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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter51:AssessmentandManagementofPatientswithDiabetes  1.

Apatientwithtype1diabeteshastoldthenursethathismostrecenturinetestforketoneswaspositive. Whatisthenursesmostplausibleconclusionbasedonthisassessmentfinding?

A)

Thepatientshouldwithholdhisnextscheduleddoseofinsulin.

B)

Thepatientshouldpromptlyeatsomeproteinandcarbohydrates.

C)

Thepatientsinsulinlevelsareinadequate.

D)

Thepatientwouldbenefitfromadoseofmetformin(Glucophage).

Ans:

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patientsketonuria.Metformin willnotcauseshort-termresolutionofhyperglycemia.

2.

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

A)

Fastingplasmaglucosegreaterthanorequalto126mg/dL

B)

Randomplasmaglucosegreaterthan150mg/dL

C)

Fastingplasmaglucosegreaterthan116mg/dLon2separateoccasions

D)

Randomplasmaglucosegreaterthan126mg/dL

Ans:

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.

3.

A)

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.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Proteinshouldconstitute30%to40%ofcaloricintake.

C)

Mostcaloriesshouldbederivedfromcarbohydrates.

D)

Animalfatsshouldbeeliminatedfromthediet.

Ans:

C

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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. 4.

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bodysneedforinsulin?

A)

Adequatesleep

B)

Lowstimulation

C)

Exercise

D)

Low-fatdiet

Ans:

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patientsneedforinsulin.Adequate sleepisbeneficialinreducingstress,butdoesnothaveaneffectthatispronouncedasthatofexercise.

5.

Amedicalnurseiscaringforapatientwithtype1diabetes.Thepatientsmedicationadministration recordincludestheadministrationofregularinsulinthreetimesdaily.Knowingthatthepatientslunch traywillarriveat11:45,whenshouldthenurseadministerthepatientsinsulin?

A)

10:45

B)

11:15

C)

11:45

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

11:50

Ans:

B

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Feedback: Regularinsulinisusuallyadministered2030minbeforeameal.Earlieradministrationcreatesariskfor hypoglycemia;lateradministrationcreatesariskforhyperglycemia. 6.

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)

Asulfonylurea

B)

Abiguanide

C)

Athiazolidinedione

D)

Analphaglucosidaseinhibitor

Ans:

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.

7.

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?

A)

Donoteliminateinsulinwhennauseatedandvomiting.

B)

Reportelevatedglucoselevelsgreaterthan150mg/dL.

C)

Eatthreesubstantialmealsaday,ifpossible.

D)

Reducefoodintakeandinsulindosesintimesofillness.

Ans:

A

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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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. 8.

Thenurseisdiscussingmacrovascularcomplicationsofdiabeteswithapatient.Thenursewouldaddress whattopicduringthisdialogue?

A)

Theneedforfrequenteyeexaminationsforpatientswithdiabetes

B)

Thefactthatpatientswithdiabeteshaveanelevatedriskofmyocardialinfarction

C)

Therelationshipbetweenkidneyfunctionandbloodglucoselevels

D)

Theneedtomonitorurineforthepresenceofalbumin

Ans:

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.

9.

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individualsriskfordevelopingdiabetes?

A)

Havebloodglucoselevelscheckedannually.

B)

Stopusingtobaccoinanyform.

C)

Undergoeyeexaminationsregularly.

D)

Loseweight,ifobese.

Ans:

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.

10. A15-year-oldchildisbroughttotheemergencydepartmentwithsymptomsofhyperglycemiaandis

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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subsequentlydiagnosedwithdiabetes.Basedonthefactthatthechildspancreaticbetacellsarebeing destroyed,thepatientwouldbediagnosedwithwhattypeofdiabetes? A)

Type1diabetes

B)

Type2diabetes

C)

Noninsulin-dependentdiabetes

D)

Prediabetes

Ans:

A Feedback: Betacelldestructionisthehallmarkoftype1diabetes.Noninsulin-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.

11. 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? A)

Thetissuesinyourbodyareresistanttotheactionofinsulin,makingtheglucoselevelsinyour bloodincrease.

B)

Damagetoyourpancreascausesanincreaseintheamountofglucosethatitreleases,andthereis notenoughinsulintocontrolit.

C)

Theamountofglucosethatyourbodymakesoverwhelmsyourpancreasanddecreasesyour productionofinsulin.

D)

Destructionofspecialcellsinthepancreascausesadecreaseininsulinproduction.Glucoselevels risebecauseinsulinnormallybreaksitdown.

Ans:

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.

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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Ivealwaysbeenafanofsweetfoods,butlatelyImturnedoffbythem.

B)

Lately,Idrinkanddrinkandcantseemtoquenchmythirst.

C)

NomatterhowmuchsleepIget,itseemstotakemehourstowakeup.

D)

WhenIwenttothewashroomthelastfewdays,myurinesmelledodd.

Ans:

B

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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. 13. 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? A)

Ireadthatapancreastransplantwillprovideacureformydiabetes.

B)

Iwilltakemyoralantidiabeticagentswhenmymorningbloodsugarishigh.

C)

Iwillmakesuretofollowtheweightlossplandesignedbythedietitian.

D)

IwillmakesureIcallthediabeteseducatorwhenIhavequestionsaboutmyinsulin.

Ans:

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.

14. AdiabetesnurseeducatorispresentingtheAmericanDiabetesAssociation(ADA)recommendationsfor levelsofcaloricintake.WhatdotheADAsrecommendationsinclude? A)

10%ofcaloriesfromcarbohydrates,50%fromfat,andtheremaining40%fromprotein

B)

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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

966

C)

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

D)

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

Ans:

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.

15. Anolderadultpatientwithtype2diabetesisbroughttotheemergencydepartmentbyhisdaughter.The patientisfoundtohaveabloodglucoselevelof623mg/dL.Thepatientsdaughterreportsthatthe patientrecentlyhadagastrointestinalvirusandhasbeenconfusedforthelast3hours.Thediagnosisof hyperglycemichyperosmolarsyndrome(HHS)ismade.Whatnursingactionwouldbeapriority? A)

Administrationofantihypertensivemedications

B)

Administeringsodiumbicarbonateintravenously

C)

Reversingacidosisbyadministeringinsulin

D)

Fluidandelectrolytereplacement

Ans:

D Feedback: TheoverallapproachtoHHSincludesfluidreplacement,correctionofelectrolyteimbalances,and insulinadministration.Antihypertensivemedicationsarenotindicated,ashypotensiongenerally accompaniesHHSduetodehydration.SodiumbicarbonateisnotadministeredtopatientswithHHS,as theirplasmabicarbonatelevelisusuallynormal.Insulinadministrationplaysalessimportantroleinthe treatmentofHHSbecauseitisnotneededforreversalofacidosis,asindiabeticketoacidosis(DKA).

16. Anurseiscaringforapatientwithtype1diabeteswhoisbeingdischargedhometomorrow.Whatisthe bestwaytoassessthepatientsabilitytoprepareandself-administerinsulin? A)

Askthepatienttodescribetheprocessindetail.

B)

Observethepatientdrawingupandadministeringtheinsulin.

C)

Provideahealtheducationsessionreviewingthemainpointsofinsulindelivery.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

ReviewthepatientsfirsthemoglobinA1Cresultafterdischarge.

Ans:

B

967

Feedback: Nursesshouldassessthepatientsabilitytoperformdiabetesrelatedself-careassoonaspossibleduring thehospitalizationorofficevisittodeterminewhetherthepatientrequiresfurtherdiabetesteaching. Whileconsultingahomecarenurseisbeneficial,aninitialassessmentshouldbeperformedduringthe hospitalizationorofficevisit.Nursesshoulddirectlyobservethepatientperformingtheskillssuchas insulinpreparationandinfection,bloodglucosemonitoring,andfootcare.Simplyquestioningthe patientabouttheseskillswithoutactuallyobservingperformanceoftheskillisnotsufficient.Further educationdoesnotguaranteelearning. 17. Anelderlypatientcomestotheclinicwithherdaughter.Thepatientisadiabeticandisconcernedabout footcare.Thenursegoesoverfootcarewiththepatientandherdaughterasthenurserealizesthatfoot careisextremelyimportant.Whywouldthenursefeelthatfootcareissoimportanttothispatient? A)

Anelderlypatientwithfootulcersexperiencesseverefootpainduetothediabeticpolyneuropathy.

B)

Avoidingfootulcersmaymeanthedifferencebetweeninstitutionalizationandcontinued independentliving.

C)

Hypoglycemiaislinkedwithariskforfalls;thisriskiselevatedinolderadultswithdiabetes.

D)

Oralantihyperglycemicshavethepossibleadverseeffectofdecreasedcirculationtothelower extremities.

Ans:

B Feedback: Thenurserecognizesthatprovidinginformationonthelong-termcomplicationsespeciallyfootandeye problemsassociatedwithdiabetesisimportant.Avoidingamputationthroughearlydetectionoffoot ulcersmaymeanthedifferencebetweeninstitutionalizationandcontinuedindependentlivingforthe elderlypersonwithdiabetes.Whilethenurserecognizesthathypoglycemiaisadangeroussituationand mayleadtofalls,hypoglycemiaisnotdirectlyconnectedtotheimportanceoffootcare.Decreasein circulationisrelatedtovascularchangesandisnotassociatedwithdrugsadministeredfordiabetes.

18. Adiabeticeducatorisdiscussingsickdayruleswithanewlydiagnosedtype1diabetic.Theeducatoris awarethatthepatientwillrequirefurtherteachingwhenthepatientstateswhat? A)

IwillnottakemyinsulinonthedayswhenIamsick,butIwillcertainlycheckmybloodsugar every2hours.

B)

IfIcannoteatameal,Iwilleatasoftfoodsuchassoup,gelatin,orpuddingsixtoeighttimesa day.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

IwillcallthedoctorifIamnotabletokeepliquidsinmybodyduetovomitingordiarrhea.

D)

Iwillcallthedoctorifmybloodsugarisover300mg/dLorifIhaveketonesinmyurine.

Ans:

A

968

Feedback: Thenursemustexplanationthesickdayrulesagaintothepatientwhoplanstostoptakinginsulinwhen sick.Thenurseshouldemphasizethatthepatientshouldtakeinsulinagentsasusualandtestonesblood sugarandurineketonesevery3to4hours.Infact,insulin-requiringpatientsmayneedsupplemental dosesofregularinsulinevery3to4hours.Thepatientshouldreportelevatedglucoselevels(greater than300mg/dLorasotherwiseinstructed)orurineketonestothephysician.Ifthepatientisnotableto eatnormally,thepatientshouldbeinstructedtosubstitutesoftfoodssuchagelatin,soup,andpudding. Ifvomiting,diarrhea,orfeverpersists,thepatientshouldhaveanintakeofliquidsevery30to60 minutestopreventdehydration. 19. Whichofthefollowingpatientswithtype1diabetesismostlikelytoexperienceadequateglucose control? A)

Apatientwhoskipsbreakfastwhenhisglucosereadingisgreaterthan220mg/dL

B)

Apatientwhoneverdeviatesfromherprescribeddoseofinsulin

C)

Apatientwhoadherescloselytoamealplanandmealschedule

D)

Apatientwhoeliminatescarbohydratesfromhisdailyintake

Ans:

C Feedback: Thetherapeuticgoalfordiabetesmanagementistoachievenormalbloodglucoselevelswithout hypoglycemia.Therefore,diabetesmanagementinvolvesconstantassessmentandmodificationofthe treatmentplanbyhealthprofessionalsanddailyadjustmentsintherapy(possi...