Prioritization, Delegation & Assignment Chapter 13

The patient with type 2 diabetes is "nothing by mouth" (NPO) for a cardiac catheterization. An LPN/LVN who is administering medications to this patient asks you (the supervising RN) whether the patient should receive his ordered repaglinide (Prandin). What is your best response? 1) "Yes, because this drug will increase the patient's insulin secretion and prevent hyperglycemia." 2) "No, because this drug may cause the patient to experience gastrointestinal symptoms such as nausea." 3) "No, because this drug should be given 1 to 30 minutes before meals and the patient is NPO." 4) "Yes, because this drug should be taken 3 times a day whether the patient eats or not."

"No, because this drug should be given 1 to 30 minutes before meals and the patient is NPO."

You are orienting a new graduate nurse who is providing diabetes education for a patient about insulin injection. For which teaching statement by the new nurse must you intervene? 1) "To prevent lipohypertrophy, be sure to rotate injection sites from the abdomen to the thighs." 2) "To correctly inject the insulin, lightly grasp a fold of skin and inject at a 90-degree angle." 3) "Always draw your regular insulin into the syringe first before your NPH insulin." 4) "Avoid injecting the insulin into scarred sites because those areas slow the absorption rate of insulin."

"To prevent lipohypertrophy, be sure to rotate injection sites from the abdomen to the thighs."

Which actions can the school nurse delegate to UAPs who are working with a 7-year-old child with type 1 diabetes in an elementary school? SELECT ALL THAT APPLY. 1) Obtaining information about the child's usual insulin use from the parents. 2) Administering oral glucose tablets when blood glucose level falls below 60 mg/dL. 3) Teaching the child about what foods have high carbohydrate levels. 4) Obtaining blood glucose readings using the child's blood glucose monitor. 5) Reminding the child to have a snack after the physical education class.

Administering oral glucose tablets when blood glucose level falls below 60 mg/dL. Obtaining blood glucose readings using the child's blood glucose monitor. Reminding the child to have a snack after the physical education class.

A patient has newly-diagnosed type 2 diabetes. Which action should you assign to an LPN/LVN instead of a UAP? 1) Measuring the pateint's vital signs every shift. 2) Checking the patient's glucose level before each meal. 3) Administering subcutaneous insulin on a sliding scale as needed. 4) Assisting the patient with morning care.

Administering subcutaneous insulin on a sliding scale as needed.

The plan of care for a diabetic patient includes all of these interventions. Which intervention should you delegate to a UAP? 1) Checking to make sure the patient's bath water is not too hot. 2) Discussing community resources for diabetic outpatient care. 3) Teaching the patient to perform daily foot inspection. 4) Assessing the patient's technique for drawing insulin into a syringe.

Checking to make sure the patient's bath water is not too hot.

In the emergency department during initial assessment of a newly-admitted patient with diabetes, the nurse discovers all of these findings. Which finding should be reported to the health care provider immediately? 1) Hammer toe of the left second metatarsophalangeal joint. 2) Rapid respiratory rate with deep inspirations. 3) Numbness and tingling bilaterally in the feet and hands. 4) Decreased sensitivity and swelling of the abdomen.

Rapid respiratory rate with deep inspirations.

A patient has newly-diagnosed type 2 diabetes. Which task should you delegate to a UAP? 1) Arranging a consult with the dietician. 2) Assessing the patient's insulin injection technique. 3) Teaching the patient to use a glucometer to monitor glucose at home. 4) Reminding to patient to check glucose level before each meal.

Reminding to patient to check glucose level before each meal.

A patient with type 1 diabetes reports feeling dizzy. What should the nurse do first? 1) Check the patient's blood pressure. 2) Give the patient some orange juice. 3) Give the patient's morning dose of insulin. 4) Use a glucometer to check the patient's glucose level.

Use a glucometer to check the patient's glucose level.

A nursing diagnosis for a patient with newly-diagnosed diabetes is Risk for Injury related to sensory alterations. Which key points should you include in the teaching plan for this patient? SELECT ALL THAT APPLY. 1) "Clean and inspect you feet every day." 2) "Be sure that your shoes fit properly." 3) "Nylon socks are best to prevent friction on your toes from shoes." 4) "Only a podiatrist should trim your toenails." 5) "Report any nonhealing skin breaks to your health care provider."

"Clean and inspect you feet every day." "Be sure that your shoes fit properly." "Report any nonhealing skin breaks to your health care provider."

You are the preceptor for a senior nursing student who will teach a diabetic patient about self-care during sick days. For which statement by the student must you intervene? 1) "When you are sick, be sure to monitor your blood glucose at least every 4 hours." 2) "Test your urine for ketones whenever your blood glucose level is less than 240 mg/dL." 3) "To prevent dehydration, drink 8 ounces of sugar-free liquid every hour while you are awake." 4) "Continue to eat your meals and snacks at the usual times."

"Test your urine for ketones whenever your blood glucose level is less than 240 mg/dL."

While you are performing an admission assessment on a patient with type 2 diabetes, he tells you that he routinely drinks 3 beers a day. What is your priority follow-up question at this time? 1) "Do you have any days when you do not drink?" 2) "When during the day do you drink your beers?" 3) "Do you drink any other forms of alcohol?" 4) "Have you ever had a lipid profile completed?"

"When during the day do you drink your beers?"

You are serving as preceptor to a nurse who has recently graduated and passed the RN licensure examination. The new nurse has only been on the unit for 2 days. Which patient would you assign to the new nurse? 1) 68-year-old with diabetes who is showing signs of hyperglycemia. 2) 58-year-old with diabetes who has cellulitis of the left ankle. 3) 49-year-old with diabetes who has just returned from the postanesthesia care unit after a below-the-knee amputation. 4) 72-year-old with diabetes with DKA who is receiving IV insulin.

58-year-old with diabetes who has cellulitis of the left ankle.

You are caring for a diabetic patient who is developing diabetic ketoacidosis (DKA). Which task delegation is most appropriate? 1) Ask the unit clerk to page the physician to come to the unit. 2) Ask the LPN/LVN to administer IV push insulin according to sliding scale. 3) Ask the UAP to hang a new bag of normal saline. 4) Ask the UAP to get the patient a cup of orange juice.

Ask the unit clerk to page the physician to come to the unit.

A patient with diabetes has hot, dry skin; rapid and deep respirations; and a fruity odor to his breath. As charge nurse, you observe a newly-graduated RN performing all of the following patient tasks. Which one requires that you intervene immediately? 1) Checking the patient's fingerstick glucose level. 2) Encouraging the patient to drink orange juice. 3) Checking the patient's order for sliding scale insulin dosing. 4) Assessing the patient's vital signs every 15 minutes.

Encouraging the patient to drink orange juice.

The UAP reports to you that a patient with type 1 diabetes has a question about exercise. What important points would you be sure to teach this patient? SELECT ALL THAT APPLY. 1) Exercise guidelines are based on blood glucose and urine ketone levels. 2) Be sure to test your blood glucose only after exercising. 3) You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL. 4) Exercise will help resolve the presence of ketones in your urine. 5) A 5- to 10-minute warm-up and cool-down period should be included in your exercise.

Exercise guidelines are based on blood glucose and urine ketone levels. You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL. A 5- to 10-minute warm-up and cool-down period should be included in your exercise.

A 58-year-old with type 2 diabetes was admitted to your unit with a diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation. When you prepare a care plan for this patient, what would you be sure to include? SELECT ALL THAT APPLY. 1) Fingerstick blood glucose checks before meals and at bedtime. 2) Sliding-scale insulin dosing as ordered. 3) Bed rest until the COPD exacerbation is resolved. 4) Teaching about the Atkins diet for weight loss. 5) Demonstration of the components of foot care.

Fingerstick blood glucose checks before meals and at bedtime. Sliding-scale insulin dosing as ordered. Demonstration of the components of foot care.

An LPN/LVN is to administer rapid-acting insulin (Lispro) to a patient with type 1 diabetes. What essential information would be sure to tell the LPN/LVN? 1) Give this insulin after the patient's food tray has been delivered and the patient is ready to eat. 2) Only give this insulin if the patient's fingerstick glucose reading is above 200 mg/dL. 3) This insulin mimics the basal glucose control of the pancreas. 4) Rapid-acting insulin is the only insulin that can be given subcutaneously or IV.

Give this insulin after the patient's food tray has been delivered and the patient is ready to eat.

The experienced UAP has been delegated to take vital signs and check fingerstick glucose on a diabetic patient who is postoperative. Which vital sign change would you instruct the UAP to report immediately? 1) Blood pressure change from 132/80 mm Hg to 138/84 mm Hg. 2) Temperature increase from 98.4 F (36.8 C) to 99 F (37.2 C). 3) Respiratory rate increase from 18 breaths/min to 22 breaths/min. 4) Glucose increase from 190 mg/dL to 236 mg/dL.

Glucose increase from 190 mg/dL to 236 mg/dL.

You are preparing to review a teaching plan for a patient with type 2 diabetes mellitus. To determine the patient's level of compliance with his prescribed diabetic regimen, which value would you be sure to review? 1) Fasting glucose level 2) Oral glucose tolerance test results 3) Glycosylated hemoglobin (HgbA1c) 4) Fingerstick glucose findings for 24 hours

Glycosylated hemoglobin (HgbA1c)

You are caring for an 81-year-old adult with type 2 diabetes, hypertension, and peripheral vascular disease. Which admission assessment findings increase the patient's risk for development of hyperglycemic -hyperosmolar syndrome (HHS)? SELECT ALL THAT APPLY. 1) Hydrochlorothiazide (HCTZ) prescribed to control her diabetes. 2) Weigh gain of 6 pounds over the past month. 3) Avoids consuming liquids in the evening. 4) Blood pressure of 168/94 mm Hg. 5) Urine output of 50 to 75 mL/hr.

Hydrochlorothiazide (HCTZ) prescribed to control her diabetes. Avoids consuming liquids in the evening.

While working in the diabetes clinic, you obtain this information about an 8-year-old with type 1 diabetes. Which finding is most important to address when planning child and parent education? 1) Most recent hemoglobin A1c level of 7.8%. 2) Many questions about diet choices from the parents. 3) Child's participation in soccer practice after school 2 days a week. 4) Morning preprandial glucose range of 55 to 70 mg/dL.

Morning preprandial glucose range of 55 to 70 mg/dL.

An LPN/LVN's assessment of two diabetic patients reveals all of these findings. Which would you instruct the LPN/LVN to report immediately? 1) Fingerstick glucose reading of 185 mg/dL. 2) Numbness and tingling in both feet. 3) Profuse perspiration. 4) Bunion on the left great toe.

Profuse perspiration.

I the care of a patient with type 2 diabetes, which actions can you delegate to a UAP? SELECT ALL THAT APPLY. 1) Providing the patient with extra packets of artificial sweetener for coffee. 2) Assessing how well the patient's shoes fit. 3) Recording the liquid intake from the patient's breakfast tray. 4) Teaching the patient what to do if dizziness or lightheadedness occurs. 5) Checking and recording the patient's blood pressure.

Providing the patient with extra packets of artificial sweetener for coffee. Recording the liquid intake from the patient's breakfast tray. Checking and recording the patient's blood pressure.

You are caring for a diabetic patient admitted with hypoglycemia that occurred at home. Which teaching points for treatment of hypoglycemia at home would you include in a teaching plan for the patient and family before discharge? SELECT ALL THAT APPLY. 1) Signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL. 2) Treat hypoglycemia with 4 to 8 g of carbohydrate such as glucose tablets or 1/4 cup of fruit juice. 3) Retest blood glucose in 30 minutes. 4) Repeat the carbohydrate treatment if the symptoms do not resolve. 5) Eat a small snack of carbohydrate and protein if the next meal is more than an hour away.

Signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL. Repeat the carbohydrate treatment if the symptoms do not resolve. Eat a small snack of carbohydrate and protein if the next meal is more than an hour away.

A UAP tells you that, while assisting with the morning care of a postoperative patient with type 2 diabetes who has been given insulin, the patient asked if she will always need to take insulin now. What is your priority for teaching the patient? 1) Explain to the patient that she in non considered to have type 1 diabetes. 2) Tell the patient to monitor fingerstick glucose level every 4 hours after discharge. 3) Teach the patient that person with type 2 diabetes does not always need insulin. 4) Talk with the patient about the relationship between illness and increased glucose levels.

Talk with the patient about the relationship between illness and increased glucose levels.