Chapter 48 - Diabetes Mellitus
A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first? a. Infuse 1 liter of normal saline per hour. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/hr.
a. Infuse 1 liter of normal saline per hour.
the patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level? (select all) a. headache b. unsteady gait c. abdominal cramps d. emotional changes e. increase in urination f. weakness and fatigue
a. headache c. abdominal cramps e. increase in urination f. weakness and fatigue
the nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has.. a. diabetes b. elevated A1C c. impaired fasting glucose d. impaired glucose tolerance
d. impaired glucose tolerance
when caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan? a. achieving a normal weight b. performing daily aerobic exercise c. eliminating red meat from the diet d. monitoring the blood glucose periodically
a. achieving a normal weight
Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. at mealtime or within 15 minutes of meals
d. at mealtime or within 15 minutes of meals
a patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first? a. increase the evening insulin dose to prevent the dawn phenomenon b. use a single-dose insulin regimen with an intermediate-acting insulin c. monitor the glucose level at bedtime, between 2:00AM and 4:00 AM, and on arising d. decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect
c. monitor the glucose level at bedtime, between 2:00AM and 4:00 AM, and on arising
the nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as the priority by the nurse? a. bilateral numbness of both hands b. stage II pressure ulcer on the right heel c. rapid respirations with deep inspiration d. areas of lumps and dents on the abdomen
c. rapid respirations with deep inspiration
When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may a. need a diet higher in calories while receiving prednisone. b. develop acute hypoglycemia while taking the prednisone. c. require administration of insulin while taking prednisone. d. have rashes caused by metformin-prednisone interactions.
c. require administration of insulin while taking prednisone.
After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective? a. "I may feel hungrier than usual when I take this medicine." b. "I will not need to worry about hypoglycemia with the Byetta." c. "I should take my daily aspirin at least an hour before the Byetta." d. "I will take the pill at the same time I eat breakfast in the morning."
c. "I should take my daily aspirin at least an hour before the Byetta."
which tissues require insulin to enable movement of glucose into the tissue cells? (select all) a. liver b. brain c. adipose d. blood cells e. skeletal muscle
c. adipose e. skeletal muscle
why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. decrease glucose production b. stimulate glucose output by the liver c. increased glucose transport into the cells d. independently regulate glucose level in the blood
b. stimulate glucose output by the liver
Which question during the assessment of a diabetic patient will help the nurse identify autonomic neuropathy? a. "Do you feel bloated after eating?" b. "Have you seen any skin changes?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"
a. "Do you feel bloated after eating?"
Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates the most urgent need for the nurse's assessment of the patient? a. Bedtime glucose of 140 mg/dL b. Noon blood glucose of 52 mg/dL c. Fasting blood glucose of 130 mg/dL d. 2-hr postprandial glucose of 220 mg/dL
b. Noon blood glucose of 52 mg/dL
when teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. pull back on the plunger after inserting the needle to check for blood b. consistently use the same size of insulin syringe to avoid dosing errors c. clean the skin at the injection site with alcohol swab before each injection d. rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies
b. consistently use the same size of insulin syringe to avoid dosing errors
Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP) who are working in the diabetic clinic? a. Measure the ankle-brachial index. b. Check for changes in skin pigmentation. c. Assess for unilateral or bilateral foot drop. d. Ask the patient about symptoms of depression.
a. Measure the ankle-brachial index.
In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]). a. Rotate NPH vial. b. Withdraw regular insulin. c. Withdraw 20 units of NPH. d. Inject 20 units of air into NPH vial. e. Inject 2 units of air into regular insulin vial.
A, D, E, B, C
when teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. tight glycemic control can be maintained b. errors in insulin dosing are less likely to occur c. complications of insulin therapy are prevented d. frequent blood glucose monitoring is unnecessary
a. tight glycemic control can be maintained
the nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included? (select all) a. maintain a healthy weight b. exercise for 60 minutes each day c. have blood pressure checked regularly d. assess for visual changes on a monthly basis e. monitor for polyuria, polyphagia, and polydipsia
a. maintain a healthy weight e. monitor for polyuria, polyphagia, and polydipsia
which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. it can be prevented by tight glucose control b. it occurs with a higher frequency and earlier onset than in the nondiabetic population c. it is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes d. it cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake
b. it occurs with a higher frequency and earlier onset than in the nondiabetic population
in type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the fuse of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. fatigue b. polydipsia c. polyphagia d. recurrent infections
b. polydipsia
the nurse assesses the technique of the patient with diabetes for self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. doing the SMBG before and after exercising b. puncturing the finger on the side of the finger pad c. cleaning the puncture site with alcohol before the puncture d. holding the hand down for a few minutes before the puncture
c. cleaning the puncture site with alcohol before the puncture
A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? a. 10:00 AM b. 12:00 AM c. 2:00 PM d. 4:00 PM
a. 10:00 AM
In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take? a. Determine what type of activities the patient enjoys. b. Remind the patient that exercise will improve self-esteem. c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity.
a. Determine what type of activities the patient enjoys.
A 34-year-old has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye exam a. every 2 years. b. as soon as possible. c. when the patient is 39 years old. d. within the first year after diagnosis.
b. as soon as possible.
what are manifestations of diabetic ketoacidosis (DKA)? (select all) a. thirst b. ketonuria c. dehydration d. metabolic acidosis e. kussmaul respirations f. sweet, fruity breath odor
a. thirst b. ketonuria c. dehydration d. metabolic acidosis e. kussmaul respirations f. sweet, fruity breath odor
Which statement by the patient indicates a need for additional instruction in administering insulin? a. "I need to rotate injection sites among my arms, legs, and abdomen each day." b. "I can buy the 0.5 mL syringes because the line markings will be easier to see." c. "I should draw up the regular insulin first after injecting air into the NPH bottle." d. "I do not need to aspirate the plunger to check for blood before injecting insulin."
a. "I need to rotate injection sites among my arms, legs, and abdomen each day."
two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse? a. "that is a good range for your glucose levels" b. "you should call your health care provider because you need to have your insulin increased" c. "that level is too low in view of your recent hypoglycemia and you should increase your food intake" d. "you should take only half your insulin dosage for the nest few days to get your glucose level back to normal"
a. "that is a good range for your glucose levels"
during routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results? (select all) a. A1C of 7.5% b. glycosuria of 3+ c. FPG greater than/equal to 127 mg/dL (7.0 mmol/L) d. random blood glucose of 126 mg/dL (7.0 mmol/L) e. a 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)
a. A1C of 7.5% c. FPG greater than/equal to 127 mg/dL (7.0 mmol/L)
what characterizes type 2 diabetes? (select all) a. B-cell exhaustion b. insulin resistance c. genetic predisposition d. altered production of adipokines e. inherited defect in insulin receptors f. inappropriate glucose production by the liver
a. B-cell exhaustion b. insulin resistance c. genetic predisposition d. altered production of adipokines e. inherited defect in insulin receptors f. inappropriate glucose production by the liver
The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next? a. Give the patient 4 to 6 oz more orange juice. b. Administer the PRN glucagon (Glucagon) 1 mg IM. c. Have the patient eat some peanut butter with crackers. d. Notify the health care provider about the hypoglycemia.
a. Give the patient 4 to 6 oz more orange juice
A 32-year-old patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage? a. Lispro (Humalog) b. Glargine (Lantus) c. Detemir (Levemir) d. NPH (Humulin N)
a. Lispro (Humalog)
A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse takefirst? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Obtain urine glucose and ketone levels. d. Start an insulin infusion at 0.1 units/kg/hr.
a. Place the patient on a cardiac monitor.
Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? a. The patient programs the pump for an insulin bolus after eating. b. The patient changes the location of the insertion site every week. c. The patient takes the pump off at bedtime and starts it again each morning. d. The patient plans for a diet that is less flexible when using the insulin pump.
a. The patient programs the pump for an insulin bolus after eating.
A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is most important for the nurse to communicate to the health care provider? a. The patient uses oral contraceptives. b. The patient runs several days a week. c. The patient has been pregnant three times. d. The patient has a family history of diabetes.
a. The patient uses oral contraceptives.
A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient? a. The patient will reach a glycosylated hemoglobin level of less than 7%. b. The patient will follow a diet and exercise plan that results in weight loss. c. The patient will choose a diet that distributes calories throughout the day. d. The patient will state the reasons for eliminating simple sugars in the diet.
a. The patient will reach a glycosylated hemoglobin level of less than 7%
a patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. administer the usual insulin dosage b. hold fluid intake until the nausea subsides c. come to the clinic immediately for evaluation and treatment d. monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L)
a. administer the usual insulin dosage
A 38-year-old patient who has type 1 diabetes plans to swim laps daily at 1:00 PM. The clinic nurse will plan to teach the patient to a. check glucose level before, during, and after swimming. b. delay eating the noon meal until after the swimming class. c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming.
a. check glucose level before, during, and after swimming.
individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to.. a. eat regular meals at regular times b. restrict calories to promote moderate weight loss c. eliminate sucrose and other simple sugars from the diet d. limit saturated fat intake to 30% of dietary calorie intake
a. eat regular meals at regular times
a 72yr old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? a. it is more difficult to achieve strict glucose control than in younger patients b. treatment is not warranted unless the patient develops severe hyperglycemia c. it does not include treatment with insulin because of limited dexterity and vision d. it usually requires that a younger family member be responsible for care of the patient
a. it is more difficult to achieve strict glucose control than in younger patients
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? a. plan activity and food intake related to blood glucose levels b. when blood glucose is greater than 250 mg/dL and ketones are present c. when glucose monitoring reveals that the blood glucose is in the normal range d. when blood glucose levels are high, because exercise always has a hypoglycemic effect
a. plan activity and food intake related to blood glucose levels
the patient with type 2 diabetes is being put on acarbose (Precose) and wants to know about taking it. What should the nurse include in this patient's teaching? (select all) a. take it with the first bite of each meal b. it is not used in patients with heart failure c. endogenous glucose production is decreased d. effectiveness is measured by 2-hour postprandial glucose e. it delays glucose absorption from the gastrointestinal (GI) tract
a. take it with the first bite of each meal d. effectiveness is measured by 2-hour postprandial glucose e. it delays glucose absorption from the gastrointestinal (GI) tract
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? a. withdraws the NPH dose into the syringe first b. injects air equal to the NPH dose into the syringe first c. removes any air bubbles after withdrawing the first insulin d. adds air equal to the insulin dose into the regular vial and withdraws the dose
a. withdraws the NPH dose into the syringe first
After change-of-shift report, which patient should the nurse assess first? a. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12% b. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL c. 40-year-old who is pregnant and whose oral glucose tolerance test is 202 mg/dL d. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain
b. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
A diabetic patient who has reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline (Elavil)? a. Amitriptyline decreases the depression caused by your foot pain. b. Amitriptyline helps prevent transmission of pain impulses to the brain. c. Amitriptyline corrects some of the blood vessel changes that cause pain. d. Amitriptyline improves sleep and makes you less aware of nighttime pain.
b. Amitriptyline helps prevent transmission of pain impulses to the brain.
The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? a. Ask the patient's family to participate in the diabetes education program. b. Assess the patient's perception of what it means to have diabetes mellitus. c. Demonstrate how to check glucose using capillary blood glucose monitoring. d. Discuss the need for the patient to actively participate in diabetes management.
b. Assess the patient's perception of what it means to have diabetes mellitus.
To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? a. Chest x-ray b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria e. Complete blood count (CBC) f. Monofilament testing of the foot
b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria f. Monofilament testing of the foot
An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy? a. Hemoglobin A1C level 6.2% b. Blood pressure 146/88 mmHg c. Heart rate at rest 58 beats/minute d. High density lipoprotein (HDL) level 65 mg/dL
b. Blood pressure 146/88 mmHg
a nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for all minority populations every year b. FPG for all individuals at age 45 and then every 3 years c. testing people under the age of 21 for islet cell antibodies d. testing for type 2 diabetes in all overweight or obese individuals
b. FPG for all individuals at age 45 and then every 3 years
Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness? a. Assess the patient for symptoms of hyperglycemia. b. Give the patient a snack of peanut butter and crackers. c. Have the patient drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours.
b. Give the patient a snack of peanut butter and crackers.
Which information will the nurse include when teaching a 50-year-old patient who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)? a. Glyburide decreases glucagon secretion from the pancreas. b. Glyburide stimulates insulin production and release from the pancreas. c. Glyburide should be taken even if the morning blood glucose level is low. d. Glyburide should not be used for 48 hours after receiving IV contrast media.
b. Glyburide stimulates insulin production and release from the pancreas.
The nurse is taking a health history from a 29-year-old pregnant patient at the first prenatal visit. The patient reports no personal history of diabetes but has a parent who is diabetic. Which action will the nurse plan to take first? a. Teach the patient about administering regular insulin. b. Schedule the patient for a fasting blood glucose level. c. Discuss an oral glucose tolerance test for the twenty-fourth week of pregnancy. d. Provide teaching about an increased risk for fetal problems with gestational diabetes.
b. Schedule the patient for a fasting blood glucose level.
Which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? a. The patient avoids injecting the insulin into the upper abdominal area. b. The patient cleans the skin with soap and water before insulin administration. c. The patient stores the insulin in the freezer after administering the prescribed dose. d. The patient pushes the plunger down while removing the syringe from the injection site.
b. The patient cleans the skin with soap and water before insulin administration.
a patient with type 1 diabetes uses 20U of Novolin 70/30 (NPH/regular) in the morning and at 6:00PM. When teaching the patient about this regimen, what should the nurse emphasize? a. hypoglycemia is most likely to occur before the noon meal b. a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia c. flexibility in food intake is possible because insulin in available 24 hrs a day d. premeal glucose checks are required to determine needed changes in daily dosing
b. a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia
a patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medication. The patient tells the nurse she would rather control her blood sugar with herbal therapy. Which action should the nurse take? a. teach the patient that herbal therapy is not safe and should not be used b. advise the patient to discuss using herbal therapy with her HCP before using it c. encourage the patient to give the prescriptive medication time to work before using herbal therapy d. teach the patient that if she takes herbal therapy, she will have to monitor her blood sugar more often
b. advise the patient to discuss using herbal therapy with her HCP before using it
Which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. insulin b. biguanide c. meglitinide d. sulfonylurea
b. biguanide
the following interventions are planned for a patient with diabetes. Which intervention can the nurse delegate to the UAP? a. discuss complications of diabetes b. check that the bath water is not too hot c. check the patient's technique for drawing up insulin d. teach the patient to use a meter for self-monitoring of blood glucose
b. check that the bath water is not too hot
The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose a. washes the puncture site using warm water and soap. b. chooses a puncture site in the center of the finger pad. c. hangs the arm down for a minute before puncturing the site. d. says the result of 120 mg indicates good blood sugar control.
b. chooses a puncture site in the center of the finger pad.
what disorders and diseases are related to macrovascular complications of diabetes? (select all) a. chronic kidney disease b. coronary artery disease c. microaneuryms and destruction of retinal vessels d. ulceration and amputation of the lower extremities e. capillary and arteriole membrane thickening specific to diabetes
b. coronary artery disease d. ulceration and amputation of the lower extremities
the patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient? (select all) a. painless foot ulcers b. erectile dysfunction c. burning foot pain at night d. loss of fine motor control e. vomiting undigested food f. painless myocardial infarction
b. erectile dysfunction e. vomiting undigested food f. painless myocardial infarction
An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to a. give a bolus of 50% dextrose. b. insert a large-bore IV catheter. c. initiate oxygen by nasal cannula. d. administer glargine (Lantus) insulin.
b. insert a large-bore IV catheter.
what should the goals of nutrition therapy for the patient with type 2 diabetes include? a. ideal body weight b. normal serum glucose and lipid levels c. a special diabetic diet using dietetic foods d. five small meals per day with a bedtime snack
b. normal serum glucose and lipid levels
The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type 1 diabetes. Which question is most appropriate for the nurse to ask? a. "Are you anorexic?" b. "Is your urine dark colored?" c. "Have you lost weight lately?" d. "Do you crave sugary drinks?"
c. "Have you lost weight lately?"
The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? a. "I can have an occasional alcoholic drink if I include it in my meal plan. b. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I can choose any foods, as long as I use enough insulin to cover the calories." d. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."
c. "I can choose any foods, as long as I use enough insulin to cover the calories."
After change-of-shift report, which patient will the nurse assess first? a. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon b. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL c. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa d. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain
c. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery. b. Discuss the reason for the use of insulin therapy during the immediate postoperative period. c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.
c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct? a. Insulin is not used to control blood glucose in patients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
The health care provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take? a. Avoid snacking at bedtime. b. Increase the rapid-acting insulin dose. c. Check the blood glucose during the night d. Administer a larger dose of long-acting insulin.
c. Check the blood glucose during the night
A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss with the health care provider? a. Hemoglobin A1C level is 7.9%. b. Last eye exam was 18 months ago. c. Glomerular filtration rate is decreased. d. Patient has questions about the prescribed diet.
c. Glomerular filtration rate is decreased.
what describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? a. DKA requires administration of bicarbonate to correct acidosis b. potassium replacement is not necessary in management of HHS c. HHS requires greater fluid replacement to correct the dehydration d. administration of glucose is withheld in HHS until the blood glucose reaches a normal level
c. HHS requires greater fluid replacement to correct the dehydration
A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice.
c. Obtain a glucose reading using a finger stick.
Which information is most important for the nurse to report to the health care provider before a patient with type 2 diabetes is prepared for a coronary angiogram? a. The patient's most recent HbA1C was 6.5%. b. The patient's admission blood glucose is 128 mg/dL. c. The patient took the prescribed metformin (Glucophage) today. d. The patient took the prescribed captopril (Capoten) this morning.
c. The patient took the prescribed metformin (Glucophage) today.
which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. an obese 40yr old Hispanic woman b. a child whose father has type 1 diabetes c. a 34yr old woman whose parents both have type 2 diabetes d. a 12yr old boy whose father has maturity-onset diabetes of the young (MODY)
c. a 34yr old woman whose parents both have type 2 diabetes
A 26-year-old patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to administer the morning insulin? a. thigh. b. buttock. c. abdomen. d. upper arm.
c. abdomen.
the nurse should observe the patient for symptoms of ketoacidosis when.. a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy d. the patient skips meals after taking insulin, leasing to rapid metabolism of glucose and breakdown of fats for energy
c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy
A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about a. self-monitoring of blood glucose. b. using low doses of regular insulin. c. lifestyle changes to lower blood glucose. d. effects of oral hypoglycemic medications.
c. lifestyle changes to lower blood glucose.
A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to a. use only the lispro insulin until the symptoms are resolved. b. limit intake of calories until the glucose is less than 120 mg/dL. c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water" b. "I should always wear shoes to protect my feet from injury" c. "if my feet are cold, I should wear socks instead of using a heating pad" d. "I'll know if I have sores or lesions on my feet because they will be painful"
d. "I'll know if I have sores or lesions on my feet because they will be painful"
The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? a. "If I overeat at a meal, I will still take the usual dose of medication." b. "Other medications besides the Glucotrol may affect my blood sugar." c. "When I am ill, I may have to take insulin to control my blood sugar." d. "My diabetes won't cause complications because I don't need insulin."
d. "My diabetes won't cause complications because I don't need insulin."
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? a. Urine dipstick for glucose b. Oral glucose tolerance test c. Fasting blood glucose level d. Glycosylated hemoglobin level
d. Glycosylated hemoglobin level
Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful? a. The patient administers the glargine 30 minutes before each meal. b. The patient's family prefills the syringes with the mix of insulins weekly. c. The patient draws up the regular insulin and then the glargine in the same syringe. d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
The nurse is interviewing a new patient with diabetes who receives rosiglitazone (Avandia) through a restricted access medication program. What is most important for the nurse to report immediately to the health care provider? a. The patient's blood pressure is 154/92. b. The patient has a history of emphysema. c. The patient's blood glucose is 86 mg/dL. d. The patient has chest pressure when walking.
d. The patient has chest pressure when walking.
A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.
d. The patient increases daily exercise when ketones are present in the urine.
Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? a. The patient's blood glucose level is 174 mg/dL. b. The patient has gained 2 lb (0.9 kg) since yesterday. c. The patient is scheduled for a chest x-ray in an hour. d. The patient's blood urea nitrogen (BUN) level is 52 mg/dL.
d. The patient's blood urea nitrogen (BUN) level is 52 mg/dL.
a patient with diabetes is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. have the patient drink some orange juice b. administer 10 U of regular insulin subcutaneously c. call for an ambulance to transport the patient a medical facility d. administer glucagon 1 mg intramuscularly (IM) or subcutaneously
d. administer glucagon 1 mg intramuscularly (IM) or subcutaneously
which laboratory results would indicate that the patient has prediabetes? a. glucose tolerance result of 132 mg/dL (7.3 mmol/L) b. glucose tolerance result of 240 mg/dL (13.3 mmol/L) c. fasting blood glucose result of 80 mg/dL (4.4 mmol/L) d. fasting blood glucose result of 120 mg/dL (6.7 mmol/L)
d. fasting blood glucose result of 120 mg/dL (6.7 mmol/L)
the patient with type 2 diabetes has had trouble controlling his blood glucose with several OAs but wants to avoid the risks of insulin. The HCP told him a medication will be prescribed that will increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying. The nurse knows this is which medication that will have to be injected? a. dopamine receptor agonist, bromocriptine (Cycloset) b. dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin (Januvia) c. sodium-glucose co-transporter 2 (SGLT2) inhibitor, canagliflozin (Invokana) d. glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)
d. glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)
In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. enhances the breakdown of adipose tissue for energy b. stimulates hepatic glycogenolysis and gluconeogenesis c. prevents the transport of triglycerides into adipose tissue d. increases amino acid transport into cells and protein synthesis
d. increases amino acid transport into cells and protein synthesis
the home care nurse should intervene to correct a patient whose insulin administration includes.. a. warming a prefilled refrigerated syringe in the hands before administration b. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator c. placing the insulin bottle currently in use in a small container on the bathroom countertop d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration
d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to a. save the lunch tray for the patient's later return to the unit. b. ask that diagnostic testing area staff to start a 5% dextrose IV. c. send a glass of milk or orange juice to the patient in the diagnostic testing area. d. request that if testing is further delayed, the patient be returned to the unit to eat.
d. request that if testing is further delayed, the patient be returned to the unit to eat.
