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Chapter 51: Assessment and Management of Patients With Diabetes

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40 terms LnorthmanPreview Fluid a 33 terms Ale 1. A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding?

• The patient should withhold his next scheduled dose of insulin.
• The patient should promptly eat some protein and carbohydrates.
• The patient's insulin levels are inadequate.
• The patient would benefit from a dose of metformin (Glucophage).

: C

Feedback:

Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patient's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

• A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the

diagnosis of diabetes?

• Fasting plasma glucose greater than or equal to 126 mg/dL
• Random plasma glucose greater than 150 mg/dL
• Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions
• Random plasma glucose greater than 126 mg/dL

: A

Feedback:

Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.

• A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients

at this class?

• Low fat generally indicates low sugar.
• Protein should constitute 30% to 40% of caloric intake.
• Most calories should be derived from carbohydrates.
• Animal fats should be eliminated from the diet.

: C

Feedback:

Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

• A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the

patient and family that which of the following nonpharmacologic measures will decrease the body's need for insulin?

• Adequate sleep
• Low stimulation
• Exercise
• Low-fat diet

: C

Feedback:

Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patient's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.

• A medical nurse is caring for a patient with type 1 diabetes. The patient's medication administration record includes the administration of

regular insulin three times daily. Knowing that the patient's lunch tray will arrive at 11:45, when should the nurse administer the patient's insulin?

A) 10:45

B) 11:15

C) 11:45

D) 11:50

: B

Feedback:

Regular insulin is usually administered 20-30 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.

• A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production

of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?

• A sulfonylurea
• A biguanide
• A thiazolidinedione
• An alpha glucosidase inhibitor

: B

Feedback:

Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels.Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

• A diabetes nurse educator is teaching a group of patients with type 1 diabetes about "sick day rules." What guideline applies to periods of

illness in a diabetic patient?

• Do not eliminate insulin when nauseated and vomiting.
• Report elevated glucose levels greater than 150 mg/dL.
• Eat three substantial meals a day, if possible.
• Reduce food intake and insulin doses in times of illness.

: A

Feedback:

The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur.Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates.In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.

• The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address what topic during this dialogue?
• The need for frequent eye examinations for patients with diabetes
• The fact that patients with diabetes have an elevated risk of myocardial infarction
• The relationship between kidney function and blood glucose levels
• The need to monitor urine for the presence of albumin

: B

Feedback:

Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and renal function are considered to be microvascular.

• A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest

potential to reduce an individual's risk for developing diabetes?

• Have blood glucose levels checked annually.
• Stop using tobacco in any form.
• Undergo eye examinations regularly.
• Lose weight, if obese.

: D

Feedback:

Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.

• A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes.

Based on the fact that the child's pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes?

• Type 1 diabetes
• Type 2 diabetes
• Non-insulin-dependent diabetes
• Prediabetes

: A

Feedback:

Beta cell destruction is the hallmark of type 1 diabetes. Non-insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.

• A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the

etiology of type 1 diabetes, what process should the nurse describe?

• "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase."
• "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it."
• "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin."
• "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it

down."

: D

Feedback:

Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not "make" glucose.

• An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of

diabetes?

• "I've always been a fan of sweet foods, but lately I'm turned off by them."
• "Lately, I drink and drink and can't seem to quench my thirst."
• "No matter how much sleep I get, it seems to take me hours to wake up."
• "When I went to the washroom the last few days, my urine smelled odd."

: B

Feedback:

Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

• A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment

for type 2 diabetes when the patient states what?

• "I read that a pancreas transplant will provide a cure for my diabetes."
• "I will take my oral antidiabetic agents when my morning blood sugar is high."
• "I will make sure to follow the weight loss plan designed by the dietitian."
• "I will make sure I call the diabetes educator when I have questions about my insulin."

: C

Feedback:

Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.

• A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the

ADA's recommendations include?

• 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein
• 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein
• 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein
• 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

: D

Feedback:

Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.