Diabetes Mellitus and Hypoglycemia: Chapter 37, Care of Patients with Diabetes and Hypoglycemia

Question 1 of 10

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For a college student newly diagnosed with type 1 diabetes, which instruction would the campus nurse provide when the student reports vision changes, headache, and anxiety but does not have a portable blood glucose monitor available?

• • Eat a piece of pizza.The fat in the pizza would not allow the blood glucose to increase to eliminate the symptoms.
• • Drink a diet soft drink.The diet soft drink would not allow the blood glucose to increase to eliminate the symptoms.
• Correct
  • Eat 15 g of simple carbohydrates.When patients with type 1 diabetes are unsure about the meaning of the symptoms they are experiencing, they should treat themselves for hypoglycemia to prevent seizures and coma from occurring. The nurse would advise the patient to check the blood glucose as soon as possible.
• • Take an extra dose of rapid-acting insulin.The extra dose of rapid-acting insulin would further decrease the blood glucose.

Question 2 of 10

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For a patient presenting to the urgent care clinic with a blood glucose of less than 70 mg/dL for the third time this month, which teaching point would the nurse emphasize when the patient explains participation in a weight-reduction diet, taking the prescribed insulin dose, and going to the gym 4 to 5 days per week?

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  • “Avoid exercising during the peak action of insulin.”The nurse would instruct the patient to avoid exercise during peak insulin activity to prevent episodes of hypoglycemia.
• • “Stop exercising completely, and reduce your insulin dose.”The nurse would not advise the patient to stop exercising or to reduce the insulin dose because it would cause a wide variation in blood sugar.
• • “Omit your insulin on the 4 to 5 days per week that you exercise.”Omitting insulin on exercise days would not be necessary.
• • “Take an additional dose of insulin when you return from the gym.”Taking an extra dose of insulin after exercise could cause hypoglycemia.

Question 3 of 10

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When a patient recently diagnosed with type 1 diabetes mellitus (DM) inquires about the ability to continue playing competitive tennis with this diagnosis, which response would the nurse use?

• • Consider changing to a quieter sport such as walking.Although walking may also be appropriate for the patient, this does not mean the patient will need to discontinue tennis. Exercise is recommended for the patient with DM, so both forms of exercise are appropriate.
• • By adding an extra dose of insulin, you may continue playing tennis.An extra dose of insulin would not help this patient and may put them at risk of developing hypoglycemia, depending on when the insulin is administered.
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  • You may continue to play tennis, but increase dietary intake before playing.Exercise is recommended for the patient with DM. Exercise would require changes in both diet and insulin use. Eating before exercise aids in the prevention of hypoglycemia.
• • Competitive tennis is heavy exercise and not permitted with this type of diabetes.Exercise, such as competitive tennis, is recommended for the patient with DM. Because of this, nurse would not encourage the patient to stop playing tennis.

Question 4 of 10

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Which instruction would the nurse provide to a patient with diabetes mellitus (DM) to prevent the Somogyi effect?

• • “Engage in physical activity daily.”Increasing activity would not change the Somogyi effect.
• • “Increase your amount of regular insulin.”Increasing the patient’s regular insulin would not alter the Somogyi effect and may cause additional episodes of hypoglycemia.
• • “Take your insulin each day at 2:00 PM.”Taking insulin at 2:00 PM may cause additional episodes of hypoglycemia.
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  • “Eat a protein and carbohydrate snack before retiring.”A drop in blood glucose levels at 2:00 or 3:00 AM followed by a false elevation characterizes the Somogyi effect. Eating a protein and carbohydrate snack (e.g., peanut butter and crackers) before going to bed would prevent the hypoglycemia and rebound blood glucose elevation.

Question 5 of 10

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After teaching self-treatment and diet appropriate for hypoglycemia to a patient newly diagnosed with diabetes, which patient selection demonstrates understanding of content to the nurse?

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  • ½ cup of juiceHypoglycemia in which the patient is able to swallow can be treated with ½ cup of juice.
• • 1 can of diet sodaHypoglycemia in which the patient is able to swallow can be treated with 1 can of soda but not diet/sugar-free.
• • 3 boxes of raisinsTreatment for hypoglycemia in which the patient is able to swallow requires just 1 box of raisins.
• • 10 oz of skim milkHypoglycemia in which the patient is able to swallow can be treated with 8 oz, not 10 oz, of skim milk.

Question 6 of 10

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Which information would the nurse include in the teaching for a patient newly diagnosed with type 2 diabetes mellitus (DM)?

• • Weight loss is common with this disorder.Weight loss is more common with type 1 DM. Weight gain is more likely to occur with type 2 DM.
• • This condition goes away after pregnancy.Gestational diabetes improves after pregnancy, but type 2 DM is a life-long diagnosis. Females who have gestational diabetes are at a higher risk for developing type 2 DM later in life.
• • Type 2 DM occurs because of a problem with the immune system.Type 1 DM results because of a problem with the immune system. Type 2 DM occurs because of impaired glucose metabolism, lifestyle choices, and genetics.
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  • Foot care is important because your wounds may take longer to heal now.Wounds take longer to heal in patients with type 2 DM, so it will be important for the patient to maintain adequate foot care.

Question 7 of 10

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The nurse is caring for a diabetic patient prescribed an oral hypoglycemic agent. Which patient statement indicates an understanding of the medication?

• • “I will take double my dose when I have a cheat meal.”Doubling the dosage to cover for a cheat meal can result in severe episodes of hypoglycemia or other complications.
• • “I am so glad that I can stop counting my calories now.”Patients taking oral hypoglycemic agents should still be advised to count calories and eat healthy.
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  • “I need to monitor my skin for yellow discoloration that could mean a problem with my liver.”Oral hypoglycemic agents may cause liver disease, so it is important for patients to monitor for jaundice, or yellowing of the skin.
• • “There will never be a time where I need insulin injections since I am on this medication now.”Insulin injections may be required during times of stress such as when in the hospital. Typically, though, patients can return to their normal medication regimen upon discharge.

Question 8 of 10

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Which patient statement indicates an understanding of the mechanism of action of pramlintide?

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  • “This medication will slow down the emptying of my stomach.”Pramlintide is a synthetic hormone used to decrease secretion of insulin and amylin in response to food and delays gastric emptying.
• • “It acts on my kidneys to keep glucose from being absorbed there.”Sodium-glucose-cotransporter-2-inhibitors act on the kidneys to block the reabsorption of glucose.
• • “This drug causes my pancreas to make and release more insulin.”Sulfonylureas stimulate the pancreas to make more insulin.
• • “My cholesterol levels should start to go down after taking this medication.”Bile acid sequestrant medications result in lowered cholesterol levels.

Question 9 of 10

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The nurse administers insulin lispro to a patient. When should the nurse check the patient for a possible hypoglycemic reaction?

• • 15 minutesThe onset of action of lispro is 15 minutes but the peak action, when a hypoglycemic reaction is most likely, does not occur until 1 to 3 hours after administration.
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  • 1–3 hoursThe peak action of lispro occurs 1 to 3 hours after administration, so the nurse would check back during this time to assess for hypoglycemia.
• • 3–5 hoursThe duration of action of lispro is 3 to 5 hours, which is how long the effects will last, not when the nurse is likely to observe a hypoglycemic reaction.
• • 30 minutesIn 30 minutes, the peak action of lispro will not have occurred yet, meaning it is unlikely that the patient would have a hypoglycemic reaction.

Question 10 of 10

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Which assessment finding would the nurse anticipate for a patient with a blood glucose level of 65 mg/dL? Select all that apply. One, some, or all responses may be correct.

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  • ShakinessShakiness is a common symptom of hypoglycemia because of the low blood glucose level.
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  • TachycardiaTachycardia, or rapid heartbeat, is seen with hypoglycemia.
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  • Blurred visionBlurred vision is a symptom of low blood glucose levels.
• • Fruity breathFruity-smelling breath is a clinical manifestation of ketoacidosis, not hypoglycemia.
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  • Cool, clammy skinCool, clammy skin often occurs with hypoglycemia.
• • Nausea and vomitingNausea and vomiting is a common clinical manifestation of ketoacidosis, not hypoglycemia.