Lewis Chapter 52: Complications of Diabetes Mellitus Flashcards
Diabetic ketoacidosis (DKA) is associated with which cause?
A. Ketosis
B. Nitrogen deficiency
C. Profound insulin deficiency
D. Osmotic diuresis
C. Profound insulin deficiency
DKA is an acute metabolic complication of diabetes in which fats are metabolized in the absence of insulin. It is caused by a profound deficiency of insulin.
Which assessment finding would the nurse anticipate in a patient admitted with hyperosmolar hyperglycemic syndrome (HHS)?
A. Bradycardia
B. Hypertension
C. Warm, clammy skin
D. Somnolence
D. Somnolence
Profound volume loss in HHS affects neurological function, resulting in more severe neurological manifestations, such as somnolence, coma, seizures, hemiparesis, and aphasia.
Which factor disrupts the balance between glucose and insulin?
A. Administration of too much medication
B. Routine intake of carbohydrates
C. Scheduled mealtimes
D. Follow exercise routines
A. Administration of too much medication
Too much insulin produces hypoglycemia, disrupting the balance between glucose and insulin.
Which other manifestation would the nurse anticipate if diabetic ketoacidosis (DKA) is suspected when a patient with type 1 diabetes presents to the emergency department with generalized weakness, mild disorientation, increased thirst, and a fruity breath odor?
A. Mood swings
B. Severe drowsiness
C. High blood pressure
D. Kussmaul’s respirations
D. Kussmaul’s respirations
DKA is commonly seen in patients with type 1 diabetes, often at the time of diagnosis. The body compensates through osmotic diuresis to excrete excess glucose, resulting in profound water loss. Kussmaul’s respirations (deep, laboured breathing), restlessness, and orthostatic hypotension are manifestations of this complications of diabetes.
Which factor affects cardiac functioning in a patient with diabetic ketoacidosis (DKA)?
A. Potassium imbalance
B. Hyponatremia
C. Osmotic diuresis
D. Hypovolemia
A. Potassium imbalance
A decrease in potassium occurs as potassium deficits result from hypoinsulinemia and osmotic diuresis. Characteristic changes indicating potassium excess or deficit are observable on electrocardiogram tracings.
Which condition is estimated to account for the majority of deaths among patients with diabetes mellitus (DM)?
A. Diabetic ketoacidosis (DKA)
B. Angiopathy
C. Hyperosmolar hyperglycemic state (HHS)
D. Neuropathy
B. Angiopathy
Angiopathy, or blood vessel disease, is estimated to account for the majority of deaths among patients with DM. These chronic blood vessel dysfunctions are divided into two categories: macrovascular complications and microvascular complications.
Which strategy for prevention of macrovascular complications offers to reduce mortality risks of type 2 diabetes mellitus (DM)?
A. Lipid, blood pressure, and glycemic control medications
B. Limiting tobacco use
C. Periodic screening for metabolic syndrome
D. Screening for depression disorders
A. Lipid, blood pressure, and glycemic control medications
Lipid, blood pressure, and glycemic control medications are proven to delay the mortality of the disease.
Which complication of type 2 diabetes mellitus (DM) causes higher-than-normal amputation rates in patients? Select all that apply. One, some, or all responses may be correct.
A. Peripheral sensory neuropathy
B. Poor weight management
C. Persistent hyperglycemia
D. Ischemia in peripheral blood vessels
E. Retinopathy
A, C, D.
The most common type of neuropathy affecting people with DM is peripheral sensory neuropathy. Peripheral sensory neuropathy significantly increases the risk for complications that result in a lower limb amputation due to metabolic derangements with DM.
It is theorized that persistent hyperglycemia leads to an accumulation of sorbitol and fructose in the nerves that causes damage by an unknown mechanism. The result is reduced sensation and demyelinization.
Ischemia in blood vessels supplying peripheral nerves damaged by chronic hyperglycemia is implicated in the development of diabetic neuropathy.
Which characteristic of aging is closely associated with the development of diabetes mellitus (DM)?
A. Reduction in β-cell function
B. Hypoglycemic unawareness
C. Frailty
D. Poor psychomotor function
A. Reduction in β-cell function
The reduction in cellular functioning is a major reason the aging process is associated with the development of DM.
Which symptom may lead a health care provider to suspect a diagnosis of type 2 diabetes mellitus (DM)?
A. Hypertension
B. Cardiovascular disease (CVD)
C. Gastrointestinal distress
D. Recurring infections
D. Recurring infections
Recurring infections often lead the provider to suspect DM as many organisms thrive in a high glucose environment.
Which patient statement indicates a need for further teaching after receiving education about proper foot care?
A. “I will cut and file toenails even, making sure to cut down corners.”
B. “It is important to examine my feet every day.”
C. “I should refrain from wearing high-heeled shoes.”
D. “I will go to the podiatrist to get my toenails trimmed.”
A. “I will cut and file toenails even, making sure to cut down corners.”
The patient with diabetes should cut and file toenails even, with the rounded contour of the toes, making sure not to cut down corners. The best time to trim nails is after a shower or bath. The patient should see a foot care specialist if advice or treatment is needed.
Which patient education issue for older patients with diabetes mellitus (DM) should be included in the plan of care? Select all that apply. One, some, or all responses may be correct.
A. Functional ability
B. Cognitive status
C. Mobility
D. Memory
E. Vision
A, B, C,D, E.
The patient education issues for the older patient include functional ability, vision, mobility, cognitive status, memory, financial and social situation, the effect of multiple medications, eating habits, the potential for undetected hypoglycemia, and quality of life.
Which action would the nurse take first when a patient’s capillary blood glucose reading is 63 mg/dL?
A. Recheck the patient’s blood glucose level.
B. Obtain blood glucose sample drawn by the laboratory.
C. Give the patient a snack that equals 15 g of carbohydrates.
D. Teach the patient to carry a source of carbohydrates.
C.Give the patient a snack that equals 15 g of carbohydrates.
When a patient has symptoms of hypoglycemia, the nurse should give the patient 15 g of carbohydrates to increase the blood glucose level.
Which action would the nurse take when assessing a new patient with a fruity smell on their breath and rapid, deep breathing? Select all that apply. One, some, or all responses may be correct.
A. Notify the health care provider.
B. Restrict the patient’s fluid intake.
C. Check the patient’s feet for ulcers.
D. Check the patient’s capillary glucose level.
E. Give the patient a high-carbohydrate snack.
A, D.
The nurse should notify the health care provider of this finding because this patient is exhibiting signs of diabetic ketoacidosis.
This patient is exhibiting signs of diabetic ketoacidosis, so the nurse should check the patient’s capillary glucose level.
Which assessment finding would cause the nurse to implement interventions for hyperglycemia when caring for a newly admitted patient with type 1 diabetes?
A. Pale skin
B. Sweating
C. Dry mouth
D. Mood swings
C. Dry mouth
A dry mouth is a symptom of hyperglycemia. The nurse would intervene to decrease the patient’s blood sugar when a dry mouth has been noted.
Which subjective assessment finding indicates a need for further patient education about reducing the risk of developing complications from diabetes?
A. Sees an ophthalmologist twice a year
B. Walks 30 minutes per day, 5 days a week
C. Reports walking barefoot only when it is warm outside
D. Checks a capillary blood glucose level whenever feeling unwell
C. Reports walking barefoot only when it is warm outside
A patient with diabetes should not walk barefoot at all because peripheral neuropathy can prevent the patient from detecting injuries to the feet. This statement indicates a need for further education.
Which condition is a microvascular complication that is specific to type 2 diabetic mellitus (DM) patients?
A. Retinopathy
B. Atherosclerosis
C. Cardiovascular disease (CVD)
D. Peripheral vascular disease (PVD)
A. Retinopathy
Retinopathy is a microvascular complication that is specific to DM.
Which preventive strategy is best for management of diabetic eye diseases?
A. Maintain glycemic and blood pressure control
B. Vitrectomy
C. Photocoagulation
D. Intraocular injections
A. Maintain glycemic and blood pressure control
Maintaining good glycemic control and blood pressure is the critical strategy for managing diabetic eye diseases.
Which information would the nurse include in the teaching plan for a patient with diabetes about the potential vascular complications of diabetes?
A. Macroangiopathy does not occur in type 1 diabetes but rather in patients with type 2 diabetes who have severe disease.
B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, nerves, and skin.
C. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.
D. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients diagnosed with diabetes.
B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, nerves, and skin.
Microangiopathy occurs in diabetes mellitus. The areas of the body most noticeably affected are the eyes (retinopathy), the kidneys (nephropathy), the nerves (neuropathy), and the skin (dermopathy). Sexual impotency and slowed gastric emptying result from microangiopathy. Macroangiopathy can occur in either type 1 or type 2 diabetes.
Which condition is associated with hyperinsulinemia and/or insulin resistance in patients with type 2 diabetes mellitus (DM)?
A. Acanthosis nigricans
B. Granuloma annulare
C. Necrobiosis lipoidica diabeticorum
D. Dermatological neuropathy
A. Acanthosis nigricans
Acanthosis nigricans is a risk factor for DM and is associated with hyperinsulinemia and insulin resistance.
During dietary planning, the nurse would encourage a patient with diabetes to limit the intake of which food?
A. Oranges
B. Chicken
C. Broccoli
D. Cheese
D. Cheese
High saturated fat intake can increase the risk of peripheral vascular disease, which increases the risk for amputation in diabetic patients. Cheese is a product derived from animal sources and is higher in saturated fat and calories than vegetables, fruit, and poultry.
Polydipsia and polyuria related to diabetes mellitus are primarily caused by which of the following?
a. The release of ketones from cells during fat metabolism
b. Fluid shifts resulting from the osmotic effect of hyperglycemia
c. Damage to the kidneys from exposure to high levels of glucose
d. Changes in red blood cells resulting from attachment of excessive glucose to hemoglobin
B.
Which statement would be correct for a client with type 2 diabetes mellitus who is admitted to the hospital with pneumonia?
a. The client must receive insulin therapy to prevent the development of ketoacidosis.
b. The client has islet-cell antibodies that have destroyed the ability of the pancreas to produce insulin.
c. The client has minimal or absent endogenous insulin secretion and requires daily insulin injections.
d. The client may have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar hyperglycemic state.
D.
Analyze the following diagnostic findings for a client with type 2 diabetes. Which of the following results will need further assessment?
a. A1c 9.0%
b. FBG 7.2 mmol/L
c. BP 126/80
d. LDL cholesterol of 2.1 mmol/L
A.
