Ch. 48: Diabetes Mellitus

In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take? a. Determine what type of activities the patient enjoys. b. Remind the patient that exercise will improve self-esteem. c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity.

a. Determine what type of activities the patient enjoys.

Which statement by the patient indicates a need for additional instruction in administering insulin? a. I need to rotate injection sites among my arms, legs, and abdomen each day b. I can 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. I need to rotate injection sites among my arms, legs, and abdomen each day

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? a. The patient will reach a glycosylated hemoglobin level of less than 7%. b. The patient will follow 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. The patient will reach a glycosylated hemoglobin level of less than 7%.

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 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. check glucose level before, during, and after swimming.

A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for thenurse to monitor for symptoms of hypoglycemia? a.10:00 AM b.12:00 AM c.2:00 PM d.4:00

a.10:00 AM

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? a.Lispro (Humalog) b.Glargine (Lantus) c.Detemir (Levemir) d.NPH (Humulin N)

a.Lispro (Humalog)

Which patient action indicates a good understanding of the nurses teaching about the use of an insulin pump? a.The patient programs the pump for an insulin bolus after eating. b.The patient changes the location of the insertion site every week c.The patient takes the pump off at bedtime and starts it again each morning. d.The patient plans for a diet that is less flexible when using the insulin pump.

a.The patient programs the pump for an insulin bolus after eating.

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? a.Ask the patients family to participate in the diabetes education program. b.Assess the patients 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.Assess the patients perception of what it means to have diabetes mellitus.

Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness? a.Assess the patient for symptoms of hyperglycemia. b.Give the patient a snack of peanut butter and crackers. 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.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)? 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.Glyburide stimulates insulin production and release from the pancreas.

Which patient action indicates good understanding of the nurses teaching about administration of aspart(NovoLog) insulin? 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 stores the insulin in the freezer after administering the prescribed dose. d.The patient pushes the plunger down while removing the syringe from the injection site.

b.The patient cleans the skin with soap and water before insulin administration.

The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose a.washes the puncture site using warm water and soap. 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 120 mg indicates good blood sugar control.

b.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 a.give a bolus of 50% dextrose. b.insert a large-bore IV catheter. c.initiate oxygen by nasal cannula. d.administer glargine (Lantus) insulin.

b.insert a large-bore IV catheter.

Which statement by a nurse to a patient newly diagnosed with 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. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma

c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.

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? a. Are you anorexic? b. Is your urine dark colored? c. Have you lost weight lately? d. Do you crave sugary drinks?

c. Have you lost weight lately?

The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? a. I can 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 can choose any foods, as long as I use enough insulin to cover the calories. d. I will eat something at meal times to prevent hypoglycemia, even if I am not hungry

c. I can choose any foods, as long as I use enough insulin to cover the calories.

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 a. self-monitoring of blood glucose. b. using low doses of regular insulin. c. lifestyle changes to lower blood glucose. d. effects of oral hypoglycemic medications.

c. lifestyle changes to lower blood glucose.

The health care provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM bloodglucose is 230 mg/dL. Which action will the nurse teach the patient to take? a.Avoid snacking at bedtime. b.Increase the rapid-acting insulin dose. c.Check the blood glucose during the night d.Administer a larger dose of long-acting insulin.

c.Check the blood glucose during the night

A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sicktoddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dLdespite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to a.use only the lispro insulin until the symptoms are resolved. b.limit intake of calories until the glucose is less than 120 mg/dL. c.monitor blood glucose every 4 hours and notify the clinic if it continues to rise. d.decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.

c.monitor blood glucose every 4 hours and notify the clinic if it continues to rise.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rashfrom an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipatethat the patient may a.need a diet higher in calories while receiving prednisone. b.develop acute hypoglycemia while taking the prednisone. c.require administration of insulin while taking prednisone. d.have rashes caused by metformin-prednisone interactions.

c.require administration of insulin while taking prednisone.

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? a. Urine dipstick for glucose b. Oral glucose tolerance test c. Fasting blood glucose level d. Glycosylated hemoglobin level

d. Glycosylated hemoglobin level

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? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his 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. The patient increases daily exercise when ketones are present in the urine

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and takingglipizide (Glucotrol). Which patient statement indicates a need for additional teaching? a.If I overeat at a meal, I will still take the usual dose of medication. b.Other medications besides the Glucotrol may affect my blood sugar. c.When I am ill, I may have to take insulin to control my blood sugar. d.My diabetes wont cause complications because I dont need insulin.

d.My diabetes wont cause complications because I dont need insulin.

A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has beenaway from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To preventhypoglycemia, the best action by the nurse is to a.save the lunch tray for the patients later return to the unit. b.ask that diagnostic testing area staff to start a 5% dextrose IV. c.send a glass of milk or orange juice to the patient in the diagnostic testing area. d.request that if testing is further delayed, the patient be returned to the unit to eat.

d.request that if testing is further delayed, the patient be returned to the unit to eat.