Lecture 8: Diabetes Flashcards
A 10-year-old child is diagnosed with Type 1 Diabetes Mellitus (T1DM). Which clinical manifestation would the nurse expect?
A. Gradual weight gain
B. Sudden onset of symptoms
C. Tingling in the lower extremities
D. Increased insulin resistance
Correct Answer: B
Explanation: T1DM typically presents with a sudden onset of symptoms due to the autoimmune destruction of pancreatic beta cells. Gradual weight gain and insulin resistance are characteristics of Type 2 Diabetes (T2DM). Tingling in the lower extremities is a long-term complication, not an initial presentation
A 50-year-old patient with Type 2 Diabetes presents with fasting blood sugar levels consistently above 7 mmol/L. What is the primary cause of this finding?
A. Autoimmune destruction of beta cells
B. Impaired insulin secretion and resistance
C. Increased production of ketone bodies
D. Elevated levels of glucagon
Correct Answer: B
Explanation: T2DM is characterized by both impaired insulin secretion and resistance. Autoimmune destruction of beta cells is seen in T1DM.
A patient is prescribed insulin lispro. The nurse knows this type of insulin is most appropriate for:
A. Basal glucose control
B. Pre-meal glucose spikes
C. Long-term glucose management
D. Nocturnal hypoglycemia prevention
Correct Answer: B
Explanation: Insulin lispro is a rapid-acting insulin used to manage post-meal (prandial) glucose spikes. It is not suitable for basal or long-term control.
When administering long-acting insulin glargine, the nurse should:
A. Shake the vial vigorously before use
B. Ensure the patient has food within 15 minutes
C. Administer at the same time each day
D. Mix it with short-acting insulin in the same syringe
Correct Answer: C
Explanation: Insulin glargine should be administered at the same time each day for consistent basal control. It should not be mixed with other insulins, and shaking the vial is unnecessary.
A patient on metformin develops lactic acidosis. Which of the following symptoms would the nurse monitor for?
A. Hypertension and bradycardia
B. Tachypnea and myalgia
C. Hyperreflexia and agitation
D. Blurred vision and rash
Correct Answer: B
Explanation: Lactic acidosis can manifest with tachypnea (rapid breathing) and myalgia (muscle pain) due to impaired mitochondrial oxidation of lactic acid.
What is the best immediate action for a patient experiencing hypoglycemia with a blood glucose level of 3.5 mmol/L and is conscious?
A. Administer IV glucagon
B. Give the patient orange juice
C. Call the provider immediately
D. Perform a second glucose test
Correct Answer: B
Explanation: For conscious patients with hypoglycemia, a quick-acting carbohydrate like orange juice is the recommended first intervention.
A patient is learning how to use an insulin pen. Which step requires correction by the nurse?
A. Priming the pen with 2 units
B. Dialing the prescribed dose before injecting
C. Holding the pen in place for 3 seconds after injection
D. Using a new needle for each injection
Correct Answer: C
Explanation: The pen should be held in place for at least 10 seconds to ensure complete delivery of the insulin dose.
A nurse is teaching a patient with prediabetes about lifestyle modifications. Which statement indicates a need for further education?
A. “I will monitor my blood glucose regularly.”
B. “I can avoid medication if I exercise and eat healthily.”
C. “Weight loss can reduce my risk of Type 2 Diabetes.”
D. “Prediabetes is reversible with proper management.”
Correct Answer: B
Explanation: While lifestyle changes are crucial, some patients may still require medication depending on individual risk factors.
A nurse prepares to administer NPH insulin to a patient with diabetes. Which statement by the nurse requires correction?
A. “I need to roll the vial gently before drawing up the dose.”
B. “This insulin has a peak action of 4-6 hours.”
C. “This insulin will provide mealtime glucose control.”
D. “This insulin appears cloudy in the vial.”
Correct Answer: C
Explanation: NPH insulin is an intermediate-acting insulin used for basal control, not mealtime glucose control. Rolling the vial and recognizing its cloudy appearance are appropriate.
A patient on an intensive basal/bolus insulin regimen is being educated. The nurse should explain that the purpose of basal insulin is to:
A. Address blood glucose spikes after meals.
B. Maintain consistent glucose levels between meals.
C. Provide emergency glucose-lowering during hyperglycemia.
D. Replace rapid-acting insulin.
Correct Answer: B
Explanation: Basal insulin is designed to maintain steady glucose levels throughout the day and night, irrespective of meals.
A Type 1 Diabetes patient is admitted with ketoacidosis. What is the priority intervention?
A. Administer a short-acting insulin IV infusion.
B. Begin oral hypoglycemic medication therapy.
C. Provide sugary fluids to correct hypoglycemia.
D. Administer a glucagon injection
Correct Answer: A
Explanation: Diabetic ketoacidosis requires rapid correction of hyperglycemia, typically with IV insulin. Oral hypoglycemics and glucagon are not appropriate treatments for ketoacidosis.
A patient presents with symptoms of hypoglycemia, including confusion and sweating. The nurse notes the blood glucose is 3.2 mmol/L. Which treatment is appropriate if the patient is unconscious?
A. 4 oz of orange juice
B. Glucose tablets
C. 50 mL of 50% dextrose IV
D. Administer insulin
Correct Answer: C
Explanation: For unconscious patients, IV dextrose is the fastest method to restore blood glucose levels. Oral options are only suitable for conscious patients.
A nurse is caring for a patient prescribed metformin for Type 2 Diabetes. What potential complication should the nurse monitor for?
A. Hyperglycemia
B. Lactic acidosis
C. Renal stones
D. Hyperlipidemia
Correct Answer: B
Explanation: Metformin carries a risk of lactic acidosis, especially in patients with renal impairment or excessive alcohol use. Regular kidney function monitoring is essential.
The nurse administers a sulfonylurea to a patient. Which adverse effect is the most important to monitor for?
A. Hypoglycemia
B. Tachycardia
C. Increased urination
D. GI upset
Correct Answer: A
Explanation: Sulfonylureas stimulate insulin release regardless of glucose levels, increasing the risk of hypoglycemia, especially in those with renal or hepatic impairment.
A pregnant patient with gestational diabetes asks why her blood sugar levels are increasing despite eating healthily. The nurse explains this is due to:
A. Increased physical activity during pregnancy.
B. A hormone produced by the placenta that antagonizes insulin.
C. Increased glucose transfer to the fetus.
D. Higher caloric needs during pregnancy.
Correct Answer: B
Explanation: The placenta produces hormones that counteract insulin’s effects, contributing to higher blood glucose levels during pregnancy.
A patient with gestational diabetes is concerned about long-term risks. The nurse should educate the patient about:
A. The permanent need for insulin therapy post-pregnancy.
B. The risk of developing Type 2 Diabetes later in life.
C. The increased likelihood of hypoglycemia in future pregnancies.
D. The risk of neonatal hypoglycemia.
Correct Answer: B
Explanation: Women with gestational diabetes have a higher risk of developing Type 2 Diabetes after pregnancy, necessitating ongoing monitoring.
A patient with diabetes is experiencing proteinuria. Which long-term complication should the nurse suspect?
A. Neuropathy
B. Retinopathy
C. Renal failure
D. Cardiovascular disease
Correct Answer: C
Explanation: Proteinuria indicates kidney damage and can lead to renal failure, a long-term complication of diabetes.
A patient with diabetes reports tingling and reduced sensation in their feet. What is the priority nursing intervention?
A. Assess the patient’s footwear.
B. Recommend increased physical activity.
C. Schedule a referral to a neurologist.
D. Educate the patient on foot care.
Correct Answer: D
Explanation: Tingling and reduced sensation are symptoms of diabetic neuropathy. Proper foot care is critical to prevent injuries, ulcers, and potential amputations.
Which statement by a patient about continuous glucose monitoring (CGM) indicates a need for further teaching?
A. “I can check my glucose levels as often as I like.”
B. “The device alarms when my glucose is too low or high.”
C. “I don’t need to calibrate this device.”
D. “Some CGM systems can dose insulin automatically.”
Correct Answer: C
Explanation: Many CGM devices require periodic calibration to ensure accurate readings, though newer systems may be factory-calibrated.
A patient asks how to store insulin. The nurse correctly states:
A. “Insulin vials in use can be kept at room temperature for 1 month.”
B. “Mixed insulin syringes are stable at room temperature for 3 months.”
C. “Always shake the vial vigorously before administration.”
D. “Refrigerated insulin should be discarded after 1 month.”
Correct Answer: A
Explanation: Opened insulin vials can be stored at room temperature for up to 1 month, while mixed syringes should be refrigerated and used within 1 month.
A patient with Type 1 Diabetes is on a twice-daily premixed insulin regimen. The nurse knows this schedule:
A. Provides both basal and mealtime coverage.
B. Requires lunchtime insulin dosing.
C. Cannot be adjusted for basal or bolus needs.
D. Involves only short-acting insulin.
Correct Answer: A
Explanation: Twice-daily premixed insulin combines intermediate-acting and short-acting insulins to provide basal and mealtime coverage, but it lacks flexibility for individual dose adjustments.
When educating a patient on intensive basal/bolus therapy, the nurse explains that bolus insulin:
A. Is taken once a day.
B. Covers blood glucose between meals and overnight.
C. Matches carbohydrate intake at mealtimes.
D. Should be administered only if glucose exceeds 7 mmol/L.
Correct Answer: C
Explanation: Bolus insulin is administered at mealtimes to address glucose spikes resulting from carbohydrate intake.
A patient reports frequent hypoglycemic episodes after morning exercise. The nurse should advise:
A. Exercising in the evening.
B. Increasing morning insulin dosage.
C. Consuming a snack before exercise.
D. Reducing carbohydrate intake before exercise.
Correct Answer: C
Explanation: Consuming a snack before exercise can help prevent hypoglycemia, as physical activity increases glucose uptake by muscles.
A nurse assesses a patient with hypoglycemic unawareness. What intervention is most appropriate to retrain the body to exhibit symptoms of hypoglycemia?
A. Administer insulin before meals.
B. Raise blood glucose target temporarily.
C. Monitor glucose levels only when symptomatic.
D. Reduce dietary carbohydrate intake.
Correct Answer: B
Explanation: Temporarily raising the blood glucose target helps the body readjust to detect and respond to hypoglycemia symptoms.
A patient asks about the benefits of self-monitoring blood glucose (SMBG). The nurse responds by explaining SMBG:
A. Is only necessary for patients with Type 1 Diabetes.
B. Provides rapid results to guide treatment decisions.
C. Requires continuous interstitial glucose monitoring.
D. Eliminates the need for HbA1c testing.
Correct Answer: B
Explanation: SMBG offers quick glucose level results, helping patients and providers adjust treatment plans.
Which patient statement about HbA1c testing indicates a need for further teaching?
A. “It provides an average blood sugar level over 2-3 months.”
B. “The target for most patients with diabetes is below 7%.”
C. “It should be checked daily along with blood glucose.”
D. “It can help assess long-term glucose control.”
Correct Answer: C
Explanation: HbA1c testing is not performed daily; it is typically checked every 3-6 months.
A nurse educates a patient on sodium-glucose co-transporter 2 (SGLT-2) inhibitors. The nurse should highlight which adverse effect?
A. Hypoglycemia
B. Increased risk of urinary tract infections
C. Decreased risk of dehydration
D. Suppression of appetite
Correct Answer: B
Explanation: SGLT-2 inhibitors can increase glucose excretion in urine, which may predispose patients to urinary tract infections and genital fungal infections.
A patient taking gliptins reports severe abdominal pain. What action should the nurse take?
A. Reassure the patient this is a normal side effect.
B. Encourage increased fluid intake.
C. Stop the medication and notify the provider.
D. Administer an over-the-counter pain reliever.
Correct Answer: C
Explanation: Severe abdominal pain may indicate pancreatitis, a rare but serious adverse effect of gliptins, requiring immediate discontinuation and provider notification.
A patient on insulin therapy asks how to prevent lipohypertrophy. The nurse advises:
A. Avoiding abdominal injection sites.
B. Rotating injection sites within the same general area.
C. Using the same injection site for consistency.
D. Injecting insulin deeper into muscle tissue.
Correct Answer: B
Explanation: Rotating injection sites within the same general area helps prevent lipohypertrophy while maintaining consistent absorption.
A nurse is teaching a patient about diet and exercise in Type 2 Diabetes management. Which statement indicates effective understanding?
A. “Skipping meals will help lower my blood sugar.”
B. “Exercise helps my body use glucose more effectively.”
C. “I should avoid carbohydrates entirely.”
D. “I can stop my medication once my glucose levels normalize.”
Correct Answer: B
Explanation: Exercise improves glucose uptake by muscles, which is particularly beneficial for patients with insulin resistance.
A patient with diabetes undergoing surgery is at risk for hyperglycemia due to:
A. Increased insulin sensitivity during stress.
B. Increased release of stress hormones like cortisol.
C. Decreased food intake pre-surgery.
D. Reduced glucose production by the liver.
Correct Answer: B
Explanation: Stress hormones like cortisol and epinephrine increase during surgery, raising blood glucose levels.
A child with Type 1 Diabetes is starting school. The nurse provides teaching to the parents about managing diabetes at school. What statement is accurate?
A. “Your child does not need a glucagon kit if hypoglycemia occurs.”
B. “Pack a high-protein snack in case of hypoglycemia.”
C. “Notify the school staff about symptoms of hypoglycemia.”
D. “Administer extra insulin before physical activity.”
Correct Answer: C
Explanation: School staff should be informed of hypoglycemia symptoms to respond promptly if needed. A glucagon kit should also be available.
A patient taking metformin is scheduled for a CT scan with iodine contrast. What should the nurse advise?
A. “Continue taking metformin as prescribed.”
B. “Stop metformin 2 days before the scan and restart it 2 days after.”
C. “Increase fluid intake and continue metformin.”
D. “Skip the dose on the day of the scan only.”
Correct Answer: B
Explanation: Iodine contrast increases the risk of renal failure, which can exacerbate lactic acidosis when combined with metformin. Stopping metformin before and restarting after the scan ensures safety.
A patient taking sulfonylureas reports flushing and palpitations after consuming alcohol. What is the likely cause?
A. An allergic reaction to the medication
B. Drug-induced hypoglycemia
C. Alcohol interaction causing a disulfiram-like reaction
D. Increased insulin resistance
Correct Answer: C
Explanation: Sulfonylureas can cause a disulfiram-like reaction when combined with alcohol, leading to flushing, palpitations, and nausea.
A patient with diabetes is diagnosed with gastroparesis. What symptom is most consistent with this condition?
A. Diarrhea after meals
B. Vomiting undigested food hours after eating
C. Rapid stomach emptying
D. Frequent heartburn
Correct Answer: B
Explanation: Gastroparesis is delayed gastric emptying caused by autonomic nerve damage, leading to vomiting of undigested food.
The nurse is educating a patient on diabetic retinopathy. Which statement indicates understanding?
A. “Retinopathy occurs because my blood vessels in the retina are damaged.”
B. “This condition can be reversed with medication.”
C. “I should avoid using insulin to prevent retinopathy.”
D. “Retinopathy only occurs in patients with Type 1 Diabetes.”
Correct Answer: A
Explanation: Diabetic retinopathy results from capillary damage in the retina due to prolonged hyperglycemia. It is a complication seen in both Type 1 and Type 2 Diabetes.
A patient on insulin therapy is admitted with tachycardia, sweating, and confusion. What is the nurse’s priority action?
A. Check the patient’s blood glucose level.
B. Administer insulin.
C. Notify the healthcare provider.
D. Encourage the patient to drink water.
Correct Answer: A
Explanation: These symptoms suggest hypoglycemia. The first step is to confirm blood glucose levels before initiating treatment.
A nurse is caring for a patient with poorly controlled Type 2 Diabetes who frequently skips meals. The nurse should emphasize which teaching point?
A. “Skipping meals prevents blood sugar spikes.”
B. “Take your medication even if you skip meals.”
C. “Skipping meals increases the risk of hypoglycemia.”
D. “Only check your blood sugar after meals.”
Correct Answer: C
Explanation: Skipping meals can lead to hypoglycemia, especially when taking medications like sulfonylureas that lower glucose independent of food intake.
A patient using a continuous subcutaneous insulin infusion (CSII) pump asks about its advantages. The nurse explains that the pump:
A. Provides insulin at a steady basal rate and allows bolus doses for meals.
B. Delivers only basal insulin throughout the day.
C. Eliminates the need for glucose monitoring.
D. Prevents all episodes of hyperglycemia.
Correct Answer: A
Explanation: The CSII pump delivers a continuous basal rate and bolus doses for meal-related glucose spikes, but glucose monitoring is still essential.
