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    MVC 3/22 EA > MS - Diabetes > Flashcards

    Flashcards in MS - Diabetes Deck (72)
    1

    In addition to promoting the transport of glucose from the blood into the cell, what does insulin do?
    a. Enhances the breakdown of adipose tissue for energy
    b. Stimulates hepatic glycogenolysis and gluconeogenesis
    c. Prevents the transport of triglycerides into adipose tissue
    d. Accelerates the transport of amino acids into cells and their synthesis into protein

    d. Accelerates the transport of amino acids into cells and their synthesis into protein

    Insulin is an anabolic hormone that is responsible for growth, repair, and storage. It facilitates movement of amino acids into cells, synthesis of protein, storage of glucose as glycogen, and deposition of triglycerides and lipids as fat into adipose tissue. Glucagon is responsible for hepatic glycogenolysis and gluconeogenesis. Fat is used for energy when glucose levels are depleted.

    2

    Which tissues require insulin to enable movement of glucose into the tissue cells (select all that apply)?
    a. Liver
    b. Brain
    c. Adipose
    d. Blood cells
    e. Skeletal muscle

    c. Adipose
    e. Skeletal muscle

    Adipose tissue and skeletal muscle require insulin to allow the transport of glucose into the cells. Brain, liver, and blood cells require adequate glucose supply for normal function but do not depend directly on insulin for glucose transport.

    3

    Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones?
    a. Decrease glucose production
    b. Stimulate glucose output by the liver
    c. Increase glucose transport into the cells
    d. Independently regulate glucose level in the blood

    b. Stimulate glucose output by the liver

    The counter regulatory hormones have the opposite effect of insulin by stimulating glucose production and output by the liver and by decreasing glucose transport into the cells. The counter regulatory hormones and insulin together regulate the blood glucose level.

    4

    What characterizes type 2 diabetes (select all that apply)?
    a. B-Cell exhaustion
    b. Insulin resistance
    c. Genetic predisposition
    d. Altered production of adipokines
    e. Inherited defect in insulin receptors
    f. Inappropriate glucose production by the liver

    (All of the above.)
    a. B-Cell exhaustion
    b. Insulin resistance
    c. Genetic predisposition
    d. Altered production of adipokines
    e. Inherited defect in insulin receptors
    f. Inappropriate glucose production by the liver

    Type 2 diabetes is characterized by insulin resistance, B-cell exhaustion, altered production of adipokines, genetic predisposition, inherited defect in insulin receptors, and inappropriate glucose production by the liver.

    5

    Which laboratory result would indicate that the patient has prediabetes?
    a. Glucose tolerance result of 132 mg/dL
    b. Glucose tolerance result of 240 mg/dL
    c. Fasting blood glucose result of 80 mg/dL
    d. Fasting blood glucose of 120 mg/dL

    d. Fasting blood glucose of 120 mg/dL

    Prediabetes is defined as impaired glucose tolerance and impaired fasting glucose or both. Fasting blood glucose results between 100 mg/dL (5.56 mmol/L) and 125 mg/dL (6.9 mmol/L) indicate prediabetes. A diagnosis of impaired glucose tolerance is made if the 2-hour oral glucose tolerance test (OGTT) results are between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L).

    6

    The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)
    a. Maintain a healthy weight.
    b. Exercise for 60 minutes each day.
    c. Have blood pressure checked regularly.
    d. Assess for visual changes on monthly basis.
    e. Monitor for polyuria, polyphagia, and polydipsia

    a. Maintain a healthy weight.
    e. Monitor for polyuria, polyphagia, and polydipsia

    To reduce the risk of developing diabetes, the patient with prediabetes should learn to monitor for symptoms of diabetes, have blood glucose and glycosylated hemoglobin (A1C) tested regularly, maintain a healthy weight, exercise regularly, and eat a healthy diet.

    7

    In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. What classic symptom is caused by the osmotic effect of glucose?
    a. Fatigue
    b. Polydipsia
    c. Polyphagia
    d. Recurrent infections

    b. Polydipsia

    Polydipsia is caused by fluid loss from polyuria when high glucose levels cause osmotic diuresis. Cellular starvation from lack of glucose and the use of body fat and protein for energy contribute to fatigue, weight loss, and polyphagia in type 1 diabetes.

    8

    Which patient should the nurse plan to teach how to prevent or delay the development of diabetes?
    a. An obese 50-year-old Hispanic woman
    b. A child whose father has type 1 diabetes
    c. A 34-year-old woman whose parents both have type 2 diabetes
    d. A 12-year-old boy whose father has maturity onset diabetes of the young (MODY)

    c. A 34-year-old woman whose parents both have type 2 diabetes

    Type 2 diabetes has a strong genetic influence and offspring of parents who both have type 2 diabetes have an increased chance of developing it. In contrast, type 1 diabetes is associated with a genetic susceptibility that is related to human leukocyte antigens (HLAs). Offspring of parents who both have type 1 diabetes have a 1% to 4% chance of developing the disease. Other risk factors for type 2 diabetes include obesity; being a Native American, Hispanic, or African American; and being 55 years or older. Although 50% of people with a parent with maturity-onset diabetes of the young (MODY) will develop MODY, it is autosomal dominant and treatment depends on which genetic mutation caused it. It is not associated with obesity or hypertension and is not currently considered preventable.

    9

    When caring for a patient with metabolic syndrome, what should the nurse give the highest priority to teaching the patient about?
    a. Achieving a normal weight
    b. Performing daily aerobic exercise
    c. Eliminating red meat from the diet
    d. Monitoring the blood glucose periodically

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    Metabolic syndrome is a cluster of abnormalities that include elevated glucose levels, abdominal obesity, elevated blood pressure, high levels of triglycerides, and low levels of high-density lipoproteins (HDLs). Overweight individuals with metabolic syndrome can prevent or delay the onset of diabetes through a program of weight loss. Exercise is also important but normal weight is most important.

    10

    Who of the following is at the highest risk for developing type 2 diabetes?
    a. A 44-year-old Native American Indian who has a body mass index (BMI) of 32.
    b. A 55-year-old Asian American who has hypertension and two siblings with type 2 diabetes.
    c. A child whose father has type I diabetes.
    d. An 62-year-old obese white man.

    b. A 55-year-old Asian American who has hypertension and two siblings with type 2 diabetes.

    11

    A client screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL. The nurse will plan to teach the client about
    a. Self-monitoring of blood glucose (accucheck at home)
    b. Use of low doses of regular insulin
    c. Lifestyle change to lower blood glucose
    d. Effect of oral hypoglycemic medications

    c. Lifestyle change to lower blood glucose

    12

    The client with type I diabetes mellitus is taught to take NPH (Humulin N) at 5 pm. each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?
    a. 11 a.m., shortly before lunch.
    b. 1 p.m., shortly after lunch.
    c. 6 p.m. shortly after dinner.
    d. 1 a.m., while sleeping.

    d. 1 a.m., while sleeping.

    13

    The nurse has been teaching the client to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the client that indicates a need for additional instruction is
    a. I need to rotate injection sites among my arms, legs, buttock, and abdomen each day
    b. I will buy the 0.5 ml syringes because the line marking will be easier to see
    c. I should draw up the regular insulin first after injecting air into the NPH bottle
    d. I do not need to aspirate the plunger to check for blood before injecting insulin

    a. I need to rotate injection sites among my arms, legs, buttock, and abdomen each day

    The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected.

    14

    Which information will the nurse include when teaching a 50-year-old client who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)?
    a. Glyburide decreases glucagon secretion from the pancreas.
    b. Glyburide stimulates insulin production and release from the pancreas.
    c. Glyburide should be taken even if the morning blood glucose level is low.
    d. Glyburide should not be used for 48 hours after receiving IV contrast media

    b. Glyburide stimulates insulin production and release from the pancreas.

    The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking the glyburide, because hypoglycemia can occur with this class of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide.

    15

    A client with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. The nurse should advise the client to
    a. Hold the regular dose of insulin
    b. Drink cool fluids with high glucose content
    c. Check the blood glucose level every 2 to 4 hours
    d. Use a less strenuous form of exercise than usual until the illness resolves

    c. Check the blood glucose level every 2 to 4 hours

    16

    An unresponsive client with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to
    a. give a bolus of 50% dextrose
    b. insert a large-bore IV catheter
    c. initiate oxygen by nasal cannula
    d. administer glargine (Lantus) insulin

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    HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patient’s blood glucose and would be contraindicated.

    17

    Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?
    a. Assess the patient for symptoms of hyperglycemia.
    b. Give the patient a snack of peanut butter and crackers.
    c. Have the patient drink a glass of orange juice or nonfat milk.
    d. Administer a continuous infusion of 5% dextrose for 24 hours.

    b. Give the patient a snack of peanut butter and crackers.

    Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration of IV glucose might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.

    18

    To monitor for complications in a client with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)?
    a. Chest x-ray
    b. Blood pressure
    c. Serum creatinine
    d. Urine for microalbuminuria
    e. Complete blood count
    f. Monofilament testing of the foot

    b. Blood pressure
    c. Serum creatinine
    d. Urine for microalbuminuria
    f. Monofilament testing of the foot

    Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible microvascular and macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the diabetic patient presents with symptoms of respiratory or infectious problems but are not routinely included in screening.

    19

    Which of the following statements is the characteristic of the pathophysiology in type 1 diabetes
    a. Insulin resistance in which body tissues do not respond to insulin
    b. Autoimmune destruction of Beta cells
    c. Compensatory overproduction of insulin
    d. Genetic predisposition

    b. Autoimmune destruction of Beta cells

    20

    In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose?
    a. Fatigue
    b. Polydipsia
    c. Polyphagia
    d. Recurrent infections

    b. Polydipsia

    21

    Which of the following diagnostic studies is useful in determining the degree of glucose control over the past 3 months?
    a. Random plasma glucose
    b. Fasting plasma glucose
    c. Glycosylated hemoglobin (A1C)
    d. Oral glucose tolerance test (OGTT)

    c. Glycosylated hemoglobin (A1C)

    22

    When should Lispro insulin (Humalog) be administered?
    a. Only once a day
    b. 1 hour before meals
    c. 30 to 45 minutes before meals
    d. At mealtime or within 15 minutes of meals

    d. At mealtime or within 15 minutes of meals

    23

    Kussmaul respirations is one of the symptoms indicating
    a. Hypoglycemia
    b. Somogyi effect
    c. Diabetic ketoacidosis (DKA)
    d. Hyperosmolar hyperglycemic syndrome (HHS)

    c. Diabetic ketoacidosis (DKA)

    24

    Which of the following characteristics does not match with the macrovascular complications of diabetes
    a. Damage to large and medium-size blood vessels
    b. Capillary and arteriole membrane thickening specific to diabetes
    c. Associated with obesity, smoking, hypertension, and unhealthy lifestyles
    d. Increase the risk for cardiovascular and cerebrovascular diseases

    b. Capillary and arteriole membrane thickening specific to diabetes

    25

    What manifestation should the nurse expect to find from a client diagnosed with syndrome of inappropriate antidiuretic hormone?
    a. Decreased body weight
    b. Decreased urinary output
    c. Increased plasma osmolality
    d. Increased serum sodium levels

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    26

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