Lewis Chapter 52 Elsevier Flashcards
The nurse is caring for a patient admitted with type 2 diabetes. The patient asks the nurse what “type 2” means. Which of the following statements is the best response by the nurse?
A. “With type 2 diabetes, the body of the pancreas becomes inflamed.”
B. “With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased.”
C. “With type 2 diabetes, the patient is totally dependent on an outside source of insulin.”
D. “With type 2 diabetes, the body produces autoantibodies that destroy B-cells in the pancreas.”
B. In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, the cells of the body become resistant to insulin, or both.
The nurse is caring for a patient who is hospitalized with diabetes mellitus. Which of the following laboratory test results would provide information related to the patient’s past glucose control?
A. Prealbumin level
B. Urine ketone level
C. Fasting glucose level
D. Glycosylated hemoglobin level
D. A glycosylated hemoglobin level (or hemoglobin A1C [A1C] test) detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control over approximately 2–3 months.
The nurse is teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). Which of the following actions by the patient should alert the nurse that additional teaching is required?
A. Patient chooses a puncture site in the centre of the finger pad.
B. Patient washes hands with soap and water to cleanse the site to be used.
C. Patient warms the finger before puncturing the finger to obtain a drop of blood.
D. Patient tells the nurse that the result of 6.66 mmol/L indicates good control of diabetes.
A. The patient should select a site on the sides of the fingertips, not on the centre of the finger pad. This area contains many nerve endings in comparison to the side of the fingertip and would be unnecessarily painful.
The nurse is teaching a patient with diabetes about proper composition of their daily diet. Which of the following percentages should the nurse explain is the guideline for daily carbohydrate intake?
A. 80%
B. 30%
C. 45%
D. 25%
C. The recommendation for carbohydrate intake is 45% to 60% of daily energy. Low-carbohydrate diets are not recommended for diabetes management.
The nurse is caring for a patient who has been diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, which of the following actions should the nurse do first?
A. Assess patient’s perception of what it means to have diabetes.
B. Ask the patient to write down their current knowledge about diabetes.
C. Set goals for the patient to actively participate in managing their diabetes.
D. Assume responsibility for all of the patient’s care to decrease stress level.
A. In order for teaching to be effective, the first step is to assess the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient.
The nurse is beginning to teach a diabetic patient about potential vascular complications of diabetes. Which of the following information would be appropriate for the nurse to include in the teaching plan?
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 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.
The nurse is evaluating a patient who has been diagnosed with type 1 diabetes mellitus. Which of the following symptoms reported by the patient is considered one of the classic clinical manifestations of diabetes?
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).
The nurse is caring for a patient with diabetes mellitus who is scheduled for a fasting blood glucose level at 0800 hours the next day. The nurse instructs the patient to only drink water after which of the following times?
A. 1800 hours
B. 0400 hours
C. 0000 hours
D. 0700 hours
C. Typically, a patient is ordered to be NPO for eight hours before a fasting blood glucose level. For this reason, the patient who has a laboratory draw at 0800 hours should not have any food or beverages containing any calories after 0000 hours.
The nurse is caring for a patient with diabetes mellitus who has a glucose level of 21.1 mmol/L and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which of the following respiratory patterns would the nurse expect to find?
A. Central apnea
B. Hypoventilation
C. Kussmaul’s respirations
D. Cheyne-Stokes respirations
C. In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul’s respirations, which are deep and non-laboured.
The nurse is assisting a patient with diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which of the following 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.
The nurse is reviewing laboratory results for a patient with a 15-year history of diabetes. Which of the following laboratory results follows the expected pattern accompanying macrovascular disease as a complication of diabetes?
A. Increased triglyceride levels
B. Decreased low-density lipoproteins
C. Increased high-density lipoproteins
D. Decreased very-low-density lipoproteins
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. For this reason, the patient should limit the amount of fat in the diet.
The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes which of the following statements?
A. “I should walk barefoot only in nice dry weather.”
B. “I should look at the condition of my feet every day.”
C. “My shoes should fit nice and tight to provide me with firm support.”
D. “When I am allowed up out of bed, I should check the shower water with my toes.”
B. Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for delayed wound healing. Water temperature should be tested with the hands first. Properly fitted (not tight) shoes should be worn at all times.
The nurse is caring for a patient who received regular insulin 10 units subcutaneously at 2030 hours for a blood glucose level of 14.0 mmol/L. The nurse plans to monitor this patient for signs of hypoglycemia at which of the following peak action times?
A. 2100–2230 hours
B. 2230–2330 hours
C. 0030–0130 hours
D. 0230–0430 hours
B. Regular insulin exerts peak action in two to three hours, making the patient most at risk for hypoglycemia between 2230 and 2330 hours.
