CH 48 DM W2

Which question by the nurse will help identify autonomic neuropathy in a diabetic patient? a.Have you observed any recent skin changes? b.Do you notice any bloating feeling after eating? 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?

B Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions also are appropriate to ask, but would not help in identifying autonomic neuropathy.

Which action should the nurse take first when teaching a patient who is newly diagnosed with type 2 diabetes about home management of the disease? a.Ask the patients family to participate in the diabetes education program. b.Assess the patients 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 Before planning education, the nurse should assess the patients interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.

After the nurse has finished teaching a patient about self-administration of the prescribed aspart (NovoLog) insulin, which patient action indicates good understanding of the teaching? 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 places the insulin back in the freezer after administering the prescribed insulin dose. d.The patient pushes the plunger down and immediately removes the syringe from the injection site.

B Cleaning the skin with soap and water or with alcohol is acceptable. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.

When the nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis, the patient reports feeling anxious, nervous, and sweaty. Which action should the nurse take first? a.Administer 1 mg glucagon subcutaneously. b.Obtain a glucose reading using a finger stick. c.Have the patient drink 4 ounces of orange juice. d.Give the scheduled dose of lispro (Humalog) insulin.

B The patients clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patients glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the patients symptoms become worse or if the patient is unconscious. Administration of lispro would drop the patients glucose further.

Which information will the nurse include when teaching a 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 The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking the glyburide, because hypoglycemia can occur with this category of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide

A pregnant patient who has no personal history of diabetes, but does have a parent who is diabetic is scheduled for the first prenatal visit. Which action will the nurse plan to take on this initial visit? a.Teach about appropriate use of regular insulin. b.Discuss the need for a fasting blood glucose level. c.Schedule an oral glucose tolerance test for the twenty fourth week of pregnancy. d.Provide education about increased risk for fetal problems with gestational diabetes.

B Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test also may be used to check for diabetes, but it would be done before the twenty fourth week. The other actions also may be needed (depending on whether the patient develops gestational diabetes), but they are not the first actions that the nurse should take.

A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG) as part of diabetes management. During evaluation of the patients technique of SMBG, the nurse identifies a need for additional teaching when the patient a.washes the puncture site using soap and warm water. 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 130 mg indicates good blood sugar control.

B The patient is taught to choose a puncture site at the side of the finger pad. The other patient actions indicate that teaching has been effective.

The nurse and LPN/LVN are caring for a type 2 diabetic patient who is admitted for gallbladder surgery. Which nursing action can the nurse delegate to the LPN/LVN? a.Communicate the blood glucose 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 transferring the patient to surgery. d.Plan strategies to minimize the risk for hypo- or hyperglycemia during the postoperative hospitalization.

C LPN/LVN education and scope of practice includes administration of insulin. Communication about patient status with other departments, planning, and patient teaching are skills that require RN education and scope of practice.

An 18-year-old with newly diagnosed type 1 diabetes has received diet instruction. The nurse determines a need for additional instruction when the patient says, a.I may 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 may eat whatever I want, as long as I use enough insulin to cover the calories. d.I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia.

C Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.

A 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.use of low doses of regular insulin. c.lifestyle changes to lower blood glucose. d.effects of oral hypoglycemic medications.

C The patients impaired fasting glucose indicates prediabetes and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram. Which information obtained by the nurse is most important to report to the health care provider before the procedure? a.The patients admission blood glucose is 128 mg/dL. b.The patients most recent Hb A1C was 6.5%. c.The patient took the prescribed metformin (Glucophage) today. d.The patient took the prescribed captopril (Capoten) this morning.

C To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogram and should not be used for 48 hours after IV contrast media are administered. The other patient data also will be reported but do not indicate any need to reschedule the procedure.

To evaluate the effectiveness of treatment for a patient with type 2 diabetes who is scheduled for a follow-up visit in the clinic, which test will the nurse plan to schedule for the patient? a.Urine dipstick for glucose b.Oral glucose tolerance test c.Fasting blood glucose level d.Glycosylated hemoglobin leve

D The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been diagnosed.

Which patient statement after the nurse has completed teaching a patient with type 2 diabetes about taking glipizide (Glucotrol) indicates a need for additional teaching? a.Other medications besides the Glucotrol may affect my blood sugar. b.If I overeat at a meal, I will still take just the usual dose of medication. c.When I become ill, I may have to take insulin to control my blood sugar. d.My diabetes is not as likely to cause complications as if I needed to take insulin.

D The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of glipizide.

Amitriptyline (Elavil) is prescribed for a diabetic patient who has burning foot pain at night. Which information should the nurse include when teaching the patient about the new medication? a.Amitriptyline will decrease the depression caused by your foot pain. b.Amitriptyline will correct some of the blood vessel changes that cause pain. c.Amitriptyline will improve sleep and make you less aware of nighttime pain. d.Amitriptyline will help prevent the transmission of pain impulses to the brain.

D Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain. Tricyclics also improve sleep quality and are used for depression, but that is not the major purpose for their use in diabetic neuropathy. The blood vessel changes that contribute to neuropathy are not affected by tricyclics.

A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral arterial disease. Which information will the nurse include in patient teaching? a.Choose flat-soled leather shoes. b.Set heating pads on a low temperature. c.Buy callus remover for corns or calluses. d.Soak the feet in warm water for an hour every day.

A The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems.

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.9:00 AM b.11:30 AM c.4:00 PM d.8:00 PM

A The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.

When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question is most appropriate for the nurse to ask? a.Have you lost any weight lately? b.How long have you felt anorexic? c.Is your urine unusually dark colored? d.Do you crave fluids containing sugar?

A Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.

Which information from the patients health history is most important for the nurse to communicate to the health care provider when a patient has an order for an oral glucose tolerance test? a.The patient uses oral contraceptives. b.The patient runs several days a week. c.The patient has a family history of diabetes. d.The patient had a viral illness 2 months ago.

A Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values. A viral illness 2 months previously may be associated with the onset of type 1 diabetes but will not falsely affect the OGTT. Exercise and a family history of diabetes both can affect blood glucose but will not lead to misleading information from the OGTT.

The nurse has been teaching the patient to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the patient that indicates a need for additional instruction is, a.I need to rotate injection sites among my arms, legs, and abdomen each day. b.I will 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 Rotating sites is no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other patient statements are accurate and indicate that no additional instruction is needed.

A patient who has type 1 diabetes plans to take a swimming class 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 The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

A patient who has just been diagnosed with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which patient goal is most important for this patient? a.The patient will have a glycosylated hemoglobin level of less than 7%. b.The patient will have 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 complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.

The health care provider suspects the Somogyi effect in a patient whose 7:00 AM blood glucose is 220 mg/dL. Which action will the nurse plan to take? a.Check the patients blood glucose at 3:00 AM. b.Administer a larger dose of long-acting insulin. c.Educate about the need to increase the rapid-acting insulin dose. d.Remind the patient about the need to avoid snacking at bedtime.

A If the Somogyi effect is causing the patients increased morning glucose level, the patient will experience hypoglycemia between 2 and 4 AM. The dose of insulin will be reduced, rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night.

A patient with type 2 diabetes that is well-controlled with metformin (Glucophage) develops an allergic rash to an antibiotic and 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.require administration of insulin while taking prednisone. c.develop acute hypoglycemia while taking the prednisone. d.have rashes caused by metformin-prednisone interactions.

B Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone, but will not need a diet that is higher in calories.

A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse will anticipate the need to a.give 50% dextrose as a bolus. b.insert a large-bore IV catheter. c.initiate oxygen by nasal cannula. d.administer glargine (Lantus) insulin.

B HHNC is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patients blood glucose and would be contraindicated.

A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take first? a.Infuse regular insulin at 20 U/hr. b.Place the patient on a cardiac monitor. c.Administer IV potassium supplements. d.Obtain urine glucose and ketone levels.

B Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Since potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring, since insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the patients care.

Which patient action indicates a good understanding of the nurses teaching about the use of an insulin pump? a.The patient changes the site for the insertion site every week. b.The patient programs the pump to deliver an insulin bolus after eating. c.The patient takes the pump off at bedtime and starts it again each morning. d.The patient states that diet will be less flexible when using the insulin pump.

B In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used. The pump will deliver a basal insulin rate 24 hours a day.

A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin develops a sore throat, cough, and fever. When the patient calls the clinic to report the symptoms and a blood glucose level of 210 mg/dL, the nurse advises the patient to a.use only the lispro insulin until the symptoms of infection are resolved. b.monitor blood glucose every 4 hours and notify the clinic if it continues to rise. c.decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%. d.limit intake of calorie-containing liquids until the glucose is less than 120 mg/dL.

B Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobins are not used to test for short-term alterations in blood glucose.

When teaching a diabetic patient who has just been started on intensive insulin therapy about mealtime coverage, which type of insulin will the nurse need to discuss? a.glargine (Lantus) b.lispro (Humalog) c.detemir (Levemir) d.NPH (Humulin N)

B Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.

Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness? a.Assess the patient for symptoms of hyperglycemia. b.Give the patient a snack of crackers and peanut butter. 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 Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and crackers will stabilize blood sugar. Administration of glucose intravenously might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration

Which action is most important for the nurse to take in order to assist a diabetic patient to engage in moderate daily exercise? a.Remind the patient that exercise will improve self-esteem. b.Determine what type of exercise activities the patient enjoys. c.Give the patient a list of activities that are moderate in intensity. d.Teach the patient about the effects of exercise on glucose level.

B Since consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions also will be implemented, but are not the most important in improving compliance.

The nurse obtains the following information about a patient before administration of metformin (Glucophage). Which finding indicates a need to contact the health care provider before giving the metformin? a.The patients blood glucose level is 166 mg/dL. b.The patients blood urea nitrogen (BUN) level is 60 mg/dL. c.The patient is scheduled for a chest x-ray in an hour. d.The patient has gained 2 lb (0.9 kg) since yesterday

B The BUN indicates impending renal failure and metformin should not be used in patients with renal failure. The other findings are not contraindications to the use of metformin.

A diabetic patient is admitted with ketoacidosis and the health care provider writes these orders. Which order should the nurse implement first? a.Administer regular IV insulin 30 U. b.Infuse 1 liter of normal saline per hour. c.Give sodium bicarbonate 50 mEq IV push. d.Start an infusion of regular insulin at 50 U/hr.

B The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be accomplished after the infusion of normal saline is initiated.

Which of these laboratory values, noted by the nurse when reviewing the chart of a hospitalized diabetic patient, indicates the need for rapid assessment of the patient? a.Hb A1C of 5.8% b.Noon blood glucose of 52 mg/dL c.Hb A1Cof 6.9% d.Fasting blood glucose of 130 mg/dL

B The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms of hypoglycemia, and give the patient some carbohydrate-containing beverage such as orange juice. The other values are within an acceptable range for a diabetic patient

A hospitalized diabetic patient who received 34 U of NPH insulin at 7:00 AM is away from the nursing unit, awaiting diagnostic testing when lunch trays are distributed. To prevent hypoglycemia, the best action by the nurse is to a.save the lunch tray to be provided upon the patients return to the unit. b.call the diagnostic testing area and ask that a 5% dextrose IV be started. c.ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic testing area. d.request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.

D Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items.

A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what type 2 means in relation to diabetes. Which statement by the nurse about 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.Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma. d.Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.

D For some patients, changes in lifestyle are sufficient for blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.

After the home health nurse has taught a patient and family about how to use glargine and regular insulin safely, which action by the patient indicates that the teaching has been successful? a.The patient administers the glargine 30 to 45 minutes before eating each meal. b.The patients family fills the syringes weekly and stores them in the refrigerator. 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 Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals, while glargine is given once daily.

The nurse teaches the diabetic patient who rides a bicycle to work every day to administer morning insulin into the a.arm. b.thigh. c.buttock. d.abdomen.

D Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.

Which information about a patient who receives rosiglitazone (Avandia) is most important for the nurse to report immediately to the health care provider? a.The patients blood pressure is 154/92. b.The patient has a history of emphysema. c.The patients noon blood glucose is 86 mg/dL. d.The patient has chest pressure when ambulating.

D Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. There is no urgent need to discuss the other data with the health care provider.

Which action by a type 1 diabetic patient indicates that the nurse should implement teaching about exercise and glucose control? a.The patient always carries hard candies when engaging in exercise. b.The patient goes for a vigorous walk when the 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 When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic patients should be taught to avoid exercise when ketosis is present. The other statements are correct.