Olivia McRitchie
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NCLEX Nursing (Medical-Surgical) Quiz sobre Exemplar 12.1: Diabetes, criado por Olivia McRitchie em 27-10-2018.

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Olivia McRitchie
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Exemplar 12.1: Diabetes

Questão 1 de 23

1

What are a couple of the major differences and similarities between type 1 and type 2 diabetes mellitus?

Selecione uma ou mais das seguintes:

  • Type 1 results from the destruction of Langerhans cells in the pancreas, type 2 is caused by cellular resistance to insulin and the pancreas being unable to compensate due to the increased demand.

  • Both types manifest with hyperglycemia and ketosis

  • Genetics is a risk factor in both types

  • Common manifestations of both types are polyuria, polydipsia, and polyphagia.

  • Most cases of type 1 are immune mediated, whereas type 2 is not largely immune-mediated.

  • Obesity, physical inactivity, race/ethnicity, and gender is a risk factor for both types

Explicação

Questão 2 de 23

1

You are talking to a mother whose 6-year-old daughter has just been diagnosed with type 1 diabetes. She has at least a high school education, but you assess that her medical literacy is low. After speaking with her about her daughter's disorder, you are concerned that she is susceptible to not complying with the treatment regimen, and instead trying naturopathic treatments to "cure" her daughter. Which of the following statements made by the mother would make you think that?

Selecione uma das seguintes:

  • "My daughter had the mumps about a month ago. She probably has a genetic background, but having the mumps could have caused it to appear."

  • "The increased eating, drinking, peeing, and tiredness were likely because of my daughter's diabetes. These should go away once her diabetes is controlled."

  • "My daughter is at risk for diabetic ketoacidosis because of high blood sugar, but this can be prevented easily with diet and proper exercise alone."

  • "I need to stress to my daughter that she needs to keep an eye on her blood sugar even when I'm not there because she can have low blood sugar and not even know it."

  • "If my daughter develops low blood sugar, I should take her blood glucose, give her 15 grams of carbohydrates, wait 15 minutes, re-test, and then give her another 15 grams if her blood sugar is still too low."

  • "My daughter's blood glucose before a meal should be between 70 and 130 mg/dL."

  • "I need to get a device to prick my daughter's finger, a glucose meter, and test strips that go with that brand of glucose meter. My insurance may cover this."

  • "I should following all the instructions that you gave me for storing and administering insulin so that my daughter does not accidentally get hurt."

  • "I should balance my daughter's diet very carefully to avoid high blood sugar."

Explicação

Questão 3 de 23

18

Match the correct signs/symptoms and lab findings with the correct hyperglycemic state. Only place the answers specific to that hyperglycemic state; if the answer is correct for both states, it does not count.

Just to make sure nobody has the answer wrong even though it should be right, I've put the answers in ALPHABETICAL ORDER.

Diabetic ketoacidosis:
-
-
-
-
-
-
-

Hyperosmolar hyperglycemic state:
-
-
-
-
-
-
-
-
-
-

Arraste e solte para completar o texto.

    Blood glucose >300 mg/dL
    Blurred vision
    Confusion
    Fruity breath
    Increased plasma & urine ketones
    Moderate fluid loss
    Plasma pH <7.3
    Blood glucose >600 mg/dL
    Extreme thirst
    Lethargy
    Malaise
    Normal breath
    Normal plasma & urine ketones
    Normal plasma pH
    Normal respirations
    Profound fluid loss
    Seizures
    Flushed, dry, and warm skin
    Increased thirst
    Decreased blood pressure
    Increased pulse rate
    Increased fluid intake
    Nausea & vomiting
    Abdominal pain
    Decreasing level of consciousness
    Abnormal K, Na, and Cl
    >340 mOsmol/L

Explicação

Questão 4 de 23

1

Select the signs and symptoms of hypoglycemia.

Selecione uma ou mais das seguintes:

  • Pallid, moist, cool skin

  • Profuse perspiration

  • Increased thirst

  • Anxiousness & restlesness

  • Hunger

  • Abdominal pain

  • Fluid loss

  • Fatigued

  • Headache

  • Mood changes

Explicação

Questão 5 de 23

1

You have a 6-year-old boy (J.C.) brought to your emergency room via ambulance after his father (A.C.) called 911. A.C. states that he was about to drive J.C. to urgent care because he was "acting weird" when J.C. suddenly became unresponsive. When asked by the R.N. to specify "acting weird", A.C. states that J.C. could not remember his age, birthday, or location. Prior to passing out, J.C. had been sick at home for about a day with what A.C. called a "stomach flu": he was nauseated, vomiting, had a fever, and had abdominal pain. He was very thirsty, but not diaphoretic.

Temp is 101.2 degrees Fahrenheit; BP 85/50; HR 134 bpm; respirations 32/min, labored, regular, even, and symmetrical; SpO2 91%. J.C. is not conscious. Skin is flushed, warm, and dry. Breath smells like fruit.

Telemetry shows flat, inverted T waves. Serum potassium is 2.5 mEq/L; serum sodium is 124 mEq/L; serum chloride is 90 mEq/L.. Blood glucose is 375 mg/dL. ABG results shows that pH is 7.29, HCO2 is 18 mEq/L, PaCO2 is 36 mmHg.

What acute manifestation of diabetes is J.C. suffering from?

Selecione uma das seguintes:

  • Diabetic ketoacidosis

  • Hyperosmolar hyperglycemic state.

  • Hypoglycemia

Explicação

Questão 6 de 23

1

Select appropriate interventions to enact for a patient that is conscious and suffering from diabetic ketoacidosis. Assume that this patient is suffering from severe textbook DKA, with blood pH above 7.20 but below 7.35, hypokalemia, and hyponatremia.

Selecione uma ou mais das seguintes:

  • 4-6 L of oral fluid within first 12 hours of treatment.

  • 0.45% saline, administered 500-1,000 mL/hr until BP returns to normal range.

  • 0.9% saline, administered 500-1,000 mL/hr until BP returns to normal range.

  • 0.45% saline with dextrose administered at 200-500 mL/hr once BP is normal & blood glucose is 250 mg/dL or less.

  • Intravenous insulin.

  • Administration of potassium with 0.9% saline.

  • Constant telemetry monitoring.

  • Reassessment of vitals, heart sounds, lung sounds, and blood glucose every 2 hours while fluid is being administered, and every 4 hours once fluid is done being administered.

  • Electrolyte panel retaken every 2 hours.

Explicação

Questão 7 de 23

1

You have a 40-year-old single mother (C.D.) being brought into your ER via ambulance, reportedly because her 12-year-daughter (O.M.) called 911 stating that her mother was "acting weird".

Temp is 99.7; BP is 100/62; HR is 120 bpm; respirations are 16/min, regular, even, unlabored, and symmetrical; SpO2 is 96%. C.D. is conscious, but lethargic. She reports dull, throbbing pain, 7/10, generalized throughout abdomen that is worst right before vomiting and better (1/10) for "about 30 minutes" after. Skin is flushed, dry warm, diaphoresis not noted. She reports that she has been running a fever around 102 degrees Fahrenheit, accompanied by nausea and vomiting, for the past 3-4 days. She further reports that she has been very thirsty and has been peeing a lot for "about 2 weeks".

Her blood glucose is 720 mg/dL. Sodium is 123 mEq/L, potassium is 2.0 mEq/L, chloride is 91 mEq/L. Telemetry shows inverted T waves. Her ABGs are pH 7.40, HCO3 26 mEqL, and PaCO2 39 mmHg.

What acute complication of diabetes is this patient experiencing?

Selecione uma das seguintes:

  • Diabetic ketoacidosis

  • Hyperosmolar hyperglycemic state

  • Hypoglycemia

Explicação

Questão 8 de 23

1

You have a 30-year-old male (M.H.) brought to your ER from the grocery store because, according to a police officer (J.V.), he was allegedly "verbally abusing the customers, employees, and managers". J.V. and his partner were called to detained M.H.. but after noticing a medical alert bracelet stating that M.H. is type 1 diabetic, J.V. opted to call an ambulance instead.

Temp is 98.8 degrees Fahrenheit; BP is 98/58; HR is 125 BPM; respirations are 24 breaths/min; SpO2 is 95%. Headache 5/10 reported; M.H. cannot recall when it started, but states there are no alleviating factors. M.H. is still combative; he appears anxious, and cannot recall when be last took his insulin. His skin is pallid, moist, and cool, and he is sweating profusely. He is not thirsty, but informs the RN that he is very hungry.

His ABGs are pH 7.38, HCO3 25 mEq/L, PaCO2 40 mmHg. His sodium is 132 mEq/L, potassium is 4.1 mEq/L, and his chloride is 101 mEq/L. Serum osmolality is 290 mOsm/L.

Even without being given the blood glucose value, what acute complication of diabetes do you think this patient is experiencing?

Selecione uma das seguintes:

  • Diabetic ketoacidosis

  • Hyperosmolar hyperglycemic state

  • Hypoglycemia

Explicação

Questão 9 de 23

1

You are a high school nurse. Following a very public incident in which a type 1 diabetic student was denied the ability to replenish her blood glucose with a food or drink, you are giving a talk to the teachers about how to manage type 1 diabetes.

Which of the following statements about type 1 diabetes is accurate?

Selecione uma das seguintes:

  • "Type 1 diabetics will sometimes have to eat 15 grams of carbohydrate in the form of a snack or a drink, wait 15 minutes, then eat another 15 grams if their sugar is still low. This is called the 15/15 rule, and it is important for diabetics to be able to do this."

  • "Type 1 diabetics can almost always identify when they are hypoglycemic, especially at this age."

  • "Although hypoglycemia can sometimes manifest as mood changes and fatigue, diabetic students should be aware that they are hypoglycemic, and therefore should be held to the same behavioral standards as other students at all times."

  • "Additionally, students with type 1 diabetics can go into a hyperosmolar hyperglycemic state and be unaware of it. This is caused by hyperglycemia, counts as a medical emergency, and is something that you should be watching out for."

Explicação

Questão 10 de 23

1

Treatment for hyperosmolar hyperglycemic state is similar to the treatment for diabetic ketoacidosis.

Selecione uma das opções:

  • VERDADEIRO
  • FALSO

Explicação

Questão 11 de 23

1

You have a 55-year-old male patient that is at risk for developing type 2 diabetes. When you bring it up to him at his yearly physical, he responds with "So what? It just means I'll have to inject myself with insulin. I'll survive."

You assess that he might not know the long term effects of diabetes, and asks him if he knows all the problems diabetics face in the long run. He said no, but he seems open to teaching.

Select the accurate statements that you can give this patient about the long term-effects of diabetes.

Selecione uma ou mais das seguintes:

  • "Patients with diabetes might eventually develop hardening of the blood vessels, called atherosclerosis. This leads to other complications such as coronary artery disease, cerebral vascular disease, and peripheral vascular disease."

  • "Stroke is the most common cause of death in diabetics. This is because hypertension is very common in diabetics, and atherosclerosis of the cerebral vessels develops at an earlier age in diabetics."

  • "You could develop gangrene in your legs because of impaired peripheral vascular circulation."

  • "The capillaries in your eyes can undergo changes that cause less oxygen to get to your corneas and breakdown in the blood-retinal barrier. This is called retinopathy, and it causes blindness."

  • "Although it's rare, diabetes can even cause kidney failure. Hardening of the renal blood vessels and the excess glucose in your blood causes the vessels to thicken and be leaky at the same time."

  • "The blood vessels that supply nerves can thicken, nerve cells can demyelinate, and nerve conduction can be impaired. This causes neuropathies, which causes tingling & pain in the extremities and can even cause cardiovascular, gastrointestinal, and genitourinary dysfunction,"

  • "Diabetes can cause you to be more susceptible to various types of disease due to the presence of other complications."

  • "Peridontal disease occurs more often in diabetics and progresses more rapidly."

  • "Peripheral neuropathy can cause you to lose perception of pain in your feet. In fact, direct injury that goes unnoticed is the most common cause of foot trauma in diabetics."

  • "Because the self-care for diabetes is really complex, diabetics are at an increased risk of developing depression, which affects the ability to self-manage diabetes mellitus."

Explicação

Questão 12 de 23

1

Select the lab values that would strongly warrant a diabetes mellitus diagnosis.

Selecione uma ou mais das seguintes:

  • Hemoglobin A1C > or = 6.5%

  • Hemoglobin A1C <5.7%

  • Fasting plasma glucose >126 mg/dL.

  • Fasting plasma glucose <100 mg/dL

  • 2 hour plasma glucose >200 mg/dL during an oral glucose tolerance test.

  • 2 hour plasma glucose <140 mg/dL during an oral glucose tolerance test.

  • Hemoglobin A1C 5.7-6.4%

  • 2 hour plasma glucose 140-199 mg/dL during an oral glucose tolerance test.

  • Fasting plasma glucose 100-125 mg/dL.

Explicação

Questão 13 de 23

1

You are teaching a patient newly diagnosed patient with type 2 diabetes about how to test blood glucose. Which of the following statements made by the patient indicates that proper teaching has been received?

Selecione uma das seguintes:

  • "I have to test my blood glucose 2-3 times a day."

  • "It is only necessary for me to check my fasting blood glucose."

  • "It doesn't matter what brand my testing supplies are, so long as I always have a supply readily available."

  • "I should wash my hands before pricking my finger for my glucose test; substances such as vitamin C can mess with the meter's reading."

Explicação

Questão 14 de 23

12

Selecione das listas do Menu para completar o texto.

Select the correct option from the drop down menu for each type of insulin.

-( Aspart (NovoLog), Lispro (Humalog), Glulisine (Apidra) ): Onset- 15 min; peak- 40-50 min; duration- 3-5 hrs.
-( Detemir (Levemir), Glargine (Lantus) ): Onset- 1 hr; peak- 6-23 hrs; duration- 24+ hrs.
-( Glargine (Lantus), Detemir (Levemir) ): Onset- 2 hrs; peak- 16-20 hrs; duration- 24+ hrs
-( Glulisine (Apidra), Aspart (NovoLog), Lispro (Humalog) ): Onset- 15 min; peak- 1-1.5 hrs; duration- 3-5 hrs.
-( Humalog 50/50, Humalog 75/25, Humulin 70/30, Novolin 70/30 ): Onset- 30 min; peak- 3 hrs; duration; 6-12 hrs.
-( Humalog 75/25, Humulin 70/30, Novolin 70/30, NovoLog 70/30 ): Onset- 15 min; peak- 2-4 hrs; duration- 6-12 hrs.
-( Humulin 70/30, Novolin 70/30, NovoLog 70/30, Humalog 75/25 ): Onset- 30 min; peak- 4-8 hrs; duration- 24 hrs.
-( Lispro (Humalog), Aspart (NovoLog), Glulisine (Apidra) ): Onset- 15 min; peak- 1-1.5 hrs; duration- 3-4 hrs.
-( Novolin 70/30, Humalog 50/50, Humalog 75/25, NovoLog 70/30 ): Onset- 30 min; peak- 4-8 hrs; duration- 24 hrs.
-( NovoLog 70/30, Novolin 70/30, Humulin 70/30, Humalog 75/25 ): Onset- 25 min; peak- 1-4 hrs; duration- 12-24 hrs.
-( NPH (Novolin N), Humulin R ): Onset- 2 hrs; peak- 6-8 hrs; duration- 12-16 hrs.
-( Regular (Novolin R), Humilin N ): Onset- 30 min-1 hr; peak- 2-3 hrs; duration- 4-6 hrs.

Explicação

Questão 15 de 23

1

The only insulin that can be given IV is a rapid-acting glucose, such as Humalog.

Selecione uma das opções:

  • VERDADEIRO
  • FALSO

Explicação

Questão 16 de 23

1

Which insulin cannot be mixed with other insulins and cannot be used in insulin pumps?

Selecione uma das seguintes:

  • Glargine (Lantus)

  • Detemir (Levemir)

  • Lispro (Humalog)

  • NPH (Novolin N).

Explicação

Questão 17 de 23

1

Select the rapid acting insulins.

Selecione uma ou mais das seguintes:

  • Lispro (Humalog)

  • Aspart (NovoLog)

  • Glulisine (Apidra)

  • Glargine (Lantus)

  • Detemir (Levemir)

Explicação

Questão 18 de 23

1

Select the short acting insulins.

Selecione uma ou mais das seguintes:

  • Regular (Novolin R)

  • Humulin R

  • NPH (Novolin N)

  • Humulin N

Explicação

Questão 19 de 23

1

Select the intermediate acting insulins.

Selecione uma ou mais das seguintes:

  • NPH (Novolin N)

  • Humulin N

  • Lispro (Humalog)

  • Aspart (NovoLog)

Explicação

Questão 20 de 23

1

Select the long acting insulins.

Selecione uma ou mais das seguintes:

  • Glargine (Lantus)

  • Detemir (Levemir)

  • Glulisine (Apidra)

  • Regular (Novolin R)

Explicação

Questão 21 de 23

1

Regular or rapid-acting insulins are the ones used in insulin pumps.

Selecione uma das opções:

  • VERDADEIRO
  • FALSO

Explicação

Questão 22 de 23

1

You are teaching a young adult newly diagnosed with type 1 diabetes how to store and properly inject her insulin. She is on Regular insulin. Which of the following statements is incorrect teaching to give to the patient?

Selecione uma das seguintes:

  • "You can keep vials refrigerated for up to 3 months, or you can keep them at room temperature for 1 month. Don't keep them if they're past expiration date."

  • "Discard vials with discoloration, clumping, granules, or solid deposits on the sides. Your insulin should NOT be cloudy."

  • "If hypoglycemia occurs, eat 3 glucose tablets, 1/2 cup of fruit juice or regular soda, 8 oz of skim milk, 5 Life Savers, 3 large marshmallows, or 3 tsp. of honey, then recheck it in 15 minutes"

  • "Since you are on Regular insulin, it does not need to be mixed. However, if needed, you will be placed on NPH (Novolin N). That must be mixed by gently rolling the vial in your hands."

  • "Any site can be used to inject insulin, but the most rapid absorption site is in the abdomen."

  • "It is okay to either massage the site or place pressure on the site for 1 min after administration."

  • "Do not inject your insulin into an area to be exercised or to an area where heat will be applied."

  • "Rotate your injection sites to avoid lipodystrophy or lipoatrophy."

  • "Insulin is given subcutaneously. Pinch the skin, insert the needle at either a 90 degree or a 45 degree angle depending on amount of fat you pinch, push down the pump, pull out the needle, then release the skin. Make sure you have a collection place for used needles."

  • "Many individuals with diabetes believe insulin pumps allow more control over their diabetes. These pumps are safe as long as you follow recommended procedure."

Explicação

Questão 23 de 23

1

You are teaching a 65-year-old female newly diagnosed with type 2 diabetes how to control her diabetes without having to receive daily insulin. You mention oral hypoglycemic agents and dietary control. Which of the following statements made by the patient indicates that more teaching about these topics is needed?

Selecione uma das seguintes:

  • "Hypoglycemic drugs will lower my blood sugar by stimulating or increasing insulin secretion, preventing breakdown of glycogen to glucose, and making cells less resistant to insulin."

  • "Glycemic index is not a good basis for my diabetic-friendly diet."

  • "My diet needs to be more structured. I will use Dietary Guidelines for Americans and ChooseMyPlate to guide my diet."

  • "Fruits are safe carbohydrates for me to eat; they will not raise my blood sugar."

  • "Carbs should make up 45-65% of my diet; protein should make up 15-20%; and saturated fats shouldn't be more than 7% of total kilocalories."

  • "I should limit my cholesterol to 200 mg/day.

  • "I need to increase my fiber intake. It might make me feel full."

  • "I should avoid table salt and processed foods, but I still need sodium in my diet."

  • "I can use noncaloric sweetners such as Sweet'N'Low, Nutrasweet, Equal, Splenda, Sunett, and Truvia. These will not raise my blood sugar. I can also use sweetners such as fructose, agave, honey, sorbitol, and xylitol, but these will raise my blood sugar slightly."

  • "I can still drink alcohol, but I must keep in mind that liqueurs, sweet wines, wine coolers, and sweet mixes contain a lot of carbohydrates, and that alcohol must still be included in the daily food intake."

Explicação

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