Med Surg 2 Test 3: Giddens Glucose Regulation

The nurse instructs a patient with type 1 diabetes mellitus to avoid
which of the following drugs while taking insulin?
a. Furosemide (Lasix)
b. Dicumarol (Bishydroxycoumarin)
c. Reserpine (Serpasil)
d. Cimetidine (Tagamet)

Furosemide is a loop diuretic and can increase serum glucose levels;
its use is contraindicated with insulin. Dicumarol, an anticoagulant;
reserpine, an anti-hypertensive; and cimetidine, an H2
receptor antagonist, do not affect blood glucose levels.
REF: Page 135 |Page 141
OBJ: NCLEX� Client Needs Category: Physiological Integrity

When a diabetic patient asks about maintaining adequate blood glucose
levels, which of the following statements by the nurse relates most
directly to the necessity of maintaining blood glucose levels no lower
than about 74 mg/dL?
a. �Glucose is the only type of fuel used by body cells to produce
the energy needed for physiologic activity.�
b. �The central nervous system cannot store glucose and needs a
continuous supply of glucose for fuel.�
c. �Without a minimum level of glucose circulating in the blood,
erythrocytes cannot produce ATP.�
d. �The presence of glucose in the blood counteracts the formation
of lactic acid and prevents acidosis.�

The brain cannot synthesize or store significant amounts of glucose;
thus a continuous supply from the body�s circulation is needed to meet
the fuel demands of the central nervous system.
REF: Page 134 OBJ: NCLEX� Client Needs Category: Physiological Integrity

The nurse associates which assessment finding in the diabetic patient
with decreasing renal function?
a. Ketone bodies in the urine during acidosis
b. Glucose in the urine during hyperglycemia
c. Protein in the urine during a random urinalysis
d. White blood cells in the urine during a random urinalysis

Urine should not contain protein. Proteinuria in a diabetic heralds
the beginning of renal insufficiency or diabetic nephropathy with
subsequent progression to end stage renal disease. Chronic elevated
blood glucose levels can cause renal hypertension and excess kidney
perfusion with leakage from the renal vasculature. This leaking allows
protein to be filtered into the urine.
REF: Page 138 OBJ: NCLEX� Client Needs Category: Physiological Integrity

What is the nurse�s best response about developing
diabetes to the patient whose father has type 1 diabetes mellitus?
a. �You have a greater susceptibility for development of the disease
because of your family history.�
b. �Your risk is the same as the general population, because there
is no genetic risk for development of type 1 diabetes.�
c. �Type 1 diabetes is inherited in an autosomal dominant pattern.
Therefore the risk for becoming diabetic is 50%.�
d. �Because you are a woman and your father is the parent with
diabetes, your risk is not increased for eventual development of the
disease. However, your brothers will become diabetic.�

Even though type 1 diabetes does not follow a specific genetic
pattern of inheritance, those with one parent with type 1 diabetes are
at an increased risk for development of the disease.
REF: Page 142 OBJ: NCLEX� Client Needs Category: Physiological Integrity

The nurse recognizes which patient as having the
greatest risk for undiagnosed diabetes mellitus?
a. Young white man
b. Middle-aged African-American man
c. Young African-American woman
d. Middle-aged Native American woman

The highest incidence of diabetes in the United States occurs in
Native Americans. With age, the incidence of diabetes increases in all
races and ethnic groups.
REF: Page 137 OBJ: NCLEX� Client Needs Category: Physiological Integrity

A diabetic patient is brought into the emergency department
unresponsive. The arterial pH is 7.28. Besides the blood pH, which
clinical manifestation is seen in uncontrolled diabetes mellitus and ketoacidosis?
a. Decreased hunger sensation
b. Report of no urine output
c. Increased respiratory rate
d. Decreased thirst

Ketoacidosis decreases the pH of the blood, stimulating the
respiratory control area of the brain to buffer the effects of the
increasing acidosis. The rate and depth of respirations are increased
(Kussmaul's respirations) to excrete more acids by exhalation. Usually
polydipsia (increased thirst), polyphagia (increased hunger), and
polyuria (increased urine output) are seen with hyperglycemia and ketoacidosis.
REF: Page 135 |Page 137
OBJ: NCLEX� Client Needs Category: Physiological Integrity

Which of the following would be included in the assessment of a
patient with diabetes mellitus who is experiencing a hypoglycemic
reaction? (Select all that apply.)
a. Tremors
b. Nervousness
c. Extreme thirst
d. Flushed skin
e. Profuse perspiration
f. Constricted pupils

ANS: A, B, E
When hypoglycemia occurs, blood glucose levels fall, resulting in
sympathetic nervous system responses such as tremors, nervousness, and
profuse perspiration. Dilated pupils would also occur, not constricted
pupils. Extreme thirst, flushed skin, and constricted pupils are
consistent with hyperglycemia.
REF: Page 135 OBJ: NCLEX� Client Needs Category: Physiological Integrity