Which of the following persons would most likely be diagnosed with diabetes mellitus?

A 44-year-old: Your Answer: African-American woman. Rationale: Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for AfricanAmericans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Taxonomic Level: Analysis

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Which of the following factors are risks for the development of diabetes mellitus? (Select all that apply.) Your Answer: Age over 45 years Overweight with a waist/hip ratio >1 Having a consistent HDL level above 40 mg/dl Maintaining a sedentary lifestyle Correct Answers: Age over 45 years Overweight with a waist/hip ratio >1 Maintaining a sedentary lifestyle Rationale: 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. Nursing Process: Assessment Client Need: Physiologic Integrity, Reduction of Risk Potential Taxonomic Level: Comprehension Rationale: 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. Nursing Process: Assessment Client Need: Physiologic Integrity, Reduction of Risk Potential Taxonomic Level: Comprehension Rationale: 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. Nursing Process: Assessment Client Need: Physiologic Integrity, Reduction of Risk Potential Taxonomic Level: Comprehension Rationale: 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. Nursing Process: Assessment Client Need: Physiologic Integrity, Reduction of Risk Potential Taxonomic Level: Comprehension

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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.) Your Answer: Fasting Plasma Glucose (FPG) Glycosylated hemoglobin (HbA1C) Correct Answers: Fasting Plasma Glucose (FPG) Two-hour Oral Glucose Tolerance Test (OGTT) Rationale: When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates longterm glucose control. A finger stick glucose three times daily spot-checks blood glucose levels. Nursing Process: Planning Client Need: Physiologic Integrity Taxonomic Level: Comprehension Rationale: When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates longterm glucose control. A finger stick glucose three times daily spot-checks blood glucose levels. Nursing Process: Planning Client Need: Physiologic Integrity Taxonomic Level: Comprehension

When the older adult reports rapid-onset weight loss. and polyphagia. and maintaining or improving general health status. Nursing Process: Assessment Client Need: Physiologic Integrity. improving self-care through education.4. and polyphagia. The principal goals of therapy for older patients who have poor glycemic control are: Your Answer: All of the above. decreasing the chance of complications. When an older adult is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss. elevated blood glucose levels. the healthcare provider should consider pancreatic tumor. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Taxonomic Level: Application 5. Rationale: The principal goals of therapy for older persons with diabetes mellitus and poor glycemic control are enhancing quality of life. Effective Care Environment Taxonomic Level: Comprehension . elevated blood glucose levels. Nursing Process: Planning Client Need: Safe. Of which of the following symptoms might an older woman with diabetes mellitus complain? Your Answer: Pain intolerance Correct Answer: Perineal itching Rationale: Older women might complain of perineal itching due to vaginal candidiasis. the gerontology nurse should anticipate which of the following secondary medical diagnoses? Your Answer: Gestational diabetes mellitus Correct Answer: Pancreatic tumor Rationale: The onset of hyperglycemia in the older adult can occur more slowly. Reduction of Risk Potential Taxonomic Level: Evaluation 6.

Nursing Process: Application Client Need: Physiologic Integrity Taxonomic Level: Analysis 8. A diabetic patient experiencing a reaction of alternating periods of nocturnal hypoglycemia and hyperglycemia might be manifesting which of the following? Your Answer: Somogyi phenomenon Rationale: Somogyi phenomenon manifests itself with nocturnal hypoglycemia. and can cause hypoglycemia. Rationale: Physical exercise slows the progression of diabetes mellitus. Insulin and foods both must be adjusted to allow safe participation in exercise. Strenuous exercise can cause retinal damage. which reduces liver glucose output and increases cell uptake of glucose. such as long-acting glyburide (Micronase). These drugs stimulate insulin secretion. Pharmacologic Therapy Taxonomic Level: Knowledge . is to: Your Answer: Stimulate the beta cells of the pancreas to secrete insulin. Rationale: Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. The primary purpose for sulfonylureas. enhancing the number of and sensitivity of cell receptor sites for interaction with insulin. Nursing Process: Analysis Client Need: Physiologic Integrity. because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity.7. Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus? Your Answer: Physical exercise can slow the progression of diabetes mellitus. followed by a marked increase in glucose and increase in ketones. Nursing Process: Analysis Client Need: Physiologic Integrity Taxonomic Level: Analysis 9.

Oral diabetic agents. b. Pharmacologic Therapy Taxonomic Level: Evaluation 11. LEHNE 6th---Edition: NCLEX-Style questions for Diabetes Mellitus . A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. Less insulin. Diabetic ketoacidosis. Insulin resistance usually is indicated by a daily insulin requirement of 200 units or more. and she is admitted to the hospital for observation and management as needed. c. d. Nursing Process: Analysis Client Need: Physiologic Integrity Taxonomic Level: Analysis Patients with Type 1 diabetes mellitus may require which of the following changes to their daily routine during periods of infection? a. The client's intake has been very poor.10. Nursing Process: Evaluation Client Need: Physiologic Integrity. One of the benefits of Glargine (Lantus) insulin is its ability to: Your Answer: Release insulin evenly throughout the day and control basal glucose levels. patients with Type 1 diabetes may need even more insulin to compensate for increased blood glucose levels. an acute metabolic condition. especially with the frail elderly patient whose appetite is poor. can result in dehydration and HHNC. usually is caused by absent or markedly decreased amounts of insulin. More insulin. C During periods of infection or illness. No changes. What is the most likely problem with this patient? Your Answer: Hyperglycemic hyperosmolar non-ketotic coma Rationale: Illness. Rationale: Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.

a nurse will: a) Draw up the Regular Insulin into the syringe first. oral agents are effective ONLY with Type II diabetes 2) When administering 30 Units of Regular Insulin and 70 Units of NPH insulin.9 questions total 1) A nurse administers oral medications that enhance insulin action to a patient with diabetes. which could cause an alteration in the onset of action of the regular insulin 3) Which long-acting insulin mimics natural basal insulins with its duration of 24 hours? a) Insulin Glargine (Lantus) b) Insulin aspart (NovoLog) c) Regular Insulin (Humulin R) d) Ultralente insulin (Humulin U) . drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin. Which type of diabetes does this patient have? a) Type I Diabetes b) Type II Diabetes c) Diabetes insipidus d) Ketosis Ans:B. followed by the cloudy NPH insulin b) Inform the patient that mixing insulin helps increase insulin production c) Rotate sites at least once a week and label the sites used on a diagram d) Use a 23-25 gauge syring with a 1-inch needle for maximum absorption Ans:A.

the abdomen provides the most consistent absorption because the blood flow to subcutaneous tissue typically is not as affected by muscular movements. Which types of insulin will the surgical nurse have available? a) Regular Insulin (Humulin R) b) Isophane insulin suspension (NPH insulin) c) Insulin zinc suspension (Lente insulin) d) Insulin Glargine (Lantus) Ans:A. if the patient does not eat a midafternoon snack. At what time is this patient at the highest risk for hypoglycemia? a) 10 AM b) 2 PM c) 5 PM d) 8 PM Ans: C. lunch at noon and dinner at 6 pm. into which site should the insulin be injected? a) Abdomen b) Deltoid c) Vastus Lateralis d) Gluteus maxius Ans:A . which mimics the natural basal insulin secretion of the pancreas 4) An operating room nurse prepares a patient with Type II diabetes for surgery. However. Insulin glargine has a duration of action of 24 hours with NO peaks. the NPH insulin may be . and lunch covers the 2 PM time frame.Ans:A. Breakfast eaten at 8:30am would cover the onset of NPH insulin. 6) A patient receives NPH insulin at 8 am. The other options are all intramuscular sites and should not be used for insulin administration. The patient eats breakfast at 830 am. Regular insulin is the ONLY insulin that can be given Intravenously 5) For the most consistent absorption.

” d) “You cannot mix this insulin in the same syringe with Regular insulin.” Ans:D. 9) To achieve the most beneficial effect.” b) “The duration of action for this insulin is about 8-10 hours. 7) A nurse would include which statement when teaching a patient about insulin Glargine (Lantus)? a) “You should inject this insulin just before meals because it is very fast acting. 8) A patient newly diagnosed with diabetes asks. “How does insulin normally work in my body?” The Nurses response should be based on which understanding of the action f insulin? Normal Insulin: a) Stimulates the pancreas to reabsorb glucose b) Promotes synthesis of amino acids into glucose c) Stimulates the liver to convert glycogen into glucose d) Promotes the passage of glucose into cells for energy Ans:D. without sufficient glucose on hand to prevent hypoglycemia. It should not be mixed with any other insulin. a) With food b) 30 minutes before a meal c) 15 minutes postprandial d) At bedtime . Insulin promotes the passage of glucose into the cells. so you’ll need to take it twice a day.peaking just before dinner. where it is metabolized for energy. the nurse plans to administer glipizide (Glucotrol).” c)“You can mix this insulin with Lente insulin to enhance its effects. Insulin Glargine is a long-acting insulin with a duration of up to 24 hours.

irritability b. This allows better management of their diabetes. Nausea b. dizziness. abdominal pain d. D. By testing your own blood. sores that are slow to heal. shaky feeling. blurred vision.Ans: B. Withdrawing NPH insulin first. drowsiness c. C. less expensive c. polydipsia. Better management. you are able to change insulin regimen to maintain their glucose level in the normoglycemic range of 80 . easier method of testing b. Hyperactivity d. better management of diabetes d. N & V A. Regular insulin is ALWAYS withdrawn first A client is learning to mix regular insulin and NPH insulin in the same syringe. Other signs include irritability. shortened attention span. and decreased level of consciousness. It is the ONLY sulfonylurea agent that should be given 30 Minutes before a meal. Frequent Urination A nurse shoud recognize which symptom as a cardinal sign of diabetes mellitus? a. polyuria. Accompanied by acdetone breath. dry skin. lowered frustration tolerance. Why is blood glucose monitoring needed? a. dehydration. and flushed skin. and vomiting are signs of HYPERglycemia. Which action. fatigue. Seizure c. hunger. a. greater sense of control over diabetes BG monitoring improves diabetes management and is used successfully from the onset of their diabetes. 300 mg / dl A nurse should understand that hyperglycemia associated with diaabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than? DKA determined by BG of 300 or greater. Frequent urination Polyphagia. Food inhibits the absorption of Glipizide. Which symptom is indicative of hypoglycemia? a.120 mg / dl. Irritability: signs of hypoglycemia include irritability. if performed by the client. headache. and weight loss are cardinal signs of DM. would indicate the need for FURTHER teaching? . weak and rapid pulse. abdominal pain. nausea. Drowsiness.

1/2 hr to 1 hr c. Weight gain. Symptoms of Crohn's disease include diarrhea. Injecting an amt of air equal to the desired dose of insulin NPH insulin bottle equal to the amt of insulin to be withdrawn because there will be regular insulin in the syringe and he won't be able to inject air when he needs to withdraw the NPH. tiredness. diaphoresis. abdominal pain. 1/2 hour to 1 hour A client is diagnosed with diabetes type 1. Metformin and sulfonylureas are commonly ordered medications. After drawing up first insulin. and weight loss Symptoms of hyperglycemia include polydipsia. Injecting air into the NPH insulin bottle first c. Polydispisa. and weight loss. How soon after administration will the onset of regular insulin begin? Lispro insulin has an onset within 5 minutes a. within 5 minutes b. and tachycardia are symptoms of hypoglycemia. 4-8 hrs NPH has onset within 2-4 hrs Ultralente insulin is the longest acting with an onset of 6-10 hrs a. diaphoresis. b. and weight loss. morning. and duration is 3-6 hours. peak is insluin and NPH insulin administered subcutaneously each 2-4 hours. tiredness. polyuria. 1 . A client who is started on metformin and glyburide would have initially presented with which symptoms? a.1 1/2 hrs d. and weight loss b. weight gain. & bradycardia c. polyuria. Polydispisa. removing air bubbles The client is instructed to inject air into the d. so it won't become contaminated with NPH insulin. It's necessary to remove the air bubbles to ensure a correct dosage before drawing u p the second insulin. and bradycardia are symptoms of hypothyroidism. and tachycardia d. and weight loss . diarrhea. abdominal pain. polyuria. irritability. The primary health care provider prescribes an insulin regimen of regular Regular insulin's onset is 1/2 to 1 hr. Withdrawing the NPH insulin first b.a. Irritability.

used in the management of clients undergoing stressful procedures such as transplants or coronary artery bypass surgery Diabetes Mellitus type II Which type of diabetes is controlled primarily through diet. Checking the blood glucose level and administering carbs will elevate blood glucose. check blood glucose level and administer carbohydrates The client is experiencing symptoms of hypoglycemia. take on-half of usual daily dose of intermediate acting insulin Which nursing consideration must be taken into account for If the client takes his full daily dose of a client with type 1 diabetes mellitus on the morning of intermediate-acting insulin when he isn't surgery? allowed anything orally before surgery. Restricting salt. jitters. take on-half of usual daily dose of intermediate acting insulin dose will provide all that is needed. admin diuretics. and tachycardia approx 1. a. Restrict salt. palpitations. the nurse should . On-half the a. Monitor blood glucose closely. and oral antidiabetic agents? Which nursing intervention should be taken for a client who c. give glyburide again antidiabetic agent vomits. exercise. receive an oral antidiabetic agent receive an IV insulin infusion take his full daily insulin dose with no dextrose infusion Clients with type 1 don't take oral antiiabetic agents IV insulin infusions aren't standard for routine surgery. check pulse oximetery and administer O2 therapy d. and performing paracentesis are tx for ascites. insulin b. administer diuretics and perform a paracentesis. he'll become hypoglycemic. ECG and nitroglycerin are treatments for MI O2 won't correct lovw blood glucose level. and look complains of N & V 1 hour after taking his morning for signs of hypoglycemia glyburide? When a client who has taken an oral a. a.5 hrs after taking his reg morning insulin. check blood glucose level and administer carbohydrates.A client presents with diaphoresis. b. give nitroglycerin and perform an ECG c. Which treatment is appropriate for this client? a.

Because of the risk of serious foot injuries. and look for signs of hypoglycemia d. and physical activity When teaching a newly diagnosed diabetic dclient about diet and exercise. Therefore. annual eye exams are recommended c. and physical activity. annual eye exams are recommended Retinopathy is a chronic complication of DM. shoes should fit properly and be the correct size. caloric goals. it's important to include which directive? a. and electrolytes c. consistency of food composition. buy shoes that are a half size larger b.b. d. excessive exercise increases insulin resistance b. Monitor blood glucose closely. monitor BG and assess for symptoms of hyperglycemia monitor glucose and assess him frequently for signs of hypoglycemia. and physical activity Diabetic clients must be taught the relationship among caloric goals. giving insulin also will lower glucose levels. repeating the dose would further lower glucose levels later in the day. food consistency. Therefore yearly eye exams are recommended. protein. causing hypoglycemia client wouldn't have hyperglycemia if they glyburide was absorbed. . caloric goals. use of fiber laxatives and bulk-forming agents b. Which info should she include in her teaching? a. proteins. food consistency. management of fluid. give subQ insulin and monitor BG c. Most of the medication has probably been absorbed. Fiber lax and bluk forming agents are treatments for constipation management of fluids. and electorlytes is important for client wit hacute renal failure diabetic client may need to intake additional calories before exercising Nurse is teaching a client with DM about chronic complications associated with the disease. reduction of calorie intake before exercising d.

urine glucose test a serum T4 test is used to diagnosis thyroid disorders. causing unpredictable absorption of insulin injected into those sites. Rotating injection sites when administering insulin prevents Insulin edema is generalized retention of which complication? fluid.d. Most of the time. rotating injection sites won't prevent these. however neither serum ketone levesls nor T4 levels are useful in determining BG levels urine glucose test monitors glucose levels . serum T4 test d. insulin resistance Insulin resistance occurs mostly in d. serum keton test c. systemic allergic reactions range from hives to anaphylaxis. podiatry visits are necessary every 5 years Exercise decreases insulin resistance A podiatrist should be seen on a yearly basis b. a. decreasing the amt of absorption. insulin edema with prolonged hypergylecemia b. sometimes seen after normal blood glucose levels are established in a client a. systemic allergic reactions overweight clients and is due to insulin binding with antibodies. insulin lipodystrophy c. insulin lipodystrophy Insulin lipodystrophy produces fatty masses at the injection sites. Capillary blood glucose test This test is a rapid test used to show BG levels. Capillary blood glucose test concentration b. Which test allows a RAPID measurement of glucose in whole ketone test is used to document diabetic blood? ketoacidosis by titration and may allow determination of serum ketone a.

may have sufficient endogenous insulin to prevent ketosis but is at risk for of ketoacidosis. results correlate poorly with BG levels c. Therefore. D.1 hr b. B. B.in urine and is influenced by both glucose and water excretion. fluid shifts resulting from the osmotic effect of hyperglycemia. the pancreas to produce insulin.1 hr The polydipsia and polyuria related to diabetes mellitus are primarily caused by A. . the nurse recognizes that the patient A. must receive insulin therapy to prevent the development D. changes in RBCs resulting from attachment of excessive glucose to hemoglobin. the release of ketones from cells during fat metabolism. 6-16 hrs d. the peak effect of rapid-acting insulin is 2-6 hrs long -acting insulin has a peak effect of 1426 hrs onset of rapid acting insulin is 15 min . C. damage to the kidneys from exposure to high levels of glucose. 2-6 hrs c. 14-26 hrs Novolin NPH has a peak effect of 6-16 hrs. 6-16 hrs How long does the peak effect last for Novolin NPH. development of hyperosmolar B. has minimal or absent endogenous insulin secretion and requires daily insulin injections. fluid shifts resulting from the osmotic effect of hyperglycemia. 15 min . When a patient with type 2 diabetes mellitus is admitted to the hospital with pneumonia. has islet cell antibodies that have destroyed the ability of hyperglycemic nonketotic syndrome. an intermediat-acting insulin? a. C.

C. to be used only for type 1 diabetes. D.” the nurse includes information about A. self-monitoring of blood glucose. need to reduce physical activity. elimination of sugar from diet. relying on the health care provider as the central figure in D. and the program for good control. The nurse assists the patient with nutritional therapy of diabetes with the knowledge that a “diabetic diet” is designed A. weight loss measures. D. and medications together with appropriate monitoring and patient and family teaching. to help normalize blood glucose through a balanced diet. activity.D. Effective collaborative management of diabetes includes A. B. B. may have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar hyperglycemic nonketotic syndrome. aiming for a balance of diet. medications together with appropriate monitoring and patient and family C. D. B. . activity. C. self-monitoring of blood glucose. treatment modality for all patients with diabetes. D. to help normalize blood glucose through a balanced diet. aiming for a balance of diet. relying solely on nutritional therapy as the initial teaching. using insulin with all patients to achieve glycemic goals. In teaching a newly diagnosed type 1 diabetic “survival skills. to normalize blood glucose by elimination of sugar. for use during periods of high stress. D.

inspect all surfaces of the feet daily. C. deep respirations. rapid. B. polyuria. prevents transport of tryglycerides into adipose tissue d. Following assessment of the patient. use iodine to disinfect cuts and abrasions. the beta cell response to the Proinsulin C-peptides hyperglycemia can be identified in the blood and urine by the presence of: Two hormones released during physical and emotional stress that Cortisol & Epinephrine are conterregulatroy to insulin are: The type of diabetes that is Type 1 . accelerates the transport of amino acids into cells and their synthesis into protein Tissues that require insulin for glucose transport are: adipose & skeletal muscle d. stimulates hepatic glycogenolysis and gluconeogenosis c.7 mmol/L) and is unresponsive. Although the primary function of insulin is to promote glucose transport from the blood into the cell. B. C. C. avoid softening lotions and creams. D. the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic nonketotic syndrome based on the finding of A. insulin also: a. severe dehydration. deep respirations. rapid. D. A diabetic patient has a serum glucose level of 824 mg/dl (45. accelerates the transport of amino acids into cells and their synthesis into protein C. use heat to increase blood supply. enhances breakdown of adipose tissue for energy b. During developement of type 1 diabetes. inspect all surfaces of the feet daily.An appropriate teaching measure for the patient with diabetes mellitus related to care of the feet is to A. decreased serum potassium.

obese. hypertension b. 50 yr old hispanic woman c. Type 1 genetic susceptibility is only 6-9%. 62 yr old obese white man b. hypoglycemia Type 1 Type 2 Type 1 Type 2 Type 1 High glucose levels cause loss of glucose in urine with osmotic diuresis Thirst caused by fluid loss of polyuria Cellular starvation from lack of glucose and use of fat and protein for energy d. 34 yr old woman whose parents both have type 2 diabetes When caring for a patient with insulin resistance syndrome. child whose father has type 1 diabetes d. cardiovascular disease . 15%-45% of dvlpt. the nurse plans teaching to decrease the patients risk for: a.strongly related to human leukocyte antigen type is: Type 1 or 2? Inherited defect in insulin receptors: Type 1 or 2? Production of islet cell antibodies Typer 1 or 2? Genetic susceptibility for antibody production? Type 1 or 2? Inappropriate glucose production by the liver Type 1 or 2? Beta Cell destruction Describe process occurring with POLYURIA Describe process occurring with POLYDYPSIA Describe process occuring with POLYPHAGIA The nurse identifies that the risk for developing diabetes is highes in: a. Is more related to HLA Lower risks include the obesity / age / and race of the other answers c. 34 yr old woman whose parents both have type 2 diabetes Type 2 diabetes has STRONG influence.

c. elevated glycosolated hemoglobin When teaching patient about isulin administration. has enough endogenous insulin to prevent diabetic ketoacidosis with the hyperglycemia .38. impaired fasting glucose c. impaired glucose tolerance d. is demonstrating abrupt onset of type 1 diabetes c. the nurse instructs Between 140 . random plasma glucose of 210 during a routine health screening a patient has a fasting plasma On at least two testings. FPG of 126 or a OGTT over 200 c. will require insulin treatment only during stress b. impaired glucose tolerance a. AT following diagnosed with a random plasma visit diabetes would be diagnoses glucose over 200 based on: a fasting plasma glucose over 126 a. glucosuria of 3+ b. hyperglycemic hyperosmolor nonketosis 52 yr old patient admitted to hospital with vomiting and diarrhea has a fasting BS of 512 and pH 7. has enough endogenous insulin to prevent diabetic ketoacidosis with the hyperglycemia c. consistently use the same size of the appropriate strength insulin d. random plasma glucose of 210 d. will require long-term insulin therapy to control diabetes d. cardiovascular disease d. The ruse recognizes that it is most likely that this patient: a. diabetes is Glucose of 132. Diagnosed with diabetes M and treated with insulin and IV. diabetes b.200 is "Pre-diabetes" OVer 200 = dx of diabetes c. OGTT of 190 fasting plasma glucose testing preferred Nurse determines that a patient with a 2-hour OGTT of 152 has: c.

consistently use the same size of the appropriate strength insulin syringe to avoid dosing errors syringe to avoid dosing errors d. rotate inj. indicating the need for carbohydrates. clean the skin at inj. immunologic. C. Type 1 Diabetes Type 1 diabetes is an autoimmune disorder in which insulin producing cells are destroyed. Answer: B Hypoglycemia in diabetes mellitus causes confusion. site from arms to thighs to abdomen A patient with type 1 diabetes uses A set meal pattern with a bedtime 20U of 70/30 (NPH/regular) in the snack is necessary to prevent morning and at 6 pm. Which of the following symptoms is indicative of hypoglycemia? A.the patient to: a. and environment factors. Insulin is a hormone produced by the pancreas. B. The symptoms include: increased urination increased thirst hunger . Polydipsia. site c. 20. Polyphagia. Diabetes type 1 is also called juvenile diabetes because the onset is usually during childhood. D. Blurred vision. The nurse hypoglycemia stresses what about meal plans? 20. A patient with newly diagnosed diabetes mellitus is learning to recognize the symptoms of hypoglycemia. Confusion. that controls the level of glucose in the blood. Without insulin present glucose can not enter into the cells. pull back on plunger to check for blood b. There is no definite cause of type 1 diabetes. it is thought to stem from a combination of genetic.

When fat breakdown occurs. If ketones are present in the body. The three main symptoms are: Acidosis Dehydration/electrolyte loss Hyperglycemia The ketone production will create an acidotic state in the body. abdominal pain. Other signs of DKA: fruity breath. On NCLEX remember to teach about: blood glucose monitoring different types of insulin giving insulin with meals prevention of diabetic complications Answers: Insulin . clients are at risk for diabetic ketoacidosis. vomiting. clients may lose up to 6 liters a day. This is important because if insulin is not available for energy consumption the body will burn fats. Diabetic Ketoacidosis (DKA) is a life threatening condition that occurs when not enough insulin is present. Hyperglycemia is caused due to a lack of insulin. Dehydration will be caused by excessive urination. The insulin injections could range from 1-7 times a day with a combination of short and long acting insulin. The Insulin will reverse both the acidosis and hyperglycemia.blurred vision weight loss The primary treatment for type 1 diabetes will be insulin injection. NCLEX Review Questions: What is the primary way type 1 diabetes is controlled? What is the life threatening condition that can occur if type 1 diabetes is uncontrolled? If ketones are present in the body should the client exercise? What is the treatment for diabetic ketoacidosis? **Remember if insulin injection is the primary mode of treatment for type 1 diabetes education will be the key. the result is ketone production. nausea. hyperventilation Treatment for DKA will be IV fluid + electrolytes and Regular Insulin IV.

HHNS occurs when high blood sugar causes severe dehydraton in the client. This is the potential risk for type 2 diabetics. Eventually the body realizes that secreting all the extra insulin won't help. The client's constant hyperglycemic state (blood sugar over 600) causes osmotic diuresis. However you may see another acute condition called Hyperglycemic Hyperosmolar NonKetotic Syndrome (HHNS). You will not see DKA in type 2 diabetes. so the pancreas stops producing it. When the cells become resistant to the insulin bond the body tries harder by secreting more insulin.Diabetic Ketoacidosis No-will cause more fat to be consumed for energy leading to more ketone production IV fluids and insulin Type 2 Diabetes Type 2 diabetes occurs primarily because of two problems: 1)insulin resistance 2)impaired insulin production Normally. There is no known cause for type 2 diabetes although clients can have predisposing factors such as: family history obesity usually over 40 yrs old physically inactive have high blood pressure African American. or Hispanic American Signs of type 2 diabetes include: . insulin binds to special receptors on the cell surface which initiate glucose metabolism however with type 2 diabetes insulin is not as effective in causing glucose metabolism. Unlike Type 1 Diabetes there is still enough insulin in the body to prevent the breakdown of fats which leads to ketones. The cells still don't respond so now there is a ton of glucose floating around which leads to hyperglycemia. Several events can cause HHNS: acute illness (pneumonia) medications (thiazides) dialysis Treatment for HHNS is the same as for DKA: fluid/electrolyte replacement and regular insulin IV. resulting in water and electrolyte loss. Native American.

Rapid Acting Humalog. Exercise also lowers the blood glucose in diabetics. If these things are not successful then clients may be started on oral antidiabetics. If oral agents are not effective then the client may need to advance to insulin SQ injections. Exercise increases the effective of insulin binding to the cells. exercise may cause hypoglycemia Stress will increase the need for insulin Basic Types of Insulin The goal of insulin therapy is strict blood glucose control. Eating a well balanced meal will also be emphasized during treatment.polyuria polydipsia polyphagia Clients may also experience blurry vision. poor wound healing. Diagnostic tests for type 2 diabetes: An abnormally high glucose level is the basic criteria Fasting glucose greater than 126 (fasting=no calorie intake for at least 8 hours) Hemoglobin A1c greater than 7% **Hemoglobin A1c measures the blood sugar for the last 3 months Treatment for type 2 diabetes is primarily weight loss along with exercise. NCLEX Review Questions: What is the primary way type 2 diabetes is controlled? Why must diabetics inspect their feet daily? Will exercise increase or decrease the need for insulin? Will stress increase or decrease the need for insulin? Answers: Diet and Exercise Diabetics may have sores that go unnoticed Decrease. or frequent vaginal infections. Novolog .

2 hours Onset.4 hours Client Teaching.1 hour Duration. Humulin N Onset-4 hours Peak-8 hours Duration. Novolin R Onset-1 hour Peak.24 hours Client Teaching.No peak (continuous) Duration.Taken at bedtime General Insulin Teaching Inject subcutaneously-do not aspirate Do not massage site after injection Rotate injection site May need to decrease insulin after exercise to prevent hypoglycemia Oral Antidiabetic Agents Must be used in conjunction with diet and exercise comes in tablet form give 30 minutes before meals used to treat type 2 diabetes only Do not give to type 1 diabetics .3 hours Client Teaching-Give with meals Short Acting Humalog R.12 hours Client Teaching.Cloudy appearance When mixing insulin draw Regular before Intermediate Think "clear before cloudy" Long Acting Lantus Onset 1 hour Peak.Clear appearance Only type that can be given IV Intermediate Acting NPH.Onset-15 mins Peak.

) Headache Weight gain Client Teaching:-Several medications interfere with Oral antidiabetics: Coumadin Oral Contraceptives Corticosteriods Symptoms of hyper/hypoglycemia Diabetes Related Complications In order to critically think for the NCLEX you need to have a basic understanding of these common diabetes related complications. 8 ounze skim milk) If client is unconscious give 50% Dextrose IV or Glucagon IM Hyperglycemia (High Blood Sugar) Blood glucose is 200-800 Signs: physical-3 P's. Avandia Side Effects: GI disturbance (diarrhea. tachy. lethargic Cause: dehydration illness stress missed dose of insulin Other complications Diabetic retinopathy is the result of changes of in the small vessels in the eyes due to poorly controlled blood sugar.weak. nausea. combative. sweating mental. shaking. Hypoglycemia (Low Blood Sugar) Blood glucose is less than 65 Signs:physical. belligerent.incoherent. proper diet and . glucose tablet. etc. slurred speech Cause: too much insulin too much exercise too little food Treatment: Give a fast acting sugar (candy. stupor. tachy mental-confusion. dehydration. Glucophage.Examples: Metformin. Byetta. Cataracts and blindness are common in diabetics.trembling. hungry. Atherosclerosis is the result of blood vessels becoming hard due to uncontrolled diabetes. incoherent. weakness. teach clients to get yearly eye exams.

The risk factors for gestational diabetes include: 25 years or older Overweight Family history of diabetes African. Teach clients the importance of injection site rotation. urinary tract. The ABC's of Diabetes Care A1c less than 7% Blood pressure control Cholesterol control Diabetes education Eye exam Foot exam Glucose monitoring Gestational Diabetes Gestational diabetes is glucose intolerance that begins during pregnancy. It starts around 2am.exercise should be emphasized during treatment. and yeast) Lipodystrophy is the result of fatty masses that are produced when insulin injections are giving in the same place repeatedly. The client will wake up hyperglycemic. Somogyi phenomenon is rebound hyperglycemia. DKA (please see link) HHNS (please see link) Dawn Phenomenon occurs between 5-8 am. at first the client will be hypoglycemic so the body releases stored insulin but the effect is hyperglycemia by 7am. Infections are common in people with diabetes (foot. Hispanic. Hyperglycemia occurs because the placental hormones cause insulin resistance in the mother. or Native American Previous baby 9lbs or greater Signs of gestational diabetes: Polyuria Polydipsia Polyphagia Diagnosis: . Teach the client to eat a snack at bedtime to prevent this from happening. Think "I am hyper at dawn" Give bedtime insulin to prevent this from happening.

Fasting glucose test greater 126 mg/dL (no calorie intake for 8 hrs) or 3 hour glucose tolerance test How gestational diabetes affects the baby: Born overweight Experience hypoglycemia after birth Treatment includes: Blood glucose monitoring Diet Exercise Insulin-last resort **Never give oral glycemics during pregnancy** **On NCLEX always remember to check blood glucose level first before giving any treatment NCLEX Review Questions: What is the primary way to treat gestational diabetes? How should clients with gestational diabetes deliver? Answers: Blood glucose monitoring and Diet By C-section due to baby size and prevention of injury .

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