Question 1

A patient with type 2 diabetes reports that she can always tell when her blood sugar is low because "my fingers tingle." How should the nurse interpret this information?

Accepted Answer

Tingling in the fingers is a common catecholamine effect of hypoglycemia, as a response to the release of epinephrine and norepinephrine in response to low blood sugar. Hypoglycemia unawareness involves a patient not recognizing the symptoms of hypoglycemia. Increased blood glucose levels would not typically cause tingling in the fingers. A central nervous system effect of hypoglycemia may include confusion or seizures.

Question 2

A patient presents to the emergency department in acute diabetic ketoacidosis.The nurse administers insulin to correct metabolism of which substance that is directly causative of this condition?

Accepted Answer

Diabetic ketoacidosis is primarily caused by the breakdown of fat in the absence of insulin, leading to an accumulation of ketone bodies (acetoacetate, beta-hydroxybutyrate, and acetone) in the blood. Insulin administration helps to reverse this process by promoting glucose uptake and decreasing the breakdown of fat.

Question 3

A patient diagnosed with hyperglycemic hyperosmolar syndrome (HHS)will be started on rehydration fluids.How will the nurse anticipate managing this treatment? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

Once blood glucose decreases to around 300 mg/dL, a glucose-containing solution is used to prevent hypoglycemia. Monitoring the patient's lungs for signs of overload is important to avoid fluid overload complications.

Question 4

A patient with diabetic retinopathy is admitted to the intensive care unit.Which nursing interventions are indicated?

Accepted Answer

Patients with diabetic retinopathy may have impaired vision, so frequent reorientation to the environment can help them navigate and feel more secure in their surroundings.

Question 5

A patient with type 2 diabetes mellitus,lethargy,and a blood glucose level of 650 mg/dL has been diagnosed with hyperglycemic hyperosmolar syndrome (HHS).The nurse monitors this patient for the development of which complication?

Accepted Answer

Seizures can occur in patients with hyperglycemic hyperosmolar syndrome (HHS) due to the extreme hyperglycemia and the resultant osmotic effects on the brain, leading to altered mental status and potentially seizures.

Question 6

A patient with long-standing type 2 diabetes may be developing diabetic ketoacidosis (DKA).Which assessment findings would the nurse evaluate as supporting that diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

- A sweet smell to the breath (A) is characteristic of ketoacidosis due to the presence of ketones.- Ketonuria (B) indicates the presence of ketones in the urine, a hallmark of DKA.- A WBC count of 28,000 (D) can indicate infection, which is a common precipitant of DKA.- Potassium of 3.4 mEq/L (E) reflects the electrolyte imbalances that can occur in DKA, despite total body potassium depletion, serum levels may appear normal or low due to shifts out of cells.

Question 7

The nurse is planning the care for a patient admitted with diabetic ketoacidosis.How does the nurse anticipate this condition will be medically managed?

Accepted Answer

Diabetic ketoacidosis requires immediate and aggressive management with a continuous low-dose intravenous infusion of regular insulin to reduce blood sugar levels and reverse the metabolic acidosis. Option A is incorrect because BID dosing of NPH insulin and PRN coverage with regular insulin is not appropriate for diabetic ketoacidosis. Option C is incorrect because once-per-evening dose of Lantus insulin with daytime coverage with regular insulin is not appropriate for diabetic ketoacidosis. Option D is incorrect because sliding scale coverage with regular insulin is not appropriate for the acute management of diabetic ketoacidosis.

Question 8

A patient with type 1 diabetes mellitus is admitted with hyperglycemia and dehydration,and is being evaluated for diabetic ketoacidosis.The nurse recognizes that which laboratory finding would support this diagnosis?

Accepted Answer

An elevated anion gap indicates an increase in the concentration of unmeasured acid in the blood, which is a common finding in diabetic ketoacidosis. The other laboratory values are within normal range or do not provide specific indication of diabetic ketoacidosis.

Question 9

Just after being admitted to the emergency department for symptoms of influenza,the patient loses consciousness.His wife reports that he is diabetic but has not taken his oral medications for a "couple of days." Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

- Checking the patient's blood glucose is essential to determine if the unconsciousness is due to hypoglycemia or hyperglycemia, which is critical in a diabetic patient. Obtaining intravenous access is a standard procedure in emergency situations to allow for quick administration of medications or fluids as needed.

Question 10

A patient receiving an insulin injection for the first time asks the nurse how it works to reduce the blood glucose.Which of the following would be the best response for the nurse to make to the patient?

Accepted Answer

Insulin helps the cells in the body take up glucose to be used for energy, thereby reducing the amount of glucose in the bloodstream.

Question 11

The nurse is preparing to administer an intravenous insulin drip to a patient admitted with diabetic ketoacidosis.Which laboratory result is of most concern to the nurse?

Accepted Answer

Potassium level of 3.2 mEq/L is of most concern because insulin administration can further lower potassium levels, potentially leading to life-threatening arrhythmias.

Question 12

The nurse is preparing to administer an intravenous infusion containing regular insulin for a patient diagnosed with diabetic ketoacidosis.Which nursing intervention added to the patient's plan of care has the highest priority?

Accepted Answer

Adjusting the infusion rate according to glucose readings is crucial in managing diabetic ketoacidosis to ensure the patient's blood glucose levels are controlled effectively and safely.

Question 13

A patient tells the nurse that there is a history of diabetes in the family,and even though she has always tried to keep her blood glucose level on the "low side" she still developed diabetes.What information should the nurse provide?

Accepted Answer

It is true that genetics is involved in the development of both type 1 and type 2 diabetes. Other factors that contribute to the development of diabetes include body weight, medication use, and lifestyle factors. However, genetics play a significant role in the risk of developing the disease. It is important to understand that while family history can increase the risk of diabetes, it is not a guarantee that someone will develop the disease. Maintaining a healthy lifestyle, such as regular exercise and a balanced diet, can help to reduce the risk of developing diabetes.

Question 14

A patient will receive insulin as treatment for diabetic ketoacidosis.The patient weighs 225 pounds and has a pretreatment serum glucose of 288 mg/dL.Which prescription would the nurse be comfortable administering?

Accepted Answer

In the treatment of diabetic ketoacidosis, the preferred insulin is regular insulin given via continuous intravenous infusion. Option A is a very high dose of insulin, which could result in hypoglycemia and is not recommended. Option B is not appropriate treatment for diabetic ketoacidosis. Option D is also a high dose of insulin, and the infusion rate calculation is incorrect, which could lead to dosing errors. Therefore, option C is the safest and most appropriate choice for the patient.

Question 15

Despite the inherent risks,the patient with diabetic ketoacidosis will be given sodium bicarbonate to reverse severe metabolic acidosis.How does the nurse expect to administer this medication?

Accepted Answer

Sodium bicarbonate is often administered with potassium chloride in cases of diabetic ketoacidosis to prevent hypokalemia, as correcting acidosis can cause a shift of potassium into cells, leading to dangerously low blood potassium levels.

Question 16

The nurse comes to the cardiac patient's room to administer subcutaneous insulin.The patient says,"I have always taken pills for my diabetes.Am I getting worse?" What should the nurse consider when formulating a response to this question? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

The stress of illness and changes associated with hospitalization can make it difficult to control glucose with oral medications, necessitating temporary insulin use.

Question 17

The nurse is caring for a patient with a history of type 2 diabetes who has recently experienced a myocardial infarction.The nurse would increase monitoring for findings of diabetic ketoacidosis (DKA)when which medication is added to the patient's drug regimen?

Accepted Answer

Hydrochlorothiazide diuretic can increase blood glucose levels, potentially leading to DKA in patients with a history of type 2 diabetes. Therefore, increased monitoring for DKA is necessary when this medication is added to the patient's drug regimen. Warfarin sodium, aspirin, and calcium channel blockers are not known to increase the risk of DKA.

Question 18

A patient with type 2 diabetes mellitus experiences a hypoglycemic reaction.The capillary blood glucose level is 60 mg/dL,and the patient is given 4 ounces of apple juice.What should the nurse do next?

Accepted Answer

Rechecking the patient's blood glucose in 15 minutes is important to ensure the blood glucose level has increased to a safe range. Depending on the blood glucose level at that time, additional interventions may be necessary. Holding the next scheduled dose of insulin or giving the patient another 4 ounces of apple juice without re-checking the blood glucose level isn't appropriate interventions for this situation. Rechecking the blood glucose before the next meal may be necessary, but it isn't the most appropriate next step.

Question 19

The patient with diabetic neuropathy has been admitted to the intensive care unit after major abdominal surgery.Which nursing intervention is indicated because of this neuropathy?

Accepted Answer

Patients with diabetic neuropathy are at risk for skin breakdown and infection, so keeping the skin clean and dry is an important nursing intervention. Placing the arms and legs in the patient's position of comfort, instructing the patient to cough and take deep breaths, and placing a warming blanket are all important interventions, but they are not specifically indicated for a patient with diabetic neuropathy.

Quiz 33: Diabetic Crises