Med Surg: 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 diabetes is prepared for a coronary angiogram?
The patient took the prescribed metformin (Glucophage) today.
A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is most important for the nurse to communicate to the health care provider?
The patient uses oral contraceptives.
A 28-year-old male patient 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 nurse's teaching about the use of an insulin pump?
The patient programs the pump for an insulin bolus after eating.
The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes 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."
After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective?
"I should take my daily aspirin at least an hour before the Byetta."
The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching?
"My diabetes won't cause complications because I don't need insulin."
A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia?
10:00 AM
A diabetic patient who has reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline (Elavil)?
Amitriptyline helps prevent transmission of pain impulses to the brain.
The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first?
Assess the patient's perception of what it means to have diabetes mellitus.
An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy?
Blood pressure 146/88 mmHg
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.
A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?
Infuse 1 liter of normal saline per hour.
A 32-year-old patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?
Lispro (Humalog)
When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.
The health care provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. 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 female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs?
Choose flat-soled leather shoes.
In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take?
Determine what type of activities the patient enjoys.
The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?
Give the patient 4 to 6 oz more orange juice.
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 38-year-old patient who has type 1 diabetes plans to swim laps daily at 1:00 PM. The clinic nurse will plan to teach the patient to
check glucose level before, during, and after swimming.
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.
An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to
insert a large-bore IV catheter.
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 assessing a 22-year-old patient experiencing the onset of symptoms of type 1 diabetes. Which question is most appropriate for the nurse to ask?
"Have you lost weight lately?"
After change-of-shift report, which patient will the nurse assess first?
60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)?
* Blood pressure * Serum creatinine * Urine for microalbuminuria * Monofilament testing of the foot
After change-of-shift report, which patient should the nurse assess first?
23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) 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.
Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?
Give the patient a snack of peanut butter and crackers.
Which information will the nurse include when teaching a 50-year-old patient who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)?
Glyburide stimulates insulin production and release from the pancreas.
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?
Glycosylated hemoglobin level
Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP) who are working in the diabetic clinic?
Measure the ankle-brachial index.
Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates the most urgent need for the nurse's assessment of the patient?
Noon blood glucose of 52 mg/dL
A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?
Obtain a glucose reading using a finger stick.
A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first?
Place the patient on a cardiac monitor.
The nurse is taking a health history from a 29-year-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 patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin?
The patient cleans the skin with soap and water before insulin administration.
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.
A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient?
The patient will reach a glycosylated hemoglobin level of less than 7%.
Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?
The patient's blood urea nitrogen (BUN) level is 52 mg/dL.
In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]).
a. Rotate NPH vial. d. Inject 20 units of air into NPH vial. e. Inject 2 units of air into regular insulin vial. b. Withdraw regular insulin. c. Withdraw 20 units of NPH.
A 26-year-old patient 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 34-year-old has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye exam
as soon as possible.
A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about
lifestyle changes to lower blood glucose.
A 26-year-old female with type 1 diabetes 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 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to
monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. 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 (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may
require administration of insulin while taking prednisone.
