AQ Ch. 64
While teaching a patient about insulin injection technique, the nurse explains that injecting into which area will cause the insulin to be most rapidly absorbed? Thigh Deltoid Buttocks Abdomen
Abdomen Insulin absorption is fastest when it is injected in the abdomen, followed by the deltoid, thigh, and buttocks.
The nurse is caring for a patient with diabetes mellitus who received insulin aspart at 8:00 AM. At which time does the nurse expect hypoglycemia most likely to occur in this patient? 8:30 AM 4:00 PM 8:30 PM 11:00 AM
11:00 AM Insulin aspart is a rapid-acting insulin with an onset of 15 minutes, a peak in 1 to 3 hours, and a duration of action of 3 to 5 hours. Episodes of hypoglycemia are more likely during the peak action of the medication. In this case, it would be at 11:00 AM.
The nurse is teaching a patient being discharged about managing hypoglycemia at home. Once at home, the patient has a blood glucose level of less than 60 mg/dL. What food selections by the patient demonstrate that the teaching was effective? Select all that apply. 2 hard candies 6 saltine crackers 1 cup of fruit juice 3 graham crackers 4 teaspoons of sugar
6 saltine crackers 3 graham crackers 4 teaspoons of sugar A blood glucose level of less than 60 mg/dL is hypoglycemia. Food selections that include 6 saltine crackers, 3 graham crackers, or 4 teaspoons of sugar are indicated for treatment of hypoglycemia. Two hard candies is not enough. One cup of fruit juice is too much.
Which food will the nurse provide to a patient who has hypoglycemia and a blood glucose level of 60 mg/dL? 16 oz of milk 4 tbsp of honey Eight cubes of sugar A half cup of fruit juice
A half cup of fruit juice A half cup of fruit juice is adequate for a patient to manage his or her hypoglycemia. For milk, 16 oz are too much; 8 oz is an adequate amount. For honey, 1 tbsp is enough; 4 tbsp are too much. Eight cubes of sugar are too much; four cubes are enough.
A patient who received insulin glargine subcutaneously 30 minutes ago is now cool, clammy, and anxious. The patient states "Something is wrong with me." The blood glucose level is 54. What action by the nurse is should be taken? Administer IV insulin Administer IV dextrose Administer IM glucagon Administer a carbohydrate replacement
Administer a carbohydrate replacement The patient is awake and alert, so administration of a carbohydrate replacement is indicated. IV insulin would further decrease the blood glucose. Dextrose IV and IM glucagon are not indicated in the patient who is awake, alert, and able to take in oral carbohydrate replacement.
A patient diagnosed with type 2 diabetes is taking pioglitazone. What finding should be reported to the health care provider immediately? Blood glucose of 65 mg/dL Potassium level of 4.9 mEq Blood glucose of 180 mg/dL Alanine aminotransferase (ALT) level of 105
Alanine aminotransferase (ALT) level of 105 An alanine aminotransferase (ALT) level of 105 indicates liver involvement. A side effect of this medication is liver impairment. This finding should be reported immediately. Blood glucose levels of 65 or 180 are not priority. A potassium level of 4.9 is normal.
Which is the best referral that the nurse can suggest to a patient who has been newly diagnosed with diabetes? Health care provider office Pharmaceutical representative American Diabetes Association Centers for Disease Control and Prevention
American Diabetes Association The American Diabetes Association can provide national and regional support and resources to patients with diabetes and their families. The Centers for Disease Control and Prevention does not focus on diabetes. The patient's health care provider's office is not the best resource for diabetes information and support. A pharmaceutical representative is not an appropriate resource for diabetes information and support.
The nurse is caring for a patient who is receiving sitagliptin. Which finding requires immediate attention? Hemoglobin A 1c 7% Creatinine 1 mg/dL Amylase 546 mg/dL Arterial blood pH 7.35
Amylase 546 mg/dL Pancreatitis may occur in patients taking sitagliptin. An elevated amylase level is a sign of pancreatitis and should be reported to the provider. The target goal for hemoglobin A 1c should be less than 7%, so this value is not critical. A normal arterial pH is between 7.35 and 7.45, and a creatinine of 1 mg/dL is normal.
What symptoms should be assessed for in a patient diagnosed with hypoglycemia? Select all that apply. Ketones Confusion Weakness Dehydration Cool, clammy skin
Confusion Weakness Cool, clammy skin Confusion, weakness, and cool, clammy skin would indicate hypoglycemia and should be assessed for in this patient. Ketones would not be found in hypoglycemia. Dehydration is not found in hypoglycemia.
What method must the patient with diabetes use with regard to insulin safety? Shake insulin well before administration. Discard any unused insulin after 28 days. Refrigerate unused insulin at 32° F (0° C). Store prefilled syringes in a horizontal position.
Discard any unused insulin after 28 days The patient must discard any unused insulin after 28 days because a slight loss in potency may occur after the bottle has been in use for more than 30 days, even when the expiration date has not passed. The bottle or the prefilled syringe may be rolled gently between the hands, but not shaken vigorously before administration, to prevent loss of potency. Prefilled syringes must be stored upright, with the needle pointing upward, to prevent clogging of the needle. Unused insulin must not be exposed to temperatures below 36° F (2.2° C) to prevent loss of drug potency.
A patient who is scheduled for surgery in the morning is placed on NPO status. The patient is scheduled to receive insulin glargine before bed. What action by the nurse should be taken? Give the insulin Hold the insulin Contact the healthcare provider Reduce the dose based on the blood glucose level
Give the insulin The insulin should be administered because this medication is for basal regulation and controls the baseline blood glucose. The insulin should not be held. The healthcare provider does not need to be contacted. The nurse should not reduce the dose of insulin without the healthcare provider's orders.
What does a fasting blood glucose of 65 mg/dL indicate? Hypoglycemia Hyperglycemia More information needed Normal result in range for fasting
Hypoglycemia Hypoglycemia is defined as a fasting blood glucose level lower than 74 mg/dL. Hyperglycemia is defined as a fasting blood glucose level greater than 106 mg/dL. These are universal guidelines that are not individualized, so more information is not necessary. The normal range for fasting blood glucose levels is 74 to 106 mg/dL.
Which statement about repaglinide is correct? It may be taken without regard to food. It is effective in people with type 1 and type 2 diabetes. It increases the secretion of insulin from the pancreas. It works best when taken before the first meal of the day.
It increases the secretion of insulin from the pancreas Repaglinide is a short-acting oral hypoglycemic agent that works by increasing insulin secretion from the pancreas. The medication should not be taken if a meal is skipped. It is used only in patients with type 2 diabetes. Repaglinide should be taken 3 times daily, 1-30 minutes before each meal.
Which patient taking metformin does the nurse consider at highest risk for lactic acidosis? Patient who is receiving dialysis Patient who has hyperglycemia Patient who is also taking warfarin Patient who is also taking oral contraceptives
Patient who is receiving dialysis The patient receiving dialysis has kidney failure, which poses a high risk for lactic acidosis. The patient is taking metformin for hyperglycemia; while lactic acidosis is a side effect of metformin, hyperglycemia alone does not increase the risk for acidosis. Patients taking oral contraceptives are typically at risk for deep vein thrombosis/pulmonary embolism. Patients taking warfarin are at risk for bleeding and potential hypoglycemia when taking a sulfonylurea drug with warfarin.
What teaching should be included for a patient with a new diagnosis of type 1 diabetes? Select all that apply. Sick day rules Avoidance of exercise Daily inspection of feet Reporting any vision changes Weekly blood work for the first year
Sick day rules Daily inspection of feet Reporting any vision changes Patients should be taught about sick day rules, the need to inspect their feet daily, and to report changes in vision. Patients with diabetes do not need to avoid exercise and will not have weekly blood work for the first year.
What is an important feature of the glycosylated hemoglobin A 1c (HbA 1c) test? The results are not altered by eating habits 24 hours before the test. The patient must drink a 75 g glucose load an hour before the test. It determines the average blood glucose levels of the previous 14 days. The patient must not have any caloric intake for at least 8 hours before the test.
The results are not altered by eating habits 24 hours before the test. Glycosylated hemoglobin A 1c (HbA 1c) test results are not altered by eating habits the day before the test. Glucose binds to hemoglobin through a process called glycosylation. The glycosylated hemoglobin A 1c (HbA 1c) test is a good indicator of the average blood glucose level during the previous 120 days—the life span of red blood cells. Glycosylated serum albumin (GSA), glycosylated serum protein (GSP), and fructosamine determine blood glucose levels during the previous 14 days. The diagnosis of gestational diabetes mellitus is based on the oral glucose tolerance test, in which the patient must drink a 75 g glucose load an hour before the test. The patient must not have any caloric intake for at least 8 hours before the fasting plasma glucose test to prevent falsely elevated values.
The nurse is teaching a patient who has just been prescribed insulin glargine about administration. What statements by the patient indicate a need for further teaching? Select all that apply. "I will administer it subcutaneously." "I cannot mix this with other insulins." "The insulin will start working in 2-4 hours." "I will take this before meals and at bedtime." "If I am hospitalized, I can receive this medication intravenously."
"I will take this before meals and at bedtime" "If I am hospitalized, I can receive this medication intravenously" Insulin glargine is given once daily and lasts for 24 hours. It is not administered intravenously. It should be given subcutaneously. It cannot be mixed with other insulins. It begins working in 2 to 4 hours.
The nurse is instructing a patient with diabetes about exenatide. Which patient statement indicates a correct understanding of the teaching? "I should take these tablets before breakfast and dinner." "If I miss a dose, I should take it as soon as I remember." "I'll need to learn how to administer injections to myself." "I should not take any other diabetes medications if I take exenatide."
"I'll need to learn how to administer injections to myself." Exenatide, an injectable hypoglycemic agent, is used alone or with other medications to control type 2 diabetes. It may not be taken after meals, so a missed dose cannot be made up; rather the patient should take the next dose with the next meal.
A patient expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response? "It is overwhelming, isn't it?" "Other people do it just fine." "Let's tackle it piece by piece. What is most scary to you?" "Let's see how much you can learn today so you are less nervous."
"Let's tackle it piece by piece. What is most scary to you?" Suggesting the patient tackle it piece by piece and asking what is most scary to him or her is the best response; this approach will allow the patient to have a sense of mastery with acceptance. Referring to the illness as overwhelming is supportive, but is not therapeutic or helpful to the patient. Trying to see how much the patient can learn in one day may actually cause the patient to become more nervous; an overload of information is overwhelming. Suggesting that other people handle the illness just fine is belittling and dismisses the patient's concerns.
The nurse is providing teaching about signs of hypoglycemia to a patient diagnosed with type 2 diabetes who is being discharged after an episode of hypoglycemia. Which statement by the patient indicates a need for further teaching? "I may experience weakness." "It can cause a fast heart rate." "Sometimes it causes vomiting." "I might feel anxious or nervous."
"Sometimes it causes vomiting" Vomiting is a sign of hyperglycemia, not hypoglycemia. Weakness, tachycardia, and feelings of anxiousness or nervousness are consistent with hypoglycemia.
A diabetic patient has a glycosylated hemoglobin (A1C) level of 9.4%. What does the nurse say to the patient regarding this finding? "This is not good at all." "You need more insulin." "Keep up the good work." "What are you doing differently?"
"What are youdoing differently?" Assessing the patient's regimen or changes he or she may have made is the basis for formulating interventions to gain control of blood glucose. A1C levels for diabetic patients should be less than 7; a value of 9.4 shows poor control over the past 3 months. Telling the patient this is not good, although true, does not take into account problems that the patient may be having with the regimen and sounds like scolding. Although it may be true that the patient needs more insulin, an assessment of the patient's regimen is needed before decisions are made about medications
A patient received insulin aspart at 0700. At what time should the patient be assessed for signs of hypoglycemia? 0900 1100 1200 1400
0900 A patient receiving insulin aspart should be assessed within 1 to 3 hours of administration when the medication peaks. The times of 1100, 1200, and 1400 are not within this time frame from the time of administration at 0700.
Consuming which item is appropriate for the patient who becomes hypoglycemic at home? 1 tsp of sugar 1 tbsp of honey 1 oz of skim milk 1 cup of fruit juice
1 tbsp of honey A patient with hypoglycemia can consume 1 tbsp of honey to adjust his or her blood glucose level. The patient should have 8 oz of skim milk, not just 1 oz, to manage hypoglycemia. Half a cup of fruit juice, not a full cup, is generally sufficient to raise the glycemic level. The patient requires at least 4 tsp, not 1 tsp, of sugar to overcome hypoglycemia.
A patient with type 2 diabetes who is taking metformin is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (A1C) is 8.2%. Which action does the nurse plan to take next? Ask the patient about current dietary intake and medication use. Discuss the need to check blood glucose several times every day. Talk about the possibility of adding rapid-acting insulin to the regimen. Instruct the patient to continue with the current diet and metformin use.
Ask the patient about current dietary intake and medication use The nurse's first action should be to assess whether the patient is adherent to the currently prescribed diet and medications. The patient's current diet and medication use have not been successful in keeping glucose in the desired range. Checking blood glucose more frequently and/or using rapid-acting insulin may be appropriate, but this will depend on the assessment data. The A1C indicates that the patient's average glucose level is not in the desired range, but discussing the need to check blood glucose several times every day assumes that the patient is not compliant with the therapy and glucose monitoring. The nurse should not assume that adding insulin, which must be prescribed by the provider, is the answer without assessing the underlying reason for the treatment failure.
Which nursing action can the home health nurse delegate to a home health aide who is making daily visits to a patient with newly diagnosed type 2 diabetes? Inspect the extremities for evidence of poor circulation. Evaluate the patient's use of a home blood glucose monitor. Assist the patient's spouse in choosing appropriate dietary items. Assist the patient with washing the feet and applying moisturizing lotion.
Assist the patient with washing the feet and applying moisturizing lotion. Assisting with personal hygiene is included in the role of home health aides. Assisting with dietary choices, evaluating the effectiveness of teaching, and performing assessments are complex actions that should be implemented by licensed nurses.
Which symptoms indicate autonomic neuropathy? Select all that apply. Eye pain Paresthesias Atonic bladder Dried, cracked skin Asymmetric weakness Orthostatic hypotension
Atonic bladder Dried, cracked skin Orthostatic hypotension Atonic bladder; dried, cracked skin; and orthostatic hypotension are all symptoms of autonomic neuropathy. Eye pain is a symptom of focal neuropathy (focal ischemia). Paresthesias and asymmetric weakness are symptoms of distal symmetric polyneuropathy.
What techniques should a patient with diabetes use to administer insulin injections? Select all that apply. Avoid injecting insulin on scarred sites. Inject insulin on the thigh for faster absorption. Inject insulin into a different anatomic site every day. Avoid injecting within a 2-inch radius around the navel. Grasp a fold of the skin and inject insulin subcutaneously.
Avoid injectin ginsulin on scarred sites Avoid injectin giwthin a 2-inch radius around the navel Grasp a fold of the skin and inject insulin subcutaneously Scarred sites are less sensitive to pain, but are not preferred for insulin injections because insulin absorption is slow. When injecting insulin into the abdomen, avoid a 2-inch radius around the navel. Insulin is injected subcutaneously in a fold of the skin at an angle of 90 degrees. An angle of 45 degrees is appropriate for a thin patient to prevent intramuscular (IM) injection, which has a faster absorption rate and is not used for routine insulin use. Insulin is absorbed fastest when injected into the abdomen, followed by the deltoid, thigh, and buttocks. The patient must rotate injection sites to prevent lipohypertrophy (increased fat deposits in the skin) and lipoatrophy (loss of fatty tissue). However, rotation within one anatomic site is preferred to rotation from one area to another to prevent day-to-day changes in absorption.
A patient with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The patient's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38/min, BP 91/54 mm Hg, and O 2 saturation 99% on room air. Which action does the nurse take first? Offer reassurance. Administer oxygen. Attach a cardiac monitor. Check the blood glucose
Check the blood glucose The patient's clinical presentation is consistent with diabetic ketoacidosis, so the nurse should initially check the patient's glucose level. Based on the oxygen saturation, oxygen administration is not necessary. The nurse provides support, but it is early in the course of assessment and intervention to offer reassurance without more information. Cardiac monitoring may be implemented, but the first action should be to obtain the glucose level.
A patient presents to the emergency department with vomiting, abdominal pain, and rapid, deep respirations. The patient's blood glucose is 480 mg/dL. What nursing action should be taken? Restrict fluids Check urine for ketones Provide mechanical ventilation Administer subcutaneous insulin
Check urine for ketones The urine should be checked for ketones to determine if the patient is experiencing diabetic ketoacidosis (DKA). After the urine is checked, IV fluids would be initiated to restore and maintain fluid and electrolyte balance. Intravenous insulin, not subcutaneous, is administered to lower serum glucose levels quickly. Mechanical ventilation is not indicated for a patient manifesting these symptoms.
Which hormones raise blood glucose levels? Select all that apply. Insulin Cortisol Glucagon Epinephrine Growth hormone Incretin hormones
Cortisol Glucagon Epinephrine Growth hormone Cortisol, glucagon, epinephrine, and growth hormone are counterregulatory hormones that increase blood glucose by opposing the action of insulin when more energy is needed. Insulin is imperative for glucose regulation because it moves glucose out of the blood and into body tissues. Incretin hormones are secreted in response to food in the stomach; they increase insulin secretion, inhibit glucagon secretion, and slow the rate of gastric emptying.
Which oral medication lowers blood glucose levels by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine, allowing for the filtered glucose to be excreted in the urine rather than moved back into the blood? Alogliptin (Nesina) Exenatide (Byetta) Pramlintide (Symlin) Dapagliflozin (Farxiga)
Dapagliflozin (Farxiga) Dapagliflozin (Farxiga) is a sodium-glucose cotransport inhibitor that works by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine, allowing for the filtered glucose to be excreted in the urine rather than moved back into the blood. Alogliptin (Nesina) is a DPP-4 inhibitor that works by preventing the enzyme DPP-4 from breaking down the natural gut hormones (GLP-1 and GIP), which then allows these natural substances to work with insulin to lower glucagon secretion from the pancreas. Pramlintide (Symlin) is an amilyn analog that works by decreasing endogenous glucagon, delaying gastric emptying, and triggering satiety. Exenatide (Byetta) is an incretin mimetics (GLP-1 agonist) that works with insulin to lower blood glucose levels by reducing pancreatic glucagon secretion; reducing liver glucose production; and delaying gastric emptying, which slows the rate of nutrient absorption into the blood.
A patient is in an education class for diabetes care. What teaching should be provided to a patient regarding alcohol use and diabetes mellitus? Avoid alcohol use. Drink alcohol with meals. Check blood glucose after each drink. Prepare to administer larger doses than normal.
Drink alcohol with meals To avoid alcohol-induced hypoglycemia, the nurse should recommend that patients drink alcohol with meals or just after eating. It is not necessary to avoid alcohol. Blood glucose does not need to be checked after each drink. Larger doses of insulin are not indicated.
A patient has just been diagnosed with diabetes. Which factor is most important for the nurse to assess in the patient before providing instruction about the disease and its management? Current lifestyle Sexual orientation Current energy level Educational and literacy level
Educational and literacy level A large amount of information must be synthesized; typically written instructions are given. The patient's educational and literacy level are essential information. Although lifestyle should be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the patient to provide self-care. Although energy level will influence the ability to exercise, it is not essential.
Which information should be included when providing education to a patient about sick day rules? Select all that apply. Avoid antidiarrheal medications. Notify the healthcare provider if ill. Drink 8 to 12 ounces of sugar-free liquid each hour while awake. Test urine for ketones if blood glucose level is greater than 180 mg/dL. If unable to eat, consume liquids equal to the carbohydrate content normally eaten.
Notify the healthcare provider if ill Drink 8 to 12 ounces of sugar-free liquid each hour while awake If unable to eat, consume liquids equal to the carbohydrate content normally eaten The patient should notify the healthcare provider if ill. The patient should drink 8 to 12 ounces of sugar-free liquid each hour while awake. The patient should replace food with the equivalent carbohydrates in fluid form. Patients can take antidiarrheal medications and should test for ketones if blood glucose is greater than 240 mg/dL, not 180 mg/dL.
A patient diagnosed with type 1 diabetes has had multiple episodes of hypoglycemia. What teaching by the nurse is indicated? Administer insulin in legs only. Check blood glucose every hour. Avoid the use of insulin aspart. Use the fingertip only for blood glucose checks
Use the fingertip only for blood glucose checks Patients who have a history of hypoglycemic unawareness should only use the fingertip for blood glucose testing. They do not need to administer insulin only in the legs or check their blood glucose every hour. There's no indication that the patient should not use insulin aspart.
An intensive care patient with diabetic ketoacidosis (DKA) is receiving an insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make? Urine output Potassium level Rate of IV fluids 12-lead electrocardiogram (ECG)
Potassium level With insulin therapy, serum potassium levels fall rapidly as potassium shifts into the cells. Detecting and treating the underlying cause is essential. Insulin treats symptoms of diabetes by putting glucose into the cell as well as potassium; ectopy, indicative of cardiac irritability, is not associated with changes in urine output. A 12-lead ECG can verify the ectopy, but the priority is to detect and fix the underlying cause. Increased fluids treat the symptoms of dehydration secondary to DKA, but do not treat the cause.
Which action is correct when drawing up a single dose of insulin? Wash hands thoroughly and don sterile gloves. Shake the bottle of insulin vigorously to mix the insulin. Recap the needle and save the syringe for the next dose of insulin. Pull back plunger to draw air into the syringe equal to the insulin dose
Pull back plunger to draw air into the syringe equal to the insulin dose The plunger is pulled back to draw an amount of air into the syringe that is equal to the insulin dose. The air is then injected into the insulin bottle before withdrawing the insulin dose. Although handwashing is important before any medication administration, sterile gloves are not required. The bottle of insulin should be rolled gently in the palms of the hands to mix the insulin, not shaken. Insulin syringes are never recapped or reused; the syringe and needle should be disposed of (without recapping) in a puncture-proof container.
What findings are consistent with a diagnosis of hyperglycemia? Select all that apply. Hunger Nervousness Warm, moist skin Ketones in urine Kussmaul's respirations
Warm, moist skin Ketons in urine Kussmaul's respirations Warm, moist skin, ketones in the urine, and Kussmaul's respirations are consistent with hyperglycemia. Hunger and nervousness are common in hypoglycemia, not hyperglycemia.
The nurse is teaching a group of nursing students about the American Diabetes Association (ADA) recommendations for patient care. Which recommendation made by a nursing student indicates understanding? The patient's blood pressure should be below 120/70 mm Hg. The patient's high-density lipoprotein (HDL) cholesterol level should be below 40 mg/dL. The low-density lipoprotein (LDL) cholesterol should be below 140 mg/dL for patients with signs of cardiovascular disease (CVD). The LDL cholesterol should be below 100 mg/dL for patients without signs of CVD.
The LDL cholesterol should be below 100 mg/dL for patient without signs of CVD The ADA recommends that the LDL cholesterol be below 100 mg/dL (2.60 mmol/L) for patients without signs of CVD. The ADA also recommends that a patient's blood pressure be maintained below 140/80 mm Hg, and that the LDL cholesterol be below 70 mg/dL (1.8 mmol/L) for patients with signs of CVD. The ADA recommends that HDL cholesterol levels be below 35 mg/dL.
