Grey Matter Gauntlet (NSG 219 Exam 1)
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What blood test gives an average of blood glucose levels over the past 2-3 months?
Answer: Hemoglobin A1c.
Rationale: A1c measures long-term blood glucose control
Memory Tip: "A1c for 3."
What type of diabetes is characterized by insulin deficiency due to autoimmune destruction?
Answer: Type 1 Diabetes Mellitus (T1DM).
Rationale: In T1DM, the body’s immune system destroys insulin-producing cells
Memory Tip: "Type 1 = Total insulin loss."
What should you do if a diabetic patient’s blood sugar is below 70 mg/dL?
Answer: Follow the Rule of 15: Consume 15g of carbohydrates and recheck in 15 minutes.
Rationale: This helps raise blood sugar to a safe level
Memory Tip: "Rule of 15 for hypoglycemia."
What is the blood glucose level for diagnosing diabetes in a fasting test?
Answer: >126 mg/dL on two separate occasions.
Rationale: This is the standard threshold for diagnosis
Memory Tip: "Diabetes = Over 126."
or “Get a grip if it's over 126.”
What is the primary organ affected by diabetes?
Answer: Pancreas.
Rationale: Diabetes affects the pancreas, which produces insulin to regulate blood sugar levels
Memory Tip: "Pancreas produces insulin" (both start with "P").
Which type of diabetes is associated with insulin resistance?
Answer: Type 2 Diabetes Mellitus (T2DM).
Rationale: T2DM is characterized by insulin resistance and eventual insulin deficiency
Memory Tip: "Type 2 = Too much resistance."
What is the recommended fasting blood glucose target for patients with diabetes?
Answer: 80-130 mg/dL.
Rationale: This is the target for fasting glucose to prevent complications
Memory Tip: "Aim for 80-130."
What is the primary treatment for Type 1 Diabetes?
Answer: Insulin therapy.
Rationale: Patients with T1DM require insulin since their pancreas no longer produces it
Memory Tip: "Type 1 needs 1 thing: insulin."
What condition involves progressive deterioration of nerve function, causing sensory loss?
Answer: Peripheral neuropathy.
Rationale: Diabetes often causes nerve damage, leading to neuropathy
Memory Tip: "Nerve issues = neuropathy."
What are the three classic symptoms of hyperglycemia?
Answer: Polydipsia, polyuria, polyphagia.
Rationale: These are common symptoms due to high blood glucose
Memory Tip: "The 3 Ps: Pee, Parched, and Pile on food."
What is the main hormone that works opposite to insulin?
Answer: Glucagon.
Rationale: Glucagon raises blood glucose levels, counteracting insulin
Memory Tip: "Glucagon = glucose goes up."
What is the long-term complication of uncontrolled blood glucose that affects the eyes?
Answer: Retinopathy.
Rationale: High glucose levels damage blood vessels in the retina, leading to blindness
Memory Tip: "Retinopathy = Retina risk."
What lifestyle modification is essential for managing prediabetes?
Answer: Diet and physical activity.
Rationale: Lifestyle changes like improved diet and increased physical activity are the first line of defense in preventing Type 2 Diabetes
Memory Tip: "Move and eat right to stop Type 2's might."
What medication is the first-line oral treatment for Type 2 Diabetes?
Answer: Metformin.
Rationale: Metformin reduces liver glucose production and increases insulin sensitivity
Memory Tip: "Metformin = Metabolic fixer."
What electrolyte must be closely monitored during diabetic ketoacidosis (DKA) treatment?
Answer: Potassium.
Rationale: Insulin treatment for DKA can cause hypokalemia
Memory Tip: "DKA depletes K."
What are the glucose goals for 2 hours postprandial (after meals) for a diabetic patient?
Answer: <180 mg/dL.
Rationale: This helps prevent spikes after meals
Memory Tip: "Under 180 post-meal."
What is the main dietary recommendation for managing diabetes?
Answer: Limit simple carbohydrates and include complex carbs with meals.
Rationale: Managing carbohydrate intake helps control blood glucose
Memory Tip: "Carbs count."
Why should patients with diabetes be cautious with alcohol consumption?
Answer: Alcohol can cause hypoglycemia.
Rationale: Alcohol inhibits liver glucose production
Memory Tip: "Alcohol drops glucose."
What type of diabetes is associated with pregnancy?
Answer: Gestational diabetes.
Rationale: Gestational diabetes occurs due to hormonal changes during pregnancy
What type of diabetes is characterized by the autoimmune destruction of beta cells?
Answer: Type 1 Diabetes Mellitus (T1DM).
Rationale: In Type 1 Diabetes, the immune system attacks the insulin-producing beta cells in the pancreas, leading to an absolute insulin deficiency
Memory Tip: "Type 1 = No insulin (1 sounds like "none").
What is the hallmark sign of Diabetic Ketoacidosis (DKA)?
Answer: Kussmaul respirations.
Rationale: DKA causes metabolic acidosis, leading to deep, labored breathing called Kussmaul respirations
Memory Tip: "K for Kussmaul, Vitamin K, and Ketoacidosis".
What condition primarily occurs in patients with Type 2 Diabetes and involves severe hyperglycemia without significant ketosis?
Answer: Hyperglycemic-Hyperosmolar State (HHS).
Rationale: HHS is characterized by extreme hyperglycemia, dehydration, and altered mental status without the presence of significant ketones
Memory Tip: "HHS = High Sugar, No Ketones."
What is the treatment priority for Diabetic Ketoacidosis (DKA)?
Answer: Fluid resuscitation and insulin therapy.
Rationale: DKA is treated with fluids to correct dehydration and insulin to lower blood glucose and ketone levels
Memory Tip: "Fix the fluids and insulin".
Why should Metformin be discontinued before and after IV contrast dye?
Answer: To prevent lactic acidosis.
Rationale: Metformin can cause lactic acidosis in patients with impaired kidney function, especially when used with contrast dye
Memory Tip: "Metformin + Dye = Danger."
What is the recommended hemoglobin A1c goal for patients with diabetes?
Answer: Less than 7.0%.
Rationale: Maintaining an A1c level below 7.0% helps prevent complications from diabetes
Memory Tip: "A1c less than 7, keeps you in heaven."
What electrolyte imbalance is common in Diabetic Ketoacidosis (DKA)?
Answer: Hypokalemia (low potassium).
Rationale: As insulin and fluids are given in DKA treatment, potassium shifts into cells, leading to hypokalemia
Memory Tip: "DKA treatment = Drop in K."
What is the main complication of gestational diabetes for the newborn?
Answer: Macrosomia (large baby).
Rationale: High maternal blood sugar leads to excessive fetal growth, increasing the risk of birth complications
Memory Tip: "Gestational = Giant baby."
What should a diabetic patient do if their blood glucose is below 100 mg/dL before exercise?
Answer: Eat carbohydrate-rich food.
Rationale: Consuming carbohydrates before exercise prevents hypoglycemia
Memory Tip: "Below 100? Grab a snack."
What hormone raises blood glucose when food intake is low?
Answer: Glucagon.
Rationale: Glucagon is secreted by the pancreas and raises blood glucose by releasing stored glucose from the liver
Memory Tip: "Glucagon is the glucose giver."
Which class of diabetes medications works by increasing insulin release from the pancreas?
Answer: Sulfonylureas.
Rationale: Sulfonylureas stimulate the pancreas to release more insulin
Memory Tip: "Sulfonylureas = Squeeze out more insulin."
What is the primary treatment for Hyperglycemic-Hyperosmolar State (HHS)?
Answer: Fluid resuscitation.
Rationale: HHS is treated with fluids to correct dehydration and reduce blood
Memory Tip: "HHS = Hydration is key."
What is the mechanism of action for SGLT2 inhibitors?
Answer: They prevent glucose reabsorption in the kidneys.
Rationale: SGLT2 inhibitors promote glucose excretion through urine, lowering blood
Memory Tip: "SGLT2 = Sugar goes to the toilet."
Why should a diabetic patient avoid walking barefoot?
Answer: To prevent injury and infection.
Rationale: Diabetic patients are prone to peripheral neuropathy, leading to reduced sensation in the feet, increasing the risk of unnoticed injuries and infections
Memory Tip: "No shoes, no feel, big deal."
What type of insulin is used in insulin pumps?
Answer: Rapid-acting insulin.
Rationale: Insulin pumps use rapid-acting insulin to mimic the body’s natural insulin release.
Memory Tip: "Rapid for the pump, fast like a jump."
What is the primary treatment for a patient with hypoglycemia who is unconscious?
Answer: Glucagon injection.
Rationale: Glucagon raises blood glucose levels in unconscious patients
Memory Tip: "Unconscious = Glucagon to the rescue."
What should diabetic patients with kidney impairment avoid taking?
Answer: Metformin.
Rationale: Metformin increases the risk of lactic acidosis in patients with kidney impairment
Memory Tip: "Kidneys failing? Skip the Metformin."
Which diabetes complication is the leading cause of kidney failure in the U.S.?
Answer: Diabetic nephropathy.
Rationale: High blood glucose causes hypertension and damage to kidney blood vessels, leading to nephropathy
Memory Tip: "Diabetes damages kidneys."
An A1c of 5.7-6.4% is an indication of what?
Prediabetes
Glucagon is secreted from ___ in the pancreas.
Alpha cells
The A1c goal for someone with diabetes is ___ mg/dl.
7.0 mg/dl
Normal serum osmolarity is between ___ mOsm/L.
270-300 mOsm/L
The degree of ___ impairment is related to serum osmolarity with coma occurring once serum osmolarity is greater than 350mOsm/L.
neurologic
___ and ___ are the primary treatment for prediabetes.
Diet and activity
___, ___, ___, ___, and ___ are used to treat T2DM.
Diet, activity, stress management, diabetes education, and medications
The goal is for glucose to decrease by ___mg/dl per hour to reach goal.
50-70mg/dl
___ shouldn’t be used in clients with eGFR less than ___.
Metformin, less than 30
Metformin should be held ___ hours before and ___ hours after IV contrast
24 hours before and 48 hours after
Teach patients on DPP4 Inhibitors (-gliptins – Sitagliptin - Januvia) S/S of hypoglycemia and S/S of ___.
pancreatitis
TZD’s shouldn’t be used by patients with ___.
symptomatic heart failure
Teach patients on SGLT2s (Sodium Glucose cotransport Inhibitors) “flozin" S/S of hypoglycemia, ___ and ___.
dehydration and UTIs
The goal of insulin therapy is to ___.
replicate the normal insulin release pattern from the pancreas
Teach patients on Intermediate Acting Insulin (NPH, 70/30, 70/25) take before ___ and ___, not in the morning and at night.
breakfast and dinner
What is a primary factor contributing to GERD?
Answer: Incompetent lower esophageal sphincter (LES)
Rationale: An incompetent LES allows the backflow of stomach contents into the esophagus, leading to irritation and inflammation.
Memory Aid: LES = Let's Eat Spaghetti
What is a classic symptom of GERD?
Answer: Heartburn (pyrosis)
Rationale: Heartburn is a burning sensation that often mimics angina but is relieved with antacids.
Memory Aid: Pyrosis = Pizza (Think of heartburn after eating a spicy pizza).
Which type of diet should patients with GERD avoid?
Answer: Fatty, spicy foods and caffeine
Rationale: These foods relax the LES, worsening GERD symptoms.
Memory Aid: GERD: Go Easy on Rich Dishes.
What is a key complication of chronic GERD?
Answer: Barrett’s esophagus
Rationale: Barrett’s esophagus involves metaplasia of cells, which increases the risk for cancer.
Memory Aid: Barrett’s = Bad Esophagus (change to cancer-risk tissue).
Which drug class is most effective in treating GERD?
Answer: Proton Pump Inhibitors (PPIs)
Rationale: PPIs reduce stomach acid production more effectively and promote healing of the esophagus.
Memory Aid: PPIs = Protects Pipes (keeps the acid from flowing up).
What is the most common cause of peptic ulcer disease (PUD)?
Answer: Helicobacter pylori (H. pylori)
Rationale: H. pylori infection leads to mucosal damage, increasing the risk of ulcers.
Memory Aid: H. Pylori = Hole in your Pylorus.
What is a symptom specific to gastric ulcers?
Answer: Pain 1-2 hours after meals
Rationale: Gastric ulcers cause pain soon after eating, due to direct acid contact with the ulcer.
Memory Aid: Gastric ulcers = Grief after eating.
What is a symptom of duodenal ulcers?
Answer: Pain 2-5 hours after meals
Rationale: Duodenal ulcers cause delayed pain as food passes through the stomach into the duodenum.
Memory Aid: Duodenal ulcers = Delayed pain.
What is a life-threatening complication of peptic ulcer disease?
Answer: Perforation
Rationale: Ulcer perforation can lead to peritonitis, requiring emergency care.
Memory Aid: Ulcer Perforation = Panic (emergency).
What dietary habit increases the risk of gastritis?
Answer: Excessive alcohol consumption
Rationale: Alcohol irritates and breaks down the gastric mucosa, leading to inflammation.
Memory Aid: Alcohol = Acid trouble.
Which lab test is most commonly used to diagnose H. pylori infection?
Answer: Urea breath test
Rationale: H. pylori produces urease, which can be detected through the breath test.
Memory Aid: Urea = U (You breathe it out).
What is a key teaching point for patients taking PPIs long-term?
Answer: Risk of decreased bone density
Rationale: Long-term use of PPIs may lead to bone fractures, particularly in the hip, wrist, and spine.
Memory Aid: PPIs = Protection but beware of Porous bones.
What surgical procedure is commonly used to treat hiatal hernias?
Answer: Nissen fundoplication
Rationale: Nissen fundoplication wraps part of the stomach around the lower esophagus to prevent reflux.
Memory Aid: Think of the stomach as being "tied up" to prevent acid from going back up.
Which diagnostic study is commonly used to confirm GERD?
Answer: Endoscopy
Rationale: Endoscopy allows direct visualization of the esophagus to assess damage from acid reflux.
Memory Aid: Endoscopy = Explores Esophagus.
What symptom indicates a possible upper GI bleed?
Answer: Coffee-ground vomitus
Rationale: Digested blood appears as dark, coffee-ground material in vomit.
Memory Aid: Coffee-ground = Clotting blood.
What medication is contraindicated in patients with peptic ulcers?
Answer: NSAIDs
Rationale: NSAIDs inhibit prostaglandin production, reducing mucosal protection and worsening ulcers.
Memory Aid: NSAIDs = Not for ulcers.
What medication is used to protect the stomach lining in patients with ulcers?
Answer: Sucralfate
Rationale: Sucralfate forms a protective barrier over ulcers, promoting healing.
Memory Aid: Sucralfate = Shield for stomach
What lifestyle modification should be encouraged for patients with GERD?
Answer: Elevating the head of the bed 30 degrees
Rationale: Elevating the head helps prevent acid reflux during sleep.
Memory Aid: Lift the bed to prevent Liquid from rising.
Which diagnostic study is preferred to assess for gastric ulcers?
Answer: Endoscopy with biopsy
Rationale: This provides direct visualization and tissue samples to confirm the diagnosis.
Memory Aid: Endoscopy = Ending the ulcer mystery.
What symptom suggests esophageal cancer in an older adult?
Answer: Difficulty swallowing (dysphagia)
Rationale: Dysphagia often develops as a tumor obstructs the esophagus.
Memory Aid: Dysphagia = Difficulty Downing food.
What is the treatment goal for achalasia?
Answer: Improve esophageal emptying
Rationale: Treatment aims to relax the LES to prevent obstruction and allow food passage.
Memory Aid: Achalasia = Aid the esophagus by relaxing it.
Which lab finding would suggest an upper GI bleed?
Answer: Decreased hemoglobin and hematocrit
Rationale: Blood loss from the GI tract leads to anemia.
Memory Aid: Low H&H = Hemorrhage.
What is the preferred treatment for patients with a Mallory-Weiss tear?
Answer: Stop bleeding and allow healing
Rationale: Mallory-Weiss tears are self-limiting, and treatment focuses on supportive care to stop the bleeding.
Memory Aid: Think of Mallory-Weiss as needing to Mend on its own.
What clinical manifestation indicates a hiatal hernia?
Answer: Heartburn and regurgitation
Rationale: A hiatal hernia allows part of the stomach to push through the diaphragm, causing reflux symptoms.
Memory Aid: Hiatal hernia = Heartburn from the Hole.
What nursing intervention is crucial after esophageal surgery to prevent aspiration?
Answer: Keep the patient in a semi-Fowler's to Fowler's position
Rationale: Elevating the head of the bed reduces the risk of reflux and aspiration.
Memory Aid: Fowler’s position = Fewer reflux issues.
What specific medication is most commonly used to reduce stomach acid secretion in GERD patients?
Answer: Omeprazole
Rationale: Omeprazole is a proton pump inhibitor (PPI) that reduces stomach acid production, which helps manage GERD.
Memory Aid: "O for Omeprazole, O for Off the acid."
A patient with a history of GERD complains of difficulty swallowing (dysphagia). This may indicate what complication?
Answer: Esophageal stricture
Rationale: Chronic inflammation from GERD can lead to esophageal stricture, causing dysphagia.
Memory Aid: "Stricture = Stuck."
What diagnostic study is commonly used to confirm the presence of a peptic ulcer?
Answer: Endoscopy
Rationale: Endoscopy allows direct visualization of the mucosal lining of the stomach and duodenum to detect ulcers.
Memory Aid: "Endo explores ulcers."
A patient with a peptic ulcer is experiencing black, tarry stools. What does this indicate?
Answer: Upper GI bleed
Rationale: Melena (black, tarry stools) indicates bleeding in the upper gastrointestinal tract, often associated with peptic ulcers.
Memory Aid: "Black stools, blood up high."
What bacterium is most commonly associated with the development of peptic ulcer disease?
Answer: Helicobacter pylori
Rationale: Helicobacter pylori is known to cause damage to the stomach lining, leading to peptic ulcers.
Memory Aid: "H. pylori harasses the gut."
A patient diagnosed with a hiatal hernia what activities should be taught to avoid?
Answer: Lifting heavy objects
Rationale: Heavy lifting increases intra-abdominal pressure, which can worsen a hiatal hernia.
Memory Aid: "Hernias hate heavy lifting."
A patient with an upper GI bleed presents with bright red vomitus. What is this called?
A: Hematemesis.
Rationale: Hematemesis is vomiting blood, often indicating a severe GI bleed.
Memory Tip: Hema = blood, emesis = vomit.
What factor increases the risk of developing peptic ulcer disease?
A: Chronic NSAID use.
Rationale: NSAIDs inhibit protective prostaglandins, increasing ulcer risk.
Memory Tip: NSAIDs = No Stomach Aid.
In teaching a patient about lifestyle changes to manage GERD, what should be included?
A: Avoid lying down for 2 to 3 hours after eating.
Rationale: Lying down soon after meals increases reflux risk.
Memory Tip: After eating, stand tall to prevent the fall (of acid).
A patient is using calcium carbonate antacids for heartburn relief. What side effect should the nurse monitor for?
A: Hypercalcemia.
Rationale: Calcium-based antacids can lead to elevated calcium
levels.
Memory Tip: "Too much calcium, keep an eye on the serum!"
What diagnostic test is commonly used to confirm a hiatal hernia?
A: Barium swallow.
Rationale: A barium swallow can visualize hernias by highlighting the esophagus and stomach.
Memory Tip: "Swallow the barium to find the hernia."
What is the priority intervention for a patient with a suspected perforated peptic ulcer?
A: Notify the healthcare provider immediately.
Rationale: Perforation is a medical emergency requiring prompt surgical intervention.
Memory Tip: "Perforation equals rapid consultation."
___ is how medications travel through the body.
Pharmacokinetics
___ is the amount of medication given.
Intensity
___ determines how soon the med will take effect.
Rate of absorption
___ and ___ are the most common routes of medication administration.
(thru the GI tract) and parenteral (by injection)
The ___ affects the rate and amount of absorption.
route of administration
What factors influence the distribution of medications?
blood and tissue binding proteins, pH, and perfusion
What is the First pass effect?
when the liver inactivates some meds
___ are proteins that act as biological catalysts by accelerating chemical reactions.
Enzymes
What route of administration includes the following?
• BARRIERS TO ABSORPTION: Swallowing before dissolution allows gastric pH to inactivate the medication.
• ABSORPTION PATTERN: Quick absorption systemically through highly vascular mucous membranes
Sublingual, buccal
What route of administration includes the following?
• BARRIERS TO ABSORPTION: Medication must pass through the layer of epithelial cells lining the GI tract.
• ABSORPTION PATTERN: Varies due to GI emptying time, stability and solubility of the medication, food in the stomach, intestines, other medications and the form of the medication (liquid, enteric coated).
Oral
What route of administration includes the following?
• BARRIERS TO ABSORPTION: Presence of stool in the rectum or infectious material in the vagina limits tissue contact.
• ABSORPTION PATTERN: Easy absorption with both local and systemic effects
Other mucous membranes (rectal, vaginal)