Deck 50: Diabetes and Hypoglycemia

Question 1

A patient with type 2 diabetes shows a blood sugar reading of 68 at 6 AM.What action should the nurse implement based on the reading of 72 mg/dL?

A) Notify the charge nurse of the reading.
B) Give regular insulin per a sliding scale.
C) Give him 8 oz of skim milk.
D) Administer the oral glucose tablet.

Answer 1

Give him 8 oz of skim milk.

Question 2

A nurse assigned to care for a patient with diabetic ketoacidosis (DKA)is aware that this is a life-threatening condition.What will DKA result in?

A) Disorder of carbohydrates, fats, and proteins metabolism
B) Storage of glycogen, resulting in a severe shortage of glucose in the bloodstream
C) Dangerously elevated pH and bicarbonate levels in the blood
D) Severe hypoglycemia, which can result in coma and convulsions

Answer 2

Disorder of carbohydrates, fats, and proteins metabolism

Question 3

A patient with type 1 diabetes asks why his 0700 insulin has been changed from NPH insulin to 70/30 premixed insulin.What is the best explanation by the nurse that explains about 70/30 insulin mixture?

A) It is absorbed more rapidly into the bloodstream.
B) It has no peak action time and lasts all day.
C) It makes insulin administration easier and safer.
D) It provides a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.

Answer 3

It makes insulin administration easier and safer.

Question 4

A patient with type 1 diabetes has an insulin order for NPH insulin, 35 U, to be given at 0700.The patient has also been instructed not to take anything by mouth (NPO)in preparation for laboratory work that will not be drawn until 1000.What action should the nurse implement?

A) Give the insulin as ordered.
B) Give the insulin with a small snack.
C) Inform the charge nurse.
D) Hold the insulin until after the blood draw.

Question 5

A nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce enough insulin.What is the reason that the blood glucose is elevated?

A) Prolonged elevation of stress hormone (cortisol, epinephrine, glucagon, growth hormone)levels
B) Malfunction of the glycogen-storing capabilities of the liver
C) Destruction of the beta cells in the pancreas
D) Insulin resistance of the receptor cells in the muscle tissue

Question 6

What should a nurse include when drawing up a patient's diabetes teaching plan?

A) Develop an exercise plan because regular exercise helps control blood glucose levels.
B) Monitor blood sugar levels only if not feeling well to ensure that the fingertips are not pricked too much.
C) If nervousness, palpitations, or hunger is experienced, take a small dose (1 to 2 U)of regular insulin and call the physician.
D) Use over-the-counter measures for any foot blisters, calluses, or wounds before seeking medical help.

Question 7

A patient has been admitted to the hospital with the diagnosis of DKA.What vital signs should a nurse anticipate that the patient will exhibit?

A) Temperature, 99 $\degree$ F; pulse, 62 beats/min; respirations, 16 breaths/min and shallow
B) Temperature, 98.6 $\degree$ F; pulse, 76 beats/min; respirations, 16 breaths/min and deep
C) Temperature, 98 $\degree$ F; pulse, 84 beats/min; respirations, 18 breaths/min and shallow
D) Temperature, 97.4 $\degree$ F; pulse, 110 beats/min; respirations, 26 breaths/min and deep

Question 8

A young patient complains that diabetes is causing her to "have no life at all.It's too hard." What is the most helpful response by the nurse?

A) "Yes, you must make some sacrifices."
B) "It's hard, but with significant alterations in your lifestyle, you can live a long life."
C) "What's hard about exercise, diet, and medicine?"
D) "Let's talk about what makes it so hard."

Question 9

A patient comes to the diabetes clinic and confides to the nurse that she does not follow the diet exchange program that she was given.What is the best response by the nurse?

A) "The exchange program is a carefully developed and very important program that allows you to take control of your disease."
B) "A lot of people have trouble with that program.You aren't the first one to go off your diet."
C) "We had better check your blood work to see what you've done to yourself."
D) "Okay.Let's talk about what you do eat and drink and how you manage your diabetes."

Question 10

What has most likely occurred in a patient who has been diagnosed with endogenous hypoglycemia?

A) Taken an overdose of hypoglycemic drugs
B) Been following a very restricted fasting diet or is malnourished
C) Excessive secretion of insulin or an increase in glucose metabolism
D) Exercised unwittingly without replenishing needed fluids and nutrients

Question 11

As part of a teaching plan in preparation for discharge, a patient with type 1 diabetes needs guidelines for exercise.Which guideline should be included?

A) Plan exercise so that it coincides with the peak action of insulin.
B) Insulin should be injected into the lower extremity before exercise because that site provides the greatest absorption.
C) Exercise should be performed daily at the same time of day and at the same intensity.
D) Keep exercise at a minimum to conserve your energy.

Question 12

A patient tells a nurse that she eats "huge" amounts of food but stays hungry most of the time.What should the nurse explain as the cause of hunger experienced by persons with type 1 diabetes?

A) Excess amount of glucose
B) Need for additional calories to correct the increased metabolism
C) Fact that the cells cannot use the blood glucose
D) Need for exercise to stimulate insulin secretion

Question 13

A patient has come into the emergency department accompanied by a friend who states that the patient had been acting very strangely and seems confused.The friend states that the patient has diabetes and takes insulin.Which signs of hypoglycemia might the nurse assess?

A) Slow pulse rate and low blood pressure
B) Irritability, anxiety, confusion, and dizziness
C) Flushing, anger, and forgetfulness
D) Sleepiness, edema, and sluggishness

Question 14

A home health care nurse is assessing a patient with type 1 diabetes who has been controlled for 6 months.The nurse is surprised and concerned about a blood glucose reading of 52 mg/dL.What action by this patient most likely caused this episode of hypoglycemia?

A) Taking a new form of birth control pill this morning
B) Using large amounts of sugar substitute in her tea this morning
C) A 2-hour long exercise class at the spa this morning
D) Administering an insufficient dose of insulin this morning

Question 15

The self-care goal of a patient with diabetes is to keep the blood sugar within normal limits.What causes hyperglycemia to occur?

A) Blood glucose levels rise, stimulating the production of insulin.
B) Insulin conversion of glycogen to glucose is inhibited.
C) The body responds to glucose-starved tissues by changing stored glycogen into glucose.
D) Glycogen is unable to be stored in the liver and muscles.

Question 16

A patient has come to the physician's office after finding out that her blood glucose level was 135 mg/dL.She states that she had not eaten before the test and was told to come and see her physician.She asks the nurse if she has diabetes.What is the most accurate nursing response?

A) "Having a fasting serum glucose that high certainly indicates diabetes."
B) "That test indicates that we need to perform more tests that are specific for diabetes."
C) "How do you feel? Do you have any other signs of diabetes?"
D) "Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a diagnosis."

Question 17

When a patient with type 2 diabetes says, "Why in the world are they looking at my hemoglobin? I thought my problem was with my blood sugar." What should the nurse explain about the level of hemoglobin A1c?

A) Shows how a high level of glucose can cause a significant drop in the hemoglobin level
B) Shows what the glucose level has done during the past 3 months
C) Indicates a true picture of the patient's nutritional state
D) Reflects the effect of a high level of glucose on the ability to produce red blood cells (RBCs)

Question 18

A patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take a pill instead of insulin.The nurse explains that in type 2 diabetes mellitus, the body still makes insulin.What other information is pertinent for the nurse to relay?

A) Overweight and underactive people cannot simply use the insulin produced.
B) Metabolism is slowed in some people, so they have to take a pill to speed up their metabolism.
C) Sometimes the autoimmune system works against the action of the insulin.
D) The cells become resistant to the action of insulin.Pills are given to increase the sensitivity.

Question 19

What does the lack of insulin in patients with type 1 diabetes cause that increases the risk for cardiovascular disorders?

A) High glucose levels that irritate and shrink the vessels
B) Inadequate metabolism of proteins, which causes ketosis
C) Increased fatty acid levels
D) Increased metabolism of ketones, which causes hypertension

Question 20

A nurse is formulating a teaching plan for a 22-year-old woman taking rosiglitazone (Avandia).What should the nurse include information about in this plan to caution this patient?

A) Decreased effectiveness of her birth control pills
B) Excessive exposure to the sun
C) Sudden drop in blood pressure with dizziness
D) Possible severe diarrhea

Question 21

What are functional causes of hypoglycemia? (Select all that apply.)

A) Dumping syndrome
B) Overdose of insulin
C) Addison disease
D) Prolonged muscular exercise
E) Chronic alcoholism

Question 22

A teaching plan for a patient with diabetes is focused on smoking cessation and the control of hypertension for the avoidance of microvascular complications.What are examples of microvascular complications? (Select all that apply.)

A) Macular degeneration
B) End-stage renal disease (ESRD)
C) Coronary artery disease (CAD)
D) Peripheral vascular disease (PVD)
E) Cerebrovascular accident (CVA)

Question 23

What should a teaching plan about foot care include for a patient with diabetes? (Select all that apply.)

A) Wash and carefully dry the feet every day.
B) Apply lotion between the toes.
C) Protect the feet from extreme temperatures.
D) Walk barefoot only indoors.
E) Buy shoes that are comfortable and supportive.

Question 24

How is the Whipple triad described? (Select all that apply.)

A) Symptoms of hypoglycemia are present.
B) Low blood glucose levels are documented when symptoms are present.
C) Symptoms can be reproduced with an injection of regular insulin, 10 units.
D) Muscular activity does not have any effect on blood glucose.
E) Symptoms improved when the blood glucose level rises.

Question 25

A nurse reminds a patient with type I diabetes to rotate the insulin injection sites to prevent ______.

Question 26

A patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS).The blood glucose level is very high (880 mg/dL)on admission.The physician believes that the condition is the result of large amounts of glucose solutions administered intravenously (IV)during renal dialysis.What should the nurse anticipate that the patient would exhibit?

A) Fruity breath and a high level of ketones in her urine
B) Severe dehydration and hypernatremia caused by the hyperglycemia
C) Exactly the same symptoms and signs as DKA
D) Kussmaul respirations, nausea, and vomiting

Question 27

A nurse instructs a patient about how insulin affects blood glucose.______ (Arrange the events in sequence.Do not separate answers with a space or punctuation.Example: ABCD.)

A)Beta cells are stimulated to release insulin.
B)Glucose enters the bloodstream.
C)Glycogen is converted to glucose by alpha cells (glycogenesis).
D)Glycogen is stored in the liver.
E)Insulin transports glucose to muscle cells.

Question 28

How long does it take for Humulin R 20 units to peak?

A) 15 minutes
B) 30 minutes
C) 1 hour
D) 2 hours

Question 29

A nurse suspects that a patient with type 1 diabetes may be experiencing the Somogyi phenomenon.What symptom supports this suspicion?

A) Headache on awakening and enuresis
B) 6 AM blood sugar of 58 mg/dL and nausea
C) Abdominal pain and elevated blood pressure
D) Drowsiness and disorientation after eating