Chapter 49

Which patient should the nurse plan to teach how to prevent the delay the development of diabetes?

A 34 year old woman whose parents both have type 2 diabetes

A patient with type 1 diabetes uses 20U of 70/30 neutral protamine Hagedorn in the morning andat 6:00 PM. When teaching the patient about this regimen, what should the nurse emphasize?

A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia

During the routine health screening, a patient is found to have fasting plasma glucose of 132 mg/dL. At a follow up visit, a diagnosis of diabetes would be made based on which laboratory results?

AIC of 7.5%, FPG>126 mg/dL (7.0 mmol/L)

The nurse determines that a patient with a 2 hour OGTT of 152 mg/dL has

Impaired glucose tolerance

To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise?

About 1 hour after eating when blood glucose levels are rising

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do?

Accelerates the transport of amino acids into cells and their synthesis into protein

Priority decision: when caring for a patient with metabolic syndrome, what should the nurse give the highest priority to teaching the the patient about?

Achieving a normal weight

Which tissues require insulin to enable movement if glucose into the tissue cells (select all that apply)

Adipose, Skeletal muscle

Lispro insulin with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when the Lispro insulin is used, when should it be administered?

At mealtime or within 15 minutes of each meal

What characterize type 2 diabetes.

B-cell exhaustion, insulin resistance, genetic predisposition, altered production of adipokines, inherited defect in insulin receptors, inappropriate glucose production by the liver

Which class of oral glucose lowering agents is the most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose?

Biguanide

Delegation deicision: The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to unlicensed assistive personnel?

Check the bath water is not too hot

The nurse assesses the diabetic patients technique of self monitoring of blood glucose 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention?

Cleaning the puncture site with alcohol before the puncture

When teaching the patient with the diabetes about insulin administration, the nurse should include which instruction for the patient?

Consistently using the same size of insulin syringe to avoid dosing errors

Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to

Eat regular meals at regular times

A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendation for screening should be included?

FPG for all individuals at age 45 and then every 3 years

Which laboratory results would indicate that the patient has prediabetes?

Fasting blood glucose result of 120 mg/dL

The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included?

Maintain a healthy weight, monitor for polyuria, polyphagia, and polydipsia

The home care nurse should intervene to correct a patient whose insulin administration includes

Mixing an evening dose of regular insulin with insulin glargine in one syringe for administration

Priority decision: A patient with insulin has recorded fasting glucose levels above 200mg/dL on awakening for the last five mornings. What should the nurse at advise the patient do first?

Monitor the glucose level at bedtime, between 2:00 AM and 4:00 AM and on arising

What should the goals of nutrition therapy for the patient with type 2 diabetes include?

Normal serum glucose and lipid levels

In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose?

Polydipsia

Priority decision: The nurse is assessing a newly admitted diabetic patient. Which observation should be addressed as the priority by the nurse?

Rapid respirations with deep inspiration

Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones?

Stimulate glucose output by the liver

The patient with type 2 diabetes is being put on acarbose and wants to know why she is taking it. What should the nurse include in this patients teaching

Take it with the first bite of each meal, effectiveness is measured by 2 hour postprandial glucose, it delays glucose absorption from the GI tract

When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an an insulin pump?

Tight glycemic control can be maintained

A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what?

Withdraws the NPH dose into the syringe first