diabetes 2/15/16

 A nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce enough insulin. What is the reason that the blood glucose is elevated?

• Prolonged elevation of stress hormone (cortisol, epinephrine, glucagon, growth hormone) levels
• Malfunction of the glycogen-storing capabilities of the liver
• Destruction of the beta cells in the pancreas
•  Insulin resistance of the receptor cells in the muscle tissue

What does the lack of insulin in patients with type 1 diabetes cause that increases the risk for cardiovascular disorders?

• High glucose levels that irritate and shrink the vessels
• Inadequate metabolism of proteins, which causes ketosis
•  Increased fatty acid levels
•  Increased metabolism of ketones, which causes hypertension

When a 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.” What should the nurse explain about the level of hemoglobin A1c?

• Shows how a high level of glucose can cause a significant drop in the hemoglobin level
•  Shows what the glucose level has done during the past 3 months
•  Indicates a true picture of the patient’s nutritional state
•  Reflects the effect of a high level of glucose on the ability to produce red blood cells (RBCs)

A nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a life-threatening condition. What will DKA result in?

•  Disorder of carbohydrates, fats, and proteins metabolism
• Storage of glycogen, resulting in a severe shortage of glucose in the bloodstream
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  Dangerously elevated pH and bicarbonate levels in the blood
• Severe hypoglycemia, which can result in coma and convulsions

A nurse preparing to administer insulin to a patient who has type 1 diabetes. The physician has prescribed two types of insulin, 10 U of regular insulin and 35 U of neutral protamine Hagedorn (NPH) insulin. Which is the proper procedure for the nurse to follow when preparing these medications?

•  Draw up the insulins in two separate syringes to avoid confusion.
•  Draw up the regular insulin before drawing up the NPH insulin.
•  Inject air into the NPH insulin, draw it up to 35 U, and then inject air into the clear regular insulin and withdraw to 45 U.
•  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.

A patient has come into the emergency department accompanied by a friend who states that the patient had been acting very strangely and seems confused. The friend states that the patient has diabetes and takes insulin. Which signs of hypoglycemia might the nurse assess?

• Slow pulse rate and low blood pressure
• Irritability, anxiety, confusion, and dizziness
• Flushing, anger, and forgetfulness
• Sleepiness, edema, and sluggishness

 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. What is the most accurate nursing response?

•  “Having a fasting serum glucose that high certainly indicates diabetes.”
•  “That test indicates that we need to perform more tests that are specific for diabetes.”
•  “How do you feel? Do you have any other signs of diabetes?”
•  “Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a diagnosis.”

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first?

• Document the finding in the client’s chart.
• Assess tactile sensation in the client’s hands.
• Examine the client’s feet for signs of injury.
• Notify the health care provider.

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client’s plan of care to delay the onset of microvascular and macrovascular complications?

• “Maintain tight glycemic control and prevent hyperglycemia.”
• “Restrict your fluid intake to no more than 2 liters a day.”
• “Prevent hypoglycemia by eating a bedtime snack.”
• “Limit your intake of protein to prevent ketoacidosis.”

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition?

• Increased rate and depth of respiration
• Extremity tremors followed by seizure activity
• Oral temperature of 102° F (38.9° C)
• Severe orthostatic hypotension