to 3 liters of fluid from my abdomen.”
D
Rationale: The client should void before the procedure to prevent injury to the bladder. The client will lie
in bed with the head of the bed elevated during the procedure.