Unit 11 - Class Activities Flashcards
Frank has been noncompliant with his diabetic regimen in the past. What test will give the best information regarding his compliance?
A.random blood sugar
B.test urine for glucosuria
C.glycosylated hemoglobin Hgb A1C
D.glucose tolerance test
C.glycosylated hemoglobin Hgb A1C
*Hemoglobin A1c (HbA1c) provides an average of your blood sugar control over the past 2 to 3 months and is used along with home blood sugar monitoring/When glucose is high it combines with Hemoglobin, becoming “glycated.“
normal A1c test: 4% and 5.6%.
5.7% and 6.4% indicate increased risk of diabetes
6.5% or higher indicate diabetes
Goal for people with diabetes is less than: 7%
Mrs. Bergstrum is a 60 year old client who has been newly diagnosed with noninsulin dependent diabetes ( Type II diabetes). She is 70 pounds overweight.What information should the nurse include in a teaching plan for Mrs. Bergstrum?
A.Emphasize controlling her weight through a high protein diet.
B.The role of exercise in improving blood glucose control.
C.Oral hypoglycemic agents are less effective than insulin in managing blood glucose levels.
D.Reaching her optimal weight will cure her disease.
B.The role of exercise in improving blood glucose control.
*Exercise will improve insulin resistance and assist in controlling her disease, in addition it will help with weight loss, and use excess glucose in her body.
Metformin takes _____ weeks to take effect
4
Which of the following is a desired outcome in evaluating a new diabetic’s understanding of teaching about insulin usage?
a. After drawing up insulin from a vial, he adds an air bubble so as to clear the needle after injection.
b. He carries some form of simple carbohydrate at all times.
c. He recognizes that hunger and tremor signal a need for additional insulin.
d. He knows that adding carbohydrate to the diet can produce an insulin reaction.
b. He carries some form of simple carbohydrate at all times.
Polyuria in the client with diabetes is caused by
a. a high renal threshold.
b. osmotic diuresis.
c. increased thirst.
d. dehydration.
b. osmotic diuresis.
* diuresis due to a high concentration of osmotically active substance (Sugar)in the renal tubules, which limit the reabsorption of water. Kidneys can only reabsorb so much (sugar) rest is released and it pulls water with it.
Which of the following is priority in patient education for all persons with diabetes regarding the prevention of hypoglycemia?
a. instructions in the use of glucagon
b. use of a fast acting carbohydrate
c. need to increase caloric consumption
d. peak time of glucose lowering medication/s
d. peak time of glucose lowering medication/s
C.D., who is a diabetic, wears heavy, well constructed shoes. At work, he stepped on a nail and it pierced his foot right through his leather shoe. He didn’t notice the nail until later that evening when he was changing his shoes. What type of problem does this indicate?
a. retinopathy
b. nephropathy
c. neuropathy
d. peripheral vascular disease
c. neuropathy
* may present as numb, tingling, burning, pain sensation / feeling is stunted
Robert Jacobsen is seen at a community clinic for complaints of a wound on his foot that will hot heal. Upon examination, the wound appears to be infected. He indicates that he didn’t even realize the wound was there until he removed his shoe and found his foot was bloody. Mr. Jacobsen is obese and is being treated for type 2 diabetes mellitus. Why is Mr. Jacobsen at risk for developing infections? Mark all that apply
a. Vascular changes reduce blood flow to lower extremities
b. Hyperglycemia promotes bacterial growth
c. Impaired function of WBC
d. . Hyperglycemia causes alterations in skin integrity
e. . Decreased peripheral sensation reduces early warning signs
Robert Jacobsen is seen at a community clinic for complaints of a wound on his foot that will hot heal. Upon examination, the wound appears to be infected. He indicates that he didn’t even realize the wound was there until he removed his shoe and found his foot was bloody. Mr. Jacobsen is obese and is being treated for type 2 diabetes mellitus. Why is Mr. Jacobsen at risk for developing infections? Mark all that apply
a. Vascular changes reduce blood flow to lower extremities
b. Hyperglycemia promotes bacterial growth
Impaired function of WBC
d. Decreased peripheral sensation reduces early warning signs
*D: not directly)/ they may have more skin rashes though
A home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food or medication has been consumed for 36 hours. Which additional statement by the client indicates a need for further teaching?
a. “I need to stop my insulin.”
b. “I need to increase my fluid intake.”
c. “I need to call the physician because of these symptoms.“
d. “I need to monitor my blood glucose every 3 to 4 hours
a. “I need to stop my insulin.”
Bobby Davies a 12 year old male is newly diagnosed with type 1 diabetes mellitus. Bobby’s pathophysiologic state is most probably the result of:
A. A familial, autosomal dominant gene defect
B. Obesity and lack of exercise
C. Immune destruction of the pancreas
D. Hyperglycemia from eating too may sweets
C. Immune destruction of the pancreas
An adult client with type 2 diabetes is taking metformin (Glucophage) 1,000 mg two times every day. A nurse provides instructions regarding the interaction of alcohol and metformin. When the nurse evaluates the client’s understanding she notes that learning is evident because the client makes which of the following statements?
- “ If I know I’ll be having alcohol, I must not take metformin: I could develop lactic acidosis.”
- “ If my physician approves, I may drink alcohol with my metformin”
- Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain and rapid heartbeat.”
- “ If I feel bloated, I should call my physician”
1.“ If I know I’ll be having alcohol, I must not take metformin: I could develop lactic acidosis.”
Susan less has type 1 diabetes mellitus. She is admitted to the hospital with the following lab values: serum glucose 500 mg/dl ( high) , urine glucose and ketones 4+, arterial ph 7.20. her parents state that she has been sick with the “flu”for a week. Which of the following statements best explains her state.
a. Increased insulin levels promote protein breakdown and ketone formation
b. Her uncontrolled diabetes has led to renal failure
c. low serum insulin promotes lipid storage and corresponding release of ketones
d. Insulin deficiency promotes lipid metabolism and ketone formation
d. Insulin deficiency promotes lipid metabolism and ketone formation
A client with Type 1 DM has DKA. Which os the following findings has the greatest effect on fluid loss?
a. hypotension
b. decreased serum potassium level
c. rapid, deep respirations
d. warm, dry skin
c. rapid, deep respirations
* Due to the rapid, deep respirations, the client is losing fluid from vaporization form the lungs and skin (insensible fluid loss). Normally, about 900 ml of fluid is lost per day through vaporization .
Decreased serum potassium level has no effect on insensible fluid loss. Hypotension occurs due to polyurea and inadequate fluid intake. It may decrease the flow of blood to the skin, causing skin to be warm and dry.
A client comes to the emergency department with diabetic ketoacidosis. The nurse should identify which of the following nursing diagnoses as a priority problem?
a. Insomnia
b. Ineffective health maintenance
c. Imbalanced nutrition: Less than body requirements
d. Deficient fluid volume
d. Deficient fluid volume
* Increased osmolality from glucose leads to a fluid shift form the intracellular to the extra cellular space. The fluid shift leads to increased renal excretion of glucose and fluid. Severe dehydration, possible hypovolemic shock is a medical emergency ….
Jerry Green is a 13 year old who uses insulin to control his type 1 diabetes. During his gym class, he experiences hunger, light headedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is:
a. hyperglycemia resulting from incorrect administration.
b. dawn phenomenon caused by eating a snack before gym class.
c. hypoglycemia caused by increased exercise.
d. Somogyi effect caused by insulin sensitivity
c. hypoglycemia caused by increased exercise.