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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
Correct Answer: A
Rationale: 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.
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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 type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment?
- A. Alterations in bile metabolism and release have likely caused hyperglycemia.
- B. Stress has likely caused an increase in the patients blood sugar levels.
- C. The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures.
- D. The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
Correct Answer: B
Rationale: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The patients need for insulin is unrelated to the action of bile, the patients overestimation of previous blood sugar control, or fluid imbalance.
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.
Correct Answer: D
Rationale: 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 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 patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply.
- A. Leukocytosis
- B. Glycosuria
- C. Dehydration
- D. Hypernatremia
- E. Hyperglycemia
Correct Answer: B,C,D,E
Rationale: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.