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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?
- A. Low fat generally indicates low sugar.
- 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.
Correct Answer: C
Rationale: 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.
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A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should prioritize which of the following assessments?
- A. Monitoring the patients neutrophil levels
- B. Assessing the patient for signs of impaired liver function
- C. Monitoring the patients level of consciousness and behavior
- D. Reviewing the patients creatinine and BUN levels
Correct Answer: D
Rationale: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patients renal function. This drug does not typically affect patients neutrophils, liver function, or cognition.
A patient with a history of type I diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase of treatment?
- A. Monitoring the patient for dysrhythmias
- B. Maintaining and monitoring the patients fluid balance
- C. Assessing the patients level of consciousness
- D. Assessing the patient for signs and symptoms of venous thromboembolism
Correct Answer: B
Rationale: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.
A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best response?
- A. Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years.
- B. The cause is not known for sure but it is thought to have something to do with ketoacidosis.
- C. The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years.
- D. Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels.
Correct Answer: C
Rationale: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.
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.
Correct Answer: D
Rationale: 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.
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
Correct Answer: C
Rationale: 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.