Deck 14: Care of the Patient With Problems in Glucose Metabolism

Question 1

The nurse caring for a patient weighing 80 kg is preparing an initial dose of insulin as beginning treatment for diabetic ketoacidosis. What are the appropriate dose and route for the nurse to administer the insulin?
1) 8 units IV
2) 8 units subcutaneous
3) 12 units subcutaneous
4) 12 units IV

Answer 1

4
Explanation: 1. The formula for calculating a bolus dose of insulin is 0.15 units/kg.
2. Bolus dosing is given intravenously, rather than subcutaneously, to begin to reverse DKA.
3. Bolus dosing is given intravenously, rather than subcutaneously, to begin to reverse DKA.
4. Bolus dosing is given intravenously to begin to reverse DKA. The formula for calculating an initial bolus dosage is 0.15 unit/kg; therefore, 80 × 0.15 = 12 units for bolus.

Question 2

A newly admitted patient with HHNK has a serum glucose of 850 mg/dL and a potassium level of 3.9 mEq/L. What is an important nursing consideration that should precede replacement of potassium?
1) Assessment of urine output
2) Assessment of lung sounds
3) Assessment of dehydration
4) Calculation of serum osmolarity

Answer 2

1
Explanation: 1. Prior to the administration of potassium, the nurse should assess urine output and check the serum creatinine to evaluate renal function. Renal insufficiency and renal failure are common complications of patients with diabetes.
2. This assessment does not specifically relate to the assessment preceding replacement of potassium.
3. This assessment does not specifically relate to the assessment preceding replacement of potassium.
4. This calculation does not specifically relate to the assessment preceding replacement of potassium.

Question 3

The nurse cares for a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What should the nurse realize is a precipitating factor for this health problem?
1) Certain antibiotics that can induce HHNS in those with type 2 diabetes
2) Poor compliance to medical therapy
3) Skipping meals, especially during illness
4) Taking too much insulin during illness

Answer 3

2
Explanation: 1. Antibiotics do not cause hyperglycemia.
2. HHNS often does develop slowly from poor compliance to medical therapy. This is in contrast to DKA, which often develops rapidly.
3. HHNS would be caused by missed medication, rather than by skipping meals, causing hyperglycemia.
4. Taking additional insulin would cause hypoglycemia.

Question 4

Which medications contribute to hyperglycemia in the patient with diabetes? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Digoxin (Lanoxin)
2) Calcium channel blockers, such as nifedipine
3) Sympathomimetics, such as dopamine
4) Glucocorticoids, such as dexamethasone
5) Thiazide diuretics, such as hydrochlorothiazide/HCTZ

Question 5

A nurse caring for a patient with diabetic ketoacidosis (DKA) should evaluate the patient carefully for which potential complications? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Myocardial infarction
2) Acute respiratory distress syndrome
3) Pulmonary embolism
4) Pneumonia
5) Cerebral edema

Question 6

A patient with type 1 diabetes who is ill seeks advice from the nurse. For which statement should the nurse encourage the patient to seek medical attention? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "I have had diarrhea for more than a day."
2) "My mouth feels very dry from the flu."
3) "I have had ketones in my urine for more than 4 hours."
4) "I have had a fever of 99 degrees all day."
5) "I have been vomiting all night."

Question 7

When planning care for a patient in diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS), which goal should be included in the plan of care? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Stabilize blood glucose levels to within normal limits.
2) Increase understanding of self-management to prevent future episodes.
3) Reestablish fluid balance through rehydration.
4) Restore A_1C blood levels to at or above 8%.
5) Effectively treat the precipitating cause for DKA or HHNS.

Question 8

The nurse is determining if a patient is experiencing DKA or HHNS. Which information should the nurse use to make this determination?
1) Patients with DKA exhibit Kussmaul's respirations to blow off CO₂ and reduce pH levels.
2) Patients with HHNS have lower arterial pH levels than those with DKA.
3) Patients with DKA have more visual disturbances than patients with HHNS.
4) Patients with HHNS have moderate hyperglycemia, whereas patients with DKA have more severe hyperglycemia.

Question 9

Which type of insulin should the nurse administer for an intravenous bolus and continuous infusion to regulate a patient's blood glucose levels?
1) Lantus
2) Regular
3) Lente
4) NPH

Question 10

The nurse is caring for a patient in DKA with serum sodium of 130 and serum glucose of 600. After calculating the corrected serum sodium (CSS) [CSS = Serum Na⁺ + {[(Serum glucose (mg/dL) - 100) / 100] × 1.6}], which intravenous fluid should the nurse plan to provide this patient?
1) D5 1/2 NS
2) 0.45 NS
3) 0.9 NS
4) Lactated Ringer's (LR)

Question 11

The nurse is comparing diabetic ketoacidosis (DKA) to hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What should the nurse identify as the main difference between the two disorders?
1) DKA and HHNS are caused by too much insulin in the body.
2) No insulin is present in DKA, whereas some insulin is present in HHNS.
3) DKA results in metabolic acidosis; HHNS results in metabolic alkalosis.
4) Dehydration is greater or more severe in DKA than in HHNS.

Question 12

A patient with diabetes has a serum osmolarity level of 325 mmol/L. What is the correct interpretation and action for the nurse to take based on this result?
1) The result is somewhat high, but no immediate action is necessary.
2) The result is very low, and the physician should be notified of the result.
3) The result is somewhat low, but no immediate action is necessary.
4) The result is very high, and the physician should be notified of the result.

Question 13

A patient is admitted with diabetic ketoacidosis. The nurse realizes that which problem caused the cascade to diabetic ketoacidosis (DKA) to occur?
1) Ketosis
2) Insulin deficiency
3) Hypoglycemia
4) Dehydration

Question 14

The nurse monitors the blood glucose levels of a patient being treated with insulin for diabetic ketoacidosis. Why should the nurse ensure glucose levels decline at the rate of 50-70 mg/dL/hour?
1) When blood glucose drops rapidly, fluids shift out of the cell, which increases dehydration, causing severe hypovolemic shock.
2) When blood glucose drops rapidly, severe damage to the brain results from metabolic alkalosis.
3) A rapid drop in blood glucose can result in hypokalemia, causing life-threatening arrhythmias.
4) A rapid drop in blood glucose can result in formation of thromboses as a result of dehydration.

Question 15

When calculating the initial rate of an insulin infusion as treatment for diabetic ketoacidosis in a patient weighing 80 kg, the nurse should expect to administer insulin at what rate?
1) 120 units per hour
2) 80 units per hour
3) 8 units per hour
4) 12 units per hour

Question 16

The nurse explains the pathophysiology of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) to a group of clients. Which statement should the nurse include when teaching about this health problem?
1) Is accompanied by severe metabolic acidosis
2) Results in cellular overhydration and interstitial space dehydration
3) Causes severe dehydration from very high osmolarity
4) Causes a severe decline in glucose production, resulting in increased metabolic rates to burn fat for energy

Question 17

What increases the risk for seizures in a patient with diabetic ketoacidosis (DKA)?
1) Potassium shifts may cause cerebral ischemia.
2) Intracellular fluid shifts may cause cerebral edema.
3) High blood glucose levels overstimulate brain cells.
4) Drugs used to treat the DKA have a side effect of seizures.

Question 18

Which nursing diagnosis would be least appropriate when planning care for a patient with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?
1) Excessive fluid volume related to (RT) fluid shifts from hyperosmolarity
2) Imbalanced nutrition, less than body requirements RT inability to utilize glucose
3) Ineffective tissue perfusion RT hypovolemia and decreased peripheral blood flow
4) Risk for infection RT increased blood glucose and decreased peripheral blood flow

Question 19

What should the nurse assess before beginning insulin therapy in a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?
1) Sodium level (Na+)
2) Previous history of cardiac dysrhythmias
3) Potassium level (K+)
4) Arterial blood gas results

Question 20

A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes. What is the best explanation for a high glucose in a patient without diabetes? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) The physiologic stress of a large meal plus a myocardial infarction causes hyperglycemia.
2) Insulin resistance is caused by pro-inflammatory factors.
3) Insulin resistance is caused by beta blockers and nitroglycerin, which are commonly used to treat myocardial infarction.
4) Myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state.
5) Glucagon, cortisol, and epinephrine cause hyperglycemia.

Question 21

A patient with type 2 diabetes mellitus asks why hyperglycemic hyperosmolar nonketotic syndrome (HHNS) developed. After reviewing the patient's medical record, what should the nurse respond to this client? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "Ingesting alcohol could cause this to occur."
2) "Having a pneumonia vaccination a month ago probably caused it."
3) "It might have been set off by your surgery you had a few months ago."
4) "The medication that you take for your asthma, albuterol, might have caused it."
5) "The medication propranolol has been known to cause the health problem to occur."

Question 22

When creating the care plan for a patient in the critical care unit, the nurse includes checking capillary blood glucose levels every morning. Why is it important for the nurse to check blood glucose levels daily and maintain them at normal levels even though the patient does not have diabetes? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Prevent inflammation
2) Reduce risk for severe infections
3) Improve lipid levels
4) Protect endothelial tissue
5) Improve oxygenation

Question 23

A patient admitted with cellulitis has a hemoglobin A_1C level that revealed the patient's average blood sugars prior to admission were 300 mg/dL. The patient has been started on insulin in addition to oral diabetes medications. Which teaching point is essential for this patient to understand before discharge?
1) "Decrease your weight in order to decrease your hemoglobin A_1C."
2) "Eat for 60 minutes each morning after taking your insulin."
3) "Change the types of carbohydrates you eat to complex carbohydrates."
4) "Use the glucose meter to check your blood sugars before you take your insulin."

Question 24

While recovering from injuries obtained in a motor vehicle crash, a patient with type 1 diabetes mellitus begins to demonstrate signs of developing diabetic ketoacidosis (DKA). What finding suggested to the nurse that the patient was developing DKA? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Abdominal pain
2) Nausea and vomiting
3) Deep, rapid respirations
4) Ketones in the urine
5) Capillary refill 5 seconds

Question 25

A patient being treated with an insulin infusion for diabetic ketoacidosis (DKA) receives an injection of subcutaneous insulin. When should the nurse expect to discontinue the insulin infusion? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) When the pH is 7.38
2) When the anion gap is normal
3) When the bicarbonate level is 20 mEq/L
4) When the patient tests negative for ketones in the urine
5) When the blood pressure is > 100/60 mm Hg

Question 26

The nurse identifies that a patient with type 2 diabetes mellitus is at risk for developing hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which health problem did the nurse identify in the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Patient recovering from surgery
2) Patient prescribed prednisone
3) Patient receiving antibiotics for a skin infection
4) Patient receiving NSAIDs
5) Patient receiving enteral supplements

Question 27

The certified diabetes educator (CDE) encourages a patient with metabolic syndrome who experienced hyperglycemia during hospitalization to attend outpatient diabetes education classes. The patient asks why the classes are needed if diabetes is not a health problem. What is the nurse's best response?
1) "The certified diabetes educator (CDE) saw that you had high blood sugars while in the ICU. I will let her know that you are not diabetic."
2) "You will learn about healthy diet, weight management, and exercise. This knowledge can delay the onset of type 2 diabetes."
3) "If you maintain a healthy diet, correct weight, and exercise you can delay the onset of type 2 diabetes."
4) "The class is only for those with diabetes. If you become diabetic, you may attend the class."

Question 28

The nurse reviews critically ill patients assigned for care. Which patients should the nurse expect to have a lower than expected blood glucose level? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) The patient being treated for septic shock
2) The patient diagnosed with inflammatory bowel disease
3) The patient with exacerbation of chronic obstructive pulmonary disease
4) The patient being treated for end-stage renal disease who missed dialysis the day before
5) The patient who has experienced partial and full-thickness burns over 30% of total body surface area

Question 29

The nurse is concerned that a patient in the critical care area is experiencing short-term complications of diabetes. What did the nurse find when assessing this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Infected leg wound
2) Declining hourly urine output
3) Numb feet
4) Vision changes
5) Dropping oxygen saturation level

Question 30

When instructing a patient about metabolic syndrome, the nurse should include that which finding is a risk factor for the development of diabetes?
1) Central obesity
2) Decreased triglycerides
3) Low LDL levels
4) Low insulin levels

Question 31

The nurse is reviewing the purpose of insulin with a patient newly diagnosed with type 2 diabetes mellitus. What should the nurse teach the patient about the function of insulin in the body? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) It moves glucose from the blood into the body cells to be used as fuel.
2) It stimulates the liver to store extra glucose.
3) It is used to create energy.
4) It helps to bind oxygen to the blood.
5) It aids in the digestion of protein.

Question 32

The nurse preparing instruction for a patient recovering from a critical illness will include ways to prevent the onset of type 2 diabetes. What caused the nurse to provide this patient teaching? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Patient is obese.
2) Patient's triglyceride level is elevated.
3) Patient is 55 years old.
4) Patient has high blood pressure.
5) Patient is Caucasian.

Question 33

When instructing a patient about metabolic syndrome, what should the nurse include?
1) It is also called insulin resistance syndrome.
2) Fasting blood sugars are over 140 mg/dL.
3) It is seen more frequently in people who carry extra weight in their hips and legs.
4) It affects about 10% of the U.S. population.

Question 34

An older patient being treated for pneumonia has signs of metabolic syndrome but denies the presence of diabetes. Serum glucose is 220 mg/dL, and the hemoglobin A_1C is 5%. What can be inferred from these findings?
1) The nurse should anticipate discharge teaching related to insulin to manage blood sugars at home.
2) The nurse anticipates that the doctor will diagnose the patient with type 1 diabetes.
3) The nurse would anticipate treatment with sliding scale insulin even though diabetes is not yet evident.
4) The nurse anticipates that the doctor will diagnose the patient with type 2 diabetes.

Question 35

A patient is brought to the emergency department with manifestations of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What should the nurse assess to determine the patient's hydration status? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Vision
2) Weight loss
3) Respiratory rate
4) Oxygen saturation level
5) Urine for ketones

Question 36

A patient says that following a high-fat, high-protein diet has helped with weight loss. What should the nurse respond about this patient's eating approach? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "Fats produce 9 kcal/g."
2) "Overeating protein can lead to weight gain."
3) "You might notice a fruity odor to your breath."
4) "Glycogenolysis is the formation of glucose from amino acids."
5) "Ketone bodies are produced when a high-fat diet is consumed."

Question 37

The nurse plans to instruct a patient with type 1 diabetes mellitus on ways to prevent the onset of diabetic ketoacidosis (DKA). What should the nurse assess prior to teaching this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Ability to self-administer insulin
2) Performance of blood glucose testing
3) Current adjustments to diet during exercise
4) Frequency of eye examinations
5) Daily foot inspections