Diabetes Mellitus Patient Care

Which insulin selection indicates patient understanding of teachings received from the nurse about the use of basal insulin for glucose stabilization?

insulin glargine

Which of the four assigned patients would the nurse see first?

A patient diagnosed with diabetes and a blood glucose level of 38 mg/dl.

Which of the four assigned patients would the nurse see first?

A patient diagnosed with diabetes and blood glucose level of 38 mg/dl.

Which of the four assigned patients would the nurse see first?

A patient diagnosed with new onset type 1 diabetes who now has positive urine ketones.

For the patient with type 1 diabetes, which intervention would the nurse consider teaching when the patient reports multiple episodes of hypoglycemia?

Only use the fingertips for blood glucose checks.

For a patient using an insulin pump to treat type I DM, which intervention to manage blood glucose levels would the nurse teach the patient to implement?

Reduce the insulin dosage before planned physical exercise.

Which information would the nurse teach a patient regarding the storage of NPH and regular insulins?

Refrigerate insulin vials not in use, or if the ambient temperature exceeds 86*.

When reviewing the health care provider's admission prescriptions for a patient admitted in a hyperglycemic-hyperosomolar state, the nurse understand that which prescription is consistent with this diagnosis? (select all that apply)

Regular insulin IV at 2 units/hr. Normal saline IV at 100 ml/hr. Addition of 20 mEq KCl for each liter of IV fluids.

For the patient diagnosed with hypoglycemia, the nurse would assess for the presence of which clinical manifestation? (select all that apply)

confusion weakness cool, clammy skin

Which hormone would the nurse associate with raising blood glucose levels? (select all that apply)

cortisol glucagon epinephrine growth hormone

Which oral medication lowers blood glucose levels by preventing kidney reabsorption of glucose and sodium filtered from the blood and allows excretion of the filtered glucose into the urine, rather than movement back into the blood?

dapagliflozin

For the patient newly diagnosed with diabetes, which factor is most important for the nurse to assess before providing teachings about the disease and its management?

educational and literacy level

When providing care for an older adult patient with DM, acute renal failure, history of a thyroid tumor, and periodic angina, the nurse would anticipate administering which medication safely to control the patient's diabetes?

glipizide

Which interpretation would the nurse associate with a fasting blood glucose of 65 mg/dL?

hypoglycemia

Which symptom would the nurse associate with autonomic neuropathy? (select all that apply)

atonic bladder dried, cracked skin orthostatic hypotension

After a patient with diabetes receives teachings regarding nutrition therapy, which food item would the patient consume when becoming hypoglycemic at home?

1 tablespoon of honey

When a patient with diabetes mellitus received insulin aspart at 8 am, at which time would the nurse anticipate a potential hypoglycemic event to occur?

11 am

After a patient receives discharge instructions about managing hypoglycemia at home, which patient food selection to treat mild hypoglycemia demonstrates effective teaching? (select all that apply)

6 saltine crackers 3 graham crackers 4 teaspoons of sugar

Which patient with diabetes would the endocrine unit's charge nurse assign to a RN who floated from the labor/delivery unit?

70 year old who needs blood glucose monitoring and insulin before each meal.

After administering insulin aspart at 7am, the nurse would assess the patient for signs of hypoglycemia at which time?

9 am

Which food item would the nurse provide a patient experiencing clinical manifestations of hypoglycemia and a blood glucose level of 60 mg/dL?

A half cup of fruit juice.

For a patient newly diagnosed with type I diabetes, which patient selection indicates effective teaching of the types of premeal insulin by the nurse?

insulin aspart

A patient who receive insulin glargine subcutaneously 30 minutes ago is now cool, clammy, and anxious with a current blood glucose level of 54. The patient states, "Something is wrong with me." Which intervention would the nurse implement?

Administer a carbohydrate replacement.

For the patient diagnosed with type II diabetes and taking pioglitazone, which finding would the nurse report immediately to the health care provider?

Alanin aminotransferase level of 105 u/l

Which finding requires the nurse's immediate attention when providing care for a patient receiving sitagliptin?

Amylase 546 mg/dL

For the patient with type II diabetes who is taking metformin, which action would the nurse plan next after noting the patient's fasting blood glucose is 108 and the glycosylated hemoglobin is 8.2%

Ask the patient about current dietary intake and medication use.

Which action would the home health nurse delegate to a home health aide who makes daily visits to a patient newly diagnosed with type II diabetes?

Assist the patient with washing the feet and applying moisturizing lotion.

Which technique would a patient with diabetes use to self administer an insulin injection? (select all that apply)

Avoid injecting insulin on scarred tissue sites. Avoid injecting within 2 inch radius around the navel. Grasp a fold of the skin and inject insulin subcutaneously.

The nurse would instruct a patient newly diagnosed with diabetes to self check the blood glucose level at which time? (select all that apply)

Before meals. Frequently if you are ill. If you are thirsty and urinate frequently.

When a patient with type I diabetes arrives in the ED breathing deeply, stating "I can't catch my breath," with a temp of 98.4*F, pulse 112 bpm, respiratory rate 38 breaths/min, bp 91/54, and O2 sat 99% on room air, which action would the nurse implement now?

Check the blood glucose.

Which interventions would the nurse implement when a patient presents to the emergency department with vomiting and abdominal pain, as well as rapid, deep respirations and a current blood glucose of 480 mg/dL?

Check the urine for ketones.

Which intervention would the nurse implement first when providing care for a patient who obtains an elevated reading from continuous glucose monitoring?

Confirm the results with finger stick test.

Which complication diabetes would the nurse report to the health care provider after receiving the report on a 52 year old patient with type II diabetes?

Decreased peripheral perfusion.

Which method must a patient with diabetes implement regarding insulin safety?

Discard any unused insulin after 28 days.

When teaching a community group about diabetes care, the nurse would teach which information regarding alcohol use and diabetes mellitus?

Drink alcohol with meals.

When a patient's 7 am finger stick blood glucose readings are between 286 and 353 for three mornings in a row, which finding supports the nurse's suspicion that the patient may have dawn phenomenon?

Early morning glucose elevations.

Which feature of the glycosylated hemoglobin A1C test is important?

Eating habits, within 24 hours before the test, do not alter the results.

Which action would the nurse perform when patient in the ICU with DKA has an insulin infusion and the cardiac monitor indicates ventricular ectopy?

Examine or obtain the current potassium level.

A patient scheduled for surgery in the morning has insulin glargine schedule before bed and then is placed on NPO status at midnight. Which action would the nurse implement regarding the scheduled insulin?

Give the insulin.

For the patient diagnosed with type II diabetes and receiving discharge teachings about signs of hypoglycemia, which patient statement indicates understanding of the nurse's teachings? (select all that apply)

I may experience weakness. It can cause a fast heart rate. I might feel anxious or nervous.

Which patient statement indicates understanding of the nurse's teachings related to a newly prescribed medication, insulin glargine? (select all that apply)

I will administer it subcutaneously. I cannot mix this with other insulins. The insulin will start working in 2 to 4 hours.

For the patient diabetes, which patient statement indicates understanding of the nurse's teaching about exenatide?

I'll need to learn how to administer injections to myself.

When teaching a patient about insulin therapy, which patient action demonstrates understanding of the teaching provided by the nurse? (select all that apply)

Inserts the needle at a 90 degree angle. Turns the bottle upside down to withdraw insulin.

A patient expresses fear and anxiety over the life changes associated with diabetes by stating, "I am scared I can't do it all and I will get sick and be a burden on my family." Which statement would the nurse use as the best response to this patient?

Let us tackle this piece by piece. What is most scary to you?

When providing educational information about sick day rules, the nurse would include which information for the patient with diabetes? (select all that apply)

Notify the health care provider if ill. Drink 8 to 12 oz of sugar free liquid each hour while awake. If unable to eat, consume liquids equal to the carbohydrate content normally eaten.

Which patient would the nurse assess first after receiving a change of shift report on a group of assigned patients on the medical surgical unit?

Patient taking glyburide who is dizzy and sweaty.

Four assigned patients take metformin. Which patient would the nurse consider at the highest risk for developing lactic acidosis?

Patient who is receiving dialysis.

After receiving a change of shift report on the endocrine unit, the nurse would see which patient first?

Patient with type I diabetes whose insulin pump is beeping "occlusion".

When the nurse is providing postoperative cholecystectomy care for a patient with DM, for which reason would the nurse prioritize blood glucose management in the patient's plan of care?

Patients with postoperative hyperglycemia are prone to poor wound healing.

Which action would the caregiver of a patient with diabetes implement for treatment of moderate hypoglycemia?

Provide 15g of carbohydrate and cheese.

Which action would the nurse implement when drawing up a single dose of insulin?

Pull back the plunger to draw air into the syringe equal to the insulin dose.

When the nurse is administering metformin before breakfast to a patient with type II diabetes, which patient finding would require further follow up by the nurse before administering the medication?

Scheduled angiogram of the leg later today.

When the nurse teaches a group about the American Diabetes Association recommendations for patient care, which statement indicates understanding of the recommendations?

The LDL cholesterol should be below 100 mg/dL for patients without signs of CVD.

Which statement would the nurse associate with repaglinide?

The medication increases the secretion of insulin from the pancreas.

For the patient newly diagnosed with DM, which priority patient outcome would the nurse include in the patient's plan of care?

The patient recognizes the signs and symptoms of hypoglycemia.

Which statement would the nurse use when discussing a patient with diabetes' glycosylated hemoglobin level of 9.4%?

What are you doing differently?

For a patient recently admitted with a new onset type II diabetes who anticipates discharge with a self monitoring blood glucose machine, when is the best time for the nurse to explain the proper use of the machine to the patient?

While performing the test in the hospital.

For the patient with type II diabetes who is admitted for surgery, which response would the nurse use when the patient wants to know why the health care provider added insulin to the current dose of metformin?

Your body is under more stress, so you'll need insulin to support your medication.

When teaching a patient about insulin therapy, the nurse would explain that which injection site area has the best insulin absorption rate?

abdomen

When admitting a patient with a new diagnosis of chronic renal insufficiency secondary to type II diabetes, the nurse would hold which medication and contact the health care provider about it?

metformin

Which medication would the nurse associate with lowering blood glucose levels by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity?

metformin

Which complication of diabetes would the nurse recognize as a chronic complication? (select all that apply)

neuropathy retinopathy nephropathy

Which teaching would the nurse include for a patient with a new diagnosis of type I diabetes? (select all that apply)

sick day rules daily inspecting of feet reporting any vision changes

Which finding would the nurse associate with a diagnosis of hyperglycemia? (select all that apply)

warm, moist skin ketones in urine Kussmaul respiration