Mr. Wesley is newly diagnosed with Type I DM and is being seen by the home health nurse. The doctors orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be
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Solution
confused with cold, clammy skin and pulse of 110
Confused with cold, clammy skin and pulse of 110 indicate hypoglycemia.
A patient received 6 units of regular insulin 3 hours ago. The nurse would be MOST concerned if which of the following was observed?
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Solution
diaphoresis and trembling
Diaphoresis and trembling indicates hypoglycemia.
Anton brought his grandfather to the clinic to confirm his blood sugar levels. Which laboratory test should a nurse anticipate a physician would order when an older person is identified as high-risk for Diabetes Mellitus? Select all that apply.
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Solution
Answer: A, B
When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 126 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.
Which of the following factors are risks for the development of Diabetes Mellitus? Select all that apply.
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Solution
Answer: A, B, D
Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.
Which of the following persons would most likely be diagnosed with Diabetes Mellitus? A 44-year-old:
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Solution
African-American woman.
Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:
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Solution
gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal
An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.
A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has Type I Diabetes Mellitus. Which of the follow actions should the nurse do first?
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Solution
Give 4 to 6 oz (118 to 177 mL) of orange juice.
Because the client is awake and complaining of symptoms, the nurse should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4 to 6 oz of fruit juice, five to six hard candies such as Lifesavers, or 1 tablespoon of sugar. When a client has worsening symptoms of hypoglycemia or is unconscious, treatment includes 1 mg of glucagon subcutaneously or intramuscularly, or 50 mL of 50% glucose I.V. The nurse may also give two to three glucose tablets for a hypoglycemic reaction.
Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?
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Solution
Biguanides
Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels
Blood sugar is well controlled when Hemoglobin A1C is:
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Solution
Below 5.7%
A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.
Nurse Pira is explaining to the client about Type II Diabetes. Risk factors of such condition include all of the following except:
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Solution
Smoking
Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.
Nurse Robedee is teaching a thin client about the proper methods/techniques when giving insulin. Which one of the following is proper?
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Solution
Pinch the skin up and use a 90 degree angle
The best angle for a thin person is 90 degrees with the skin pinched up. The area is not massaged and it is not necessary to warm it.
Which of the following if stated by the nurse is correct about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?
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Solution
It has a higher mortality rate than Diabetic Ketoacidosis
HHNS occurs only in people with Type II Diabetes. It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. This condition develops very slowly over hours or days.
You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent. The client mentions that he usually has a couple of beers each night and takes an aspirin each day to prevent heart attack and/or strokes. Which of the following responses would be best on the part of the nurse?
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Solution
Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of hypoglycemia
Alcohol and/or aspirin taken with a sulfonylurea can cause development of hypoglycemia.
During the admission of a client with diabetic ketoacidosis, Nurse Kendra will anticipate the physician ordering which of the following types of intravenous solution if the client cannot take fluids orally?
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Solution
0.45% normal saline solution
0.45% normal saline solution is recommended.
During a visit in a community, the nurse will recommend routine screening for diabetes when the person has one or more of seven risk criteria. Which of the following persons that the nurse comes in contact with most needs to be screened for diabetes based on the seven risk criteria?
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Solution
A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl
The seven risk criteria include: greater than 120% of standard body weight, Certain races but not including Caucasian, delivery of a baby weighing more than 9 pounds or a diagnosis of gestational diabetes, hypertensive, HDL greater than 35 mg/dl or triglyceride level greater than 250 or a triglyceride level of greater than 250 mg/dl, and, lastly, impaired glucose tolerance or impaired fasting glucose on prior testing.