ch 48 sectn 2
After teaching the patient who was admitted with diabetes about the principles of foot care, which statement made by the patient indicates a need for further teaching? 1 "Taking a hot bath every day will help with my circulation." 2 "I should avoid walking barefoot at all times." 3 "I should look at the condition of my feet every day." 4 "I need a podiatrist to treat my ingrown toenails."
1 Hot water may injure tissue related to decreased sensation and should be avoided. Patients with diabetes mellitus should inspect the feet daily for broken areas that are at risk for delayed wound healing, avoid walking barefoot, and have a podiatrist for foot care.
A patient diagnosed with type 1 diabetes has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse would be performed initially? 1 Check the patient's blood sugar at 3:00 AM. 2 Provide the patient with an evening snack. 3 Rotate insulin injection sites between the abdomen, thigh, and arm. 4 Contact the health care provider to increase the evening insulin dose.
1 Hyperglycemia in the morning may be caused by the Somogyi effect. If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 and 4:00 AM for hypoglycemia will help determine whether the cause is the Somogyi effect. Diabetics should be given evening snacks to prevent hypoglycemia during the night, but glucose assessment is a priority to rule out the Somogyi effect. Injection sites are rotated to prevent lipodystrophy. An increased dose of evening insulin may cause further decrease in early morning glucose and increased rebound hyperglycemia.
When evaluating the outcome of patient teaching regarding aspart insulin, which statement made by the patient demonstrates correct understanding of the teaching? 1 "This insulin is used to treat the elevated sugar that occurs after meal intake." 2 "I cannot mix this insulin in the same syringe with any other type of insulin." 3 "I need to plan my meals well so I can inject my insulin 30 minutes before I begin to eat." 4 "The best thing about this type of insulin is that I take it at bedtime and it works for 24 hours."
1 Rapid-acting insulins, such as aspart, are used to control postprandial blood glucose levels. The timing of insulin injection with meals is crucial. Rapid-acting insulin has a quick onset of approximately 15 minutes and should be injected within 15 minutes of mealtime. Short-acting insulin, such as Humulin-R, because of longer onset of action, can safely be administered 30 to 60 minutes before a meal. Rapid-acting insulin such as aspart can be mixed safely with intermediate-acting insulin in the same syringe. Long-acting insulin such as glargine and detemir should not be mixed with any other insulins. Because rapid-acting insulins have a shorter duration of action, they are typically injected before meals.
Which range is the current recommendation of fiber for patients with diabetes? 1 25 to 30 g/day 2 20 to 25 g/day 3 40 to 50 g/day 4 10 to 20 g/day
1 The American Diabetes Association (ADA) recommends that diabetics consume 25 to 30 grams of fiber daily. This is the same level recommended for the nondiabetics because there is no evidence that a higher intake of fiber is essential. Forty to 50 grams is too much fiber for the patient to consume, and 10 to 25 grams is not enough fiber.
After teaching a patient with type 1 diabetes regarding diet, which statement made by the patient indicates a need for further teaching? 1 "If I go over my calories, then I can just increase my insulin." 2 "I'll need a bedtime snack because I take an evening dose of NPH insulin." 3 "I can have an occasional low-calorie dessert as long as I include it in my meal plan." 4 "I should eat meals at the scheduled times, even if I'm not hungry, to prevent hypoglycemia."
1 The goal of dietary therapy for the patient with diabetes mellitus is to attain and maintain an ideal body weight and a stable blood glucose level. Each patient should be prescribed a specific caloric intake and insulin regimen to help him or her achieve this goal. Insulin dosage should not be increased to account for an increased caloric intake. A bedtime snack for people taking evening NPH insulin, planning for an occasional low-calorie dessert, and eating at scheduled times are all part of correct diabetes management.
When evaluating a patient's technique of performing self-monitoring of blood glucose (SMBG), which action by the patient would indicate a need for additional teaching? 1 Chooses a puncture site in the center of the finger pad 2 Washes hands with soap and water to cleanse the site to be used 3 Warms the finger before puncturing it to obtain a drop of blood 4 Tells the nurse that the result of 110 mg/dL indicates good control of diabetes
1 The patient should select a site on the sides of the fingertips, not on the center of the finger pad, because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.
The nurse would instruct the patient with diabetes to fast for which period of time when scheduled for a fasting blood glucose level at 8:00 a.m.? 1 At least eight hours 2 4:00 a.m. on the day of the test 3 After dinner the evening before the test 4 7:00 a.m. on the day of the test
1 Typically, a patient is prescribed to be NPO for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 a.m. should not have any food or beverages containing any calories after midnight. It is not necessary to fast longer than eight hours; 4:00 a.m. and 7:00 a.m. would not allow for sufficient time to fast for morning laboratory testing.
Which statement made by the patient in an outpatient diabetes clinic indicates an understanding of the teaching regarding sick day rules? 1 "I will be sure to measure my finger-stick blood glucose level four times a day, and more frequently when I am ill." 2 "When I am ill, I will eliminate my Lantus insulin and only cover my finger-stick blood glucose if it is over 250." 3 "When I am ill, I will continue to take my Lantus insulin only." 4 "I will only take my rapid-acting insulin when I am ill."
1 When a patient with diabetes is ill, it is recommended he or she continues checking blood sugar every four hours and more frequently to prevent hyperglycemia and hypoglycemia during illness. The diabetic patient should adhere to the sick day rules, which indicate to continue with the basal dosing of insulin and continue to correct a finger-stick blood sugar greater than 200. The patient also should be checking urine ketones for two blood sugars over 250 in a row.
Which precautions would the patient with type 1 diabetes take when exercising? Select all that apply. 1 Exercise after meals. 2 Have a warm-up and cool-down period. 3 Avoid carbohydrate snacks during exercise. 4 Carry glucose tablets or hard candies when exercising. 5 Avoid exercise if blood glucose is equal to 120 mg/dL.
1, 2, 4 The nurse should inform the patient to exercise one hour after meals when blood sugar levels are rising. The exercise program should be started gradually and increased slowly, with warm-up and cool-down periods. Patients using medications are at a risk for hypoglycemia when exercising and should always carry a fast-acting source of carbohydrate such as glucose tablets or hard candies or eat small carbohydrate snacks every 30 minutes when exercising. If blood glucose is less than or equal to 100 mg/dL, then the patient should retest blood glucose levels after a 15-g carbohydrate snack. The patient should then exercise if glucose levels increase after 15 to 30 minutes.
Which instruction would the nurse give a patient when teaching about the importance of self-monitoring of blood glucose (SMBG) using a glucometer? Select all that apply. 1 Test blood glucose whenever hypoglycemia is suspected. 2 Test blood glucose before and after exercise. 3 Take a blood sample immediately after a meal. 4 Take a blood sample from the side of the finger pad. 5 Wash hands in cold water when preparing to puncture.
1, 2, 4 The nurse should instruct the patient to test blood glucose levels whenever hypoglycemia is suspected so that immediate action can be taken. The patient should test blood glucose before and after exercise to determine the effects of exercise on metabolic control. Blood sample should be taken from the side of the finger pad rather than near the center, because there are fewer nerve endings along the side of the finger. Blood glucose is generally tested two hours after a meal to determine whether the bolus insulin dose was adequate for the meal. Blood glucose may also be tested before a meal by patients who use insulin pumps or multiple daily injections and base the insulin dose on the carbohydrates in a meal or make adjustments if the preprandial value is above or below target. Hands should be washed in warm water before the finger puncture is made to promote blood flow to the fingers.
Which statements made by the nurse to a patient newly diagnosed with type 1 diabetes would be included in a teaching plan? Select all that apply. 1 "You should decrease your dietary sugar intake." 2 "I will teach you how to self-administer your insulin." 3 "It is important to consume a diet that is high in fats." 4 "It is important for you to reduce your physical activity." 5 "You should monitor your blood sugar as prescribed."
1, 2, 5 The nurse should teach the patient to decrease dietary sugar intake, self-administer insulin, and regularly monitor blood glucose levels as prescribed. A high-fat diet increases the patient's cholesterol levels and may increase the blood sugar levels. Reduction of physical exercise can also lead to an increase in blood glucose level.
Which defining characteristics are associated with the Somogyi effect? Select all that apply. 1 Documented morning hyperglycemia 2 Caused by not rotating insulin injection sites 3 Avoided by consuming a bedtime snack 4 Treated with a lower dose of insulin in the evening 5 Documented hypoglycemia between 2:00 AM and 4:00 AM 6 Required adjustment of administration time of evening insulin
1, 3, 4, 5 Hyperglycemia in the morning can be caused by the Somogyi effect, which can be stimulated by too much insulin in the evening. During the night, typically between 2:00 AM and 4:00 AM, hypoglycemia occurs, which stimulates a release in counterregulatory hormones in an attempt to raise the blood sugar. What results is rebound hyperglycemia resulting in higher blood sugar readings upon awakening. The Somogyi effect must be differentiated from dawn phenomenon, which also results in higher morning blood sugar readings. The treatment for Somogyi effect includes consuming a bedtime snack or reducing the evening insulin dose, whereas the treatment for dawn phenomenon is an increase in the evening insulin dose or an adjustment in the timing of the evening insulin dose. Not rotating insulin injection sites does not result in either the Somogyi effect or dawn phenomenon. In fact, current recommendations are to use the same anatomic injection site (e.g., the abdomen) for one week before moving to another anatomic injection site.
Which factors would the nurse include in an assessment of a patient with diabetes who is complaining of night sweats, hyperglycemia, and headache on awakening? Select all that apply. 1 The variability in mealtime or insulin administration 2 Measurement of two-hour oral glucose tolerance test (OGTT) 3 Measurement of glycemic index (GI) 4 Measurement of bedtime and morning fasting blood glucose levels on several occasions 5 Measurement of blood glucose levels between 2:00 AM and 4:00 AM on several occasions
1, 4, 5 When assessing the patient with complaints of night sweats, hyperglycemia, and headache on awakening, the nurse must assess the patient for symptoms of Somogyi effect and dawn phenomenon. The nursing assessment must include insulin dose, injection sites, and variability in the time of meals or insulin administration. The nurse should ask the patient to measure and document bedtime, nighttime (between 2:00 AM and 4:00 AM), and morning fasting blood glucose levels on several occasions. These values help to adjust insulin dosage. A two-hour OGTT is performed to assess the risk of future diabetes. GI is the term used to describe the rise in blood glucose levels after a person has consumed a carbohydrate-containing food. OGTT and GI need not be assessed for this patient.
The nurse is monitoring a family caregiver who is learning to inject pramlintide prescribed for glucose control. The nurse would intervene when noting which caregiver action? 1 Gently rolling the insulin vial before drawing up prescribed dose 2 Preparing the injection site on the back of the arm with an alcohol wipe 3 Injecting air equal to prescribed dose into vial before withdrawing dose 4 Drawing up pramlintide in separate syringe from other mealtime insulin prescribed
2 Pramlintide is administered subcutaneously before major meals. Because of the variation of absorption from injection sites in the arm, only the thigh or abdomen are appropriate sites for this medication. Gently rolling an insulin vial before drawing up a dose aids in mixing insulin solution. To ease in withdrawal of the dose, adding equal amounts of air into the vial before removing the dose will equalize pressure within the vial. Pramlintide should not be mixed in the same syringe with any other insulin.
The patient received regular insulin eight units subcutaneously (SQ) at 0900. During which time range would the nurse plan to monitor this patient for signs of hypoglycemia? 1 1000 and 1100 2 1100 and 1400 3 1200 and 1300 4 1300 and 1500
2 Regular insulin exerts peak action in two to five hours, placing the patient at greatest risk for hypoglycemia between 1100 and 1400. At this time, the nurse should offer the patient a snack. 1000 and 1100, 1200 and 1300, and 1300 and 1500 are not consistent with peak action of insulin administered at 0900.
A patient's blood glucose level before breakfast is 324 mg/dL. The nurse reviews the electronic medical record and notes that the patient receives a high dose of insulin each evening at bedtime. The nurse suspects that the patient's hyperglycemia is most likely due to which problem with insulin therapy? 1 Lipodystrophy 2 Somogyi effect 3 Allergic reaction 4 Dawn phenomenon
2 The Somogyi effect occurs when a patient receives a high dose of evening/bedtime insulin that produces a decline in blood glucose levels during the night. As a result, counter regulatory hormones are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia. Lipodystrophy is atrophy or hypertrophy of the subcutaneous tissue. Allergic reactions related to insulin occur as local inflammatory reactions and do not produce hyperglycemia. The dawn phenomenon also is characterized by hyperglycemia that is present on awakening; however, it is caused by growth hormone and cortisol excretion during the early morning hours and is unrelated to the amount of insulin given at nighttime.
A patient calls the health care provider's office at 8:00 a.m. and states, "I just experienced an episode of low blood sugar, which responded to oral glucose tablets." Which question would the nurse ask to help to identify the cause of the low blood sugar? 1 "Did you check your urine for ketones?" 2 "Were you more active than usual yesterday?" 3 "Did you take a lower-than-normal dose of insulin today?" 4 "Have you been running a fever, or do you have any illness symptoms?"
2 The glucose-lowering effects of exercise can last up to 48 hours, so it is possible for hypoglycemia to occur after activity, particularly if exercise is at a greater intensity or time than normal. Asking the patient about activity level would be the most appropriate question for the nurse to ask. Ketones can be found in the urine with elevated blood glucose levels and may indicate the presence of diabetic ketoacidosis. Ketones would not be of concern with hypoglycemia. Taking a lower dose of insulin would result in higher blood glucose. Fever and illness can lead to hyperglycemia as well.
A patient calls the health care provider's office at 8:00 a.m. and states, "I just experienced an episode of low blood sugar, which responded to oral glucose tablets." Which question would the nurse ask to help to identify the cause of the low blood sugar? 1 "Did you check your urine for ketones?" 2 "Were you more active than usual yesterday?" 3 "Did you take a lower-than-normal dose of insulin today?" 4 "Have you been running a fever, or do you have any illness symptoms?" 00:00:02 Question Answer Confidence ButtonsJust a guessPretty sureNailed it
2 The glucose-lowering effects of exercise can last up to 48 hours, so it is possible for hypoglycemia to occur after activity, particularly if exercise is at a greater intensity or time than normal. Asking the patient about activity level would be the most appropriate question for the nurse to ask. Ketones can be found in the urine with elevated blood glucose levels and may indicate the presence of diabetic ketoacidosis. Ketones would not be of concern with hypoglycemia. Taking a lower dose of insulin would result in higher blood glucose. Fever and illness can lead to hyperglycemia as well.
Which instruction would the nurse give a patient who is prescribed metformin and complains of an "upset stomach" after ingestion of the medication? 1 "Stop taking the medication immediately and notify the prescriber." 2 "Take metformin with food to decrease gastrointestinal (GI) side effects." 3 "Get your blood glucose checked because it sounds like hypoglycemia." 4 "Take diphenhydramine 25 mg before taking metformin to prevent nausea."
2 The nurse should suggest that the patient take metformin with food to decrease GI side effects. It is not within the nurse's scope of practice to prescribe medications such as diphenhydramine for nausea. Advising the patient to stop the medication immediately may result in a hyperglycemic response and should not be done without medication prescriber guidance. Getting the patient's blood glucose checked will not address the complaints of GI distress.
Which instruction would the nurse give the patient with diabetes about self-administering insulin? 1 Shake the bottle thoroughly to mix the insulin. 2 Rotate the injection within one anatomic site for a week. 3 Inject insulin at a 15- to 30-degree angle. 4 Inject insulin into the thigh because it has the fastest subcutaneous absorption.
2 The nurse should teach the patient to rotate the injection within one anatomic site, such as the abdomen, for at least one week before using a different site to allow for better absorption of insulin. It is important to gently roll the insulin bottle between the palms 10 to 20 times to warm the insulin and resuspend the particles. Injections must be administered at a 45- to 90-degree angle, depending on the thickness of the patient's fat pad. The fastest subcutaneous absorption is from the abdomen, followed by the arm, thigh, and buttock.
Which statement is characteristic of metformin? 1 It causes weight gain. 2 It decreases hepatic glucose production. 3 It should not be given with sulfonylureas. 4 It is inappropriate for initial management of type 2 diabetes.
2 The primary action of metformin is to reduce glucose production by the liver. Metformin often causes weight loss instead of weight gain. Metformin can be administered in conjunction with sulfonylureas. Metformin is preferred for the initial management of type 2 diabetes.
A patient with type 2 diabetes who takes metformin daily to manage blood sugar is scheduled for scan with IV contrast. Which question by the nurse is most important to ask the patient when preparing for the procedure? 1 "Have you ever skipped a dose of metformin?" 2 "When was the last time you took your metformin?" 3 "How many times a day do you take your metformin?" 4 "How long have you been taking metformin for diabetes?
2 To reduce risk of kidney injury, metformin should be discontinued a day or two before any procedure that uses IV contrast and for 48 hours following the use of IV contrast. Medication administration adherence, dosage, and history are important to assess but will not affect the interaction.
A patient with diabetes who takes long-acting and mealtime insulin calls the ambulatory center with complaints of an upper respiratory infection and has a decreased appetite, fever, and cough. Which instructions would the nurse give the patient? Select all that apply. 1 "Come to the clinic if you have a single blood glucose level over 300 mg/dL." 2 "Any illness can cause a hormone response that can result in hyperglycemia." 3 "Common illnesses, such as the flu, cannot impact glucose or insulin requirements." 4 "Do not inject any insulin until you can eat normally because hypoglycemia may occur." 5 "If you are sick, you should check your blood sugar every four hours, even if you are not eating regularly."
2, 5 Any illness or surgery can cause a regulatory hormonal response that may lead to hyperglycemia. Patients with diabetes and concurrent illnesses should check their blood sugar at least every four hours, despite current eating patterns, to monitor for hyperglycemia. Many clinics will ask a patient to report to his or her health care provider for two blood glucose readings over 300 mg/dL in a row, not just one. Common illnesses such as an upper respiratory illness or the flu can cause changes in glucose requirements. Patients should be encouraged to continue their insulin injectables as prescribed and monitor for hyperglycemia or hypoglycemia. These patients should supplement with carbohydrate-containing foods or beverages as necessary.
Which intervention included in the care plan would be beneficial for the patient with diabetes who is on bromocriptine therapy? 1 Providing vitamin K-rich food 2 Monitoring serum thyroid levels 3 Assisting the patient when changing position 4 Monitoring for the symptoms of myocardial infarction
3 Bromocriptine is a dopamine agonist that may cause orthostatic hypotension, which in turn causes the patient to become dizzy when changing position. Therefore the nurse should assist the patient when changing position to prevent accidental falls. Bromocriptine does not reduce absorption of vitamin K. Hence, the nurse does not provide vitamin K-rich food to the patient. The nurse does not monitor thyroid hormone levels because bromocriptine does not impair thyroid functioning. Bromocriptine does not increase the risk of myocardial infarction.
Which goal of the treatment plan for a patient with diabetic ketoacidosis (DKA) would be the initial focus? 1 Treatment for hypokalemia 2 Rapid reduction of elevated blood glucose 3 Rehydration through IV fluid replacement 4 Reduction of ketosis by encouraging oral nourishment
3 Fluid imbalance is potentially life threatening for patients with DKA. The initial goal of therapy is to establish IV access and begin fluid replacement. Once urine output is established, electrolyte replacement will be addressed. Potassium levels will need to be monitored because insulin therapy, which is needed to correct the hyperglycemia, may further reduce the potassium level. Insulin therapy will be used to lower the blood glucose gradually to prevent rapid drops in serum glucose, which could lead to fluid shifts and the potential for cerebral edema. Ketosis results from the use of fat stores for energy because excess glucose is not being transported to the cells and used as a source of energy. Patients with DKA often present with nausea and vomiting; oral nourishment may be limited until symptoms lessen.
Which instruction, in relation to mealtimes, would the nurse give to a patient who is prescribed lispro? 1 Take on an empty stomach between meals. 2 Take it simultaneously with a meal. 3 Take it within 15 minutes of mealtime. 4 Take it 30 to 45 minutes before a meal.
3 Rapid-acting synthetic insulin analogs, which include lispro (Humalog), aspart (NovoLog), and glulisine (Apidra), have an onset of action of approximately 15 minutes and should be injected within 15 minutes of mealtime. The rapid-acting analogs most closely mimic natural insulin secretion in response to a meal. Lispro is not administered on an empty stomach or simultaneously with a meal. Short-acting regular insulin, not rapid-acting synthetic insulin, is administered 30 to 45 minutes before a meal to ensure the onset of action coincides with meal absorption.
During which timeframe would the nurse monitor the patient for hypoglycemia after administering 10 units regular insulin subcutaneously at 8:30 p.m.? 1 8:40 p.m. to 9:00 p.m. 2 9:00 p.m. to 11:30 p.m. 3 10:30 p.m. to 1:30 a.m. 4 12:30 a.m. to 8:30 a.m.
3 Regular insulin exerts peak action in two to five hours, making the patient most at risk for hypoglycemia between 10:30 p.m. and 1:30 a.m. Rapid-acting insulin's onset is between 10 to 30 minutes, with peak action and hypoglycemia most likely to occur between 9:00 p.m. and 11:30 p.m. With intermediate acting insulin, hypoglycemia may occur from 12:30 a.m. to 8:30 a.m.
A nurse is providing discharge teaching to a patient with a new diagnosis of type 1 diabetes mellitus who will need to give self-injections of insulin at home. Which statement by the patient indicates to the nurse that the discharge teaching was effective? 1 "I can use my lower forearm for insulin injections." 2 "If my intermediate-acting insulin looks cloudy, I should discard the bottle." 3 "I need to rotate sites of injection to allow for better absorption of the insulin." 4 "I should push the plunger all the way down and then remove the needle as soon as possible."
3 Teaching the patient to rotate the injection within and between sites is important to allow for better insulin absorption. The lower forearm is not an injection site for subcutaneous insulin administration. The abdomen, arm, thigh, and buttock are the preferred sites. Intermediate-acting insulin is normally cloudy, and the patient should gently roll the bottle between the palms of hands to mix the insulin. The patient should push the plunger all the way down and leave the needle in place for 5 seconds to ensure that all of the insulin has been injected before removing the needle.
A patient with type 1 diabetes asks the nurse why the abdomen is the chosen site to inject insulin. Which response by the nurse demonstrates an understanding of the choice of injection site? 1 "The abdomen is the preferred site for injection because it does not hurt as badly." 2 "The abdomen is the preferred site for injection because it is easier to administer there." 3 "The abdomen is the preferred site for injection because the insulin will be absorbed faster there than at other sites." 4 "The abdomen is the preferred site for injection because you've been self-injecting there at home, and I should use the same site."
3 The abdomen is the preferred site for subcutaneous injection of insulin because it has the fastest subcutaneous absorption. The reason that the abdomen is the preferred site for injection is not because it does not hurt; all injections are uncomfortable. The abdomen may be an easier site to access, but that is not the reason the abdomen is used as an injection site. The nurse should not use the same injection site for administration that the patient has been using for self-injection; instead, the nurse should rotate the injection within and between sites to allow for better insulin absorption.
Which instruction would the nurse include in a teaching plan about diabetes and healthy eating? 1 Avoid non-nutritive sweeteners. 2 Consume a high-protein diet for weight loss. 3 If ingesting alcohol, also consume carbohydrates. 4 Include 50 to 60 g/day of dietary fiber.
3 The nurse should inform the patient to eat carbohydrates when drinking alcohol to reduce the risk for alcohol-induced hypoglycemia. Nutritive and nonnutritive sweeteners may be included in a healthy meal plan in moderation. The amount of daily protein in the diet for people with diabetes should be 15% to 20% of the total calories consumed. High-protein diets are not recommended as a weight loss method for people with diabetes. There is no evidence that a person with diabetes should consume more fiber than an individual who does not have diabetes. The current recommendation for the general population is 25 to 30 g/day.
A patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care would the nurse expect for this patient? 1 Routine insulin therapy and exercise 2 Administer a different antibiotic for the UTI 3 Cardiac monitoring to detect potassium changes 4 Administer IV fluids rapidly to correct dehydration
3 This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.
After a teaching session with the nurse, which statement made by the patient who is newly diagnosed with diabetes indicates correct understanding regarding type 1 diabetes? 1 "If I lose weight, I will be able to stop taking insulin." 2 "My pancreas will produce more insulin as I recover." 3 "I will need to be medicated with insulin for the rest of my life." 4 "I will be able to take insulin pills once my blood sugar is stabilized."
3 Type 1 diabetes is caused by destruction of pancreatic β-cells, which causes permanent insulin insufficiency and eventual absence that requires insulin for the rest of the life. Weight loss and recovery will not affect insulin production. Exogenous insulin is not absorbed in the gastrointestinal (GI) system and therefore must be given parenterally.
After admitting a patient with diabetic ketoacidosis (DKA) to the emergency department, which nursing intervention is a priority? 1 Administer IV insulin 2 Administer oxygen 3 Insert a Foley catheter 4 Establish IV access
4 Because fluid imbalance in a patient with DKA is potentially life threatening, the initial goal of therapy is to establish IV access and begin fluid and electrolyte replacement. Insulin is administered IV only after a potassium level is determined, because insulin administration may cause hypokalemia. Administration of oxygen and insertion of a Foley catheter may be necessary in the initial emergency management of DKA, but obtaining IV access is a priority.
The nurse has been teaching a patient newly diagnosed with diabetes to test blood glucose level. During evaluation of the technique, the nurse determines that the teaching has been adequate when the patient performs which task? 1 Reports control of diabetes is present when blood sugar level is less than 65 mg/dL 2 Chooses a puncture site in the center of the finger pad 3 Runs the hand under cool water for 30 seconds to cleanse the site 4 Hangs the arm in the dependent position for one minute before puncturing
4 Hanging the hand down will promote blood flow to the finger and allow for an adequate blood sample. A blood sugar of 65 mg/dL is considered low and does not necessarily mean the diabetes is well controlled. The patient should select a site on the side of a fingertip, not on the center of a finger pad, and the site should be washed with soap and warm water.
Which statement by a patient indicates a lack of understanding of the prescribed medication metformin? 1 "I should take this medication in the morning with breakfast." 2 "I will need to have my hemoglobin A1C level checked in three months." 3 "I may have diarrhea with this medication, but I should not stop taking it." 4 "I will take this medication when my blood sugar is greater than 200 mg/dL."
4 Metformin should be taken daily for diabetes control; it is not indicated for as-needed use. The medication should be taken with breakfast. Routine monitoring of hemoglobin A1C levels, every 3-6 months, is important to monitor longer term control of diabetes. Metformin may initially cause diarrhea, which will resolve, so the patient should continue to use as prescribed.
When teaching the patient how to self-administer subcutaneous insulin, which instruction would the nurse include in the teaching plan? 1 "At home, you must use an alcohol swab on the site before self-injection." 2 "If you are planning on going jogging, you should use the thigh injection site to administer insulin." 3 "You should use one site for insulin injections so you get used to the process of administering insulin." 4 "Avoid injecting insulin intramuscularly because rapid and unpredictable absorption could result in hypoglycemia."
4 Patient education for administration of insulin for diabetes should include teaching the patient to avoid IM injections because of the rapid and unpredictable absorption that could result in hypoglycemia. The use of an alcohol swab on the site before self-injection is no longer recommended. Routine hygiene such as washing with soap and water is adequate at home. When injection occurs in a health care agency, policy usually mandates site preparation with alcohol to prevent a health care-associated infection (HAI). Patients should be taught to avoid injection sites that will be exercised because doing so could increase body heat and circulation, increase the rate of insulin absorption, and speed up the onset of action, resulting in hypoglycemia. Patients should be taught to rotate the injection within and between sites, not to use one site, to allow for better insulin absorption.
When reviewing the diabetic self-care management with a patient newly diagnosed with diabetes, which statement made by the patient indicates a need for further education? 1 "I am going to check my feet for pressure areas every morning before I take a bath." 2 "I need to be careful on how I cut my toenails. I should not cut down the corners of the nail." 3 "I have scheduled an eye examination with an ophthalmologist for next week. I will need to have an annual eye exam." 4 "To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath."
4 Patients with diabetes are at great risk for skin breakdown because of peripheral vascular problems and peripheral neuropathy. Patients should avoid using rubbing alcohol on skin to prevent tissue damage. The best way to prevent foot ulcers is prevention and early detection. Inspecting the feet every day for cuts, abrasions, pressure areas, or sores is a good practice. Toenails should be cut with the rounded contour of the nail and not cut down the corners of the nail. Another complication of diabetes is retinopathy. Patients with a history of diabetes should have an eye examination annually by an ophthalmologist.
After discussing prevention of type 1 diabetes complications with the nurse, the patient is correct when making which statement? 1 "I must limit fats in my diet to help prevent neuropathy." 2 "I should use a hot water bottle on my feet when they feel cold." 3 "I should have an eye examination at least once every two years for glaucoma screening." 4 "It is important that I take my blood pressure medication to help prevent kidney damage."
4 Patients with diabetes who have albumin in their urine should receive angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists to treat hypertension, which would also delay the progression of nephropathy. Dietary fat intake will not affect kidney function. Hot water bottle use increases the risk of tissue damage because of the diabetic's neuropathy and delayed healing. Diabetics should have an eye examination once a year to screen for retinopathy.
Which statement made by the patient with diabetes mellitus indicates that further education regarding exercise is required? 1 "I should exercise about 30 minutes five days a week." 2 "Because I take insulin daily, I should exercise about one hour after eating a meal." 3 "Exercise will help me to lose weight, which will help my body to better use insulin." 4 "It is especially important that I exercise if my blood sugar is above 250 mg/dL and my urine is positive for ketones."
4 Strenuous activity can be perceived by the body as a stress and cause an increase in blood sugar by the release of counterregulatory hormones when the blood sugar is elevated and ketosis is present. The American Diabetes Association recommends that people with diabetes exercise 30 minutes per day, five days per week. To prevent hypoglycemia, it is important to exercise about an hour after consuming a meal or eat small carbohydrate snacks every 30 minutes during exercise. Weight loss decreases insulin resistance, which can lower blood glucose.
Which statement made by the patient with type 1 diabetes indicates a need for further instruction? 1 "I'll have a snack available when I exercise." 2 "I'll check my blood sugar level after every meal." 3 "I'll eat my meals and snacks at regular times every day." 4 "I'll start learning how to make high-fiber, low-fat foods."
2 Finger-stick blood glucose testing should be performed before meals. Checking the blood glucose after meals will yield inaccurate results. This is of essential concern if the patient is basing insulin dosage on finger-stick blood glucose results. Having a snack nearby during exercise, eating meals and snacks at regular times, and eating high-fiber, low-fat foods are all correct in regard to diabetes management.
A newly diagnosed patient with type 2 diabetes has been prescribed metformin and asks the nurse how it works. Which explanation would the nurse give the patient? 1 It increases insulin production from the pancreas. 2 Metformin slows the absorption of carbohydrates in the small intestine. 3 It decreases the rate of hepatic glucose production and augments glucose uptake by tissues, especially muscles. 4 Metformin increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.
3 Metformin is a biguanide that decreases the rate of hepatic glucose production and augments glucose uptake by tissues, especially muscles. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrates in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.
A patient hospitalized with diabetes has become shaky, anxious, and diaphoretic. Which action would the nurse implement first? 1 Administer a 15-g snack. 2 Notify the health care provider. 3 Check the blood glucose level. 4 Administer crackers with peanut butter.
3 The blood glucose level should be checked with the first signs of hypoglycemia because it can be reversed easily but can be life threatening if not treated. In the hospital setting, it is convenient to check the blood glucose. A 15-g snack should be provided after the blood glucose has been determined to be low. The health care provider should be notified after the blood glucose level is known. Once the glucose level is stable, then the patient can be given additional food of carbohydrates plus protein or fat (e.g., crackers with peanut butter) if the next meal is more than one hour away.
Which statement made by the patient with type 2 diabetes indicates understanding the teaching plan about exercise as a method to control blood glucose levels? 1 "I want to go fishing for 30 minutes each day. I will drink fluids and wear sunscreen." 2 "I will go running each day when my blood sugar is too high to bring it back to normal." 3 "I will plan to keep my job as a teacher because I get a lot of exercise every school day." 4 "I will take a brisk 30-minute walk five days per week and do resistance training three times a week."
4 The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity five days per week and resistance training three times a week. Brisk walking is moderate activity. Fishing and teaching are light activity, and running is considered vigorous activity.
Who can serve as a health care proxy? 1 A blood relative 2 A family member 3 A domestic partner 4 Anyone the patient chooses
4 The patient may choose anyone to serve as a health care proxy. Proxies do not have to be a domestic partner, family member, or blood relative.
A patient with type 2 diabetes who takes oral hypoglycemics at home is admitted to the hospital with an infection and asks why insulin injections have been prescribed. Which explanation would the nurse provide? 1 Insulin acts synergistically with the antibiotic that was prescribed. 2 Insulin should have been prescribed for the patient to take at home. 3 Oral hypoglycemic medications are contraindicated in patients with infections. 4 The infection increases the glucose level, resulting in a need for more insulin.
4 When the body is under stress, as in an acute illness, the need for insulin is more than oral hypoglycemics can provide. Insulin injections are usually required until the illness resolves. Insulin does not act synergistically with antibiotics, the patient did not need insulin at home, and oral hypoglycemics are not contraindicated in patients with infections.
Which statement made by the patient newly diagnosed with type 1 diabetes indicates a need for further instruction? 1 "If I skip breakfast, I can hold my insulin until noon." 2 "I'll have some options when it comes to food choices." 3 "If I feel sweaty, shaky, or dizzy, my blood sugar might be low." 4 "If I have to urinate a lot, feel thirsty all of the time, or have blurred vision, my blood sugar might be high."
1 A diabetic patient should adhere to an American Diabetes Association diet and insulin regimen. These patients should not self-regulate insulin unless directed to do so by their health care provider. The statements in the other answer options are all correct regarding self-management of diabetes at home.
The nurse would encourage a patient newly diagnosed with type 2 diabetes to limit intake of which foods to help reduce the percent of fat in the diet? 1 Cheese 2 Broccoli 3 Chicken 4 Oranges
1 Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help to avoid macrovascular changes.
After administering glucagon to an unconscious patient, the nurse would place the patient in which position? 1 Supine 2 Side-lying 3 High-Fowler's 4 Semi-Fowler's
2 Nausea is a common reaction after glucagon injection. The patient should be placed in the side-lying position to prevent aspiration should the patient vomit. The supine, high-Fowler's, and semi-Fowler's positions are not advisable because of the risk of aspiration of vomitus.
Which class of drugs used to treat diabetes may be referred to as "insulin sensitizers"? 1 Sulfonylureas 2 Thiazolidinediones 3 α-glucosidase inhibitors 4 Dipeptidyl peptidase-4 (DPP-4) inhibitors
2 Thiazolidinediones are a class of drugs used to treat diabetes mellitus (DM). They are often referred to as an "insulin sensitizers." This class of drugs improves insulin sensitivity, transport, and utilization at target tissues. Sulfonylureas increase insulin production by the pancreas. α-glucosidase inhibitors slow down absorption of carbohydrate in the small intestine. DPP-4 inhibitors enhance the activity of incretins, which stimulate release of insulin from pancreatic β-cells. This class of drug also decreases hepatic glucose production.
The nurse is teaching a patient with insulin-dependent diabetes about the effects of exercise on blood glucose level. When collaborating with the patient to develop a self-management plan, which examples of moderate activity would the nurse suggest? Select all that apply. 1 Fishing 2 Bowling 3 Dancing 4 Walking briskly 5 Aerobic exercises
2, 3, 4 Examples of moderate activity include bowling, walking briskly, and dancing. The American Diabetes Association (ADA) recommends at least 150 minutes per week of moderate activity, which expends 200-350 kcal/hr. Fishing is considered a light activity in which approximately 100-200 kcal/hr are expended. Aerobic exercises are considered vigorous activity expending approximately 400-900 kcal/hr.
Which statement made by the patient indicates correct knowledge of the onset of action of the mealtime insulin aspart? 1 "I will administer my aspart 30 minutes before mealtime." 2 "I will administer my aspart 60 minutes before mealtime." 3 "I will administer my aspart within 15 minutes of eating my meal." 4 "I will administer my aspart 30 minutes after the conclusion of my meal."
3 Aspart is rapid-acting insulin, onsets within five minutes, and peaks within an hour. The patient is instructed to administer it when food is in front of him or her, making the option "I will administer aspart within 15 minutes of eating" correct. If the patient administers the aspart 30 or 60 minutes before the food arriving, then the patient may experience hypoglycemia. The patient may have hyperglycemia if he or she waits 30 minutes until after eating to administer the insulin.
Which action would the nurse take first when teaching the patient with type 2 diabetes to become an active participant in his or her care? 1 Assess the patient's understanding of the disease. 2 Make a list of food restrictions for proper diabetes management. 3 Refer the patient to a nutritionist. 4 Set long-term goals to decrease the risk of complications.
1 For teaching to be effective, the first step is assessing the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. Food restrictions, nutritionist referral, and setting long-term goals can occur once the nurse is confident the patient understands what it means to have diabetes.
When teaching the patient with diabetes about repaglinide, which instruction regarding the timing of the medication would the nurse teach the patient? 1 Immediately before meals 2 When blood sugar levels are greater than 250 mg/dL 3 Two hours after meals 4 At bedtime
1 Repaglinide is an oral antidiabetic agent that should be given any time from 30 minutes to just before meals. It is given on a fixed schedule rather than only when blood sugars are elevated. The medication will not be effective if administered after meals or at bedtime.
