Diabetes Test 4 — Questions and Answers
Question 1: A patient with type 2 diabetes who has been diagnosed by the nurse is being admitted. In an assessment, the nurse should anticipate the following symptoms, with the exception of:
- Frequent bruising
- Ketonuria
- Dry mouth
- Hypoglycemia (Correct answer)
Correct answer: Hypoglycemia
A patient newly diagnosed with type 2 diabetes and being admitted would typically present with symptoms of hyperglycemia (high blood sugar), such as dry mouth (polydipsia), frequent bruising (impaired wound healing), and potentially ketonuria in severe cases. Hypoglycemia (low blood sugar) is generally a complication of diabetes treatment, particularly with insulin or certain oral medications, and is not a typical presenting symptom of newly diagnosed, untreated type 2 diabetes.
Question 2: Obesity, type 2 diabetes, hypertension, and hyperlipidemia are all conditions your patient has. His memory takes him back to last night's meal, which included a low-fat turkey and cheese sandwich with mustard, a side salad with low-fat Italian dressing, pickles, a small portion of baked chips, and one can of club soda. Which of the patient's conditions is more at risk from his dietary choices, in your opinion?
- Obesity
- Hypertension (Correct answer)
- Hyperlipidemia
- Type 2 diabetes
Correct answer: Hypertension
The meal described, while low in fat, includes pickles and baked chips, which are typically high in sodium. High sodium intake is a significant risk factor for hypertension (high blood pressure). Given the patient's existing hypertension, this dietary choice poses a direct and immediate risk to blood pressure control. While the meal could indirectly affect other conditions, the sodium content specifically targets hypertension.
Question 3: All of the following are part of the clinical nursing examination for a patient with microangiopathy who has demonstrated reduced peripheral arterial circulation, with the exception of:
- Observation for blanching of the feet after the legs are elevated for 60 seconds
- Integumentary inspection for the presence of brown spots on the lower extremities
- Palpation for increased pulse volume in the arteries of the lower extremities (Correct answer)
- Observation for paleness of the lower extremities
Correct answer: Palpation for increased pulse volume in the arteries of the lower extremities
Reduced peripheral arterial circulation (microangiopathy) means there is diminished blood flow to the lower extremities. Therefore, a clinical examination would reveal *decreased* or absent pulse volume in the arteries of the lower extremities, not increased. Observations like blanching, paleness, and brown spots (diabetic dermopathy or hemosiderin staining) are consistent with poor circulation or diabetic complications.
Question 4: The HbA1C test for glycosylated hemoglobin gauges a person's average blood glucose control over the past three months. Which of the following readings constitutes a pre-diabetes diagnosis?
- >5.6%
- 5-5.6%
- 6.5-7%
- 5.7-6.4% (Correct answer)
Correct answer: 5.7-6.4%
The HbA1C test provides an average of blood glucose control over the past 2-3 months. A pre-diabetes diagnosis is specifically defined by an HbA1C level ranging from 5.7% to 6.4%. Levels below 5.7% are considered normal, while 6.5% or higher indicates diabetes.
Question 5: A clinical trait that separates a ketoacidosis reaction from a hypoglycemia reaction is:
- Nausea
- Blurred vision
- Weakness
- Diaphoresis (Correct answer)
Correct answer: Diaphoresis
Diaphoresis, or sweating, is a classic symptom of hypoglycemia, resulting from the sympathetic nervous system's response to low blood sugar. In contrast, diabetic ketoacidosis (DKA) typically causes dehydration and dry skin. While other symptoms like nausea, blurred vision, and weakness can occur in both conditions, diaphoresis is a key distinguishing feature of hypoglycemia.
Question 6: How much of a type 1 diabetic's morning dose of insulin is anticipated to be administered preoperatively, according to the nurse?
- 25-40%
- 50-60% (Correct answer)
- 85-90%
- 10-20%
Correct answer: 50-60%
For a type 1 diabetic undergoing surgery, the morning dose of insulin is typically reduced to 50-60% of the usual dose. This adjustment helps prevent hypoglycemia during the NPO (nothing by mouth) period and the physiological stress of surgery. The remaining insulin needs are often managed with intravenous insulin infusions to maintain stable blood glucose.
Question 7: A man nurse is giving his patient a snack before bed. This is based on the understanding that intermediate-acting insulins work over roughly the following time period:
- 10-14 hours
- 14-18 hours (Correct answer)
- 24-28 hours
- 6-8 hours
Correct answer: 14-18 hours
Intermediate-acting insulins, such as NPH, typically have a duration of action ranging from 14 to 18 hours. Administering a bedtime snack is crucial to counteract the peak effect of evening intermediate-acting insulin and prevent nocturnal hypoglycemia. This ensures stable blood glucose levels throughout the night.
Question 8: Injecting insulin should only be done at rotation sites, which should be spaced apart by 2.5 cm (1 inch).
- 2-4 weeks
- Third day
- Every other day
- 1-2 weeks (Correct answer)
Correct answer: 1-2 weeks
Insulin injection sites should be rotated within the same general area (e.g., abdomen) for 1-2 weeks before moving to a new general area. This practice helps prevent lipohypertrophy or lipoatrophy, which can impair insulin absorption and lead to erratic blood glucose levels. Spacing injections 2.5 cm (1 inch) apart within the rotation area is also important.
Question 9: When a nurse went to a patient's room to perform routine vital sign monitoring, she discovered that the patient had not eaten his or her bedtime snack. This should prompt the nurse to look for and evaluate:
- Signs of hypoglycemia earlier than expected (Correct answer)
- Symptoms of hyperglycemia during the peak time of NPH insulin
- Sugar in the urine
- Elevated serum bicarbonate and decreased blood pH
Correct answer: Signs of hypoglycemia earlier than expected
If a patient on insulin, particularly intermediate or long-acting insulin, misses their bedtime snack, they are at a significantly increased risk for hypoglycemia during the night or early morning. The snack is essential to counteract the peak action of the insulin and maintain stable blood glucose levels overnight. Therefore, the nurse should anticipate and monitor for signs of low blood sugar earlier than expected.
Question 10: In the ER, a patient who has diabetic ketoacidosis (DKA) is receiving treatment. Which observation would a nurse anticipate making to support this diagnosis?
- Decreased urine output
- Elevated blood glucose level and a low plasma bicarbonate (Correct answer)
- Comatose state
- Increased respiration and an increase in pH
Correct answer: Elevated blood glucose level and a low plasma bicarbonate
Diabetic ketoacidosis (DKA) is characterized by severe hyperglycemia (elevated blood glucose) and metabolic acidosis. The metabolic acidosis is reflected by a low plasma bicarbonate level, as bicarbonate is consumed while buffering the excess ketones produced. The presence of ketones in the blood and urine further supports this diagnosis.
Question 11: NPH insulin is being taken by a client every morning. The client is informed by the nurse that the following situations increase the likelihood of a hypoglycemia reaction:
- 6-14 hours after administration (Correct answer)
- 16-18 hours after administration
- 18-24 hours after administration
- 2-4 hours after administration
Correct answer: 6-14 hours after administration
NPH insulin is an intermediate-acting insulin, and its peak action, when the risk of hypoglycemia is highest, typically occurs 6-14 hours after administration. Patients need to be educated about this timeframe to monitor for symptoms of low blood sugar and ensure adequate food intake. This helps prevent dangerous hypoglycemic episodes.
Diabetes Test 4
A patient with type 2 diabetes who has been diagnosed by the nurse is being admitted.
In an assessment, the nurse should anticipate the following symptoms, with the exception of: