Question 1

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.

Accepted Answer

1. Precipitating factors for HHNS include alcohol.
2. Pneumonia vaccination is not identified as a precipitating factor for HHNS.
3. Precipitating factors for HHNS include surgery.
4. Precipitating factors for HHNS include the medication albuterol.
5. Precipitating factors for HHNS include the medication propranolol.

Question 2

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.

Accepted Answer

1. Maintaining normal blood glucose levels during critical illness has been proven to prevent inflammation.
2. Maintaining normal blood glucose levels during critical illness has been proven to reduce the risk of developing severe infections.
3. Maintaining normal blood glucose levels during critical illness has been proven to improve lipid profiles.
4. Maintaining normal blood glucose levels during critical illness has been proven to protect endothelial tissue.
5. Maintaining normal blood glucose levels during critical illness has no effect on oxygenation.

Question 3

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?

Accepted Answer

1. Though weight management is important, the hemoglobin A_1C is not directly related to weight management. 2. The patient should not be taught to eat for an hour. Instead the patient should eat within 15 to 30 minutes of taking insulin (depending on the type of insulin). 3. Complex carbohydrates do stabilize the blood sugar, but the patient may eat some simple carbohydrates, especially with meals. 4. It is essential that this patient check his or her blood sugars with a meter when taking insulin.

Question 4

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.

Accepted Answer

1. Abdominal pain is an indication of metabolic acidosis, which is seen in DKA.
2. Nausea and vomiting are indications of metabolic acidosis, which is seen in DKA.
3. Kussmaul's respirations are an indication of metabolic acidosis, which is seen in DKA.
4. Ketones in the urine are seen in DKA.
5. A change in capillary refill is not an indication of developing DKA.

Question 5

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.

Accepted Answer

1. Intravenous insulin is discontinued when signs of acidosis resolve, which includes a pH greater than 7.3.
2. Intravenous insulin is discontinued when signs of acidosis resolve, which includes a normal anion gap.
3. Intravenous insulin is discontinued when signs of acidosis resolve, which includes a bicarbonate level greater than 18 mEq/L.
4. Intravenous insulin is discontinued when signs of acidosis resolve, which includes the absence of ketones in the urine.
5. Blood pressure measurement is not an indicator to determine when to discontinue intravenous insulin in the treatment of DKA.

Question 6

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.

Accepted Answer

1. Surgery is a precipitating factor for the development of HHNS in the patient with type 2 diabetes mellitus.
2. Glucocorticoids such as prednisone can be a precipitating factor for the development HHNS in the patient with type 2 diabetes mellitus.
3. Infection is a precipitating factor for the development of HHNS in the patient with type 2 diabetes mellitus.
4. The use of NSAIDs is not a precipitating factor for the development of HHNS in the patient with type 2 diabetes mellitus.
5. Enteral supplements do not precipitate the development of HHNS in the patient with type 2 diabetes mellitus.

Question 7

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?

Accepted Answer

1. The patient would benefit from attending these classes since the risk of developing type 2 diabetes is high.
2. Knowledge itself does not delay the onset of diabetes.
3. This patient would benefit from diabetes education because healthy diet, weight management, and types of exercise are taught during the class. The patient will need to actually maintain a healthy diet, correct weight, and exercise in order to delay the onset of type 2 diabetes.
4. Most people would benefit from attending this class.

Question 8

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.

Accepted Answer

1. Factors or health problems that may cause a decrease in blood glucose level includes septic shock.
2. Factors or health problems that may cause a decrease in blood glucose level includes inflammatory bowel disease.
3. Chronic obstructive pulmonary disease is not identified as a health problem that may cause a decrease in blood glucose level.
4. Factors or health problems that may cause either a decrease or increase in blood glucose level include the patient with renal failure who had a change to the dialysis or continuous renal replacement therapy schedule.
5. Factors or health problems that may cause either a decrease or increase in blood glucose level include burns.

Question 9

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.

Accepted Answer

1. Short-term complications of hyperglycemia include an increased risk for infection.
2. Short-term complications of hyperglycemia include an increased risk of organ failure. A declining hourly urine output could be an indication that the patient is developing acute renal failure.
3. Peripheral neuropathy is considered a long-term complication of hyperglycemia.
4. Retinopathy is considered a long-term complication of hyperglycemia.
5. A drop in oxygen saturation levels may or may not be related to hyperglycemia.

Question 10

When instructing a patient about metabolic syndrome, the nurse should include that which finding is a risk factor for the development of diabetes?

Accepted Answer

1. Central obesity is present in metabolic syndrome and is a risk factor for the development of diabetes.
2. Triglycerides are elevated in this syndrome.
3. LDL levels are elevated in this syndrome.
4. Insulin levels are high because insulin becomes more resistant.

Question 11

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.

Accepted Answer

1. One function of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be metabolized into fuel.
2. A function of insulin is to stimulate the liver to store excess glucose in the form of glycogen.
3. Insulin is not used to create energy. Glucose is used to create energy.
4. Insulin does not assist in the binding of oxygen to the red blood cell.
5. Insulin does not play a role in digestion.

Question 12

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.

Accepted Answer

1. One risk factor for the development of type 2 diabetes mellitus is obesity.
2. One risk factor for the development of type 2 diabetes mellitus is an elevated triglyceride level.
3. Age greater than 45 years is a risk factor for the development of type 2 diabetes mellitus.
4. One risk factor for the development of type 2 diabetes mellitus is hypertension.
5. The rates of type 2 diabetes mellitus are higher in African, Hispanic, and Native Americans.

Question 13

When instructing a patient about metabolic syndrome, what should the nurse include?

Accepted Answer

1. Metabolic syndrome is also known as insulin resistance syndrome.
2. Metabolic syndrome is characterized by fasting blood glucose greater than 110 mg/dL (rather than 140 mg/dL).
3. Central obesity is a characteristic of this disorder.
4. The CDC estimates that 37% of U.S. adults over the age of 20 and 51% of adults over the age of 65 have prediabetes based on lab data of glucose levels.

Question 14

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?

Accepted Answer

1. The patient would not require insulin at home. If treatment became necessary, oral agents are initiated in the patient with type 2 diabetes. 2. Type 1 diabetes mellitus is not usually diagnosed in older patients. 3. High glucose would be treated with sliding scale insulin to prevent or reduce short-term complications of hyperglycemia. As the infection is treated, the nurse would expect glucose to return to normal. 4. Though the serum glucose is elevated, the hemoglobin A_1C is normal, meaning the blood glucose has been normal over approximately the past 3 months. The patient does not have diabetes but is at high risk for the development of type 2 diabetes.

Question 15

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.

Accepted Answer

1. The patient in HHNS should be assessed for visual disturbances and blurred vision since these are signs of severe dehydration complicated by high blood osmolarity and high blood glucose.
2. The patient in HHNS should be assessed for weight loss since this is a sign of severe dehydration complicated by high blood osmolarity and high blood glucose.
3. The patient in HHNS will not have a change in respirations as a result of dehydration.
4. The patient in HHNS will not have a change in oxygen saturation level as a result of dehydration.
5. The patient in HHNS will not have ketones in the urines as a result of dehydration.

Question 16

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.

Accepted Answer

1. Fats produce 9 kcal/g, compared with 4 kcal/g for carbohydrates.
2. If more proteins are eaten than are needed, they are converted to glycogen and stored in the liver or converted to fat and stored in adipose tissue.
3. The breakdown of fatty acids and glycerol result in the formation of ketone bodies. One of these ketone bodies, acetone, cannot be used by the body in cellular metabolism and is excreted in the urine and through exhalation. When acetone is exhaled, a "fruity breath" or "ketone breath" odor is produced and is a recognized symptom of ketosis.
4. Gluconeogenesis is the formation of glucose from amino acids and fats when carbohydrate intake is limited and there are no glycogen stores.
5. The breakdown of fatty acids and glycerol result in the formation of ketone bodies.

Question 17

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.

Accepted Answer

1. The nurse should assess the patient's ability to self-administer insulin prior to teaching the patient on prevention of DKA.
2. The nurse should assess if the patient is testing blood glucose levels prior to teaching on the prevention of DKA.
3. The nurse should assess what adjustments the patient makes to the diet or exercise prior to teaching on the prevention of DKA.
4. The frequency of eye examinations will not help prevent the development of DKA.
5. Daily foot inspections will not help prevent the development of DKA.

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

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.

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.

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.

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.

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?

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.

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.

When instructing a patient about metabolic syndrome, the nurse should include that which finding is a risk factor for the development of diabetes?

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.

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.

When instructing a patient about metabolic syndrome, what should the nurse include?

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?

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

When instructing a patient about metabolic syndrome, the nurse should include that which finding is a risk factor for the development of diabetes?

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.

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.

When instructing a patient about metabolic syndrome, what should the nurse include?

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 A1C is 5%. What can be inferred from these findings?

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.

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.

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.

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?