Question 1

The nurse is caring for a patient who struggles to maintain glycemic control at night and during early morning hours.Which statement correctly explains the reason for this problem?

Accepted Answer

Dawn phenomenon is produced in the morning by the circadian release of growth hormones,epinephrine,and glucagon during the night.Rebound hyperglycemia,also known as the Somogyi effect,follows a period of hypoglycemia,often during sleep.When hypoglycemia occurs,the body secretes glucagon,epinephrine,growth hormone,and cortisol to counteract the effects of low blood sugar.The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose,it worsens the problem.The dawn phenomenon is characterized by elevated blood glucose in the morning and is caused by release of growth hormone,glucagon,and epinephrine during the night,as part of the body's natural circadian rhythm.These hormones act to raise the body's blood sugar.The dawn phenomenon is the reason why most people with diabetes do not tolerate carbohydrates well in the morning.The treatment is an intermediate-acting insulin at night.

Question 2

Which reason best explains why diabetics are prone to infection?

Accepted Answer

The primary reason for increased risk of infection in diabetic patients is the hyperglycemic environment.Lesser risk factors include atherosclerotic vascular changes,abnormal phagocyte function,and decreased leukocyte function.

Question 3

A patient asks the nurse if stress can be a potential cause of type 2 diabetes.Which response is most appropriate for the nurse to make?

Accepted Answer

Stress stimulates the adrenal cortex to release glucocorticoids,which can cause hyperglycemia.

Question 4

The nurse is caring for an older adult patient who is diabetic.The nurse cautions against the technique of "tight control" of hyperglycemia.Which statement explains why this management method is not recommended?

Accepted Answer

One complication of the "tight control" method includes hypoglycemia.Older adults experience hypoglycemia more quickly than do younger people,and older adults are more prone to hypoglycemic episodes.The older adult may progress to dangerously low levels of blood glucose before signs and symptoms are obvious.Severe hypoglycemia in the older adult can precipitate myocardial infarction,angina,stroke,or seizures.For this reason,"tight control" may not be the best thing for the older adult.Older adults can accurately test and administer insulin,possess a higher risk for hypoglycemia,and do not possess an unstable metabolic rate.

Question 5

The nurse is counseling an overweight,noncompliant,30-year-old female with type 2 diabetes.Which change is most important for the nurse to suggest?

Accepted Answer

All of these changes are important,but exercise and weight loss are priority changes.In the type 2 diabetic,weight reduction and increased physical activity can restore blood glucose to normal levels and maintained it-hence the importance of diet and exercise in the management of type 2 diabetes.Annual eye examinations are important to detect onset of diabetic retinopathy.A food diary can help the patient to visualize food intake that may be subconscious otherwise.Diabetics are prone to foot problems and wounds and should inspect their feet daily.

Question 6

The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient.Which information accurately explains why the type 1 diabetic does not produce adequate insulin?

Accepted Answer

In type 1 diabetes mellitus (DM),the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction.

Question 7

A patient recently diagnosed with type 1 diabetes mellitus (DM)asks why she is experiencing increased thirst.Which explanation is most appropriate?

Accepted Answer

Polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling intracellular fluid into the circulating volume.

Question 8

The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy.The patient complains of hunger but denies pain.The nurse performs a bedside blood glucose check.What should the nurse do next?

Accepted Answer

These findings are consistent with hypoglycemia; manifestations of hypoglycemia include tremulousness,hunger,headache,pallor,sweating,palpitations,blurred vision,and weakness.Management includes providing a source of quick-acting carbohydrate/glucose such as orange juice.The nurse should withhold the patient's scheduled insulin at this time.The nurse should document the findings and then notify the charge nurse.

Question 9

The patient takes his NovoLog 70/30 at 0700.When should the nurse suggest that the patient schedule exercise?

Accepted Answer

Exercise should occur after peak action time to prevent hypoglycemia.NovoLog is a rapid-acting insulin that peaks 1 to 3 hours after administration.Since the insulin is administered at 70/30,scheduling exercise for 1300 would mean that it occurs after the peak insulin action.

Question 10

The nurse is educating the patient about the significance of islet cell antibodies.Which statement accurately describes islet cell antibodies?

Accepted Answer

The antibodies cause beta cells to quit production of insulin.

Question 11

The nurse is caring for a patient with ketosis.Which statement indicates that the patient correctly understands the phenomenon?

Accepted Answer

People with type 1 diabetes are more prone to a serious complication,ketosis,associated with an excess production of ketone bodies,leading to ketoacidosis (metabolic acidosis).When the glucose level gets too high,the body attempts to metabolize fats for energy,and the result is a buildup of ketone bodies.

Question 12

Which goal is the primary objective of a diabetic diet?

Accepted Answer

Currently,the diabetic diet is much less stringent than diets of years past.The primary goal of the current diabetic diet includes adequate nutrition with weight and cholesterol control.The newer diets allow for some sweets and some fast foods.Fats are not adequate sources of energy.Fat intake should be limited to reduce complications related to weight gain and cardiovascular concerns.

Question 13

The patient comes to the emergency room complaining of abdominal pain.The nurse assesses dry,hot skin,fruity breath,and deep respirations.To which problem should the nurse attribute these findings?

Accepted Answer

Abdominal pain with dry,hot skin,fruity breath,and deep respirations is characteristic of ketoacidosis.Manifestations of an insulin reaction,or hypoglycemia,include tremulousness,hunger,headache,pallor,sweating,palpitations,blurred vision,and weakness.Rebound hyperglycemia,or the Somogyi effect,follows a period of hypoglycemia,often during sleep.When hypoglycemia occurs,the body secretes glucagon,epinephrine,growth hormone,and cortisol to counteract the effects of low blood sugar.The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose,it worsens the problem.

Question 14

The nurse is discussing insulin administration with an assigned patient.The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites.What response by the nurse is most appropriate?

Accepted Answer

Insulin injections are rotated within one body area to enhance absorption.Patients are given charts showing the places on the arms,legs,buttocks,and abdomen where insulin can be injected.Patients should be encouraged to keep a daily record of injection sites to help remember which sites have been used and to avoid the problem of altered or erratic absorption,which is a complication associated with overuse of a single site.The most important way to reduce the incidence of infection is to wash the hands before insulin administration and to avoid reusing syringes.Fatty tumors are not complications of overuse of a single injection site.The term insulin reaction refers to hypoglycemia,and hypoglycemia is not directly associated with the failure to rotate injection sites.

Question 15

A long-term diabetic patient reports that he has been diagnosed with early cardiovascular disease.How does diabetes predispose the patient to cardiovascular complications?

Accepted Answer

Periods of hyperglycemia cause thickening of the vessels,chiefly the basement membrane (thin layer of connective tissue under the epithelium).The vessels of the retina,renal glomeruli,peripheral nerves,muscles,and skin are affected.Larger vessels are also affected,predisposing the patient to atherosclerosis and vascular occlusion.Two out of three people with diabetes die prematurely from heart attack or stroke.

Question 16

The nurse is educating a 50-year-old patient about diabetes monitoring.Which statement reinforces the American Diabetes Association's (ADA's)recommendation?

Accepted Answer

The ADA recommends screening with a fasting blood glucose.Adherence to a weight loss plan,regular exercise,and stress reduction techniques help control diabetes but do not monitor it.

Question 17

Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes?

Accepted Answer

Type 2 diabetics comprise 90% to 95% of all known cases.

Question 18

Which laboratory values are consistent with a patient in ketoacidosis?

Accepted Answer

Diabetic ketoacidosis results when the body attempts to metabolize protein and fats,which results in high BUN readings.The CO₂ should be normal or low depending on the effectiveness of Kussmaul respirations.The arterial pH will be low,and there will be high glucose,which the diabetic patient cannot use.

Question 19

The nurse is educating a patient with gestational diabetes.Which statement indicates that the patient needs additional teaching?

Accepted Answer

Giving birth does not automatically resolve gestational diabetes.Of the women who have gestational diabetes,5% to 10% go on to develop type 2 diabetes.The patient correctly understands that gestational diabetes occurs because of hormonal changes in pregnancy,proper diet and regular exercise may help decrease the likelihood of developing type 2 diabetes,and the baby will require monitoring for hypoglycemia throughout the patient's pregnancy.

Question 20

The nurse notes that the HbA_1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%.What can the nurse infer from these findings?

Accepted Answer

HbA_1c is a diagnostic assessment used to review blood glucose levels retrospectively.A reduction in the value indicates improved glucose control by the patient.There is no evidence of insulin sensitivity.The need for insulin is not decreased in this patient.

Quiz 37: Care of Patients with Diabetes and Hypoglycemia

The nurse is caring for a patient who struggles to maintain glycemic control at night and during early morning hours.Which statement correctly explains the reason for this problem?

Which reason best explains why diabetics are prone to infection?

A patient asks the nurse if stress can be a potential cause of type 2 diabetes.Which response is most appropriate for the nurse to make?

The nurse is caring for an older adult patient who is diabetic.The nurse cautions against the technique of "tight control" of hyperglycemia.Which statement explains why this management method is not recommended?

The nurse is counseling an overweight,noncompliant,30-year-old female with type 2 diabetes.Which change is most important for the nurse to suggest?

The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient.Which information accurately explains why the type 1 diabetic does not produce adequate insulin?

A patient recently diagnosed with type 1 diabetes mellitus (DM) asks why she is experiencing increased thirst.Which explanation is most appropriate?

The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy.The patient complains of hunger but denies pain.The nurse performs a bedside blood glucose check.What should the nurse do next?

The patient takes his NovoLog 70/30 at 0700.When should the nurse suggest that the patient schedule exercise?

The nurse is educating the patient about the significance of islet cell antibodies.Which statement accurately describes islet cell antibodies?

The nurse is caring for a patient with ketosis.Which statement indicates that the patient correctly understands the phenomenon?

Which goal is the primary objective of a diabetic diet?

The patient comes to the emergency room complaining of abdominal pain.The nurse assesses dry,hot skin,fruity breath,and deep respirations.To which problem should the nurse attribute these findings?

The nurse is discussing insulin administration with an assigned patient.The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites.What response by the nurse is most appropriate?

A long-term diabetic patient reports that he has been diagnosed with early cardiovascular disease.How does diabetes predispose the patient to cardiovascular complications?

The nurse is educating a 50-year-old patient about diabetes monitoring.Which statement reinforces the American Diabetes Association's (ADA's) recommendation?

Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes?

Which laboratory values are consistent with a patient in ketoacidosis?

The nurse is educating a patient with gestational diabetes.Which statement indicates that the patient needs additional teaching?

The nurse notes that the HbA_1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%.What can the nurse infer from these findings?

Quiz 37: Care of Patients with Diabetes and Hypoglycemia

The nurse is caring for a patient who struggles to maintain glycemic control at night and during early morning hours.Which statement correctly explains the reason for this problem?

Which reason best explains why diabetics are prone to infection?

A patient asks the nurse if stress can be a potential cause of type 2 diabetes.Which response is most appropriate for the nurse to make?

The nurse is caring for an older adult patient who is diabetic.The nurse cautions against the technique of "tight control" of hyperglycemia.Which statement explains why this management method is not recommended?

The nurse is counseling an overweight,noncompliant,30-year-old female with type 2 diabetes.Which change is most important for the nurse to suggest?

The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient.Which information accurately explains why the type 1 diabetic does not produce adequate insulin?

A patient recently diagnosed with type 1 diabetes mellitus (DM) asks why she is experiencing increased thirst.Which explanation is most appropriate?

The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy.The patient complains of hunger but denies pain.The nurse performs a bedside blood glucose check.What should the nurse do next?

The patient takes his NovoLog 70/30 at 0700.When should the nurse suggest that the patient schedule exercise?

The nurse is educating the patient about the significance of islet cell antibodies.Which statement accurately describes islet cell antibodies?

The nurse is caring for a patient with ketosis.Which statement indicates that the patient correctly understands the phenomenon?

Which goal is the primary objective of a diabetic diet?

The patient comes to the emergency room complaining of abdominal pain.The nurse assesses dry,hot skin,fruity breath,and deep respirations.To which problem should the nurse attribute these findings?

The nurse is discussing insulin administration with an assigned patient.The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites.What response by the nurse is most appropriate?

A long-term diabetic patient reports that he has been diagnosed with early cardiovascular disease.How does diabetes predispose the patient to cardiovascular complications?

The nurse is educating a 50-year-old patient about diabetes monitoring.Which statement reinforces the American Diabetes Association's (ADA's) recommendation?

Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes?

Which laboratory values are consistent with a patient in ketoacidosis?

The nurse is educating a patient with gestational diabetes.Which statement indicates that the patient needs additional teaching?

The nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%.What can the nurse infer from these findings?

The nurse notes that the HbA_1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%.What can the nurse infer from these findings?