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Chapter 46 MSIII

Chapter 46 Stem Questions

1. The nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce enough insulin so my blood glucose is elevated because of: Viral infection that may cause destruction of the beta cells and development of insulin antibodies and prodution of islet cell antibodies. pg 1002 and slide 5-6
2. When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a pill instead of insulin, you reply that in type 2 diabetes, the body makes insulin but: specific receptor sites become insulin resistant (the beta cells are desensitized) and the body isn't able to use the glucose. pg 1002, slide 7
3. A patient tells the nurse that she eats "huge" amounts of food but stays hungry most of the time. The nurse explains that hunger experienced by persons with type 1 diabetes is caused by the: tissue breakdown and loss of lean body mass. Without insulin, the extra glucose cannot be used. pg 1002, slide 8
4. The nurse stresses that the type 1 diabetic is at risk for cardiovascular disorders because lack of insulin causes: Increased fatty acids and triglycerids, which increase lipo-proteins, which leads to atherosclerosis. pg 1002, slide 9
5. The goal of diabetic self care is to keep the patient's blood sugar leve normal. Hyperglycemia occurs when: insulin secretion is inadequate, glycogen is converted to glucose in an attempt to nourish glucose-starved cells, but the cells cannot use the glucose. pg 1002
6. The young patient complains that diabetes is causing her to "have no life at all..... It's too hard." The most helpful response is: something therapeutic. Show emotional support, prepare, tell what to expect, explore feelings/concerns, support, guide, ask questions, etc. pg 1028
7. When the type 2 diabetic patient says, "Why in the world re they looking at my hemoglobin? I thought my problem was with my blood sugar." The nurse responds that the level of hemoglobin A1c: reflects glucose levels over the past few months. pg 1017
8.The patient with type 2 diabetes shows a blood sugar reading of 72 at 6am. Based on the reading of 72, the nurse should: give juice, milk, sugar, corn syrup, jam, candy, glucose tablets, etc. pg 1007
9. The nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a life threatening condition that results in: dehydration, electrolyte imbalance, acidosis, disorders in metabolism of carbs, fats and proteins (proteinuria, acidosis, etc) pg 1007
10. The patient has been admitted to the hospital with the dignosis of diabetic ketoacidosis. The nurse anticipates that the patient will exhibit vital signs of: decreased temperature, increased respirations that are kussmaul's (deep, rapid) pg 1007
11. The home health nurse is assessing a type 1 diabetic patient who has been controlled for 6 months. The nurse is surprised and concerned about a blood glucose reading of 52. This episode of hypoglycemia is probably caused by the patient's having: low calorie intake, too much insulin, too heavy of exercise. pg 1010-1011
12. As part of the teaching plan in preparation for discharge, the patient with type 1 diabetes needs guidance for exercise. Be sure to include which of the following? (see patient teaching box and paragraphs pg 1010-1011) Use caution when exercising, check glucose levels before and after, adjust intake of carbs as appropriate, avoid exercise if glucose is >250/300, wear good shoes, warm up, avoid, exercise during insulin peak, exercise shortly after eating, and more.
13. The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor has ordered two types of insulin, 10 U of regular and 35 U of NPH. The proper procedure is to: Roll the vial of intermediate acting to mix. Wipe both tops with alcohol. Draw 35 units of air and inject into the NPH. Draw 10 of regular and injectect into the regular. Withdraw 10 units of regular into syringe, then withdraw 35 units of NPH. pg 1014
14. A patient has come to the ER with her friend. Her friend states that she has been acting very strangley and confused. The friend states that the patient has diabetes and takes insulin. The nurse knows that signs and symptoms of hypoglycemia include: weakness, hunger, diaphoresis, tremors, anxiety, irritability, headache, pallor, tachycardia, confusion, dizziness, blurred or double vision, seizure, coma. pg 1023
15. A patient has come to the doctor's office after finding out that her blood glucose level was 135. She states that she had not eten before the test and was told to come see her doctor. She asks you if she has diabetes. The nurse responds: Something therapeutic regarding criteria for diagnosis: symptoms, fasting serum blood glucose, OGTT. pg 1009
16. The teaching plan for a 22 year old woman on Avandia (rosiglitazone) would include a caution relative to: hypoglycemia,weight gain, decreased effectiveness of birth control pills, liver dysfunction. pg 1016
17. The type 1 diabetic patient has an insulin order for NPHinsulin, 35 U, to be given at 7am. The patient is also NPO for lab wok that will not be drawn until 10am. The nurse should: Hold the injection. per lecture
18. The patient comes to the diabetes clinic and confides to a nurse that she does not follow the diet exchange program that she was given. You respond: Something therapeutic. Ask questions, explore barriers. pg 1021
19. When the type 1 diabetic patient asks why his 7am insulin has been changed from NPH to 70/30 premixed insulin, the nurse explains tht 70/30 insulin: Contains 70% NPH, 30% regular. It is easier to prepareand decreases the risk of errors. pg 1012
20. In drawing up a patient diabetes teaching plan, the nurse needs to include the following: learn about drugs, take some form of carbs, monitor bood glucose, follow dietary guidelines, regular exercise program, protect feet. pg 1023
21. A patient who has been diagnosed with endogenous hypoglycemiamost likely has: A tumor or genetics. pg 1023 or 1027
22. The nurse giving Humulin R 20 U at 7am is aware that this drug will peak in: 2-3 hours. pg 1013
23. It is recognized that people with diabetes are at greater risk for complications than nondiabetic patients ecause of: duration, poor control of glucose levels, microvascular changes, macrovascular changes, neuropathy, nephropathy, retinopathy hypoglycemia, foot problems. pg 1004
24. The nurse suspects that the patient with type 1 diabetes may be experiencing the Somogyi phenomenon when the patient exhibits: rebound hyperglycemia, headache, restless sleep, nightmares, enuresis, nausea/vomiting. pg 1017
25. The patient is admitted with HHNKS. Blood glucose is very high (880). The physician believes that her condition is the result of large amounts of glucose solutions adinistered IV during dialysis. The nurse would anticipate that the patient would: exhibit dehydration, hypernatremia, neuro changes. pg. 1008
26. The nurse tells a patient that the functional causes of hypoglycemia include (select all that apply): alimentary hypoglycemia, drug related causes, abrupt d/c of hyperalimentation, glucocorticoid deficiency, severe liver deficiency, etc. pg 1027-1028
27. The teaching plan for a diabetic patient for foot care would include that the patient should (select all that apply): Check feet, be active, wash, soft and smooth, trim nails across, file edges, protect from hot/cold, wear shoes always, test water, inspect feet/shoes, buy good shoes, see dr. Don't: smoke, soak feet, use heated things, walk barefoot or on hot surface.1006
28. The teaching plan for a diabetic is focused on smoking cessation and control of HTN for the avoidance of microvascular (capillary) complications such as (select all that apply): retinopathy, nephropathy. pg 1004-1005
Created by: christiealde