Sem 2 Unit 2 Lewis
When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. Tight glycemic control can be maintained. b. Errors in insulin dosing are less likely to occur. c. Complications of insulin therapy are prevented. d. Frequent blood glucose monitoring is unnecessary.
a. Insulin pumps provide tight glycemic control by continuous subcutaneous insulin infusion based on the patient's basal profile, with bolus doses at mealtime at the patient's discretion and related to blood glucose monitoring. Errors in insulin dosing and complications of insulin therapy are still potential risks with insulin pumps.
Priority Decision: When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan? a. Achieving a normal weight b. Performing daily aerobic exercise c. Eliminating red meat from the diet d. Monitoring the blood glucose periodically
a. Metabolic syndrome is a cluster of abnormalities that include elevated glucose levels, abdominal obesity, elevated BP, high levels of triglycerides, and low levels of high-density lipoproteins (HDLs). Overweight persons with metabolic syndrome can prevent or delay the onset of diabetes through a program of weight loss. Regular physical activity is also important, but normal weight is most important.
Which components can change to adapt to small increases in intracranial pressure (ICP) (select all that apply)? a. Blood b. Skull bone c. Brain tissue d. Scalp tissue e. Cerebrospinal fluid (CSF)
a, c, e. Blood adapts with increased venous outflow, decreased cerebral blood flow (CBF), and collapse of veins and dural sinuses. Brain tissue adapts with distention of the dura, slight compression of tissue, or herniation. Cerebrospinal fluid (CSF) adapts with increased absorption, decreased production, and displacement into the spinal canal. Skull bone and scalp tissue do not adapt to changes in intracranial pressure (ICP).
How are the metabolic and nutritional needs of the patient with increased ICP best met? a. Enteral feedings that are low in sodium b. Simple glucose available in D5W IV solutions c. Fluid restriction that promotes a moderate dehydration d. Balanced, essential nutrition in a form that the patient can tolerate
d. A patient with increased ICP is in a hypermetabolic and hypercatabolic state and needs adequate glucose to maintain fuel for the brain and other nutrients to meet metabolic needs. Malnutrition promotes cerebral edema and if a patient cannot take oral nutrition, other means of providing nutrition should be used, such as tube feedings or parenteral nutrition. Glucose alone is not adequate to meet nutritional requirements, and 5% dextrose solutions may increase cerebral edema by lowering serum osmolarity. Patients should remain in a normovolemic fluid state with close monitoring of clinical factors, such as urine output, fluid intake, serum and urine osmolality, serum electrolytes, and insensible losses.
. In type 1 diabetes, glucose has an osmotic effect when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. Fatigue b. Polydipsia c. Polyphagia d. Recurrent infections
. b. Polydipsia is caused by fluid loss from polyuria when high glucose levels cause osmotic diuresis. Cellular starvation from lack of glucose and the use of body fat and protein for energy contribute to fatigue, weight loss, and polyphagia in type 1 diabetes.
. Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times. b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars from the diet. d. limit saturated fat intake to 30% of dietary calorie intake.
a. The body needs food at regularly spaced intervals throughout the day. Omission or delay of meals can result in hypoglycemia, especially for the patient using conventional insulin therapy or OAs. Weight loss may be recommended in type 2 diabetes if the person is overweight, but many patients with type 1 diabetes are thin and do not require a decrease in caloric intake. Fewer than 7% of total calories should be from saturated fats and simple sugar should be limited, but moderate amounts can be used if counted as a part of total carbohydrate intake.
The patient with diabetes has a blood glucose level of 248 mg/dL. Which assessment findings would be related to this blood glucose level (select all that apply)? a. Headache b. Unsteady gait c. Abdominal cramps d. Emotional changes e. Increase in urination f. Weakness and fatigue
a, c, e, f. Manifestations of hyperglycemia include abdominal cramps, polyuria, weakness, fatigue, and headache. The headache may also be seen with hypoglycemia that is manifested by the remaining options.
What is an appropriate nursing intervention for a patient with cerebral edema and increased ICP? a. Avoid positioning the patient with neck and hip flexion. b. Maintain hyperventilation to a PaCO2 of 15 to 20 mm Hg. c. Cluster nursing activities to provide periods of uninterrupted rest. d. Routinely suction to prevent accumulation of respiratory secretions.
a. Nursing care activities that increase ICP include hip and neck flexion, suctioning, clustering care activities, and noxious stimuli. They should be avoided or done as little as possible in the patient with increased ICP. Lowering the PaCO2 below 20 mm Hg can cause ischemia and worsening of ICP.
What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)? a. Chronic kidney disease b. Coronary artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremities e. Capillary and arteriole membrane thickening specific to diabetes
b, d. Macrovascular disease causes coronary artery disease and ulceration and results in amputation of the lower extremities. However, neuropathy may contribute to not feeling ulcerations. The remaining options are related to microvascular complications of diabetes.
The nurse assesses the technique of the patient with diabetes for self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. Doing the SMBG before and after exercising b. Puncturing the finger on the side of the finger pad c. Cleaning the puncture site with alcohol before the puncture d. Holding the hand down for a few minutes before the puncture
c. Cleaning the puncture site with alcohol is not necessary and may interfere with test results and lead to drying and splitting of the fingertips. Washing the hands with warm water is adequate cleaning and promotes blood flow to the fingers. Blood flow is also increased by holding the hand down. Punctures on the side of the finger pad are less painful. Selfmonitored blood glucose (SMBG) should be performed before and after exercise.
The nurse recognizes the presence of Cushing's triad in the patient with which vital sign changes? a. Increased pulse, irregular respiration, increased BP b. Decreased pulse, increased respiration, decreased systolic BP c. Decreased pulse, irregular respiration, widened pulse pressure d. Increased pulse, decreased respiration, widened pulse pressure
c. Cushing's triad consists of 3 vital sign measures that reflect increased ICP and its effect on the medulla, hypothalamus, pons, and thalamus. Because these structures are very deep, Cushing's triad is usually a late sign of increased ICP. The signs include an increasing SBP with a widening pulse pressure, a bradycardia with a full and bounding pulse, and irregular respirations.
Which events cause increased ICP (select all that apply)? a. Vasodilation b. Necrotic cerebral tissue c. Blood vessel compression d. Edema from initial brain insult e. Brainstem compression and herniation
a, b, d. Increased ICP is caused by vasodilation and edema from an initial brain insult or necrotic tissue. Blood vessel compression and brainstem compression and herniation occur because of increased ICP.
The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)? a. Exercise regularly. b. Maintain a healthy weight. c. Have BP checked regularly. d. Assess for visual changes on a monthly basis. e. Monitor for polyuria, polyphagia, and polydipsia.
a, b, e. To reduce the risk of developing diabetes, the patient with prediabetes should maintain a healthy weight, learn to monitor for symptoms of diabetes, have blood glucose and glycosylated hemoglobin (A1C) tested regularly, exercise regularly, and eat a healthy diet.
The patient with type 2 diabetes is being put on acarbose (Precose) and wants to know about taking it. What should the nurse include in this patient's teaching (select all that apply)? a. Take it with the first bite of each meal. b. It is not used in patients with heart failure. c. Endogenous glucose production is decreased. d. Effectiveness is measured by 2-hour postprandial glucose. e. It delays glucose absorption from the gastrointestinal (GI) tract
. a, d, e. Acarbose (Precose) is an α-glucosidase inhibitor that is taken with the first bite of each meal. The effectiveness is measured with 2-hour postprandial blood glucose testing, as it delays glucose absorption from the gastrointestinal (GI) tract. The other options describe rarely used thiazolidinediones.
A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about managing diabetes in the older adult? a. It is harder to achieve strict glucose control than in younger patients. b. Treatment is not warranted unless the patient develops severe hyperglycemia. c. It does not include treatment with insulin because of limited dexterity and vision. d. It usually requires that a younger family member be responsible for care of the patient.
a. Older adults have more conditions that may be treated with medications that impair insulin action. Hypoglycemic unawareness is more common, so these patients are more likely to suffer adverse consequences from blood glucose-lowering therapy. Manifestations of long-term complications of diabetes take 10 to 20 years to develop, so the goals for glycemic control are not as rigid as in the younger population. Treatment is indicated and insulin may be used if the patient does not respond to oral agents. The patient's needs rather than age determine the responsibility of others in care.
The following interventions are planned for a patient with diabetes. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP)? a. Discuss complications of diabetes. b. Check that the bath water is not too hot. c. Check the patient's technique for drawing up insulin. d. Teach the patient to use a meter for self-monitoring of blood glucose.
b. Checking the temperature of the bath water is part of assisting with activities of daily living (ADLs) and within the scope of care for the UAP. This is important for the patient with neuropathy. Discussing complications, teaching, and assessing learning are appropriate for RNs.
Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. When should the nurse administer lispro insulin? a. Only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. At mealtime or within 15 minutes of meals
d. Lispro is a rapid-acting insulin that has an onset of action of approximately 15 minutes and should be injected at the time of the meal to within 15 minutes of eating. Regular insulin is short acting with an onset of action in 30 to 60 minutes following administration and should be given 30 to 45 minutes before meals.
The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration. b. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c. placing the insulin bottle currently in use in a small container on the bathroom countertop. d. mixing an evening dose of regular insulin with insulin glargine in 1 syringe for administration.
d. Insulin glargine (Lantus), a long-acting insulin that is continuously released with no peak of action, cannot be diluted or mixed with any other insulin or solution. Mixed insulins should be stored needle-up in the refrigerator and warmed before administration. Currently used bottles of insulin may be kept at room temperature out of sunlight for 4 weeks.
Which drug treatment helps decrease ICP by expanding plasma and the osmotic effect to move fluid? a. Dexamethasone b. Oxygen administration c. Pentobarbital (Nembutal) d. Mannitol (Osmitrol) (25%)
d. Mannitol (Osmitrol) (25%) is an osmotic diuretic that expands plasma and causes fluid to move from tissues into the blood vessels. Hypertonic saline reduces brain swelling by moving water out of brain tissue. The corticosteroid dexamethasone is used to treat vasogenic edema to stabilize cell membranes and improve neuronal function by improving CBF and restoring autoregulation. Oxygen administration is done to maintain brain function. Pentobarbital (Nembutal) and other barbiturates are used to reduce cerebral metabolism.
Increased ICP in the left cerebral cortex caused by intracranial bleeding causes displacement of brain tissue to the right hemisphere beneath the falx cerebri. The nurse knows that this is referred to as what? a. Uncal herniation b. Tentorial herniation c. Cingulate herniation d. Temporal lobe herniation
c. The dural structures that separate the 2 hemispheres and the cerebral hemispheres from the cerebellum influence the patterns of cerebral herniation. A cingulate herniation occurs where there is lateral displacement of brain tissue beneath the falx cerebri. Uncal herniation occurs when there is lateral and downward herniation. Tentorial herniation occurs when the brain herniates down through the opening created by the brainstem. The temporal lobe can be involved in central herniation.
Why is the Glasgow Coma Scale (GCS) used? a. To quickly assess the LOC b. To assess the patient's ability to communicate c. To assess the patient's ability to respond to commands d. To assess the patient's coordination with motor responses
a. The Glasgow Coma Scale (GCS) is used to quickly assess the LOC with a standardized system. The 3 areas assessed are the patient's ability to open eyes, speak, and obey commands to verbal or painful stimulus. Although best motor response is an indicator, it is not used to assess coordination.
. When teaching the patient with diabetes about insulin administration, the nurse should include which instruction? a. Pull back on the plunger after inserting the needle to check for blood. b. Consistently use the same size of insulin syringe to avoid dosing errors. c. Clean the skin at the injection site with an alcohol swab before each injection. d. Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.
b. Patients should consistently use the same size of insulin syringe to avoid dosing errors. Errors can be made if patients switch back and forth between different sizes of syringes. Aspiration before injection of the insulin is no longer recommended, nor is the use of alcohol to clean the skin. Because the rate of peak serum concentration varies with the site selected for injection, injections should be rotated within a particular area, such as the abdomen, before changing to another area. Lipodystrophies are rare with the use of human insulin.
An early sign of increased ICP that the nurse should assess for is a. Cushing's triad. b. unexpected vomiting. c. decreasing level of consciousness (LOC). d. dilated pupil with sluggish response to light.
c. One of the most sensitive signs of increased ICP is a decreasing level of consciousness (LOC). A decrease in LOC will occur before changes in vital signs, ocular signs, or projectile vomiting occur.
1. The nurse is monitoring a patient for increased ICP after a head injury. What are manifestations of increased ICP (select all that apply)? a. Fever b. Oriented to name only c. Narrowing pulse pressure d. Right pupil dilated greater than left pupil e. Decorticate posturing to painful stimulus
a, b, d, e. The first sign of increased ICP is a change in LOC. Other manifestations are dilated ipsilateral pupil, changes in motor response, such as posturing, and fever, which may indicate pressure on the hypothalamus. Changes in vital signs would be an increased SBP with widened pulse pressure and bradycardia.
Which class of oral glucose-lowering agents (OA) is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. Insulin b. Biguanide c. Meglitinide d. Sulfonylurea
b. Biguanides (e.g., metformin [Glucophage]) are most commonly used with type 2 diabetes. They reduce glucose production by the liver and increase insulin sensitivity at the tissue level that improves glucose transport into the cells. Insulin is not taken orally, as it is ineffective. Meglitinides and sulfonylureas increase insulin production from the pancreas.
Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful."
d. Complete or partial loss of protective sensation of the feet is common with peripheral neuropathy of diabetes, and patients with diabetes may suffer foot injury and ulceration without ever having pain. Feet must be inspected during daily care for any cuts, blisters, swelling, or reddened areas.
. The patient with type 2 diabetes has had trouble controlling his blood glucose with several OAs but wants to avoid the risks of insulin. The health care provider (HCP) told him a medication will be prescribed that will increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying. Which medication will have to be injected? a. Dopamine receptor agonist, bromocriptine (Cycloset) b. Dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin (Januvia) c. Sodium-glucose co-transporter 2 (SGLT2) inhibitor, canagliflozin (Invokana) d. Glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)
d. This glucagon-like peptide-1 (GLP-1) receptor agonist stimulates GLP-1 to increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, slow gastric emptying, and must be injected subcutaneously once every 7 days. The other medications are oral agents (OAs). The mechanism of action for glycemic control for the dopamine receptor agonist is unknown. Dipeptidyl peptidase-4 (DPP-4) inhibitors block the action of the DPP-4 enzyme that inactivates incretin so there is increased insulin release, decreased glucagon secretion, and decreased hepatic glucose production. Sodium-glucose co-transporter 2 (SGLT2) inhibitors block the reabsorption of glucose by the kidney and increase urinary glucose excretion.
What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. Ideal body weight b. Normal serum glucose and lipid levels c. A special diabetic diet using dietetic foods d. Five small meals per day with a bedtime snack
. b. The specific goals of nutrition therapy for people with diabetes include maintaining near-normal blood glucose levels and achievement of optimal serum lipid levels and BP. Dietary modifications are believed to be important factors in preventing both short- and long-term complications of diabetes. Loss of weight, which may or may not be to ideal body weight, may improve insulin resistance. There is no longer a specific "diabetic diet," and use of dietetic foods is not necessary for glucose control. Most patients with diabetes eat 3 meals a day, and some require a bedtime snack for control of nighttime hypoglycemia. The other goals of nutrition therapy include prevention of chronic complications of diabetes, attention to individual nutritional needs, and maintenance of the pleasure of eating.
During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results (select all that apply)? a. A1C of 7.5% b. Glycosuria of 3 + c. FPG ≥ 127 mg/dL (7.0 mmol/L). d. Random blood glucose of 126 mg/dL (7.0 mmol/L) e. A 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)
a, c. The patient has 1 prior test result of fasting plasma glucose (FPG) ≥ to 126 mg/dL (7.0 mmol/L) that meets criteria for a diagnosis of diabetes, and the result is confirmed on this follow-up visit. The A1C is 7.5% and greater than diagnostic criteria of 6.5% or higher. The other diagnostic criteria include a 2-hour OGTT level ≥ 200 mg/dL (11.1 mmol/L), or a patient with classic symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, unexplained weight loss) or hyperglycemic crisis, a random plasma glucose ≥ 200 mg/dL (11.0 mmol/L).
The patient with diabetes is brought to the emergency department by his family members, who say that he has had an infection, is not acting like himself, and he is more tired than usual. Number the nursing actions in the order of priority for this patient. _______ a. Establish IV access. _______ b. Check blood glucose. _______ c. Ensure patent airway. _______ d. Begin continuous regular insulin drip. _______ e. Administer 0.9% NaCl solution at 1 L/hr. _______ f. Establish time of last food and medication(s).
a. 3; b. 2; c. 1; d. 5; e. 4; f. 6. As with all patients, first establish an airway. With a patient with diabetes and abnormal behavior, the blood glucose must then be checked to determine if the patient's symptoms are related to the diabetes. In this case, it is hyperglycemia, so an IV must be started for fluid resuscitation and insulin administration. The last food intake and times at which medications were recently taken may establish a cause for the hyperglycemia and aid in determining further treatment.
A patient has ICP monitoring with an intraventricular catheter. What is a priority nursing intervention for the patient? a. Aseptic technique to prevent infection b. Constant monitoring of ICP waveforms c. Removal of CSF to maintain normal ICP d. Sampling CSF to determine abnormalities
a. An intraventricular catheter is a fluid-coupled system that can provide direct access for microorganisms to enter the ventricles of the brain and aseptic technique is a very high nursing priority to decrease the risk for infection. Constant monitoring of ICP waveforms is not usually necessary and removal of CSF for sampling or to maintain normal ICP is done only when specifically ordered.
Two days after a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse? a. "That is a good range for your glucose levels." b. "You should call your HCP because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia and you should increase your food intake." d. "You should take only half your insulin dosage for the next few days to get your glucose level back to normal."
a. Blood glucose levels of 80 to 90 mg/dL (4.4 to 5 mmol/L) are within the normal range and are desired in the patient with diabetes, even following a recent hypoglycemic episode. Hypoglycemia is often caused by a single event, such as skipping a meal, taking too much insulin, or vigorous exercise. Once corrected, normal glucose control should be maintained.
A patient with diabetes calls the clinic because she has nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. Administer the usual insulin dosage. b. Hold fluid intake until the nausea subsides. c. Come to the clinic immediately for evaluation and treatment. d. Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L).
a. During minor illnesses, the patient with diabetes should continue drug therapy and fluid and food intake. Insulin is important because counter regulatory hormones may increase blood glucose during the stress of illness. Food or a carbohydrate liquid substitution is important because during illness the body requires extra energy to deal with the stress of the illness. Blood glucose monitoring should be done every 4 hours, and the HCP should be notified if the level is >240 mg/dL (13.9 mmol/L) or if fever, ketonuria, or nausea and vomiting occur.
To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? a. Plan activity and food intake related to blood glucose levels b. When blood glucose is greater than 250 mg/dL and ketones are present c. When glucose monitoring reveals that the blood glucose is in the normal range d. When blood glucose levels are high, because exercise always has a hypoglycemic effect
a. To plan for exercise, a person with diabetes must monitor blood glucose and make adjustments to insulin dose (if taken) and food intake to prevent exercise-induced hypoglycemia. Exercise is delayed if blood glucose is ≥ 250 mg/dL with ketones. Before exercise if blood glucose is ≤ 100 mg/dL a 15-g carbohydrate snack is eaten. Blood glucose levels should be monitored before, during, and after exercise to determine the effect of exercise on the levels.
A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. Withdraws the NPH dose into the syringe first b. Injects air equal to the NPH dose into the NPH vial first c. Removes any air bubbles after withdrawing the first insulin d. Adds air equal to the insulin dose into the regular vial and withdraws the dose
a. When mixing regular and intermediate-acting insulin, regular insulin should always be drawn into the syringe first to prevent contamination of the regular insulin vial with intermediate-acting insulin additives. Air is added to the NPH vial first. Then air is added to the regular vial and the regular insulin is withdrawn, bubbles are removed, and then the dose of NPH is withdrawn.
A patient with type 1 diabetes uses 20 U of Novolin 70/30 (NPH/regular) in the morning and at 6:00 pm. When teaching the patient about this regimen, what should the nurse emphasize? a. Hypoglycemia is most likely to occur before the noon meal. b. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. c. Flexibility in food intake is possible because insulin is available 24 hours a day. d. Premeal glucose checks are required to determine needed changes in daily dosing.
b. A split-mixed dose of insulin requires that the patient adhere to a set meal pattern to provide glucose for the peak action of the insulin, and a bedtime snack is usually required when patients take an intermediateacting insulin late in the day to prevent nocturnal hypoglycemia. Hypoglycemia is most likely to occur with this dose late in the afternoon and during the night. When premixed formulas are used, flexible dosing based on glucose levels is not recommended.
A patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medication. The patient tells the nurse she would rather control her blood sugar with herbal therapy. Which action should the nurse take? a. Teach the patient that herbal therapy is not safe and should not be used. b. Advise the patient to discuss using herbal therapy with her HCP before using it. c. Encourage the patient to give the prescriptive medication time to work before using herbal therapy. d. Teach the patient that if she takes herbal therapy, she will have to monitor her blood sugar more often.
b. Advise the patient to seek the guidance of the HCP regarding the safety, efficacy, and specifics of using herbal therapy rather than or with the medication prescribed. Not all herbal therapy is unsafe, but dosages are not universal.
A patient with an intracranial problem does not open his eyes to any stimulus, has no verbal response except moaning and muttering when stimulated, and flexes his arm in response to painful stimuli. What should the nurse record as the patient's GCS score? a. 6 b. 7 c. 9 d. 11
b. No opening of eyes = 1; incomprehensible words = 2; flexion withdrawal = 4. Total = 7
While the nurse performs range of motion (ROM) on an unconscious patient with increased ICP, the patient has severe decerebrate posturing reflexes. What should the nurse do first? a. Use restraints to protect the patient from injury while posturing. b. Perform the exercises less often because posturing indicates increased ICP. c. Administer CNS depressants to lightly sedate the patient. d. Continue the exercises because they are necessary to maintain musculoskeletal function
b. If reflex posturing occurs during range of motion (ROM) or positioning of the patient, these activities should be done less often until the patient's condition stabilizes because posturing can cause increases in ICP and may indicate herniation. Neither restraints nor central nervous system (CNS) depressants would be indicated.
A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for all minority populations every year b. FPG for all persons at age 45 years and then every 3 years c. Testing people under the age of 21 years for islet cell antibodies d. Testing for type 2 diabetes in all overweight or obese persons
b. The American Diabetes Association recommends that testing for type 2 diabetes with a FPG, A1C, or 2-hour OGTT should be considered for all persons at the age of 45 years and above and, if normal, repeated every 3 years. Testing for immune markers of type 1 diabetes is not recommended. Testing at a younger age or more frequently should be done for members of a high-risk ethnic population, including blacks, Hispanics, Native Americans, Asian Americans, and Pacific Islanders. Overweight adults with additional risk factors should be tested.
Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. It can be prevented by tight glucose control. b. It occurs with a higher frequency and earlier onset than in the nondiabetic population. c. It is caused by hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. It cannot be modified by reducing risk factors, such as smoking, obesity, and high fat intake.
b. The development of atherosclerotic vessel disease seems to be promoted by the altered lipid metabolism common in diabetes. Although tight glucose control may help delay the process, it does not prevent it completely. Atherosclerosis in patients with diabetes does respond somewhat to a reduction in general risk factors, as it does in nondiabetics, and reduction in fat intake, control of hypertension, abstention from smoking, maintenance of normal weight, and regular exercise should be carried out by all patients.
A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last 5 mornings. What should the nurse have the patient to do first? a. Increase the evening insulin dose to prevent the dawn phenomenon. b. Use a single-dose insulin regimen with an intermediate-acting insulin. c. Monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising. d. Decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect.
c. The patient's high glucose on arising may be the result of either dawn phenomenon or Somogyi effect. The best way to determine whether the patient needs more or less insulin is by monitoring the glucose at bedtime, between 2:00 am and 4:00 am, and on arising. If the 2:00 am to 4:00 am blood glucose levels are below 60 mg/dL, the insulin dose should be reduced to prevent Somogyi effect; if it is high, the insulin should be increased to prevent dawn phenomenon.
Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. An obese 40-year-old Hispanic woman b. A 20-year-old man whose father has type 1 diabetes c. A 34-year-old woman whose parents both have type 2 diabetes d. A 12-year-old boy whose father has maturity-onset diabetes of the young (MODY)
c. Type 2 diabetes has a strong genetic influence (8% to 14% risk for offspring) and offspring of parents who both have type 2 diabetes have an increased chance of developing it. In contrast, type 1 diabetes is associated with a genetic susceptibility that is related to human leukocyte antigens (HLAs). Offspring of a mother with type 1 diabetes have a 1% to 4% chance of developing the disease, while offspring of a father with diabetes have 5% to 6% risk. Other risk factors for type 2 diabetes include obesity; Native American, Hispanic, or African ancestry; and age of 55 years or older. Although 50% of people with a parent with maturity-onset diabetes of the young (MODY) will develop MODY, it is autosomal dominant, and treatment depends on which genetic mutation caused it. It is not associated with obesity or hypertension and is not currently considered preventable.
The nurse should observe the patient for symptoms of ketoacidosis when a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.
c. When insulin is insufficient and glucose cannot be used for cellular energy, the body uses stored fats to meet energy needs. Free fatty acids from stored triglycerides are metabolized in the liver in such large quantities that ketones are formed. Ketones are acidic and alter the pH of the blood, causing acidosis. Osmotic diuresis from the elimination of both glucose and ketones in the urine causes dehydration, not ketosis. The loss of bicarbonate and skipping a meal after insulin administration do not cause ketosis.
A patient with diabetes is found unconscious at home, and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. Have the patient drink some orange juice. b. Administer 10 U of regular insulin subcutaneously. c. Call for an ambulance to transport the patient to a medical facility. d. Administer glucagon 1 mg intramuscularly (IM) or subcutaneously.
d. If a patient with diabetes is unconscious, immediate treatment for hypoglycemia must be given to prevent brain damage, and IM or subcutaneous administration of 1 mg of glucagon should be done. If the unconsciousness has another cause, such as ketosis, the rise in glucose caused by the glucagon is not as dangerous as the low glucose level. Following administration of the glucagon, the patient should be transported to a medical facility for further treatment and evaluation. Oral carbohydrates cannot be given when patients are unconscious, and insulin is contraindicated without knowledge of the patient's glucose level.
