Chapter 37: Care of Patients with Diabetes and Hypoglycemia |DeWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin? a. A pituitary disorder inhibits beta cells. b. An allergic response alters beta cell responses to hyperglycemia. c. Alpha cells proliferated in the islets of Langerhans. d. The body’s immune system destroyed beta cells. ANS: D In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction. PTS: 1 DIF: Cognitive Level: Comprehension REF: 858 OBJ: 1 (clinical) TOP: Type 1 DM: Etiology KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes? a. 70% b. 75% c. 80% d. 95% ANS: D Type 2 diabetics comprise 90% to 95% of all known cases. PTS:1 DIF: Cognitive Level: Knowledge REF: 858 OBJ:1 (theory) TOP: Type 2 DM: Incidence KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 3. The nurse is educating a patient with gestational diabetes. Which statement indicates that the patient needs additional teaching? a. “Gestational diabetes happens because of the hormonal changes of pregnancy.” b. “I should exercise regularly and lose weight to reduce my risk of becoming a diabetic.” c. “This problem goes away completely once I give birth.” d. “The baby will have to be monitored for hypoglycemia during my pregnancy.” ANS: C Giving birth does not automatically resolve gestational diabetes. Of the women who have gestational diabetes, 5% to 10% go on to develop type 2 diabetes. The patient correctly understands that gestational diabetes occurs because of hormonal changes in pregnancy, proper diet and regular exercise may help decrease the likelihood of developing type 2 diabetes, and the baby will require monitoring for hypoglycemia throughout the patient’s pregnancy. PTS:1 DIF: Cognitive Level: 858, Table 37Application REF: 1, 859 OBJ:2 (theory) TOP: Gestational Diabetes: Risks KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. A patient asks the nurse if stress can be a potential cause of type 2 diabetes. Which response is most appropriate for the nurse to make? a. “Stress decreases the number of alpha cells in the pancreas, and increases the workload on the beta cells.” b. “Periods of stress cause increases in glycogen production by the adrenal cortex.” c. “Stress is directly associated with decreased insulin tolerance.” d. “The inhibition of beta cells to glucose is increased in periods of stress.” ANS: B Stress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia. PTS:1 DIF: Cognitive Level: Application REF: 859 OBJ:2 (theory) TOP: DM: Metabolic Risks KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse is counseling an overweight, noncompliant, 30-year-old female with type 2 diabetes. Which change is most important for the nurse to suggest? a. Begin an exercise program and lose weight. b. Obtain annual eye examinations. c. Keep a food diary. d. Inspect feet daily. ANS: A All of these changes are important, but exercise and weight loss are priority changes. In the type 2 diabetic, weight reduction and increased physical activity can restore blood glucose to normal levels and maintained it—hence the importance of diet and exercise in the management of type 2 diabetes. Annual eye examinations are important to detect onset of diabetic retinopathy. A food diary can help the patient to visualize food intake that may be subconscious otherwise. Diabetics are prone to foot problems and wounds and should inspect their feet daily. PTS:1 DIF: Cognitive Level: Analysis REF: 859 OBJ:2(theory) TOP: DM: Modifiable Risks KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. The nurse is educating the patient about the significance of islet cell antibodies. Which statement accurately describe sislet cell antibodies?