Chapter 49: Diabetes Mellitus
Which information is most important for the nurse to report to the health care provider before a patient with type 2 is prepared for coronary angiogram
The patient took the prescribed metformin today
A female patient is scheduled for oral glucose tolerance test. Which information form the health history is most important for the nurse to communicate to the health care provider.
The patient uses oral contraceptives
When a patient with type 2 is admitted for a cholecystectomy, which nursing action can the nurse delegate to a LPN
Administer the prescribed Lispro (Humalog) before transporting the patient to surgery
A diabetic patient who has reported burning foot pain at night receives a new script. Which information should the nurse teach the patient about amitriptyline
Amitirptyline helps prevent transmission of pain impulses to the brain
After change of shift report which patient should the nurse assess first
23yr old with type 1 whos has a bgm of 40
A patient receives Novolog at 8AM Which time will be most important for the nurse to monitor for symptoms of hypoglycemia
10AM
After change of shift report which patient will the nurse assess first
60yr old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
Which question during the assessment of a diabetic patient will help the nurse identify autonomic neuropathy
Do you feel bloated after eating
The nurse is preparing to teach a 43yr old man who is newly diagnosed with type 2 about home management of the disease. Which action should the nurse take first.
Assess the patients perception of what it means to have DM
To monitor for complications in a patient with type 2 which tests will the nurse in the diabetic clinic schedule at least annually
BP/Serum creatinine/Urine for microalbuminuria/Monofilament testing of the foot
An active 28yr male with type 1 is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy.
Blood Pressure 146/88
After the nurse has finished teaching a patient who has a new prescription for exenatide, f(Byetta), which patient statement indicates that the teaching has been effective
I should take my daily aspirin at least an hour before the Byetta
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct
Changes in diet and exercise may control blood glucose levels in type 2 diabetes
The health care provider suspects the Somogyi effect in a 50yr old patient whose 6am blood glucose is 230. Which action will the nurse teach the patient to take
Check the blood glucose during the night
Which information will the nurse include in teaching a femal patient who has peripheral arterial disease, type 2, and sensory neuropathy of the feet and legs
Choose flat soled leather shoes
A patient who was admitted with DKA secondary to UTI has been weaned off an insulin drip 30 min ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?
Obtain glucose reading using a finger stick
A few weeks after an 82yr with a new diagnosis of type 2 has been placed on metformin 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
Glomerular filtration rate is decreased.
In order to assist an older diabetic to engage in moderate daily exercise, which action is most important to take
Determine what type of activities the patient enjoys
The nurse has administered 4oz orange juice to an alert patient whose bgm was 62. 15min later the bgm is 67. which action should the nurse take next.
Give the patient 4-6oz more orange juice
Which actin should the nurse take after a 36yr old treated with intramuscular glucagon for hypoglycemia regains consciousness
Give the patient a snack of peanut butter and crackers
The nurse is assessing a 22yr patient experiencing onset of symptoms of type 1. Which question is most appropriate to ask
Have you lost weight lately
A 32yr old with diabetes is starting on intensive insulin therapy. which type of insulin will the nurse discuss using for mealtime coverage.
Humalog
The nurse determines a need for additional instruction when the patient with newly diangnosed type 1 says which of the following
I can choose any foods as long as I use enough insulin to cover the calories
Which statement by the patient indicates a need for additional instruction in administering insulin
I need to rotate injection sites among my arms, legs, and abdomen, each day
A 54yr old is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first
Infuse 1 liter of normal saline per hour
A 48yr old male screened for diabetes at a clinic has a fasting plasma glucose level of 120. The nurse will plan to teach the patient about
Lifestyle changes to lower blood glucose
Which nursing actin can the nurse delegate to UAP who are working in the diabetic clinic
Measure the ankle brachial index.
The nurse has been teaching a patient with type 2 about managing blood glucose levels and taking glipizide. which patient statement indicates a need for additional teaching
My diabetes wont cause complications because I don't need insulin
A 27yr old admitted with DKA has a serum glucose level of 732 and serum K+ level of 3.1. Which action prescirved by the health care provider should the nurse take first
Place the patient on cardiac monitor
The nurse is taking a health history from a 29yr 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.
Schedule the patient for a fasting blood glucose level.
Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful
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
The patient has chest pressure when walking
A 26yr old with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to administer the morning insulin
abdomen
A 34yr old has a new diagnosis of type 2. The nurse will discuss the need to schedule a dilated eye exam
as soon as possible
The nurse identifies a need for additional teaching when the patient who is self monitoring blood glucose
chooses a puncture site in the center of the finger pad
Which information will the nurse include when teaching 50yr old who has type 2 about glyburide
glyburide stimulates insulin production and release from the pancreas
A patient with type 2 is scheduled for follow up visit several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment
glycosylated hemoglobin level
An unresponsive patient with type 2 is brought to the ED and diagnosed with hyperosmolar hyperglycemic syndrome. The nurse will anticipate the need to
insert a large bore IV catheter
A 6yr old female with type 1 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 despite taking her usual Lantus and Humalog. The nurse advises the patient to
monitor blood glucose every 4 hours and notify the clinic if it continues to rise
Which lab value reported to the nurse by the UAP indicates the most urgent need for the nurse's assessment of the patient
noon blood glucose of 52
A hospitalized diabetic received 38U of NPH at 7am. At 1pm the patient has been away from the nursing unit for 2 hours, missing lunch delivery while awaiting a chest xray. To prevent hypoglycemia, the best action by the nurse is to
request that if testing is further delayed the patient be returned to the unit to eat
When a patient who takes metformin to manage type 2 develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. The nurse will anticipate the patient may
require administration of insulin while taking prednisone
Which patient action indicates good understanding of the nurses teaching about administration of novolog
the patient cleans the skin with soap and water before insulin administration
A 28yr old male with type 1 diabetes reports how he manages his exercise and glucose control. which behavior indicates that the nurse should implement additional teaching
the patient increases daily exercise when ketones are present in the urine
Which patient action indicates a good understanding of the nurses teaching about the use of an insulin pump
the patient programs the pump for an insulin bolus after eating
A 55yr female with type 2 has a diagnosis of imbalanced nutrition: more than body requirements. Which is most important goal
the patient will reach a glycosylated hemoglobin level less than 7%
Which finding indicates a need to contact the health care provider before the nurse administers metformin
the patients BUN level is 52
A 38yr old who has type 1 plans to swim laps daily at 1pm. the clinic nurse will plat to teach
to check glucose level before during and after swimming
