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Which instructions would the nurse include when educating a patient with diabetes about how to prevent fasting hyperglycemia known as "dawn phenomenon"? "Administer Humalog (insulin lispro) between 5 and 6 a.m." "Administer Humulin R (insulin [human recombinant]) between 5 and 6 a.m." "Administer Lantis (insulin glargine) at 10 p.m. instead of with the evening meal." "Administer Humulin 70/30 (insulin isophane and insulin regular) at 10 p.m. instead of with the evening meal."
"Administer Humulin 70/30 (insulin isophane and insulin regular) at 10 p.m. instead of with the evening meal." To prevent fasting hyperglycemia known as the "dawn phenomenon," the patient would be instructed to administer Humulin 70/30 at 10 p.m. instead of with the evening meal. Dawn phenomenon results from a nighttime release of adrenal hormones that cause blood glucose elevations in the early morning. It is managed by providing more insulin in the overnight period. Giving a dose of intermediate-acting insulin such as Humulin 70/30 at 10 p.m. instead of with an evening meal will provide more insulin for the overnight period, reducing the chance of dawn phenomenon. Humalog and Humulin R are, respectively, rapid- and short-acting insulins that are not appropriate for this purpose. Administering Lantis at 10 p.m. instead of with the evening meal will not help prevent dawn phenomenon, because insulin glargine is a 24-hour acting insulin.
The nurse is triaging a patient diagnosed with type 2 diabetes who is prescribed metformin. It is suspected that the patient is having an adverse drug interaction. What question by the nurse is priority? "Has anyone else been taking your medication?" "Do you know how to properly use an insulin syringe?" "Are you currently taking any over-the-counter medications?" "Is there a chance you could have given yourself the wrong insulin?"
"Are you currently taking any over-the-counter medications?" It is important to ask the patients if they are taking any over-the-counter medications to identify any possible adverse drug interactions. Someone else taking the patient's medication will not cause the patient to have an adverse drug interaction. The question does not state the patient is taking insulin; metformin is an oral antidiabetic medication.
The nurse is teaching a patient with diabetes about proper foot care. Which statement by the patient indicates that teaching was effective? "I should go barefoot in my house so that my feet are exposed to air." "I must inspect my shoes for foreign objects before putting them on." "I will soak my feet in warm water to soften calluses before trying to remove them." "I must wear canvas shoes as much as possible to decrease pressure on my feet."
"I must inspect my shoes for foreign objects before putting them on." To avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on. Diabetic patients should not go barefoot because foot injuries can occur. To avoid injury or trauma, a callus should be removed by a podiatrist, not by the patient. The diabetic patient must wear firm support shoes to prevent injury.
The nurse is teaching the parents of a pediatric patient who has recently been diagnosed with type 1 diabetes mellitus. What statement will the nurse include about the pathophysiology of the disease? "The body starts to attack itself and destroy the cells that convert insulin in the liver." "The body starts to attack itself and destroy the cells that make insulin in the pancreas." "Consistently high insulin levels leads to the inability of the cells to recognize and utilize the insulin." "Consistently high glucose levels leads to the increase in insulin secretion that cannot be utilized by the cells."
"The body starts to attack itself and destroy the cells that make insulin in the pancreas." Type 1 diabetes mellitus is an autoimmune disorder where the body begins to attack the beta cells, which are the insulin-forming cells, in the pancreas. This type of diabetes does not destroy the cells in the liver. In this type of diabetes insulin levels are absent, not elevated. High glucose levels are not what cause type 1 diabetes mellitus.
A patient recently diagnosed with type 2 diabetes mellitus (DM) states, "I don't understand how I got diabetes. I don't eat sugary foods." How does the nurse respond? "Type 2 diabetes is an autoimmune disease." "Individuals with type 2 diabetes are born with the disease." "Individuals with type 2 diabetes are typically young and their pancreas is not fully developed." "Type 2 diabetes is the result of resistance to insulin combined with an inability to secrete sufficient insulin."
"Type 2 diabetes is the result of resistance to insulin combined with an inability to secrete sufficient insulin." Type 2 DM is a progressive disorder in which the person has a combination of insulin resistance and decreased secretion of insulin by pancreatic beta cells. Insulin resistance develops from obesity and physical inactivity in a genetically susceptible person. Heredity does play a major role in the development of type 2 DM, but the nurse cannot assume that is why this patient developed type 2 DM; Many patients with type 2 DM are obese, with an increased rate of obesity and type 2 DM occurring in younger people.
The nurse is assessing a patient with a family history of type 2 diabetes. What does the nurse instruct the patient, considering the patient's risk for this disease? Select all that apply. 1. Engage in regular exercise. 2. Maintain body weight within 10 Ib of ideal weight. 3. Report failure of a wound to heal in less than 2 weeks. 4. Include concentrated simple sugars in the diet. 5. Consume a high-carbohydrate diet.
1. Engage in regular exercise. 2. Maintain body weight within 10 Ib of ideal weight. 3. Report failure of a wound to heal in less than 2 weeks A patient at risk for type 2 diabetes should engage in regular exercise to maintain a body weight within 10 lb of ideal weight because obesity is a risk factor for diabetes mellitus. The patient must report failure of a wound to heal in within less than 2 weeks; patients with diabetes are known to recover slowly from injuries and are prone to ulcer formation. The patient must reduce his or her intake of concentrated simple sugars and high-carbohydrate content in the diet because this may lead to elevated glucose in the blood because of poor metabolism.
The nurse is providing education to a patient with a new diagnosis of type 1 diabetes. What action by the patient indicates a need for further teaching? Utilizing only the abdomen for injections Grasping a skin fold and injecting at a 90-degree angle Aspirating for blood return before administering the medication Mixing regular human insulin with isophane insulin NPH for injection
Aspirating for blood return before administering the medication Aspirating for blood return is not indicated with insulin administration. Utilizing the abdomen only for injection (one anatomic site) is preferred to rotation from one area to another to prevent day-to-day changes in absorption. Grasping the skin and injecting at 90 degrees is correct practice. Mixing regular insulin and NPH is acceptable.
Which is a chronic complication that can occur in patients with diabetes? Cell death from macrovascular changes Hypoglycemia from too much insulin or too little glucose Diabetic ketoacidosis caused by lack of insulin and ketosis Hyperglycemic-hyperosmolar state caused by insulin deficiency and profound dehydration
Cell death from macrovascular changes Cell death from macrovascular changes is a chronic complication of diabetes. Diabetic ketoacidosis, hyperglycemic-hyperosmolar state, and hypoglycemia are acute complications from diabetes and require emergency treatment.
What information should be included when teaching a patient with diabetes about foot care? It is important to soak your feet once a week. It is important to wear the same shoes most days. Apply moisturizing cream between your toes and on your feet. Check bath water temperature before stepping in the water.
Check bath water temperature before stepping in the water. It is important to check bath water temperature prior to stepping into the water. Patients with diabetes should not soak their feet, they should not put moisturizing cream between their toes, and they should avoid wearing the same shoes two days in a row.
A patient with diabetes mellitus reports a burning or tingling sensation in the toes. A primary health care provider suspects distal symmetric neuropathy. The nurse recognizes that which findings indicate motor alterations in the intrinsic muscles of the foot associated with this condition? Select all that apply. Foot drop Claw toes High arch Hammertoes Carpal tunnel syndrome
Claw toes High arch Hammertoes Neuropathy is a serious complication of diabetes mellitus. Distal symmetric neuropathy affects peripheral areas such as the toes and fingers. A burning or tingling sensation in the toes indicates sensory alteration. Claw toes, high arches, and hammertoes indicate motor alterations in the intrinsic muscles of the foot. Foot drop is seen in entrapment neuropathy because of the involvement of the popliteal nerve. Carpel tunnel syndrome is a median nerve entrapment neuropathy characterized by pain and paresthesia.
When providing teaching about nutrition to a patient diagnosed with diabetes, what instruction should the nurse include? It is important to avoid snacks. Decrease calories when exercising. Carbohydrates should be restricted to once a day. Eat consistent amounts of food at consistent times.
Eat consistent amounts of food at consistent times. It is important to have consistent amounts of food at consistent times. Snacks are OK, calories should not be avoided when exercising, and carbohydrates should not be restricted to once a day.
Which manifestation is associated with hyperglycemia in a patient with diabetes mellitus? Pallor Irritability Diaphoresis Excessive urination
Excessive urination Manifestations of hyperglycemia and diabetes include polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive eating). Symptoms of hypoglycemia include diaphoresis, pallor, irritability, tremor, anxiety, confusion, hunger, and loss of consciousness.
The nurse is providing education for a patient newly diagnosed with diabetes. The patient is discussing healthy sources of carbohydrates. What sources should be included? Select all that apply. Fish Fruits Legumes Margarine Low-fat milk products
Fruits Legumes Low-fat milk products Fruits, legumes, and low-fat milk products are healthy sources of carbohydrates. Fish and margarine are not sources of carbohydrates.
What information does the nurse include when planning teaching for a patient with diabetes? Select all that apply. Importance of foot care Need to avoid exercise Correct storage for insulin Protein sources for periods of hypoglycemia Understanding of why the insulin is being prescribed
Importance of foot care Correct storage for insulin Understanding of why the insulin is being prescribed It is important for a patient to have regular foot care, understand where and how to store insulin, and understand why the insulin is prescribed. Exercise should not be avoided, and proteins are not given for hypoglycemia.
The nurse instructs a patient with diabetes and hypertension about the importance of controlling blood sugar and blood pressure. What is the potential effect of these systemic conditions on the eye and vision? Vision loss Presbyopia Arcus senilis Relaxation of the lower eyelids
Vision loss Systemic disorders such as diabetes and hypertension can lead to glaucoma and vision loss. The patient must have regular examinations to assess for complications. Presbyopia is a natural occurrence in most people over 40 years of age in which the near point of vision increases. Arcus senilis is also an age-related change in which fat deposits form a bluish ring outside the cornea. Decreased muscle tone due to aging causes the relaxation or weakening of the lower eyelids, leading to dry-eye symptoms.