Question 1

What should the nurse emphasize when teaching a patient with type 1 diabetes about the Somogyi effect and dawn phenomenon?

Accepted Answer

The nurse should emphasize that the Somogyi effect occurs in response to too much insulin, leading to rebound hyperglycemia, while the dawn phenomenon results from too little insulin being released overnight, causing elevated blood glucose levels in the morning. The other options contain inaccurate information.

Question 2

A patient receives a daily injection of 70/30 NPH/regular insulin premix at 0700 hours.The nurse expects that a hypoglycemic reaction is most likely to occur between which of the following times?

Accepted Answer

70/30 NPH/regular insulin premix has an onset of action of approximately 1-2 hours, and a peak action around 4-6 hours. Therefore, the hypoglycemic reaction is most likely to occur between 1600 and 1800 hours, which is 8-10 hours after the injection was given. This corresponds to the time when the insulin is expected to be at its maximum effect, and when the patient may have gone for a long period of time without eating. The other time options are either too early or too late for the insulin to cause hypoglycemia.

Question 3

During a clinic visit 3 months following a diagnosis of type 2 diabetes,the patient reports that she has been following her reduced-calorie diet,but she has not lost any weight,and she has neglected to bring her record of glucose monitoring results.What does the nurse recognize as the best indicator of the patient's control of her diabetes since her initial diagnosis and instruction?

Accepted Answer

The glycosylated hemoglobin (HbA1C) level is the best indicator of the patient's control of her diabetes since her initial diagnosis and instruction. It provides a measure of the average glucose level over the preceding 2-3 months, unlike a fasting glucose level, which only provides information about the glucose level at one point in time. Analysis for microalbuminuria may be a useful test to assess kidney function in patients with diabetes, but it is not specific to diabetes control. Verbal report of symptoms is subjective and may not accurately reflect the patient's actual glucose control.

Question 4

A 20-year-old university student who has type 1 diabetes normally walks each evening as part of her exercise regimen.She now plans to enroll in a swimming class to meet her physical education requirement.What should the nurse teach the patient that adjustments to her treatment plan should include?

Accepted Answer

Monitoring glucose levels before, during, and after swimming will allow the patient to determine if adjustments need to be made to her food or insulin intake. Swimming is a form of exercise that can affect blood glucose levels differently than walking, so it is important to closely monitor levels and make changes as needed. Delaying meals or adding extra insulin without monitoring levels can lead to hypoglycemia or hyperglycemia. Timing the morning insulin injection to peak during the swim session may also not be appropriate as the peak may occur at a different time due to the change in exercise type.

Question 5

When teaching a patient with type 2 diabetes about taking an oral antihyperglycemic medication,the nurse determines that additional teaching about the medication is needed when the patient gives which of the following responses?

Accepted Answer

This response indicates a misunderstanding about the seriousness of type 2 diabetes and the potential complications it can cause. Therefore, additional teaching is needed to address this misconception. The other responses demonstrate understanding of medication management, potential need for insulin, and monitoring for medication interactions.

Question 6

During a diabetes screening program,a young woman tells the nurse that her mother died of complications of diabetes and asks whether she will inherit the disease.After determining that the woman's mother most likely had type 2 diabetes,what should the nurse explain?

Accepted Answer

The nurse should explain that the patient has a higher familial risk for developing type 2 diabetes than for type 1 diabetes, and she should have her glucose level tested periodically. The nurse should also educate her on the importance of maintaining a healthy weight and diet to help prevent the development of diabetes. Option A is not entirely accurate, as not all cases of type 2 diabetes can be prevented by weight management and a low-carbohydrate diet. Option C is not relevant to the patient's situation, as the question states that her mother had type 2 diabetes. Option D is not entirely accurate, as the inherited risk for developing type 2 diabetes is still significant, although not as high as it is for type 1 diabetes.

Question 7

A patient with newly diagnosed type 2 diabetes asks the nurse what "type 2" means in relation to diabetes.Which of the following statements best explains to the patient how type 2 diabetes primarily differs from type 1 diabetes?

Accepted Answer

Type 2 diabetes is primarily characterized by decreased insulin secretion, cellular resistance to insulin, or both. This is different from type 1 diabetes, where islet cell antibodies and insulin autoantibodies destroy beta cells in the pancreas, leading to a lack of insulin production. Option A is incorrect because many patients with type 2 diabetes still produce insulin but may require additional insulin from an outside source. Option D is incorrect because the C-peptide chain of proinsulin is removed by the liver in both type 1 and type 2 diabetes.

Question 8

A patient screened for diabetes at a clinic has a fasting plasma glucose of 6.7 mmol/L (120 mg/dL).What will the nurse plan to teach the patient about?

Accepted Answer

A fasting plasma glucose of 6.7 mmol/L (120 mg/dL) indicates impaired fasting glucose, which is a pre-diabetic state. The nurse should focus on lifestyle modifications, such as maintaining a healthy weight, to prevent progression to diabetes.

Question 9

A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes.The patient tells the nurse that she hates to exercise and asks whether just following her diet would control her diabetes.What primary reason should the nurse stress to the patient for planning a pleasant,regular exercise routine?

Accepted Answer

Regular exercise in combination with a calorie-controlled diet is essential for weight loss, which can decrease insulin resistance and improve blood glucose control in type 2 diabetes patients. It is important for the nurse to stress this to the patient to ensure optimal diabetes management.

Question 10

A patient is diagnosed with type 2 diabetes at the clinic.A nursing assessment of the patient reveals vital signs of blood pressure 158/96 mm Hg,heart rate 88 beats/min,respiration 18 breaths/min,temperature 37.1°C,height 160 cm,and weight 82 kg.The physician prescribes a 1200-calorie diet with a daily exercise program as initial therapy for the patient.The nurse refers the patient to the dietitian for initial diet planning and teaching with the knowledge that which of the following is the primary goal of nutritional therapy for the patient?

Accepted Answer

The primary goal of nutritional therapy for a patient with type 2 diabetes is to reduce dietary calories and fat to normalize glucose, lipid, and blood pressure levels. This can help manage the patient's blood sugar levels and reduce the risk of complications. While achieving an ideal body weight and maintaining consistent carbohydrate intake are important considerations, they are not the primary goals of nutritional therapy. Eliminating simple sugars in exchange for complex carbohydrates can also be helpful, but it is not the primary goal.

Question 11

When intensive insulin therapy is used for control of diabetes,the nurse recognizes that which of the following types of insulin is preferred for mealtime coverage?

Accepted Answer

Lispro insulin is a rapid-acting insulin that is preferred for mealtime coverage in intensive insulin therapy. It has a quick onset of action, peaks within 30-90 minutes, and has a shorter duration of action compared to other types of insulin. This allows for more flexibility in timing meals and adjusting insulin doses based on blood glucose levels. NPH insulin and Lente insulin are intermediate-acting insulins, while Insulin glargine is a long-acting insulin, and they are typically used for basal insulin coverage rather than mealtime coverage.

Question 12

When assessing the patient experiencing the onset of type 1 diabetes,which question should the nurse ask?

Accepted Answer

Weight loss is a common symptom of type 1 diabetes, and asking about it can help the nurse assess for possible diabetes onset. Craving fluids containing sugar and anorexia are not typical symptoms of diabetes. Urine color changes can occur with diabetes, but it is not a specific or indicative symptom.

Question 13

A patient with type 1 diabetes has been using self-capillary blood glucose monitoring (CBGM)as part of his diabetes management.During evaluation of his technique of CBGM,the nurse identifies a need for additional teaching when the patient does which of the following actions?

Accepted Answer

Choosing a puncture site in the center of the finger pad can cause unnecessary pain and is not recommended. It is better to use the side of the fingertip.

Question 14

A hospitalized patient with diabetes receives 12 units of regular insulin mixed with 34 units of NPH insulin at 0700 hours.The patient is away from the nursing unit for diagnostic testing at noon,when lunch trays are distributed.What is the most appropriate nursing action?

Accepted Answer

The patient needs to eat on time to prevent hypoglycemia due to the insulin administered. If testing will not be completed promptly, the patient should return to the unit to eat.

Question 15

A program of weight loss and exercise is recommended for a patient with insulin resistance syndrome.When the patient asks why these measures are necessary when she really does not have diabetes,what should the nurse explain?

Accepted Answer

Weight loss and exercise can reduce the risk of cardiovascular disease and delay or prevent the onset of diabetes in patients with insulin resistance syndrome.

Question 16

The nurse has been teaching the patient to administer a dose of 10 units regular insulin and 28 units Lente insulin.Which of the following statements by the patient indicates a need for additional instruction?

Accepted Answer

The answer of The nurse has been teaching the patient...

Question 17

Glyburide (Diabeta)is prescribed for a patient when her type 2 diabetes has not been controlled with diet and exercise.When teaching the patient about glyburide,what should the nurse explain?

Accepted Answer

The nurse should explain that glyburide is thought to stimulate insulin production and release from the pancreas. This medication belongs to the class of drugs called sulphonylureas, which work by increasing the release of insulin from the beta cells in the pancreas. This results in increased uptake of glucose by cells, decreased glucose production by the liver, and a reduction in blood glucose levels. It is important for the patient to understand how the medication works and how to take it properly to effectively manage her diabetes.

Question 18

A patient with type 1 diabetes has received diet instruction as part of his treatment plan.The nurse determines a need for additional instruction when the patient makes which one of the following comments?

Accepted Answer

This statement is not correct as the patient needs to avoid high glycemic index foods and maintain a balanced diet even if they cover the calories with sufficient insulin.

Question 19

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage)also has severe rheumatoid arthritis.During an acute exacerbation of the patient's arthritis,the physician prescribes prednisone (Deltasone)to control inflammation.What will the nurse anticipate?

Accepted Answer

Prednisone can increase blood glucose levels, so the nurse should anticipate the need for insulin to control the patient's blood glucose while taking prednisone. Diet may also need to be adjusted, but the primary concern is managing the patient's blood glucose levels. There is no evidence to suggest rashes caused by metformin-prednisone interactions, and acute hypoglycemia is unlikely as prednisone typically causes hyperglycemia.

Question 20

A patient using a split mixed-dose insulin regimen tells the nurse that he is interested in using intensive insulin therapy because he has read that it promotes fewer and less severe complications of diabetes.In response to the patient's comment,what should the nurse explain?

Accepted Answer

Intensive insulin therapy, also known as basal-bolus therapy, requires multiple injections per day, typically three or more, in addition to an injection of a long-acting basal insulin. This is in contrast to a split mixed-dose insulin regimen, which typically involves two injections per day of a combination of short- and long-acting insulin. Intensive insulin therapy has been shown to effectively reduce the risk of long-term complications of diabetes, but it requires careful monitoring and frequent adjustments to insulin doses. It is not indicated only for recently diagnosed type 1 diabetes or only for preventing macrovascular complications in type 2 diabetes. Insulin pump therapy is another form of intensive insulin therapy, but it requires even more attention and is not necessarily equivalent in terms of long-term outcomes.

Quiz 52: Nursing Management: Diabetes Mellitus