Lewis ch49 Diabetes
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about a. self-monitoring of blood glucose. b. use of low doses of regular insulin. c. lifestyle changes to lower blood glucose. d. effects of oral hypoglycemic medications.
C
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? a. 9:00 AM b. 11:30 AM c. 4:00 PM d. 8:00 PM
A
A patient who has just been diagnosed with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which patient goal is most important for this patient? a. The patient will have a glycosylated hemoglobin level of less than 7%. b. The patient will have a diet and exercise plan that results in weight loss. c. The patient will choose a diet that distributes calories throughout the day. d. The patient will state the reasons for eliminating simple sugars in the diet.
A
A patient who has type 1 diabetes plans to take a swimming class daily at 1:00 PM. The clinic nurse will plan to teach the patient to a. check glucose level before, during, and after swimming. b. delay eating the noon meal until after the swimming class. c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming.
A
A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral arterial disease. Which information will the nurse include in patient teaching? a. Choose flat-soled leather shoes. b. Set heating pads on a low temperature. c. Buy callus remover for corns or calluses. d. Soak the feet in warm water for an hour every day.
A
The health care provider suspects the Somogyi effect in a patient whose 7:00 AM blood glucose is 220 mg/dL. Which action will the nurse plan to take? a. Check the patient's blood glucose at 3:00 AM. b. Administer a larger dose of long-acting insulin. c. Educate about the need to increase the rapid-acting insulin dose. d. Remind the patient about the need to avoid snacking at bedtime.
A
The nurse has been teaching the patient to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the patient that indicates a need for additional instruction is, a. "I need to rotate injection sites among my arms, legs, and abdomen each day." b. "I will buy the 0.5 mL syringes because the line markings will be easier to see." c. "I should draw up the regular insulin first after injecting air into the NPH bottle." d. "I do not need to aspirate the plunger to check for blood before injecting insulin."
A
When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question is most appropriate for the nurse to ask? a. "Have you lost any weight lately?" b. "How long have you felt anorexic?" c. "Is your urine unusually dark colored?" d. "Do you crave fluids containing sugar?"
A
Which information from the patient's health history is most important for the nurse to communicate to the health care provider when a patient has an order for an oral glucose tolerance test? a. The patient uses oral contraceptives. b. The patient runs several days a week. c. The patient has a family history of diabetes. d. The patient had a viral illness 2 months ago.
A
A diabetic patient is admitted with ketoacidosis and the health care provider writes these orders. Which order should the nurse implement first? a. Administer regular IV insulin 30 U. b. Infuse 1 liter of normal saline per hour. c. Give sodium bicarbonate 50 mEq IV push. d. Start an infusion of regular insulin at 50 U/hr.
B
A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse will anticipate the need to a. give 50% dextrose as a bolus. b. insert a large-bore IV catheter. c. initiate oxygen by nasal cannula. d. administer glargine (Lantus) insulin.
B
A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take first? a. Infuse regular insulin at 20 U/hr. b. Place the patient on a cardiac monitor. c. Administer IV potassium supplements. d. Obtain urine glucose and ketone levels.
B
A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG) as part of diabetes management. During evaluation of the patient's technique of SMBG, the nurse identifies a need for additional teaching when the patient a. washes the puncture site using soap and warm water. b. chooses a puncture site in the center of the finger pad. c. hangs the arm down for a minute before puncturing the site. d. says the result of 130 mg indicates good blood sugar control.
B
A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin develops a sore throat, cough, and fever. When the patient calls the clinic to report the symptoms and a blood glucose level of 210 mg/dL, the nurse advises the patient to a. use only the lispro insulin until the symptoms of infection are resolved. b. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. c. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%. d. limit intake of calorie-containing liquids until the glucose is less than 120 mg/dL.
B
A patient with type 2 diabetes that is well-controlled with metformin (Glucophage) develops an allergic rash to an antibiotic and the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may a. need a diet higher in calories while receiving prednisone. b. require administration of insulin while taking prednisone. c. develop acute hypoglycemia while taking the prednisone. d. have rashes caused by metformin-prednisone interactions.
B
A pregnant patient who has no personal history of diabetes, but does have a parent who is diabetic is scheduled for the first prenatal visit. Which action will the nurse plan to take on this initial visit? a. Teach about appropriate use of regular insulin. b. Discuss the need for a fasting blood glucose level. c. Schedule an oral glucose tolerance test for the twenty fourth week of pregnancy. d. Provide education about increased risk for fetal problems with gestational diabetes.
B
After the nurse has finished teaching a patient about self-administration of the prescribed aspart (NovoLog) insulin, which patient action indicates good understanding of the teaching? a. The patient avoids injecting the insulin into the upper abdominal area. b. The patient cleans the skin with soap and water before insulin administration. c. The patient places the insulin back in the freezer after administering the prescribed insulin dose. d. The patient pushes the plunger down and immediately removes the syringe from the injection site.
B
Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness? a. Assess the patient for symptoms of hyperglycemia. b. Give the patient a snack of crackers and peanut butter. c. Have the patient drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours.
B
The nurse obtains the following information about a patient before administration of metformin (Glucophage). Which finding indicates a need to contact the health care provider before giving the metformin? a. The patient's blood glucose level is 166 mg/dL. b. The patient's blood urea nitrogen (BUN) level is 60 mg/dL. c. The patient is scheduled for a chest x-ray in an hour. d. The patient has gained 2 lb (0.9 kg) since yesterday.
B
When teaching a diabetic patient who has just been started on intensive insulin therapy about mealtime coverage, which type of insulin will the nurse need to discuss? a. glargine (Lantus) b. lispro (Humalog) c. detemir (Levemir) d. NPH (Humulin N)
B
When the nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis, the patient reports feeling anxious, nervous, and sweaty. Which action should the nurse take first? a. Administer 1 mg glucagon subcutaneously. b. Obtain a glucose reading using a finger stick. c. Have the patient drink 4 ounces of orange juice. d. Give the scheduled dose of lispro (Humalog) insulin.
B
Which action is most important for the nurse to take in order to assist a diabetic patient to engage in moderate daily exercise? a. Remind the patient that exercise will improve self-esteem. b. Determine what type of exercise activities the patient enjoys. c. Give the patient a list of activities that are moderate in intensity. d. Teach the patient about the effects of exercise on glucose level.
B
Which action should the nurse take first when teaching a patient who is newly diagnosed with type 2 diabetes about home management of the disease? a. Ask the patient's family to participate in the diabetes education program. b. Assess the patient's perception of what it means to have diabetes mellitus. c. Demonstrate how to check glucose using capillary blood glucose monitoring. d. Discuss the need for the patient to actively participate in diabetes management.
B
Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)? a. Glyburide decreases glucagon secretion from the pancreas. b. Glyburide stimulates insulin production and release from the pancreas. c. Glyburide should be taken even if the morning blood glucose level is low. d. Glyburide should not be used for 48 hours after receiving IV contrast media.
B
Which of these laboratory values, noted by the nurse when reviewing the chart of a hospitalized diabetic patient, indicates the need for rapid assessment of the patient? a. Hb A1C of 5.8% b. Noon blood glucose of 52 mg/dL c. Hb A1Cof 6.9% d. Fasting blood glucose of 130 mg/dL
B
Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? a. The patient changes the site for the insertion site every week. b. The patient programs the pump to deliver an insulin bolus after eating. c. The patient takes the pump off at bedtime and starts it again each morning. d. The patient states that diet will be less flexible when using the insulin pump.
B
Which question by the nurse will help identify autonomic neuropathy in a diabetic patient? a. "Have you observed any recent skin changes?" b. "Do you notice any bloating feeling after eating?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"
B
Which information about a patient who receives rosiglitazone (Avandia) is most important for the nurse to report immediately to the health care provider? a. The patient's blood pressure is 154/92. b. The patient has a history of emphysema. c. The patient's noon blood glucose is 86 mg/dL. d. The patient has chest pressure when ambulating.
D
A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram. Which information obtained by the nurse is most important to report to the health care provider before the procedure? a. The patient's admission blood glucose is 128 mg/dL. b. The patient's most recent Hb A1C was 6.5%. c. The patient took the prescribed metformin (Glucophage) today. d. The patient took the prescribed captopril (Capoten) this morning.
C
An 18-year-old with newly diagnosed type 1 diabetes has received diet instruction. The nurse determines a need for additional instruction when the patient says, a. "I may have an occasional alcoholic drink if I include it in my meal plan." b. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I may eat whatever I want, as long as I use enough insulin to cover the calories." d. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia."
C
The nurse and LPN/LVN are caring for a type 2 diabetic patient who is admitted for gallbladder surgery. Which nursing action can the nurse delegate to the LPN/LVN? a. Communicate the blood glucose and insulin dose to the circulating nurse in surgery. b. Discuss the reason for the use of insulin therapy during the immediate postoperative period. c. Administer the prescribed lispro (Humalog) insulin before transferring the patient to surgery. d. Plan strategies to minimize the risk for hypo- or hyperglycemia during the postoperative hospitalization.
C
A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2" means in relation to diabetes. Which statement by the nurse about type 2 diabetes is correct? a. Insulin is not used to control blood glucose in patients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma. d. Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.
D
A hospitalized diabetic patient who received 34 U of NPH insulin at 7:00 AM is away from the nursing unit, awaiting diagnostic testing when lunch trays are distributed. To prevent hypoglycemia, the best action by the nurse is to a. save the lunch tray to be provided upon the patient's return to the unit. b. call the diagnostic testing area and ask that a 5% dextrose IV be started. c. ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic testing area. d. request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.
D
After the home health nurse has taught a patient and family about how to use glargine and regular insulin safely, which action by the patient indicates that the teaching has been successful? a. The patient administers the glargine 30 to 45 minutes before eating each meal. b. The patient's family fills the syringes weekly and stores them in the refrigerator. c. The patient draws up the regular insulin and then the glargine in the same syringe. d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
D
Amitriptyline (Elavil) is prescribed for a diabetic patient who has burning foot pain at night. Which information should the nurse include when teaching the patient about the new medication? a. Amitriptyline will decrease the depression caused by your foot pain. b. Amitriptyline will correct some of the blood vessel changes that cause pain. c. Amitriptyline will improve sleep and make you less aware of nighttime pain. d. Amitriptyline will help prevent the transmission of pain impulses to the brain.
D
The nurse teaches the diabetic patient who rides a bicycle to work every day to administer morning insulin into the a. arm. b. thigh. c. buttock. d. abdomen.
D
To evaluate the effectiveness of treatment for a patient with type 2 diabetes who is scheduled for a follow-up visit in the clinic, which test will the nurse plan to schedule for the patient? a. Urine dipstick for glucose b. Oral glucose tolerance test c. Fasting blood glucose level d. Glycosylated hemoglobin level
D
Which action by a type 1 diabetic patient indicates that the nurse should implement teaching about exercise and glucose control? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when the glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.
D
Which patient statement after the nurse has completed teaching a patient with type 2 diabetes about taking glipizide (Glucotrol) indicates a need for additional teaching? a. "Other medications besides the Glucotrol may affect my blood sugar." b. "If I overeat at a meal, I will still take just the usual dose of medication." c. "When I become ill, I may have to take insulin to control my blood sugar." d. "My diabetes is not as likely to cause complications as if I needed to take insulin."
D
