Collaborative care of diabetes

Which dietary instruction should the nurse include when reviewing dietary needs with a patient newly diagnosed with diabetes? "Consume 45 to 60 grams of carbohydrates per meal." "Fats should comprise 10% of your daily food intake." "Ensure that 30% of daily food intake comes from protein." "Men and women are allowed to consume up to two alcoholic beverages per day."

"Consume 45 to 60 grams of carbohydrates per meal." The patient with diabetes should be instructed to include 45 to 60 grams of carbohydrates in every meal to maintain a well-balanced diet and prevent hypo- and hyperglycemia.

Which instruction should the nurse give to a patient who is scheduled for a fasting blood glucose test? "Do not take your cardiac medications before the test." "You will drink a glucose solution 2 hours before the test." "Do not eat or drink anything for 8 hours before the test." "Bring someone with you to drive you home after the test."

"Do not eat or drink anything for 8 hours before the test." A patient should not eat or drink anything for 8 hours before a fasting blood glucose test. Food and drink can interfere with test results.

The nurse administers a dose of NPH insulin to a patient at 8:00 am. At which time should the nurse provide a snack or meal? 9:00 am 4:00 pm 8:00 pm 12:00 pm

12:00 pm The peak time for NPH insulin is 4 hours, so the nurse should make sure the patient eats at 12:00 pm.

The nurse is providing patient education to a high school athlete with diabetes who was seen in the emergency department after a syncopal episode during a basketball game. Which teaching interventions are appropriate for the nurse to provide? Select all that apply. "Carry a source of quick-acting carbohydrate with you." "Wait to take your oral agent until you have finished exercising." "Obtain a capillary blood glucose level before you exercise." "Monitor blood glucose levels every hour when you are exercising." "Withhold your insulin before you begin any exercise session."

Carry a source of quick-acting carbohydrate with you." Exercise lowers blood glucose levels so the nurse should instruct the patient to carry a source of quick-acting carbohydrate to prevent hypoglycemia. "Obtain a capillary blood glucose level before you exercise." Exercise lowers blood glucose levels, so the nurse should instruct the patient to check his or her blood glucose level before exercise to obtain a baseline reading.

Which source of fat should the nurse instruct the patient with diabetes to include in the diet at least twice a week? Fish Butter Olive Oil Whole milk

Fish The patient should include at least two servings of fish per week. Fish is a good source of healthy fats.

Which diagnostic test result will the nurse review to evaluate a patient's blood glucose control over an extended period? Fasting blood glucose Random blood glucose Oral glucose tolerance test Glycosylated hemoglobin (HgbA1c)

Glycosylated hemoglobin (HgbA1c) A glycosylated hemoglobin (HgbA1c) value indicates blood glucose control over time (approximately 3 months) by measuring the percentage of glycosylated hemoglobin molecules.

A patient with newly diagnosed type 1 diabetes tells the nurse that he or she likes to go camping, but is now afraid to go because of insulin needs. Which information should the nurse provide to the patient? Insulin can be stored at room temperature. Insulin can withstand temperatures between 20° and 90° F. The patient should not go camping until the disease is stabilized. The patient should have a cooler with ice available at all times to store the insulin.

Insulin can be stored at room temperature. Insulin does not need to be refrigerated and can be stored at room temperature. If the patient obtains a storage method that can keep the insulin at room temperature while camping outdoors, he or she can continue to go on camping trips.

The nurse is caring for a patient with diabetes who underwent magnetic resonance imaging with and without intravenous (IV) contrast dye yesterday. Which medication should the nurse withhold? Glipizide Exenatide Metformin Regular insulin

Metformin Metformin should be withheld on the day of the test and for 48 hours after the test when a patient has received IV contrast dye because the combination of metformin and the dye can lead to acute kidney injury.

A patient reports a new onset of increased thirst, hunger, and frequent urination. Which action should the nurse take first? Review the patient's medical history. Obtain a diet history from the patient. Obtain a random plasma glucose level. Obtain a hemoglobin A1c level immediately.

Obtain a random plasma glucose level Increases in thirst and hunger and frequent urination are typical manifestations of hyperglycemia. The nurse should obtain a random plasma glucose level to determine whether hypogly

The nurse is caring for a patient with diabetes who is also receiving treatment for chronic obstructive pulmonary disease. The nurse should obtain capillary blood glucose levels based on documentation of which medication in the patient's chart? Albuterol Prednisone Diphenhydramine Dextromethorphan

Prednisone Prednisone is a corticosteroid that can increase blood glucose levels.

Which laboratory finding warrants a repeat test to confirm a diagnosis of diabetes? Hemoglobin A1c (HgbA1c) of 6.0% Fasting plasma glucose level of 90 mg/dL Random blood glucose value of 250 mg/dL Oral glucose tolerance test with 2-hour glucose level of 150 mg/dL

Random blood glucose value of 250 mg/dL A random plasma glucose value ≥200 mg/dL may indicate diabetes, but if the patient has no symptoms, the test must be repeated to confirm the diagnosis and rule out a false-positive result.

A nurse is preparing a patient with suspected diabetes for a fasting blood glucose test. The nurse should ask the patient about which factors? Select all that apply. Recent acute illness History of alcohol use Recent antibiotic therapy History of recent exercise Typical daily caloric intake

Recent acute illness A recent acute illness can generate a false positive result on a fasting plasma glucose (FPG) diagnostic test, so the nurse should inquire about this. History of alcohol use Recent consumption of alcohol can cause blood glucose levels to increase. Chronic consumption of alcohol by patients with diabetes can cause hypoglycemia. The nurse should obtain this information to ensure an accurate test result. History of recent exercise The nurse should ask the patient about recent exercise as this can affect blood glucose levels. Recent strenuous exercise can cause blood glucose levels to increase.

Which subjective assessment finding indicates a need for further patient education about reducing the risk of developing complications from diabetes? Sees an ophthalmologist twice a year Walks 30 minutes per day, 5 days a week Reports walking barefoot only when it is warm outside Checks a capillary blood glucose level anytime he or she feels unwell

Reports walking barefoot only when it is warm outside. A patient with diabetes should not walk barefoot at all because peripheral neuropathy can prevent the patient from detecting injuries to the feet. This statement is incorrect and indicates a need for further education.

A 16-year-old patient with diabetes reports to the nurse that morning blood glucose levels have been averaging around 200 mg/dL but are within an acceptable range the rest of the day. Which situation should the nurse suspect? The patient is consuming large late night snacks. The patient is experiencing the dawn phenomenon. The patient has not been taking insulin as prescribed. The patient is not following dietary recommendations.

The patient is experiencing the dawn phenomenon. Increased blood glucose levels in the morning and normal blood levels during the day indicate the patient is experiencing the dawn phenomenon.

A patient with diabetes asks the nurse about the option of using inhaled insulin because of a fear of self-administered injections. Which finding in the medical record would prevent the patient using this form of insulin? Decreased renal function Presence of an egg allergy History of hepatitis B infection Tobacco use (1 pack of cigarettes per day)

Tobacco use (1 pack of cigarettes per day) An inhaled form of insulin is contraindicated for patients who smoke because it can lead to bronchospasms.

The patient with new-onset type 2 diabetes asks the nurse about ways to lose weight. Which instruction should the nurse include in patient education? Use portion control. Increase protein intake. Begin a low-carbohydrate diet. Eliminate all foods that are high in sugar.

Use portion control. The patient should control portion size and total intake to promote weight loss.

A nurse is providing dietary teaching to a patient with diabetes. Which patient action indicates a good understanding of dietary restrictions? Using artificial sweeteners for beverages Preparing meals that consist of 50% protein Consuming 5 carbohydrate servings per day Drinking one or two glasses of wine before going to bed

Using artificial sweeteners for beverages. A patient with diabetes should use artificial sweeteners instead of sugar, following Food and Drug Administration guidelines for use.

Which actions should the nurse take when administration of NPH and regular insulin is required for a patient with diabetes? Select all that apply. Ask the provider to order a different formulation of insulin. Withdraw the regular insulin first, then the NPH, in the same syringe. Assess the patient's capillary blood glucose level before the injection. Administer the medications in two separate syringes using two injections. Have a second nurse check the insulin type and dosage before administration.

Withdraw the regular insulin first, then the NPH, in the same syringe. The nurse should withdraw the regular insulin first and then the NPH insulin. This prevents mixing of the intermediate-acting insulin with the short-acting insulin. These can both be administered with the same syringe. Assess the patient's capillary blood glucose level before the injection. The nurse should always assess capillary blood glucose levels before administering insulin of any kind. This prevents hypoglycemia. Have a second nurse check the insulin type and dosage before administration. Because of risk for error, two nurses should always verify that the correct insulin and the correct dosage are being used.