Week 8 – Endocrine/IBD Flashcards
A 54-year-old patient admitted with type 2 diabetes asks the nurse what “type 2” means. Which of the following is the most appropriate 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. “With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased”
In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced and the cells of the body become resistant to insulin or both.
The nurse caring for a 54-year-old patient hospitalized with diabetes mellitus would look for which of the following laboratory test results to obtain information on the patient’s past glucose control?
a. Prealbumin level b. Urine ketone level c. Fasting glucose level d. Glycosylated hemoglobin level
d. Glycosylated hemoglobin level
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 two to three months.
The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient’s technique, the nurse identifies a need for additional teaching when the patient does which of the following?
a. Chooses a puncture site in the centre of the finger pad b. Washes hands with soap and water to cleanse the site to be used c. Warms the finger before puncturing the finger to obtain a drop of blood d. Tells the nurse that the result of 6.66 mmol/L indicates good control of diabetes
a. Chooses a puncture site in the centre of the finger pad
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 and would be unnecessarily painful
The nurse is teaching a 54-year-old patient with diabetes about proper composition of the daily diet. The nurse explains that the guideline for carbohydrate intake is which of the following?
a. 80% b. 30% c. 45% d. 25%
c. 45%
The recommendation for carbohydrate intake is 45% to 60% of daily energy. Low-carbohydrate diets are not recommended for diabetes management.
The nurse is assigned to the care of a 64-year-old patient 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 should be the nurse’s initial intervention?
a. Assess patient’s perception of what it means to have diabetes. b. Ask the patient to write down current knowledge about diabetes. c. Set goals for the patient to actively participate in managing his diabetes. d. Assume responsibility for all of the patient’s care to decrease stress level.
a. Assess the patients perception of what it means to have diabetes
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 vascular complications of diabetes. Which of the following information would be appropriate for the nurse to include?
a. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics 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 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.
The nurse is evaluating a 45-year-old patient diagnosed with type 2 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. Excessive Thirst
The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger) the 3 Ps!!!
A 54-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 0800 hrs. The nurse instructs the patient to only drink water after what time?
a. 1800 hrs on the evening before the test b. 0400 hrs on the day of the test c. Midnight before the test d. 0700 hrs on the day of the test
c. Midnight before the test
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 lab draw at 0800 hrs should not have any food or beverages containing any calories after midnight.
A patient is admitted with diabetes mellitus, 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. Kussmaul’s Respiration’s
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 nonlaboured
The nurse is assisting a diabetic patient to learn dietary planning as part of 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
Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry.
Lab results are back for a 54-year-old patient with a 15-year history of diabetes. Which of the following lab results follows the expected pattern accompanying macro-vascular 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. Increased triglyceride levels
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. “I am lucky my shoes fit so nice and tight because they give me firm support.” d. “When I am allowed up out of bed, I should check the shower water with my toes.”
b. “I should look at the condition of my feet everyday”
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 patient received regular insulin 10 units subcutaneously at 2030 hrs 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?
2100 hrs to 2230 hrs 2230 hrs to 2330 hrs 0030 hrs to 0130 hrs 0230 hrs to 0430 hrs
b. 2230 hrs to 2330 hrs
Regular insulin exerts peak action in two to three hours, making the patient most at risk for hypoglycemia between 2230 hrs and 2330 hrs.
A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient’s potassium level is 5.6 mmol/L. The nurse considers that which of the following could be a contributing factor for this lab result? (Select all that apply.)
a. The patient may be excreting extra sodium and retaining potassium because of malnutrition.
b. The level is consistent with renal insufficiency that can develop with renal nephropathy.
a. The patient may be excreting extra sodium and retaining potassium because of malnutrition
A patient diagnosed with ulcerative colitis is admitted to the medical unit. When assessing the patient, which of these findings would be of the most concern?
a. Borborygmi
b. Oral temperature of 99.0 F (37.2 C)
c. Bloody diarrhea
d. Rebound tenderness
d. Rebound tenderness
Think of the assessments that may be expected when assessing a patient who has ulcerative colitis.
Hint #2
After remembering what is expected, recall the potential complications of the disorder, and how a healthcare provider would recognize these complications.
Hint #3
Bloody diarrhea is a common finding because of bleeding lesions and anal excoriation. A temperature of 99.0 F (37.2 C) is within normal range, and chronic inflammation may keep temperatures within the high normal range or above. Rebound tenderness is a sign of peritonitis that could be the result of rupture of the colon.
