DM Sherpath
A child with type 1 diabetes mellitus who is taking insulin is seen in the school's clinic. The nurse develops a teaching plan for the child regarding food and exercise because the child has told the nurse that she will begin basketball practice. Which instruction should the nurse provide to the child?
Eat an extra snack of carbohydrates before the basketball practice starts.
While meeting with an adolescent to address diabetes management, which statement by the adolescent regarding compliance with insulin usage would be concerning to the nurse?
"I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast."
A home care nurse is teaching a parent and 16-year-old patient with type 1 diabetes mellitus about insulin administration and rotating sites. Which statement, if made by the patient, would indicate effective teaching?
"I rotate sites between areas of my abdomen and arms."
The patient with Type 2 DM receives metformin (Glucophage). What statements would the nurse include when educating the patient about the drug?
"Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications."
The nurse is meeting with an early school-age patient and parent to discuss management of the patient's Type 1 DM. The nurse understands that further teaching is needed when the parent makes which statement about the child's ability to participate in care?
"My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times."
The nurse is providing nutrition education to a patient newly diagnosed with Type 1 Diabetes Mellitus. The patient states, "I should have a glass of orange juice with a teaspoon of sugar if I feel lightheaded, cool, and clammy mid-morning." Which statement is the best response by the nurse?
"Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia."
A patient has type 1 diabetes mellitus and receives insulin. The patient asks the nurse why she cannot take pills instead. What is the best explanation by the nurse?
"Your pancreas is unable to secrete an adequate amount of insulin."
Which patient is at highest risk to develop Type 2 Diabetes Mellitus?
1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily
A diabetic patient arrives at the ER with tachycardia, diaphoresis, and unresponsive to voice. Which intervention is the priority action?
Administer 50% dextrose IV per protocol
The patient is managed with NPH and regular insulin before breakfast, lunch, and dinner. When is the patient most likely to experience a hypoglycemic reaction?
Before lunch
A patient with type 2 diabetes mellitus complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing actions should the nurse perform first?
Check the patient's blood glucose level.
The diabetes educator is meeting with school nurses to discuss ways to increase diabetes management in the schools, allowing for students with diabetes to take part in everyday activities, before, during, and after school. The school nurses provide scenarios of their involvement with diabetes management. Which statement indicates a safe nursing action on the part of the school nurse?
I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose.
A young patient newly diagnosed with diabetes is admitted with a BP of 85/58 mm Hg, pulse of 120 bpm, respirations 42, blood glucose level of 450 mg/dL, pH of 7.07 and bicarbonate level of 13 mEq/L. The patient is lethargic and slow to respond to touch. Which conditions will the nurse need to monitor?
Monitor blood pH Check level of consciousness Monitor level of potassium Maintain Fluid intake and output
A 19-year-old with Type 1 DM is taking 30 units of NPH insulin each morning and 15 units at night. Because of persistent morning glycosuria with some ketonuria, the evening dose is increased to 20 units. This worsens the morning glycosuria, and now moderate ketones are noted in urine. The patient complains of sweats and headaches at night. The next step in management is:
Obtain blood glucose levels at 2 a.m.
A child is using regular insulin according to blood glucose monitoring results. At 2 pm, the child has a blood glucose of 185 mg/dl, for which the patient received 8 units of regular insulin. The nurse should expect the dose's onset and peak to be at which times?
Onset 2:30-3:00 pm and peak 4:00-5:00 pm
The blood glucose of a patient newly diagnosed with Type 1 diabetes mellitus has a blood glucose level of 310 mg/dL. Which type of insulin would the nurse expect to be ordered at this time?
Regular
A patient with DKA is given normal saline and intravenous regular insulin. The nurse checks blood glucose level hourly. Which other assessment data is the best indicator of clinical improvement?
Respiration rate of 12 to 15 and normal BP in the standing position
The nurse has taught a patient with type 2 diabetes mellitus about the clinical manifestations and evaluates that learning has occurred if the patient makes which statement?
"I can expect that my blood sugars will increase when I am sick or under stress."
The diabetes educator is meeting with a group of parents to discuss diabetes mellitus management. Many parents have questions about the role of the child. Together the diabetes educator and parents discuss ways to improve adherence with medication administration. The diabetes educator evaluates that learning has occurred when one parent makes which statements?
"My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game".
A parent calls the nurse line, reporting that the child with diabetes is nauseated and vomiting. What is the priority statement the nurse will include in the instructions to the parent?
"Test the blood glucose level frequently."
When providing education to the parents of a toddler with Type 1 DM, the nurse should include which statement related to hypoglycemia?
"The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency."
The adolescent patient and parent have completed diabetic education. Which statements by the parent would indicate an understanding of the goals of insulin therapy for diabetic management?
"We will schedule the insulin to correspond to the child's usual meal times." "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern."
A patient is admitted with a diagnosis of DKA. What signs and symptoms would the nurse expect to find in the patient?
Mild disorientation Constantly feeling tired
The provider writes orders for a patient with Type 1 DM admitted with DKA. Which order should the nurse question?
Monitor blood glucose every 3-4 hours during IV insulin infusion.
The provider writes orders for a patient with Type 1 DM admitted with elevated blood glucose levels. Which order should the nurse question?
Monitor blood glucose every 3-4 hours during IV insulin infusion.
A child has been diagnosed with Type 1 Diabetes Mellitus (DM) and the parent asks the nurse what this means. What is the best response by the nurse?
"In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy."
During an exercise class for patients with type 2 diabetes, the nurse instructs the patients and parents on recommended daily activity. The nurse notes the need to reinforce teaching when a parent makes which statement?
"My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes."
A pre-school child newly diagnosed with Type 1 DM and parent meet with the nurse. Which statement best explains why play therapy can be effective in dealing with diabetes mellitus when meeting with the patient?
"Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks."
An adolescent patient was recently diagnosed with Type 2 DM. The nurse knows that learning has taken place when the child makes which statement related to prevention?
"Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes."
A patient with Type 1 diabetes mellitus is admitted to the emergency department in DKA. Which action should the nurse take first?
Initiate fluid replacement with 0.9% saline
