Med-Surg Ch. 64, Care of Patients with Diabetes Mellitus

The nurse is teaching a patient who has just been prescribed insulin glargine about administration. What statements by the patient indicate a need for further teaching? Select all that apply.

"I will take this before meals and at bedtime." "If I am hospitalized, I can receive this medication intravenously."

The nurse is instructing a patient with diabetes about exenatide. Which patient statement indicates a correct understanding of the teaching?

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

The nurse is providing teaching about signs of hypoglycemia to a patient diagnosed with type 2 diabetes who is being discharged after an episode of hypoglycemia. Which statement by the patient indicates a need for further teaching?

"Sometimes it causes vomiting."

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with new-onset type 1 diabetes who now has positive ketones in his urine

A patient with type 2 diabetes has been admitted for surgery, and the health care provider has placed the patient on insulin in addition to the current dose of metformin. The patient wants to know the purpose of taking the insulin. What is the nurse's best response?

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

A patient received insulin aspart at 0700. At what time should the patient be assessed for signs of hypoglycemia?

0900

In reviewing the health care provider admission requests for a patient admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis?

1 ampule NaHCO 3 IV now

The nurse is teaching a patient with diabetes mellitus how to inject a mixture of NPH and regular insulins. In which order does the nurse instruct the patient to prepare and administer the insulin?

1.Wash the hands. 2.Swab the rubber stoppers of the vials with alcohol. 3.Draw up regular insulin. 4.Draw up NPH insulin. 5.Wipe the skin with alcohol. 6.Inject the insulin at a 90-degree angle.

The nurse is caring for a patient with diabetes mellitus who received insulin aspart at 8:00 AM. At which time does the nurse expect hypoglycemia most likely to occur in this patient?

11:00 AM

The nurse is teaching a patient being discharged about managing hypoglycemia at home. Once at home, the patient has a blood glucose level of less than 60 mg/dL. What food selections by the patient demonstrate that the teaching was effective? Select all that apply.

6 saltine crackers 3 graham crackers 4 teaspoons of sugar

Which food will the nurse provide to a patient who has hypoglycemia and a blood glucose level of 60 mg/dL?

A half cup of fruit juice

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with diabetes with a blood glucose level of 38 mg/dL

While teaching a patient about insulin injection technique, the nurse explains that injecting into which area will cause the insulin to be most rapidly absorbed?

Abdomen

A patient who received insulin glargine subcutaneously 30 minutes ago is now cool, clammy, and anxious. The patient states "Something is wrong with me." The blood glucose level is 54. What action by the nurse is should be taken?

Administer a carbohydrate replacement

A patient diagnosed with type 2 diabetes is taking pioglitazone. What finding should be reported to the health care provider immediately?

Alanine aminotransferase (ALT) level of 105

Which is the best referral that the nurse can suggest to a patient who has been newly diagnosed with diabetes?

American Diabetes Association

A patient with type 2 diabetes who is taking metformin is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (A1C) is 8.2%. Which action does the nurse plan to take next?

Ask the patient about current dietary intake and medication use.

Which nursing action can the home health nurse delegate to a home health aide who is making daily visits to a patient with newly diagnosed type 2 diabetes?

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

Which symptoms indicate autonomic neuropathy? Select all that apply.

Atonic bladder Dried, cracked skin Orthostatic hypotension

A patient newly diagnosed with diabetes is being instructed when to perform blood glucose monitoring. At what times does the nurse instruct the patient to check blood glucose? Select all that apply.

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

Which oral medication lowers blood glucose levels by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine, allowing for the filtered glucose to be excreted in the urine rather than moved back into the blood?

Dapagliflozin (Farxiga)

The nurse receives a report on a 52-year-old patient with type 2 diabetes. Which complication of diabetes does the nurse report to the provider?

Decreased peripheral perfusion

What method must the patient with diabetes use with regard to insulin safety?

Discard any unused insulin after 28 days.

A patient is in an education class for diabetes care. What teaching should be provided to a patient regarding alcohol use and diabetes mellitus?

Drink alcohol with meals.

The nurse is caring for an older adult patient with diabetes mellitus, acute renal failure, history of a thyroid tumor, and periodic angina. Which drug can be safely administered to control the patient's diabetes?

Glipizide

What does a fasting blood glucose of 65 mg/dL indicate?

Hypoglycemia

The nurse is teaching a patient about insulin administration. Which actions by the patient demonstrate an accurate understanding of the teaching provided? Select all that apply.

Inserting needle at 90-degree angle Turning bottle upside down to withdraw insulin

A patient newly diagnosed with type 1 diabetes is receiving education about the types of premeal insulin. What selection by the patient indicates the teaching was effective?

Insulin aspart

Which statement about repaglinide is correct?

It increases the secretion of insulin from the pancreas.

A patient with chronic renal insufficiency was recently diagnosed with type 2 diabetes. The nurse should contact the health care provider and hold which medication?

Metformin

Which medication lowers blood glucose levels by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity?

Metformin (Glucophage)

Which complications of diabetes are considered chronic complications? Select all that apply.

Neuropathy Retinopathy Nephropathy

Which information should be included when providing education to a patient about sick day rules? Select all that apply.

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

The nurse has just taken a change-of-shift report on a group of patients on the medical-surgical unit. Which patient does the nurse assess first?

Patient taking glyburide who is dizzy and sweaty

Which patient taking metformin does the nurse consider at highest risk for lactic acidosis?

Patient who is receiving dialysis

The nurse has just received a change-of-shift report on the endocrine unit. Which patient does the nurse see first?

Patient with type 1 diabetes whose insulin pump is beeping "occlusion"

A patient with diabetes mellitus has had a cholecystectomy. The nurse prioritizes blood glucose management in the patient's plan of care for which reason?

Patients with postoperative hyperglycemia are prone to poor wound healing.

What measure should the caregiver of a patient with diabetes take to treat moderate hypoglycemia?

Provide 15 g of carbohydrate and cheese.

Which measure helps the patient with type 1 diabetes mellitus (DM) who uses an insulin pump to appropriately manage blood glucose levels?

Reducing the insulin dosage before planned physical exercise

The nurse is teaching a patient about the storage of NPH and regular insulins. Which information does the nurse convey?

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

The nurse is administering metformin to a patient with type 2 diabetes prior to breakfast. Which finding during administration requires further follow-up by the nurse?

Scheduled angiogram of the leg later today

What teaching should be included for a patient with a new diagnosis of type 1 diabetes? Select all that apply.

Sick day rules Daily inspection of feet Reporting any vision changes

The nurse is teaching a group of nursing students about the American Diabetes Association (ADA) recommendations for patient care. Which recommendation made by a nursing student indicates understanding?

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

The nurse is caring for a patient with continuous glucose monitoring (CGM) and obtains an elevated reading. Which action would the nurse take first?

The nurse is caring for a patient with continuous glucose monitoring (CGM) and obtains an elevated reading. Which action would the nurse take first?

What is an important feature of the glycosylated hemoglobin A 1c (HbA 1c) test?

The results are not altered by eating habits 24 hours before the test.

What findings are consistent with a diagnosis of hyperglycemia? Select all that apply.

Warm, moist skin Ketones in urine Kussmaul's respirations