Nursing Care of Patients With Disorders of the Endocrine Pancreas

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. A patient is experiencing rapid deep breathing, fruity odor, lethargy, and weight loss. Laboratory results include a blood glucose of 720 mg/dL. Which symptom should indicate to the nurse that the patient has type 1 diabetes mellitus?
a. Thirst
b. Hunger
c. Lethargy
d. Fruity odor
____ 2. The nurse is reviewing the causes for the development of type 1 diabetes mellitus with a patient who is newly diagnosed with the disorder. What major factor in the development of this disease should the nurse include?
a. Obesity
b. A high-fat diet
c. An autoimmune response
d. A diet high in concentrated carbohydrates
____ 3. A patient with type 1 diabetes mellitus asks what caused the fruity odor that was present at diagnosis. How should the nurse respond?
a. “Excess sugar is excreted in the urine, which causes the fruity odor.”
b. “The proteins in the blood are metabolized to a substance that has a fruity odor.”
c. “The excess sugar in the blood is metabolized to fructose and excreted via the lungs.”
d. “In the absence of available sugar, the body breaks down fat into ketones, which have a fruity odor.”
____ 4. A patient is newly diagnosed with type 1 diabetes mellitus. How should the nurse respond when the patient asks how long insulin injections will be necessary?
a. “You will need insulin injections for the rest of your life.”
b. “Once your pancreas recovers, you may be able to discontinue the injections.”
c. “If you follow your diet closely, your blood sugar may be controlled by just taking insulin pills.”
d. “You may be able to stop the injections if you exercise regularly and adhere to the prescribed diet.”
____ 5. The nurse is assisting with nutrition teaching for a patient who voices concern over coping with a diabetic diet. What response about medical nutrition therapy is correct?
a. “You will have a well-balanced, individualized meal plan that will be healthy for your whole family.”
b. “You will need to avoid sugars and fats, but the dietitian will assist you in finding acceptable alternatives.”
c. “Your diabetes will require special foods, but many stores now stock a variety of choices for people with diabetes.”
d. “Medical nutrition therapy stresses high protein and low carbohydrate intake, but most people readily adapt to these restrictions.”
____ 6. The nurse is providing care for a marathon runner who is newly diagnosed with diabetes mellitus. What explanation about exercise is best for the nurse to provide?
a. “You will need to avoid regular exercise since it will lower your blood sugar.”
b. “You can still exercise, but running is too strenuous for someone with diabetes.”
c. “You should always take some emergency glucose with you when you are running.”
d. “Exercise is best done when insulin is peaking, so it is important to know the onset and peak of your type of insulin.”
____ 7. The nurse is reinforcing teaching for a patient who is on four injections of regular insulin daily. About how many hours after each injection of insulin should the nurse teach the patient to be alert for symptoms of hypoglycemia?
a. 1/2 hour
b. 3 hours
c. 8 hours
d. 12 hours
____ 8. The nurse teaches a patient to self-administer insulin. How can the nurse best evaluate whether the patient understands the instructions?
a. Observe as the patient prepares and injects a dose of insulin.
b. Have the patient list the steps of the procedure for insulin administration.
c. Ask the patient an open-ended question about feelings related to the procedure.
d. Ask the patient to repeat the information in the insulin pamphlet that was provided.
____ 9. The nurse is caring for a patient with diabetes. For which symptom should the nurse be the most concerned?
a. Fatigue
b. Heartburn
c. Diaphoresis
d. Muscle cramps
____ 10. The nurse is assisting with a group class on complications of diabetes. Which information should the nurse include as factors that can precipitate hyperglycemia?
a. Skipping meals
b. Stress or illness
c. Frequent urination
d. Drinking too much water
____ 11. The LPN answers the call light of a patient with diabetes. The patient has a mild tremor, slight diaphoresis, and is fully oriented. What should the nurse do?
a. Check the patient’s blood glucose level.
b. Call the laboratory for a STAT glucose level.
c. Call the RN to administer dextrose 50% intravenously.
d. Administer 4 oz of orange juice with one packet of sugar.
____ 12. A patient asks what can be done to prevent long-term complications of diabetes. What should the nurse respond to this patient’s question?
a. Regularly inspect feet.
b. Carefully control blood glucose.
c. Limit fluids to prevent stress to kidneys.
d. Keep orange juice with sugar available at all times.
____ 13. A patient is admitted to the hospital with hyperosmolar hyperglycemia. The patient is 40% overweight and has a blood glucose value of 987 mg/dL. What is the priority nursing diagnosis for this patient?
a. Ineffective Self Health Management
b. Deficient Fluid Volume related to osmotic diuresis
c. Noncompliance related to diabetes self-care regimen
d. Imbalanced Nutrition: More Than Body Requirements
____ 14. A patient with diabetes has peripheral neuropathy. What should the nurse do to prevent related complications?
a. Wash, dry, and inspect feet daily.
b. Use a lubricating lotion on feet daily.
c. Avoid wearing shoes as much as possible.
d. Soak feet in soap and water for 20 minutes daily.
____ 15. A standard care plan for impaired skin integrity has been implemented for a patient with a small sore on the sole of the left foot. What action should the nurse use to evaluate the effectiveness of the plan?
a. Monitor and record blood glucose levels daily.
b. Assess and document the wound condition daily.
c. Observe the patient’s ability to change the dressing.
d. Assess the patient’s understanding of preventive foot care.
____ 16. A patient on an American Diabetes Association (ADA) exchange list diet receives a dinner meal tray and does not wish to eat the rice. Which food should the nurse substitute for the rice?
a. A slice of bread
b. A 4-oz glass of juice
c. A half cup of custard
d. A half cup of cottage cheese
____ 17. A patient being seen for diabetes at an outpatient clinic has a hemoglobin A1c level of 14%. On what conclusion should the nurse base further assessment?
a. The patient has not been following the treatment regimen at home.
b. The patient’s blood glucose levels have been elevated for the last 2 to 3 months.
c. The patient may have had numerous hypoglycemic episodes during the last month.
d. The patient generally adheres to the treatment regimen but has had increased carbohydrate intake in the last 3 months.
____ 18. The nurse is caring for a patient who has not been diagnosed with diabetes. Which serum glucose result should the nurse expect on routine laboratory work?
a. 45 mg/dL
b. 88 mg/dL
c. 115 mg/dL
d. 270 mg/dL
____ 19. A female patient is prescribed glyburide (DiaBeta) for control of blood glucose. What precaution should the nurse teach the patient about this medication?
a. “Avoid drinking alcohol.”
b. “Do not take it if you skip a meal.”
c. “You will need to use two forms of birth control.”
d. “Be sure it is discontinued before any tests involving contrast dye.”
____ 20. The nurse is preparing to discuss long-term complications of diabetes with a patient newly diagnosed with the disorder. Which structure should the nurse identify as causing complications because of underlying damage?
a. Heart
b. Liver
c. Brain
d. Blood vessels
____ 21. A patient at home with type 1 diabetes has a glucose level of 324 mg/dL. It is usually less than 150 mg/dL. What should the patient do first?
a. Call the physician.
b. Have a glass of orange juice.
c. Check the urine for ketones and drink water.
d. Exercise and recheck glucose level in 2 hours.
____ 22. A patient whose blood glucose level ranges between 150 to 200 mg/dL has an episode of hypoglycemia. Which patient activity most likely caused the hypoglycemia?
a. Took a nap
b. Took a bicycle ride
c. Went to a birthday party
d. Received news of a pay raise
____ 23. A patient being treated with rosiglitazone (Avandia) for type 2 diabetes mellitus is receiving a routine follow-up assessment. In addition to hemoglobin A1c and a fasting plasma glucose test, which other laboratory test should the nurse expect to be monitored in this patient?
a. Blood lipids
b. Liver function tests
c. Urine for microalbumin
d. Complete blood count (CBC)
____ 24. A patient is diagnosed with hypoglycemia. What glucose level should the nurse expect when monitoring the capillary blood glucose?
a. 65 mg/dL
b. 100 mg/dL
c. 138 mg/dL
d. 200 mg/dL
____ 25. The nurse is reviewing goals for blood glucose monitoring with a patient newly diagnosed with type 2 diabetes mellitus. What pre-prandial blood glucose goal should the nurse instruct the patient to achieve?
a. 50 to 100 mg/dL
b. 60 to 100 mg/dL
c. 70 to 130 mg/dL
d. 80 to 150 mg/dL
____ 26. The nurse is caring for a patient in the critical care unit. What should the nurse identify as a goal for this patient’s blood glucose levels?
a. 50 to 100 mg/dL
b. 100 to 150 mg/dL
c. 140 to 180 mg/dL
d. 180 to 240 mg/dL
____ 27. A patient comes into the clinic with complaints of extreme thirst, extreme urination, and ongoing hunger. Which blood glucose level should the nurse use to determine if the patient has diabetes?
a. 110 mg/dL
b. 126 mg/dL
c. 185 mg/dL
d. 210 mg/dL
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 28. The nurse is preparing to administer insulin to a patient with type 1 diabetes mellitus. Which sites should the nurse consider for this injection? (Select all that apply.)
a. Forearm
b. Buttocks
c. Abdomen
d. Anterior thigh
e. Ventrogluteus
f. Posterior aspect of the arm
____ 29. The nurse is providing teaching to a patient with reactive hypoglycemia. Which instructions related to glucose monitoring should the nurse provide? (Select all that apply.)
a. “It is important to check your blood sugar at bedtime.”
b. “It is important to check blood sugar 1 hour before meals.”
c. “You will need to check your blood sugar 2 hours after meals.”
d. “You should check your blood sugar when you get up in the morning.”
e. “Two hours before each meal is the best time to check your blood sugar.”
f. “Checking your blood sugar once a day, at the same time each day, is sufficient.”
____ 30. A patient is diagnosed with diabetic ketoacidosis (DKA). Which manifestations should the nurse expect to observe in this patient? (Select all that apply.)
a. Dehydration
b. Hypertension
c. Flulike symptoms
d. Kussmaul’s respirations
e. Cheyne-Stokes respirations
f. Edema associated with fluid overload
____ 31. The nurse is reviewing the goals and recommendations of the American Diabetes Association (ADA) prior to planning a patient’s care. What should the nurse keep in mind for this patient? (Select all that apply.)
a. Aspirin therapy
b. Yearly flu vaccine
c. Hemoglobin A1c less than 7%
d. Blood pressure less than 150/90 mm Hg
e. Statin therapy for patients over 40 years old
f. Peak postprandial capillary glucose less than 180 mg/dL
____ 32. A patient with type 1 diabetes mellitus is prescribed insulin glargine (Lantus). What should the nurse instruct the patient about this medication? (Select all that apply.)
a. It can be inhaled.
b. It is not injectable.
c. It has no peak action time.
d. It has a duration of 24 hours.
e. It cannot be mixed with other insulin.
____ 33. A patient with type 2 diabetes mellitus is prescribed metformin (Glucophage). What should the nurse assess and monitor in this patient? (Select all that apply.)
a. Weight gain
b. Fluid retention
c. Family history of glaucoma
d. Presence of renal or hepatic disease
e. Presence of congestive heart failure (CHF)
f. Need for diagnostic tests involving use of contrast dyes
____ 34. The nurse is teaching a patient about the HbA1c laboratory test. Which patient statements indicates teaching has been effective? (Select all that apply.)
a. “The test shows long-term blood sugar control.”
b. “This test can be used to help diagnose diabetes.”
c. “The test can be done in the physician’s office while I’m waiting.”
d. “The test looks back at blood sugar averages over the past 6 months.”
e. “If I eat anything with sugar in it the day before the test, it will show up on the test.”
f. “This test can help determine if my treatment plan is managing my diabetes effectively.”
____ 35. The nurse is caring for a patient with type 2 diabetes mellitus. Which symptoms should the nurse recognize as indicating the patient is experiencing a Somogyi effect? (Select all that apply.)
a. Patient reports night sweats.
b. Bedtime glucose is 110 mg/dL.
c. Fasting morning glucose is 80 mg/dL.
d. Fasting morning glucose is 264 mg/dL.
e. Patient complains of headaches in the morning.
f. Blood glucose is rising despite increased doses of insulin.
____ 36. After completing a health interview the nurse is concerned that a patient is at risk for developing type 2 diabetes mellitus. What information did the nurse use to make this determination? (Select all that apply.)
a. BMI 33
b. Belongs to a book club
c. Mother has type 2 diabetes mellitus
d. Recently was downsized from employment
e. First cousin killed in an automobile crash
____ 37. A patient diagnosed with prediabetes asks what can be done to prevent the development of the disease. What should the nurse recommend to this patient? (Select all that apply.)
a. Exercise
b. Lose weight
c. Stop smoking
d. Eliminate all starches from the diet
e. Avoid red meat and root vegetables
____ 38. The nurse is reinforcing teaching on diet therapy provided to a patient with type 2 diabetes mellitus. Which patient explanations about create your plate indicate that teaching has been effective? (Select all that apply.)
a. Half the plate is protein
b. Divide the plate into 4 quarters
c. One quarter of the plate is fruit
d. One 8 ounce glass of low-fat milk
e. Half the plate is non-starchy vegetables
Completion
Complete each statement.

39. A patient is upset to learn that a recent hemoglobin A1c level is 10.3%. What should the nurse provide as the patient’s average blood glucose level based upon this percentage if the equation 28.7 ´ HbA1c – 46.7 is used? (Round to the nearest whole number.)

Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas
Answer Section

MULTIPLE CHOICE

1. ANS: D
Fruity odor occurs with ketoacidosis in type 1 diabetes, which is very rare in type 2. A. B. C. The symptoms can occur in either type 1 or type 2 diabetes mellitus.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis

2. ANS: C
In type 1 diabetes, it is believed that the pancreas may attack itself following certain viral infections or administration of certain drugs; this is called an autoimmune response. Almost 90% of patients newly diagnosed with type 1 diabetes have islet cell antibodies in their blood. B. D. Diet can be a risk factor in many disorders but does not directly cause diabetes. A. Obesity is a risk factor for type 2 diabetes.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

3. ANS: D
The expired air has a fruity odor caused by the ketones which occurs when fat is broken down and may be mistaken for alcohol. Some nurses have likened the odor to Juicy Fruit gum. A. B. C These responses do not correctly describe the process for the fruity odor.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

4. ANS: A
Unless the patient receives a pancreas or islet cell transplant, insulin will be required for life. B. The pancreas will not recover. D. Patients with type 1 diabetes must have insulin to survive. C. Oral insulin is not available.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

5. ANS: A
Because all diabetic nutrition recommendations emphasize low fat intake and balanced intake of other food groups, it is healthy for the whole family. B. Patients with diabetes do not have to avoid all sugars and fats. D. High protein is not recommended; low protein may be necessary if nephropathy occurs. C. Special foods are not necessary.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

6. ANS: C
Persons with diabetes should always carry a quick source of sugar when exercising in case the blood glucose drops too low. D. Individuals on intermediate-acting insulin are taught to avoid exercising at the time of day when their blood glucose is at its lowest point (i.e., when insulin or medication is peaking) and to have a carbohydrate snack before exercising if blood glucose is less than 100 mg/dL. A. Exercising at similar times each day also helps prevent blood glucose fluctuations. B. Running is not too strenuous for someone who is used to doing it, but patients with neuropathy or foot problems should consult with a physician first.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis

7. ANS: B
Regular insulin peaks in 2 to 5 hours, so blood sugar will be lowest at this time. A. C. D. Onset is a half hour, and duration is 5 to 8 hours.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

8. ANS: A
Observing the patient as he or she demonstrates injection is the most objective measure. B. C. D. These are good additional steps, but they are not the best way to evaluate effectiveness of teaching.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Evaluation

9. ANS: C
Tremor and sweating are sympathetic symptoms of hypoglycemia. Treatment of hypoglycemia is more urgent than treatment of hyperglycemia. A. Thirst, fatigue, and glycosuria are symptoms of hyperglycemia. B. Heartburn is more commonly related to gastric acid secretion. D. Muscle cramps are more commonly related to electrolyte imbalances.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

10. ANS: B
Stress or illness causes release of stress hormones, which are associated with hyperglycemia. A. Skipping meals causes hypoglycemia. C. D. Thirst and urination are symptoms of hyperglycemia, not causes.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

11. ANS: A
Since the patient is oriented, there is time to check the blood glucose. B. Calling the laboratory takes too long and is unnecessary. D. Giving orange juice or another CHO (carbohydrate) source will be the next step, but adding sugar increases the risk of hyperglycemia. C. 50% dextrose is used if the patient is unable to take oral CHO.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

12. ANS: B
Over time, chronic hyperglycemia causes a variety of serious complications in persons with diabetes. The Diabetes Control and Complications Trial showed that individuals with type 1 diabetes who maintain tight control of blood glucose experience fewer long-term complications than individuals who take traditional care of their diabetes. A. Feet should be inspected daily, but this is not the most important strategy to prevent complications. C. Fluids are only limited in patients who already have end-stage nephropathy. D. Orange juice (without sugar) is good to have on hand but will not prevent long-term complications.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

13. ANS: B
Hyperosmolar hyperglycemia causes diuresis and dehydration. A. C. D. Dehydration and diuresis is more immediately life threatening than noncompliance, ineffective health management, or imbalanced nutrition.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis

14. ANS: A
The feet must be washed, dried, and inspected daily to recognize pressure points or red areas before they turn into problems. D. Soaking feet can macerate skin. C. Well-fitting shoes protect the feet. B. Lubricating lotion is a good idea but is only one way to protect the feet and is not as essential as daily washing and inspection for the patient with neuropathy.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

15. ANS: B
Evaluation must address skin integrity—assessing and documenting wound condition is the only response that does this. A. Monitoring glucose levels evaluates diabetes control, not skin integrity. C. D. Assessing the patient’s understanding or observing a dressing change evaluates the patient’s knowledge, not skin integrity.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Evaluation

16. ANS: A
Rice and bread are both starches. C. D. Cottage cheese and custard are in the milk group. B. Juice is a fruit.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

17. ANS: B
A normal HbA1c is 4% to 6%. Glucose in the blood attaches to hemoglobin in the red blood cells, which live about 3 months. When the glucose that is attached to the hemoglobin is measured, it reflects the average blood glucose level for the previous 2 to 3 months. A. C. D. The result simply shows that glucose has been high, not the reason behind it.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

18. ANS: B
According to the American Diabetes Association a normal plasma glucose level is less than 100 mg/dL. A. This is considered hypoglycemia. C. If the fasting plasma glucose is between 100 and 125 mg/dL, the patient has prediabetes. D. A value over 126 mg/dL is diabetes.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

19. ANS: A
Sulfonylureas interact with alcohol and can make the patient very ill. B. This action should be taken for meglitinides and alpha-glucosidase inhibitors. D. This action should be taken for metformin. C. Glitazones may interfere with birth control.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

20. ANS: D
Most of the complications of diabetes involve either the large blood vessels in the body (macrovascular complications) or the tiny blood vessels, such as those in the eyes or kidneys (microvascular complications). A. C. Damage to the blood vessels can affect the brain or heart. B. Liver complications are not common in diabetes.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

21. ANS: C
Patients with type 1 diabetes are at risk of ketoacidosis when blood glucose is out of control. Hydration is important. Checking the urine for ketones can help determine if ketoacidosis is developing. B. Orange juice will further increase blood glucose. A. The physician should be contacted if it remains high or if ketones are present. D. Exercise is not recommended when glucose is high.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

22. ANS: B
Exercise can lower blood glucose. C. D. Eating at a party or stress (such as a pay raise) can raise glucose. A. Taking a nap should not affect it.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

23. ANS: B
Liver function must be monitored in patients taking glitazones. A. C. Lipids and microalbumin are important to monitor in any diabetic patient but are not unique to glitazones. D. CBC is nonspecific.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Analysis

24. ANS: A
Hypoglycemia is usually defined as a blood glucose level below 70 mg/dL, although patients may feel symptoms at higher or lower levels. B. This is a normal blood glucose level. C. D. These levels indicate hyperglycemia.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

25. ANS: C
Preprandial glucose should be 70 to 130 mg/dL to maintain control and reduce risk of complications. A. B. D. These are not recognized pre-prandial blood glucose goals.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

26. ANS: C
In 2009, the American Diabetes Association (ADA) and American Association of Clinical Endocrinologists determined that glucose levels in critically ill hospitalized patients should be maintained between 140 and 180 mg/dL, preferably with the use of IV insulin. A. B. D. These are not recognized blood glucose level goals for a patient who is critically ill.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

27. ANS: D
Diabetes is diagnosed if the random plasma glucose is 200 mg/dL or greater, with symptoms of diabetes. A. B. C. These levels will not be used to determine if the patient has diabetes.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

MULTIPLE RESPONSE

28. ANS: B, C, D, F
The abdomen, back of the arm, buttocks, and thigh have adequate subcutaneous tissue for injection. E. The ventrogluteus is a muscle. A. The forearm does not have adequate subcutaneous tissue.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

29. ANS: A, C, D
Low blood glucose may occur as an overreaction of the pancreas to eating. The pancreas senses a rising blood glucose and produces more insulin than is necessary for the use of that glucose. As a result, the blood glucose drops to below normal. Readings should be taken in the morning on arising, 2 hours after each meal, at bedtime, and during symptoms of hypoglycemia. These results may then be taken to the physician for interpretation. B. E. F. Checking blood glucose levels at these times will not help the patient control reactive hypoglycemia.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

30. ANS: A, C, D
The body attempts to compensate for acidosis by deepening respirations, thereby blowing off excess carbon dioxide. The deep, sighing respiratory pattern is called Kussmaul’s respirations. F. With such high blood glucose and the accompanying polyuria, the body becomes dehydrated very quickly. B. Tachycardia, hypotension, and shock can result. Acidosis also causes potassium to leave the cells and accumulate in the blood (hyperkalemia). Potassium is then lost in large amounts in the urine. The combination of dehydration, potassium imbalance, and acidosis causes the patient to develop flulike symptoms, including abdominal pain and vomiting. The patient loses consciousness and death occurs if DKA is not treated. E. Cheyne-Stokes respirations are not associated with diabetes.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis

31. ANS: A, B, C, E, F
The ADA recommends all of the goals. D. Blood pressure should be less than 140/80 mm Hg.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

32. ANS: C, D, E
This insulin has not peak action time, lasts 24 hours, and cannot be mixed with any other insulins. B. Lantus is injected subcutaneously. A. It cannot be inhaled.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

33. ANS: B, C, D, E, F
Withhold if the patient is having tests involving contrast dye. It is contraindicated in renal and hepatic disease and CHF. Notify physician of early symptoms of lactic acidosis: hyperventilation, myalgia, and malaise. A. Glucophage may enhance weight loss, not gain. C. A family history of glaucoma is not a contraindication for this medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

34. ANS: A, B, C, F
The hemoglobin A1c is used to gather baseline data and to monitor progress of diabetes control. In 2009, the American Diabetes Association (ADA) also changed its guidelines to include the HbA1c as a diagnostic test for diabetes. It also assists in determining the degree of effectiveness of a patient’s treatment plan. Newer methods allow this test to be done in a physician’s office while the patient waits. D. E. It reflects the average blood glucose level for the previous 2 to 3 months.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

35. ANS: A, D, E, F
The Somogyi effect may be at fault when the patient’s blood glucose seems to be rising in spite of increasing insulin doses. If insulin levels are too high, the blood glucose may drop too low, stimulating release of counterregulatory hormones (epinephrine, glucagon, corticosteroids, growth hormone) that then elevate the blood glucose. The low glucose levels often occur during the night, and the patient may report night sweats or morning headaches. The high morning glucose is then interpreted as hyperglycemia, and the insulin dose may be further increased, compounding the problem. B. C. These are not manifestations of the Somogyi effect.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

36. ANS: A, C, D, E
Heredity is responsible for up to 90% of cases of type 2 diabetes. Obesity is also a major contributing factor. Often the patient with a new diagnosis of type 2 diabetes is obese, relates a family history of diabetes, and has had a recent life stressor such as the death of a family member, illness, or loss of a job. B. Belonging to a book club would not increase this patient’s risk of developing type 2 diabetes mellitus.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

37. ANS: A, B
Those with prediabetes may be able to prevent the onset of diabetes with weight loss and exercise. C. Smoking does not influence the development of the disease. D. E. The patient should not be encouraged to eliminate a type or category of food.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

38. ANS: D, E
Half the plate is filled with non-starchy vegetables. An 8 ounce glass of nonfat or low-fat milk completes the meal. B. When creating the plate, the place should be divided into one half and two quarters. C. One quarter is filled with starchy foods, such as whole grains and starchy vegetables. Fruit should be one serving A. The last quarter is used for meats and meat substitutes.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

COMPLETION

39. ANS:
249
When using this equation, the patient’s average blood glucose level is calculated as being: 28.7 ´ 10.3 – 46.7 = 248.91. With rounding, it would be 249 mg/dL.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application