Deck 46: Diabetes Mellitus and Hypoglycemia

Question 1

The 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.This episode of hypoglycemia is probably caused by the patient's having:

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

Answer 1

Had a 2-hour long exercise class at the spa this morning.

Question 2

As part of the teaching plan in preparation for discharge,the patient with type 1 diabetes needs guidelines for exercise.Which one of the following must 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.

Answer 2

Exercise should be performed daily at the same time of day and at the same intensity.

Question 3

The patient has been admitted to the hospital with the diagnosis of DKA.The nurse anticipates that the patient will exhibit vital signs of:

A) Temperature, 99° F; pulse, 62 beats/min; respirations, 16 breaths/min and shallow
B) Temperature, 98.6° F; pulse, 76 beats/min; respirations, 16 breaths/min and deep
C) Temperature, 98° F; pulse, 84 beats/min; respirations, 18 breaths/min and shallow
D) Temperature, 97.4° F; pulse, 100 beats/min; respirations, 20 breaths/min and deep

Answer 3

Temperature, 97.4° F; pulse, 100 beats/min; respirations, 20 breaths/min and deep

Question 4

The young patient complains that diabetes is causing her to "have no life at all.It's too hard." The most helpful response is:

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 5

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.The nurse responds:

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 6

The self-care goal of the patient with diabetes is to keep the blood sugar level normal.Hyperglycemia occurs when:

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 7

The nurse is drawing up a teaching plan for a patient who has type 1 diabetes.The physician has ordered two types of insulin,10 U of regular insulin and 35 U of neutral protamine Hagedorn (NPH)insulin.The proper procedure is to:

A) Draw up the insulins in two separate syringes to avoid confusion.
B) Draw up the regular insulin before drawing up the NPH insulin.
C) Inject air into the NPH insulin, draw it up to 35 U, then inject air into the clear regular insulin and withdraw to 45 U.
D) Inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.

Question 8

The nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce enough insulin; consequently,the blood glucose is elevated because of the:

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 9

A patient has come into the emergency department accompanied by a friend who states that the patient had been acting very strange and seems confused.The friend states that the patient has diabetes and takes insulin.The nurse assesses for signs of hypoglycemia which are:

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 10

When a patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take a pill instead of insulin,the nurse replies that in type 2 diabetes mellitus,the body makes insulin but:

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 11

When the 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." The nurse responds that 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 last 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 12

The patient with type 1 diabetes has an insulin order for NPH insulin,35 U,to be given at 7 AM.The patient has also been instruction not to take anything by mouth (NPO)in preparation for laboratory work that will not be drawn until 10 AM.The nurse should:

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 13

The patient with type 2 diabetes shows a blood sugar reading of 72 at 6 AM.Based on the reading of 72,the nurse should:

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

Question 14

The nurse assigned to care for a patient with diabetic ketoacidosis (DKA)is aware that this is a life-threatening condition that results in:

A) Inability of carbohydrates, fats, and proteins to be metabolized
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

Question 15

In drawing up a patient's diabetes teaching plan,the nurse needs to include the following:

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 are 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 16

A patient tells the nurse that she eats "huge" amounts of food but stays hungry most of the time.The nurse explains that hunger experienced by persons with type 1 diabetes is caused by the:

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 17

When the patient with type 1 diabetes asks why his 7 AM insulin has been changed from NPH insulin to 70/30 premixed insulin,the nurse explains that 70/30 insulin mixture:

A) Is absorbed more rapidly into the bloodstream.
B) Has no peak action time and lasts all day.
C) Makes insulin administration easier and safer.
D) Give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.

Question 18

The nurse stresses that the patient with type 1 diabetes is at risk for cardiovascular disorders because the lack of insulin causes:

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 19

The patient comes to the diabetes clinic and confides to the nurse that she does not follow the diet exchange program that she was given.The nurse responds:

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 20

The teaching plan for a 22-year-old woman taking rosiglitazone (Avandia)would include a caution relative to:

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

The nurse administering Humulin R 20 U at 7 AM is aware that this drug will peak in:

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

Question 22

The teaching plan for a patient with diabetes is focused on smoking cessation and the control of hypertension for the avoidance of microvascular complications,such as: (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

The nurse reminds the patient with type I diabetes to rotate the insulin injection sites to prevent ___________________________.

Question 24

A patient who has been diagnosed with endogenous hypoglycemia most likely has:

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 25

The nurse tells a patient that the functional causes of hypoglycemia include: (Select all that apply.)

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

Question 26

The teaching plan for a patient with diabetes for foot care would include that the patient should: (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 27

Whipple triad,which is the diagnostic criterion for hypoglycemia not associated with diabetes mellitus,is described as follows: (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 U.
D) Muscular activity does not have any effect on blood glucose.
E) Symptoms improved when the blood glucose level rises.

Question 28

The nurse suspects that the patient with type 1 diabetes may be experiencing the Somogyi phenomenon when the patient exhibits:

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

Question 29

The nurse instructs a patient about how insulin affects blood glucose.(Arrange the events in sequence.)

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 30

The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS).Her blood glucose level is very high (880 mg/dl)on admission.The physician believes that her condition is the result of large amounts of glucose solutions administered intravenously (IV)during kidney dialysis.The nurse anticipates 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