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

2.
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

3.
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

4.
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. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Taxonomic Level: Application

5.
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, and polyphagia, 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. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumor. Nursing Process: Assessment Client Need: Physiologic Integrity, Reduction of Risk Potential Taxonomic Level: Evaluation

6.
The principal goals of therapy for older patients who have poor glycemic control are: Your Answer: All of the above. Rationale: The principal goals of therapy for older persons with diabetes mellitus and poor glycemic control are enhancing quality of life, decreasing the chance of complications, improving self-care through education, and maintaining or improving general health status. Nursing Process: Planning Client Need: Safe, Effective Care Environment Taxonomic Level: Comprehension

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. Rationale: Physical exercise slows the progression of diabetes mellitus, because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity. Strenuous exercise can cause retinal damage, and can cause hypoglycemia. Insulin and foods both must be adjusted to allow safe participation in exercise. 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, followed by a marked increase in glucose and increase in ketones. Nursing Process: Analysis Client Need: Physiologic Integrity Taxonomic Level: Analysis

9.
The primary purpose for sulfonylureas, such as long-acting glyburide (Micronase), 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. These drugs stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin. Nursing Process: Analysis Client Need: Physiologic Integrity, Pharmacologic Therapy Taxonomic Level: Knowledge

10.
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. Rationale: Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels. Nursing Process: Evaluation Client Need: Physiologic Integrity, Pharmacologic Therapy Taxonomic Level: Evaluation

11.
A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client's intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient? Your Answer: Hyperglycemic hyperosmolar non-ketotic coma Rationale: Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly decreased amounts of insulin. 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. b. c. d. No changes. Less insulin. More insulin. Oral diabetic agents.

C During periods of infection or illness, patients with Type 1 diabetes may need even more insulin to compensate for increased blood glucose levels.
LEHNE 6th---Edition: NCLEX-Style questions for Diabetes Mellitus

9 questions total 1) A nurse administers oral medications that enhance insulin action to a patient with diabetes. Which type of diabetes does this patient have? a) Type I Diabetes b) Type II Diabetes c) Diabetes insipidus d) Ketosis Ans:B; oral agents are effective ONLY with Type II diabetes 2) When administering 30 Units of Regular Insulin and 70 Units of NPH insulin, a nurse will: a) Draw up the Regular Insulin into the syringe first, 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; drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, 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)

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

peaking just before dinner, without sufficient glucose on hand to prevent hypoglycemia. 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. b) The duration of action for this insulin is about 8-10 hours, so youll need to take it twice a day. c)You can mix this insulin with Lente insulin to enhance its effects. d) You cannot mix this insulin in the same syringe with Regular insulin. Ans:D; Insulin Glargine is a long-acting insulin with a duration of up to 24 hours. It should not be mixed with any other insulin. 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; Insulin promotes the passage of glucose into the cells, where it is metabolized for energy. 9) To achieve the most beneficial effect, the nurse plans to administer glipizide (Glucotrol); a) With food b) 30 minutes before a meal c) 15 minutes postprandial d) At bedtime

Ans: B; Food inhibits the absorption of Glipizide. It is the ONLY sulfonylurea agent that should be given 30 Minutes before a meal.

Which symptom is indicative of hypoglycemia? a. irritability b. drowsiness c. abdominal pain d. N & V

A. Irritability: signs of hypoglycemia include irritability, shaky feeling, hunger, headache, dizziness. Drowsiness, abdominal pain, nausea, and vomiting are signs of HYPERglycemia. 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. Accompanied by acdetone breath, dehydration, weak and rapid pulse, and decreased level of consciousness. D. Frequent Urination

A nurse shoud recognize which symptom as a cardinal sign of diabetes mellitus? a. Nausea b. Seizure c. Hyperactivity d. Frequent urination

Polyphagia, polyuria, polydipsia, and weight loss are cardinal signs of DM. Other signs include irritability, shortened attention span, lowered frustration tolerance, fatigue, dry skin, blurred vision, sores that are slow to heal, and flushed skin. C. Better management.

Why is blood glucose monitoring needed? a. easier method of testing b. less expensive c. better management of diabetes d. greater sense of control over diabetes

BG monitoring improves diabetes management and is used successfully from the onset of their diabetes. By testing your own blood, you are able to change insulin regimen to maintain their glucose level in the normoglycemic range of 80 - 120 mg / dl. This allows better management of their diabetes. a. Withdrawing NPH insulin first. Regular insulin is ALWAYS withdrawn first

A client is learning to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, would indicate the need for FURTHER teaching?

a. Withdrawing the NPH insulin first b. Injecting air into the NPH insulin bottle first c. After drawing up first insulin, removing air bubbles The client is instructed to inject air into the d. 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.

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. b. 1/2 hour to 1 hour A client is diagnosed with diabetes type 1. The primary health care provider prescribes an insulin regimen of regular Regular insulin's onset is 1/2 to 1 hr. peak is insluin and NPH insulin administered subcutaneously each 2-4 hours, and duration is 3-6 hours. morning. How soon after administration will the onset of regular insulin begin? Lispro insulin has an onset within 5 minutes a. within 5 minutes b. 1/2 hr to 1 hr c. 1 - 1 1/2 hrs d. 4-8 hrs NPH has onset within 2-4 hrs Ultralente insulin is the longest acting with an onset of 6-10 hrs a. Polydispisa, polyuria, and weight loss Symptoms of hyperglycemia include polydipsia, polyuria, and weight loss. Metformin and sulfonylureas are commonly ordered medications. Weight gain, tiredness, and bradycardia are symptoms of hypothyroidism. Irritability, diaphoresis, and tachycardia are symptoms of hypoglycemia. Symptoms of Crohn's disease include diarrhea, abdominal pain, and weight loss.

A client who is started on metformin and glyburide would have initially presented with which symptoms? a. Polydispisa, polyuria, and weight loss b. weight gain, tiredness, & bradycardia c. irritability, diaphoresis, and tachycardia d. diarrhea, abdominal pain, and weight loss

A client presents with diaphoresis, palpitations, jitters, and tachycardia approx 1.5 hrs after taking his reg morning insulin. Which treatment is appropriate for this client? a. check blood glucose level and administer carbohydrates. b. give nitroglycerin and perform an ECG c. check pulse oximetery and administer O2 therapy d. Restrict salt, administer diuretics and perform a paracentesis.

a. check blood glucose level and administer carbohydrates The client is experiencing symptoms of hypoglycemia. Checking the blood glucose level and administering carbs will elevate blood glucose. ECG and nitroglycerin are treatments for MI O2 won't correct lovw blood glucose level. Restricting salt, admin diuretics, and performing paracentesis are tx for ascites. a. 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, he'll become hypoglycemic. On-half the a. take on-half of usual daily dose of intermediate acting insulin dose will provide all that is needed. insulin b. 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; 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, exercise, and oral antidiabetic agents?

Which nursing intervention should be taken for a client who c. Monitor blood glucose closely, 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. give glyburide again antidiabetic agent vomits, the nurse should

b. give subQ insulin and monitor BG c. Monitor blood glucose closely, and look for signs of hypoglycemia d. monitor BG and assess for symptoms of hyperglycemia

monitor glucose and assess him frequently for signs of hypoglycemia. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. giving insulin also will lower glucose levels, causing hypoglycemia client wouldn't have hyperglycemia if they glyburide was absorbed. d. caloric goals, food consistency, and physical activity

When teaching a newly diagnosed diabetic dclient about diet and exercise, it's important to include which directive? a. use of fiber laxatives and bulk-forming agents b. management of fluid, protein, and electrolytes c. reduction of calorie intake before exercising d. caloric goals, food consistency, and physical activity

Diabetic clients must be taught the relationship among caloric goals, consistency of food composition, and physical activity. Fiber lax and bluk forming agents are treatments for constipation management of fluids, proteins, 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. Which info should she include in her teaching? a. buy shoes that are a half size larger b. annual eye exams are recommended c. excessive exercise increases insulin resistance

b. annual eye exams are recommended Retinopathy is a chronic complication of DM. Therefore yearly eye exams are recommended. Because of the risk of serious foot injuries, shoes should fit properly and be the correct size.

d. podiatry visits are necessary every 5 years

Exercise decreases insulin resistance A podiatrist should be seen on a yearly basis b. insulin lipodystrophy Insulin lipodystrophy produces fatty masses at the injection sites, 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, sometimes seen after normal blood glucose levels are established in a client a. insulin edema with prolonged hypergylecemia b. insulin lipodystrophy c. insulin resistance Insulin resistance occurs mostly in d. systemic allergic reactions overweight clients and is due to insulin binding with antibodies, decreasing the amt of absorption. systemic allergic reactions range from hives to anaphylaxis; rotating injection sites won't prevent these. a. Capillary blood glucose test This test is a rapid test used to show BG levels. 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. Capillary blood glucose test concentration b. serum keton test c. serum T4 test d. urine glucose test a serum T4 test is used to diagnosis thyroid disorders. Most of the time, however neither serum ketone levesls nor T4 levels are useful in determining BG levels urine glucose test monitors glucose levels

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

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

D. to help normalize blood glucose through a balanced diet.

An appropriate teaching measure for the patient with diabetes mellitus related to care of the feet is to A. use heat to increase blood supply. B. avoid softening lotions and creams. C. inspect all surfaces of the feet daily. D. use iodine to disinfect cuts and abrasions. A diabetic patient has a serum glucose level of 824 mg/dl (45.7 mmol/L) and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic nonketotic syndrome based on the finding of A. polyuria. B. severe dehydration. C. rapid, deep respirations. D. decreased serum potassium. Although the primary function of insulin is to promote glucose transport from the blood into the cell, insulin also: a. enhances breakdown of adipose tissue for energy b. stimulates hepatic glycogenolysis and gluconeogenosis c. prevents transport of tryglycerides into adipose tissue d. 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. accelerates the transport of amino acids into cells and their synthesis into protein C. inspect all surfaces of the feet daily.

C. rapid, deep respirations.

During developement of type 1 diabetes, 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

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. 62 yr old obese white man b. obese, 50 yr old hispanic woman c. child whose father has type 1 diabetes d. 34 yr old woman whose parents both have type 2 diabetes When caring for a patient with insulin resistance syndrome, the nurse plans teaching to decrease the patients risk for: a. hypertension 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 Type 2 diabetes has STRONG influence, 15%-45% of dvlpt. Type 1 genetic susceptibility is only 6-9%. Is more related to HLA Lower risks include the obesity / age / and race of the other answers

c. cardiovascular disease

c. cardiovascular disease d. hyperglycemic hyperosmolor nonketosis 52 yr old patient admitted to hospital with vomiting and diarrhea has a fasting BS of 512 and pH 7.38. Diagnosed with diabetes M and treated with insulin and IV. The ruse recognizes that it is most likely that this patient: a. will require insulin treatment only during stress b. is demonstrating abrupt onset of type 1 diabetes c. will require long-term insulin therapy to control diabetes d. has enough endogenous insulin to prevent diabetic ketoacidosis with the hyperglycemia c. random plasma glucose of 210 during a routine health screening a patient has a fasting plasma On at least two testings, diabetes is Glucose of 132. 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. FPG of 126 or a OGTT over 200 c. random plasma glucose of 210 d. OGTT of 190 fasting plasma glucose testing preferred Nurse determines that a patient with a 2-hour OGTT of 152 has: c. impaired glucose tolerance a. diabetes b. impaired fasting glucose c. impaired glucose tolerance d. elevated glycosolated hemoglobin When teaching patient about isulin administration, the nurse instructs Between 140 - 200 is "Pre-diabetes" OVer 200 = dx of diabetes c. consistently use the same size of the appropriate strength insulin d. has enough endogenous insulin to prevent diabetic ketoacidosis with the hyperglycemia

the patient to: a. pull back on plunger to check for blood b. clean the skin at inj. site c. consistently use the same size of the appropriate strength insulin syringe to avoid dosing errors

syringe to avoid dosing errors

d. rotate inj. 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. The nurse hypoglycemia stresses what about meal plans?

20. A patient with newly diagnosed diabetes mellitus is learning to recognize the symptoms of hypoglycemia. Which of the following symptoms is indicative of hypoglycemia? A. Polydipsia. B. Confusion. C. Blurred vision. D. Polyphagia. 20. Answer: B Hypoglycemia in diabetes mellitus causes confusion, indicating the need for carbohydrates.

Type 1 Diabetes
Type 1 diabetes is an autoimmune disorder in which insulin producing cells are destroyed. Insulin is a hormone produced by the pancreas, that controls the level of glucose in the blood. Without insulin present glucose can not enter into the cells. There is no definite cause of type 1 diabetes; it is thought to stem from a combination of genetic, immunologic, and environment factors. Diabetes type 1 is also called juvenile diabetes because the onset is usually during childhood. The symptoms include: increased urination increased thirst hunger

blurred vision weight loss The primary treatment for type 1 diabetes will be insulin injection. The insulin injections could range from 1-7 times a day with a combination of short and long acting insulin. This is important because if insulin is not available for energy consumption the body will burn fats. When fat breakdown occurs, the result is ketone production. If ketones are present in the body; clients are at risk for diabetic ketoacidosis. Diabetic Ketoacidosis (DKA) is a life threatening condition that occurs when not enough insulin is present. The three main symptoms are: Acidosis Dehydration/electrolyte loss Hyperglycemia The ketone production will create an acidotic state in the body. Dehydration will be caused by excessive urination, clients may lose up to 6 liters a day. Hyperglycemia is caused due to a lack of insulin. Other signs of DKA: fruity breath, abdominal pain, nausea, vomiting, hyperventilation Treatment for DKA will be IV fluid + electrolytes and Regular Insulin IV. The Insulin will reverse both the acidosis and hyperglycemia.

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. On NCLEX remember to teach about: blood glucose monitoring different types of insulin giving insulin with meals prevention of diabetic complications

Answers: 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, 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. When the cells become resistant to the insulin bond the body tries harder by secreting more insulin. The cells still don't respond so now there is a ton of glucose floating around which leads to hyperglycemia. Eventually the body realizes that secreting all the extra insulin won't help; so the pancreas stops producing it. Unlike Type 1 Diabetes there is still enough insulin in the body to prevent the breakdown of fats which leads to ketones. You will not see DKA in type 2 diabetes. However you may see another acute condition called Hyperglycemic Hyperosmolar NonKetotic Syndrome (HHNS). HHNS occurs when high blood sugar causes severe dehydraton in the client. The client's constant hyperglycemic state (blood sugar over 600) causes osmotic diuresis, resulting in water and electrolyte loss. 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. This is the potential risk for type 2 diabetics. 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, Native American, or Hispanic American Signs of type 2 diabetes include:

polyuria polydipsia polyphagia Clients may also experience blurry vision, poor wound healing, or frequent vaginal infections. 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. Exercise increases the effective of insulin binding to the cells. Exercise also lowers the blood glucose in diabetics. Eating a well balanced meal will also be emphasized during treatment. 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. 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; 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.

Rapid Acting Humalog, Novolog

Onset-15 mins Peak- 1 hour Duration- 3 hours Client Teaching-Give with meals Short Acting Humalog R, Novolin R Onset-1 hour Peak- 2 hours Onset- 4 hours Client Teaching- Clear appearance Only type that can be given IV Intermediate Acting NPH, Humulin N Onset-4 hours Peak-8 hours Duration- 12 hours Client Teaching- Cloudy appearance When mixing insulin draw Regular before Intermediate Think "clear before cloudy" Long Acting Lantus Onset 1 hour Peak- No peak (continuous) Duration- 24 hours Client Teaching- 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

Examples: Metformin, Byetta, Glucophage, Avandia Side Effects: GI disturbance (diarrhea, nausea, etc.) 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. Hypoglycemia (Low Blood Sugar) Blood glucose is less than 65 Signs:physical- trembling, tachy, shaking, hungry,weak, sweating mental- incoherent, combative, belligerent, slurred speech Cause: too much insulin too much exercise too little food Treatment: Give a fast acting sugar (candy, glucose tablet, 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, dehydration, weakness, tachy mental-confusion, incoherent, stupor, 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. Cataracts and blindness are common in diabetics, teach clients to get yearly eye exams. Atherosclerosis is the result of blood vessels becoming hard due to uncontrolled diabetes, proper diet and

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

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