Which of the Following Scenarios May Result in Hypoglycemia

1. The nurse knows that which of the following is a normal fasting serum glucose level for a patient 18 years of age? a. 50mg / dL b. 90mg / dL c. 120mg / dL d. 150mg / dL A Normal fasting serum glucose range for ages 2 to 18 years of age is 60 to 100 mg/dL. 2. The nurse would expect that a patient experiencing moderate hypoglycemia would exhibit which of the following sets of signs and symptoms? a. Headache, light headedness, slurred speech b. Double vision, cool dry skin c. Hyperactivity, tachycardia, anorexia d. Bradycardia, polyuria, acidosis The Clinical manifestations of hypoglycemia may be grouped into two categories: adrenergic symptoms and central nervous system symptoms. in moderate hypoglycemia, they drop in blood glucose affects the brain, resulting in headache, Lightheadedness, and slurred speech, as well as other symptoms that may include loss of consciousness, hunger, tachycardia, and sweating. 3. Is the following statement TRUE or FALSE? Insulin regimens typically involve a combination of short-acting and long-acting insulin. TRUE The Normally functioning pancreas secretes insulin throughout the day in response to blood glucose levels. Using a combination of short and long-lasting insulin mimics this normal pattern. 4. The nurse understands that the pathophysiology of type 1 DM is characterized by which of the following? a. Impaired insulin production b. Destruction of pancreatic beta cells c. Insulin resistance d. Necrosis of pancreatic alpha cells Type 1 diabetes is characterized by the destruction of the pancreatic beta cells which are responsible for the secretion of insulin. Type 2 diabetes is the result of impaired insulin production or insulin resistance which may be related to necrosis of the pancreatic alpha cells. 5. The nurse would educate the patient that which of the following factors increase the risk of developing type 2 diabetes? (Select all that apply) a. Family history b. HDL cholesterol >36 mmol c. Decreased triglycerides d. Obesity e. Hypertension Family history, obesity, race/ethnicity, age, previously impaired fasting glucose or impaired glucose tolerance, hypertension, HDL = 35, and/or triglyceride = 250, and a history of gestational diabetes are all risk factors. 6. The nurse understands that diabetes can lead to which of the following long-term complications? (Select all that apply) a. Peripheral neuropathy b. Blindness c. Diabetic ketoacidosis d. Cardiovascular disease e. Renal disease Atherosclerotic Changes leading to cardiovascular disease develops at an earlier age in patients with diabetes. Most Patients with diabetes have some degree of retinopathy after 20 years, which can lead to blindness. Nephropathy, or kidney disease secondary to microvascular changes in the kidney, is a common complication that develops over 10 to 15 years period peripheral neuropathy increases with the age of the patient and the duration of diabetes. Diabetic ketoacidosis is an acute, short term complication from inadequate insulin. 7. For an unconscious pt who is experiencing hypoglycemia in a health care facility, the nurse would make what emergency management intervention? a. Glucagon 10 mg IM b. 25 to 50 mL of dextrose 50% in water c. IV bolus of 500 mL D5W over 30 mins d. 2-3 teaspoons of honey In In emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of dextrose 50% in water may be administered IV. 8. Glycosylated hemoglobin (HgbA1c) represents average blood glucose levels over a period of approximately 2-3 mos. Which of the following would the nurse know to be a normal level range indicating good maintenance of blood glucose over time? a. 6 to 8 % b. 3 to 4 % c. 1 to 2% d. 4-6% (indicates consistently near-normal blood glucose concentrations) The HgbA1C Normal values range from 4% to 6% and indicate consistently near normal blood glucose concentrations. s 9. Another medication that may have been given in this case would have been glucagon. what does the nurse understand would be the correct dosage for this medication? a. 25 to 50 mL IV b. None of the choices c. 1 mg IV, IM, or subQ d. 2 mg IV, IM, or subQ In emergency situations, for unconscious patients, and injection of Glucagon 1 mg can be administered either subcutaneously or IM. 10. When providing the patient education for skyler, it is important for the nurse to emphasize the peak effect times for insulin. The expected peak for regular insulin is which of the following? a. 4 to 15 hours after injection b. 2-3 hours after injection c. 10 to 30 hours after injection d. 1 to 2 hours after injection Regular insulin has a peak of 2 to 3 hours after injection; subcutaneous intermediate insulin has a peak of 4 to 15 hours after injection; and long acting has a peak of 10 to 30 hours after injection. 11. While in the hospital, Skyler Hansen receives short-acting and intermediate-acting insulin. The nurse knows that, when preparing the two insulins, which insulin should be drawn into the syringe first? a. It does not matter, either one may be drawn up first b. Neither, they should be administered in two different syringes c. short-acting d. intermediate-acting There are varying opinions, but the ADA recommend that the regular or short acting insulin be drawn up first. 12. Once Skyler Hansen, regains consciousness after receiving 50% dextrose in water (D50W) to treat an acute hypoglycemic episode comma which of the following is the most appropriate intervention by the nurse to prevent another decrease in blood glucose? a. Administer 6 ounces of fruit juice b. provide a snack of cheese and crackers c. provide six hard candies to eat d. administer an additional 25 to 50 mL of D50W After the dextrose, a snack including starch and protein should be given to the patient on awakening to prevent recurrence of hypoglycemia and to replenish liver stores of glucose. 13. Which of the following does the nurse recognize as the major, acute complication of diabetes? (select all that apply) a. Hypoglycemia b. Nephropathy c. Retinopathy d. Hyperglycemic hyperosmolar syndrome e. diabetic ketoacidosis There are three major acute complications of diabetes related to short-term imbalances in blood glucose levels: hypoglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar syndrome. Neuropathy and retinopathy are long term complications of diabetes. 14. The nurse assesses the IV site prior to administering 50 mL of dextrose 50% in water (D50W) intravenously to a patient with hypoglycemia per protocol. The nurse identifies redness and swelling at the IV site which action should the nurse take? a. Inform the patient that it may be painful b. Flush the IV the prior to administering the D50 W c. IV push the medication quickly since it is an emergency d. insert another IV to administer the D50W It is essential for the nurse to ensure patency of the IV loan used for injection of dextrose 50% in water because D50W is a hypertonic solution and very irritating to veins. the redness and swelling are signs of phlebitis and the nurse should not use the current IV line. 15. The nurse realizes additional patient education is required when Skyler Hanson makes which of the following statements? a. “I will make sure I have my medic alert bracelet on when I leave the house in the morning.” b. “I will make sure to eat one snack per day.” c. “I will rotate my insulin injection sites from the abdomen to thighs and upper arms.” d. “I will carry a fast-acting sugar source like life savers with me at all times.” Pacing food intake throughout the day places more manageable demands on the pancreas and enables better control. 16. The nurse recognizes that which factors may have contributed to Skyler Hansen’s low blood glucose in this case? (Select all that apply) a. too much insulin b. too little food c. excessive physical exercise d. too much food e. dehydration Hypoglycemia can occur when there is too much insulin, excess oral hypoglycemic agent, too little food, or excessive physical activity. 17. Which of the following is the rationale for the nurse administering dextrose 50% in water (D50W) intravenously rather than another concentrated source of carbohydrates for a patient with type one diabetes? (Select all that apply) a. the patient is unconscious b. sugar is not available to add to juice c. the patient cannot swallow d. be patient does not like injections In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of D50W may be administered IV. the fruit sugar in juice contains enough carbohydrates to raise blood glucose levels; adding table sugar to juice can cause a sharp increase in the blood glucose level. the nurse would ensure that the disoriented patient is able to swallow before giving an oral concentrated carbohydrate. the nurse would explain to the patient that the medication is being delivered through the IV line and not as an injection. 18. Is the following statement true or false? Glucagon works by promoting conversion of hepatic glycogen to glucose. TRUE Glucagon is a hormone produced by the alpha cells of the pancreas that stimulates the liver to breakdown glycogen, the stored glucose.