ATI Chapter 39 NCLEX PREP Questions, EXAM 6 USE THIS: Chapter 37 Care of

ATI Chapter 39 NCLEX PREP Questions, EXAM 6 USE THIS: Chapter 37 Care of

Patients with Diabetes and Hypoglycemia ScienceMedicineNursing Kaycee_Felan Save Diabetes Mellitus NCLEX Style Ques...Teacher 36 terms ssandholmPreview ATI diabetes 30 terms cousinmaryvick Preview diabetes/hyperglycemia nclex ques...10 terms WendeesuePreview ATI pra 49 terms hal A nurse is teaching clients in an output facility about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak 1 to 5 hr after administration.

• Insulin glargine (Latus)
• NPH insulin (Humulin N)
• Regular insulin (Humulin R)
• Insulin lispro (Homolog)
• Regular insulin (Humulin R)

Regular insulin has a peak effect around 1 to 5 hr following administration A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide (Prandin). Which of the following statements made by the client indicates understanding of the administration of this medication?

• " I'll take this medicine with my meals"
• " I'll take this medicine 30 minutes before I eat"
• " I'll take this medicine just before I go to bed"
• " I'll take this medicine as soon as I wake up in the morning"
• " I'll take this medicine 30 minutes before I eat"

Repaglinide causes a rapid, short-lived release of insulin. The client should take this medication within 30 minutes before each meal so that insulin is available when food is digested.

A nurse is caring for a client who has a prescription for metformin (Glucophage). The nurse should monitor the client for which of the following adverse effects?

• Lactic acidosis
• Hypoglycemia
• Hyperlipidemia
• Respiratory alkalosis
• Lactic acidosis

Lactic acidosis, manifested by extreme drowsiness, hyperventilation, and muscle pain, is rare but very serious adverse effect caused by metformin.A nurse is providing teaching to a client who has a prescription for pramlintide (Symlin) for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply)

• "Take oral medications 1 hr before injection"
• "Use upper arms as preferred injection sites"
• "Mix pramlintide with breakfast dose of insulin"
• "Inject pramlintide just before a meal"
• "Discard open vials after 28 days"
• "Inject pramlintide just before a meal"

Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medication.

• "Discard open vials after 28 days"

Unused mediation in the open pramlintide vial should be discarded after 28 days.A nurse is caring for a client in an outpatient facility who has been taking acarbose (Precose) for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor.

A. WBC

• Serum potassium
• Platelet count
• Liver function tests
• Liver function tests

Acarbose can cause liver toxicity when taken long-term. Liver function tests should be monitored periodically while the client takes this medication.The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin?

• A pituitary disorder inhibits beta cells.
• An allergic response alters beta cell responses to hyperglycemia.
• Alpha cells proliferated in the islets of Langerhans.
• The body's immune system destroyed beta cells.

ANS: D

In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction.

Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes?

• 70%
• 75%
• 80%
• 95%

ANS: D

Type 2 diabetics comprise 90% to 95% of all known cases.The nurse is educating a patient with gestational diabetes. Which statement indicates that the patient needs additional teaching?a "Gestational diabetes happens because of the hormonal changes of pregnancy." b."I should exercise regularly and lose weight to reduce my risk of becoming a diabetic." c."This problem goes away completely once I give birth."

• "The baby will have to be monitored for hypoglycemia during my pregnancy."

ANS: C

Giving birth does not automatically resolve gestational diabetes. Of the women who have gestational diabetes, 5% to 10% go on to develop type 2 diabetes.A patient asks the nurse if stress can be a potential cause of type 2 diabetes. Which response is most appropriate for the nurse to make?

• "Stress decreases the number of alpha cells in the pancreas, and increases the workload on the beta cells."
• "Periods of stress cause increases in glycogen production by the adrenal cortex."
• "Stress is directly associated with decreased insulin tolerance."
• "The inhibition of beta cells to glucose is increased in periods of stress."

ANS: B

Stress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia.The nurse is counseling an overweight, noncompliant, 30-year-old female with type 2 diabetes. Which change is most important for the nurse to suggest?

• Begin an exercise program and lose weight.
• Obtain annual eye examinations.
• Keep a food diary.
• Inspect feet daily.

ANS: A

All of these changes are important, but exercise and weight loss are priority changes. In the type 2 diabetic, weight reduction and increased physical activity can restore blood glucose to normal levels and maintained it—hence the importance of diet and exercise in the management of type 2 diabetes.The nurse is educating the patient about the significance of islet cell antibodies. Which statement accurately describes islet cell antibodies?

• Islet cell antibodies cause beta cells to quit producing insulin and lead to type 1 diabetes mellitus (DM).
• Islet cell antibodies protect beta cells from viral attack.
• Islet cell antibodies increase production of insulin from beta cells.
• Islet cell antibodies decrease the size of the pancreas.

ANS: A

The antibodies cause beta cells to quit production of insulin.

The nurse is educating a 50-year-old patient about diabetes monitoring. Which statement reinforces the American Diabetes Association's (ADA's) recommendation?

• Obtain regularly scheduled fasting blood glucose levels.
• Strictly adhere to weight reduction diets.
• Exercise regularly in intervals lasting a minimum of 30 minutes.
• Use stress reduction techniques.

ANS: A

The ADA recommends screening with a fasting blood glucose. Adherence to a weight loss plan, regular exercise, and stress reduction techniques help control diabetes but do not monitor it.A patient recently diagnosed with type 1 diabetes mellitus (DM) asks why she is experiencing increased thirst. Which explanation is most appropriate?

• Diabetes results in a lack of protein absorption that decreases amino acids and causes increased thirst.
• High glucose levels in the blood pull cellular water into circulating volume and increase thirst.
• Thirst results from the body's increased loss of fluids from frequent urination.
• Diabetes causes large amount of fluid to shut to the pancreas, which dehydrates the body.

ANS: B

Polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling intracellular fluid into the circulating volume.The nurse is caring for a patient with ketosis. Which statement indicates that the patient correctly understands the phenomenon?

• "I took too much insulin to decrease my body's glucose levels."
• "The condition resulted when my body tried to break down and use my stores of fats."
• "My blood glucose went over 150 mg/dL and caused this condition."
• "I exercised too much reduced my blood glucose level too dramatically."

ANS: B

People with type 1 diabetes are more prone to a serious complication, ketosis, associated with an excess production of ketone bodies, leading to ketoacidosis (metabolic acidosis). When the glucose level gets too high, the body attempts to metabolize fats for energy, and the result is a buildup of ketone bodies.The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy. The patient complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next?

• Administer insulin as scheduled.
• Notify the charge nurse.
• Give 6 ounces of orange juice.
• Document the findings.

ANS: C

These findings are consistent with hypoglycemia; manifestations of hypoglycemia include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Management includes providing a source of quick-acting carbohydrate/glucose such as orange juice.The nurse should withhold the patient's scheduled insulin