EAQ Diabetes

A patient has 0700 fingerstick blood glucose readings of 353-286 for 3 mornings in a row, and the nurse is concerned the patient may have dawn phenomenon. Which finding is consistent with this phenomenon?

Early morning glucose elevations

Which action does the nurse take first for the patient who is admitted to the emergency department (ED) with a panic attack and whose blood gases indicate respiratory alkalosis?

Encourage the patient to take slow breaths.

In teaching a patient about the prevention of complications from type 2 diabetes mellitus, which instruction does the nurse include?

Maintain a hemoglobin A 1c level less than 6%.

The nurse is caring for a critically ill patient with septic shock. The serum lactate level is 6.2. For which acid-base disturbance should the nurse assess?

Metabolic acidosis

The nurse documents that a patient has a class II impairment of activities of daily living (ADLs) related to dyspnea. What amount of breathlessness does this patient exhibit?

Mild

An intensive care patient with diabetic ketoacidosis (DKA) is receiving an insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make?

Potassium level

The laboratory reports of a patient show the patient has metabolic alkalosis. What conditions may result in metabolic alkalosis? Select all that apply.

Blood transfusion Prolonged vomiting Nasogastric suctioning Total parenteral nutrition

A patient has been poisoned by botulinum toxins. What assessment findings suggest the patient has acidosis? Select all that apply.

Confusion Warm, flushed, dry skin

A patient is diagnosed with chronic obstructive pulmonary disease (COPD). What laboratory values does the nurse expect? Select all that apply.

Elevated eosinophils count Elevated red blood cell count Decreased partial pressure of arterial oxygen

The nurse is performing a chest assessment on a 70-year-old patient. The nurse observes a barrel shape to the patient's chest with a greater than 2-centimeter width of intercostal spaces. Upon percussion, the nurse notes hyperresonant sounds over all lung fields. These findings are characteristic of which respiratory condition?

Emphysema

A patient has been newly diagnosed with diabetes mellitus. Which factors does the nurse emphasize should be monitored regularly by the patient to prevent and detect complications of the disease? Select all that apply.

Feet Urine Vision Kidney function Hemoglobin A 1c

The nurse is percussing the lungs of a patient. The nurse hears a high-pitched, soft intensity, extremely dull sound over the sternum. How does the nurse document this finding?

Flatness

The nurse is providing teaching to a patient with visual impairment about safe insulin administration. Which action by the patient indicates effective teaching?

Places rubber band around fast-acting insulin

The nurse is triaging a patient diagnosed with type 2 diabetes who is prescribed metformin. It is suspected that the patient is having an adverse drug interaction. What question by the nurse is priority?

"Are you currently taking any over-the-counter medications?"

The nurse is teaching a patient with diabetes about proper foot care. Which statement by the patient indicates that teaching was effective?

"I must inspect my shoes for foreign objects before putting them on."

A patient diagnosed with diabetes has received education regarding safety with exercise. What statement by the patient demonstrates a need for further teaching?

"I should not exercise if my blood sugar is over 150 mg/dL." Patients can exercise with a blood sugar of 150 mg/dL; they should not if it is over 250 mg/dL. Patients should inspect their feet after exercise. Exercise should not be done at peak onset of medications. If it has been more than an hour since food intake, a carbohydrate snack should be consumed.

A young adult patient does not identify as a smoker. However, based on patient's initial statement, the nurse still asks questions related to smoking behavior and records that the patient is a smoker. Which statement led to the nurse's decision to do so?

"I smoke only when I am at big parties."

A patient is scheduled for a glycosylated hemoglobin (A1C) test. The patient calls to request the day be changed because he has a family function the weekend before the test and is concerned about following the nutritional plan. What statement by the nurse is most appropriate?

"The A1C test will not be affected by what you eat in the days before it."

A patient with type 2 diabetes has been admitted for surgery, and the health care provider has placed the patient on insulin in addition to the current dose of metformin. The patient wants to know the purpose of taking the insulin. What is the nurse's best response?

"Your body is under more stress, so you'll need insulin to support your medication."

Which blood glucose level does the operating room nurse recognize as optimal during surgery to prevent hypoglycemia?

150 mg/dL

The nurse educator teaches a student nurse about auscultation of the lungs. Which action performed by the student nurse indicates a need for further education?

Listens to the sound over bony structures

After successful resuscitation of cardiopulmonary arrest, the nurse views these arterial blood gases: pH 7.28; CO 2 52; HCO 3 - 16. What is the interpretation of these values?

Combined respiratory and metabolic acidosis

The patient has been smoking one pack a day for 5 years and two packs a day for the last 2 years. How does the nurse document the smoking history in pack-years for this patient?____ years

9 pack-years. Pack-years is calculated as the number of packs smoked per day multiplied by the number of years the patient has smoked. For the first 5 years, the patient smoked 1 pack a day; 1 pack × 5 years = 5 pack-years. For the next 2 years, the patient smoked 2 packs a day; 2 pack × 2 years = 4 pack-years. Total pack years = 5 + 4 = 9 pack-years.

The nurse is assessing an African patient. Which would be the lowest acceptable oxygenation saturation finding considering the patient's culture?

90% oxygen saturation

Which patient does the nurse identify as needing screening for type 2 diabetes?

A 46-year-old patient with no health history

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with diabetes with a blood glucose level of 38 mg/dL

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with new-onset type 1 diabetes who now has positive ketones in his urine

A patient who had an earlier bronchoscopy has the following vital signs: heart rate 132, respiratory rate 26, and blood pressure 98/50. The patient is anxious and his skin is cyanotic. What is the nurse's first action?

Administer oxygen.

A nurse is on a committee dedicated to selecting neighborhoods in the United States that are most in need of smoking-cessation programs. A community with a high concentration of which group might be highest on this list?

Alaskan Natives Of demographic groups in the United States, this committee may want to establish a smoking cessation program in a neighborhood with a high concentration of Alaskan Natives. Asian Americans have a lower prevalence than do Alaskan Natives, white-collar workers a lower prevalence than blue-collar workers, and those with college degrees a lower prevalence than those with less education.

Which nursing action can the home health nurse delegate to a home health aide who is making daily visits to a patient with newly diagnosed type 2 diabetes?

Assist the patient with washing the feet and applying moisturizing lotion.

A patient newly diagnosed with diabetes is being instructed when to perform blood glucose monitoring. At what times does the nurse instruct the patient to check blood glucose? Select all that apply.

Before meals Frequently if you are ill If you are thirsty and urinate frequently

A patient has recently given up smoking and reports cravings, depression, and headaches. Which might the nurse anticipate will be included in the care plan? Select all that apply.

Bupropion Varenicline

The nurse is caring for a patient with continuous glucose monitoring (CGM) and obtains an elevated reading. Which action would the nurse take first?

CGM is meant to supplement, not replace, finger stick tests. An elevated reading would be confirmed with a finger stick test. Insulin should be given only after confirming the results of any of the CGM systems. The provider would be notified if the finger stick reading was out of range and the orders indicated that a call was warranted. If the reading on CGM is elevated, continuing to monitor readings without an intervention is considered neglectful behavior and puts the patient at risk.

Which noninvasive diagnostic test measures the amount of carbon dioxide present when a patient exhales?

Capnography

A new nurse is caring for a postoperative patient with the following arterial blood gas (ABG) result: pH 7.30; PaCO 2 60 mm Hg; PaO 2 80 mm Hg; bicarbonate 24 mEq/L; and O 2 saturation 96%. Which of these actions by the new graduate is indicated?

Encourage the patient to use the incentive spirometer and cough.

Which nursing intervention is the priority in preparing a patient for pulmonary function testing (PFT)?

Ensure no smoking 6 hours before the test. If the patient has been smoking, this may alter parts of the PFT (diffusing capacity [DlCO]), yielding inaccurate results. Administering bronchodilators is not indicated for PFT, but they may be withheld for 4 to 6 hours before the test. Fluid intake does not have an effect on PFT testing. Unless the patient develops distress during testing, supplemental oxygen is not required and will alter the results of PFT.

Which outcome is essential for the nurse to include in the plan of care for a patient who has been newly diagnosed with diabetes mellitus?

Ensuring the patient recognizes the signs and symptoms of hypoglycemia

The nurse is providing screening for diabetes. What findings are consistent with both type 1 and type 2 diabetes diagnosis? Select all that apply.

Fatigue, polyuria, and polydipsia are all findings consistent with both type 1 and type 2 diabetes. Weight loss is consistent with type 1 diabetes. Hypertension is not directly related to either diagnosis.

A patient who is scheduled for surgery in the morning is placed on NPO status. The patient is scheduled to receive insulin glargine before bed. What action by the nurse should be taken?

Give the insulin

The nurse is caring for an older adult patient with diabetes mellitus, acute renal failure, history of a thyroid tumor, and periodic angina. Which drug can be safely administered to control the patient's diabetes?

Glipizide

The nurse is teaching patients with diabetes about the need for annual eye care. Which groups of patients are statistically at risk of foregoing annual eye care because of the cost involved or the lack of insurance? Select all that apply.

Hispanics African Americans Those with less formal education

A patient is admitted from the emergency department for intravenous (IV) fluids to treat dehydration caused by several days of vomiting and diarrhea. The patient's admission venous blood work reveals a pH of 7.27 and bicarbonate of 26 mEq/L; potassium and chloride levels are within normal ranges. The provider has ordered adding bicarbonate to the IV fluids. Which action by the nurse is correct?

Hold the bicarbonate and report the laboratory values to the provider.

The home health care nurse is providing teaching to an insulin-dependent patient regarding infection. What symptom is priority for the patient to report to the health care provider?

Hyperglycemia

The patient returns to the medical unit after a therapeutic bronchoscopy. Which intervention does the nurse apply first?

Implement nothing by mouth (NPO) status.

What information does the nurse include when planning teaching for a patient with diabetes? Select all that apply.

Importance of foot care Correct storage for insulin Understanding of why the insulin is being prescribed

The nurse is teaching a patient about insulin administration. Which actions by the patient demonstrate an accurate understanding of the teaching provided? Select all that apply.

Inserting needle at 90-degree angle Turning bottle upside down to withdraw insulin

A patient newly diagnosed with type 1 diabetes is receiving education about the types of premeal insulin. What selection by the patient indicates the teaching was effective?

Insulin aspart

A patient has received teaching about the use of basal insulin for glucose stabilization. What selection indicates the teaching has been effective?

Insulin glargine

The nurse is caring for a patient with an oxygen saturation of 88% and use of accessory muscles for breathing. The nurse provides oxygen and anticipates which of these health care provider orders?

Intubation and mechanical ventilation

The nurse is providing education to a patient about the prevention of hypoglycemia. What signs and symptoms of this complication should be included in the teaching?

Irritability

A morbidly obese patient has chosen gastric bypass surgery to promote weight loss. The nurse plans to teach the patient about the need to perform monitoring to detect what disturbance consistent with rapid weight loss associated with this procedure?

Ketosis

A patient currently taking acetazolamide develops metabolic acidosis. Which nursing interventions are appropriate for the nurse to include in the plan of care? Select all that apply.

Monitoring electrolyte levels Administering intravenous (IV) fluids Placing the patient on fall precautions

The nurse is planning nutritional education for a patient newly diagnosed with diabetes. Who should be included as part of the treatment team? Select all that apply.

Nurse Patient's family Registered dietician

Which conditions and/or symptoms may be most likely responsible for this acid-base imbalance: pH 7.32, PaO 2 82 mm Hg, PaCO 2 50 mm Hg, HCO 3 - 18 mEq/L? Select all that apply.

Oliguria Dehydration Respiratory rate of 8 breaths/min

The nurse reviews the arterial blood gas for the patient. The nurse is most concerned with which value?

PaO 2

Which patient is most likely to exhibit the following ABG results: pH 7.30; PaCO 2 49; HCO 3 - 26; PaO 2 76?

Patient taking hydromorphone

The RN has received report about all of these patients. Which patient needs the most immediate assessment?

Patient with acute asthma who has an oxygen saturation of 89% by pulse oximetry. An oxygen saturation level less than 91% indicates hypoxemia and requires immediate assessment and intervention to improve blood and tissue oxygenation. The patient who is scheduled for a thoracentesis will be able to receive teaching and will have the opportunity to ask questions and have them answered before the procedure is performed, if this was not already completed. The patient who had a bronchoscopy 3 hours ago and has returned to the floor does not require the most immediate attention at this moment. It would not be unusual to have diminished breath sounds at the base of the lung of the patient with pleural effusion.Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options . Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response.

The nurse has just received a change-of-shift report on the endocrine unit. Which patient does the nurse see first?

Patient with type 1 diabetes whose insulin pump is beeping "occlusion"

A patient comes to the emergency department with a productive cough. Which symptom does the nurse look for that will require immediate attention?

Pink, frothy sputum

A patient's spouse calls the nurse to the room because the pulse oximeter's alarm is going off. The reading shows 82%. The patient is talking to his visitors and has unlabored respirations and pink color. What is the best action for the nurse to take?

Reposition the pulse oximeter probe and recheck the values.

The nurse is administering metformin to a patient with type 2 diabetes prior to breakfast. Which finding during administration requires further follow-up by the nurse?

Scheduled angiogram of the leg later today

The nurse is providing teaching on meal planning to an older adult patient who reports three episodes of hypoglycemia in the past several months. What action by the nurse is most appropriate?

Suggest a referral for home health care.

The nurse is teaching a patient with diabetes mellitus how to inject a mixture of NPH and regular insulins. In which order does the nurse instruct the patient to prepare and administer the insulin?

The first action should be to wash the hands to prevent infection. The next step is to swab the rubber stoppers with alcohol. The regular insulin should be drawn first; the shorter-acting insulin should always be drawn first. The NPH insulin should be drawn next, being careful not to inject any short-acting insulin into the bottle. The skin of the injection site should be prepared with alcohol, and the insulin injected at a 90-degree angle.

A patient with type 1 diabetes and a limited income is under nursing care. What nutritional teachings will the nurse provide to the patient? Select all that apply.

The nurse should teach type 1 diabetes patients to avoid gaining weight. Dietary information should be shared with the person who prepares the meals. Patients should see a registered dietician at least once a year, not once every two years. Food intake should not remain the same on all days; it may need adjustment during illness, planned exercise, and social occasions. Patients with low incomes may need more, not less, frequent evaluation and counseling.

The nurse is teaching the patient about techniques for smoking cessation. Which patient actions indicate that the teaching had been effective? Select all that apply.

The patient gets rid of ashtrays and lighters. The patient performs regular exercise to keep busy. The patient avoids situations that make him or her want to smoke.

A patient has quit smoking but has a partner who smokes. The partner does not smoke at home or in front of the patient. What can the nurse conclude about the patient?

The patient is exposed to thirdhand smoke.

The nurse is conducting a follow-up of a patient who is in a smoking cessation program. Which patient actions indicate effective outcomes? Select all that apply.

The patient's statements that he or she avoids people who are smoking, regularly exercises, and talks to the primary health care provider about nicotine replacement therapy indicate that the patient is achieving effective outcomes of the smoking cessation program. Eating junk food is not a healthy way to suppress the urge to smoke. The nurse should suggest other reward systems since even just one cigarette could undo the positive effects of smoking cessation.

Which instructions would the nurse include when educating a patient with diabetes about how to prevent fasting hyperglycemia known as "dawn phenomenon"?

To prevent fasting hyperglycemia known as the "dawn phenomenon," the patient would be instructed to administer Humulin 70/30 at 10 p.m. instead of with the evening meal. Dawn phenomenon results from a nighttime release of adrenal hormones that cause blood glucose elevations in the early morning. It is managed by providing more insulin in the overnight period. Giving a dose of intermediate-acting insulin such as Humulin 70/30 at 10 p.m. instead of with an evening meal will provide more insulin for the overnight period, reducing the chance of dawn phenomenon. Humalog and Humulin R are, respectively, rapid- and short-acting insulins that are not appropriate for this purpose. Administering Lantis at 10 p.m. instead of with the evening meal will not help prevent dawn phenomenon, because insulin glargine is a 24-hour acting insulin.

What findings are consistent with a diagnosis of hyperglycemia? Select all that apply.

Warm, moist skin Ketones in urine Kussmaul's respirations

The nurse receives a report on a 52-year-old patient with type 2 diabetes. Which complication of diabetes does the nurse report to the provider?

decreased peripheral perfusion. A cold, mottled toe may indicate arterial occlusion secondary to arterial occlusive disease or embolization; this must be reported to avoid potential gangrene and amputation. Although one glucose reading is elevated, the hemoglobin A 1c indicates successful glucose control over the past 3 months. After the age of 40, reading glasses may be needed because of difficulty in accommodating to close objects. Lungs are clear and no evidence of distress is noted.

Which arterial blood gas result does the nurse anticipate in the care of a patient diagnosed with acute kidney failure?

pH 7.33, PaO 2 82 mm Hg, PaCO 2 35 mm Hg, HCO 3 - 19 mEq/L

The nurse educates a patient who is scheduled for a bronchoscopy. Which statement made by the patient indicates an understanding of the teaching?

"I will abstain from eating or drinking for 8 hours prior to the procedure."

Which patient statements indicate that he or she has understood teaching regarding neuropathy? Select all that apply.

"I will inspect my feet every day." "I will take my prescribed gabapentin." "I will try to keep my blood glucose level steady."

The nurse is providing nutritional recommendations for a patient who has been diagnosed with diabetes. What statement by the patient indicates a need for further teaching?

"I will maintain an 1800 calorie diet."

The nurse is treating a patient with diabetes. Which are risk factors for development of vision loss in patients with diabetes? Select all that apply.

Proteinuria Poor glucose regulation

The nurse is determining the learning needs of a patient diagnosed with diabetes. What items should the nurse include in this assessment? Select all that apply.

Psychosocial concerns Current mental health status Nutrition history and practices

In instructing an older patient to help prevent age-related respiratory system disease, what does the nurse tell the patient to do?

Maintain a regular exercise program.

The nurse is providing education regarding sick day rules to a patient with diabetes. What information does the nurse include in the teaching plan? Select all that apply.

It is important for the patient to ensure there are no ketones in the urine, to monitor the glucose every 4 hours, and stay hydrated with 8 to 12 ounces of liquid every hour while awake. Patients can eat solid food if they can tolerate it. Patients can take medication for diarrhea or nausea.

What is one of the causes of acidosis?

Kidney failure

The nurse is performing auscultation to assess the lungs of a patient. What actions does the nurse take? Select all that apply.

Listens to a full respiratory cycle Places the stethoscope over the area to be auscultated Instructs the patient to breathe deeply and slowly through the mouth

What recommendations regarding exercise should the nurse provide to a high-risk diabetic patient? Select all that apply.

Low intensity Short periods

The nurse is providing teaching for a patient newly diagnosed with type 1 diabetes. Which statements by the patient indicate an understanding of the teaching provided about continuous glucose monitoring? Select all that apply.

Patients will still need to check fingersticks with continuous glucose monitoring. It is important to purchase disposable sensors for the continuous glucose monitor system. Continuous monitoring will not replace fingersticks. Continuous blood glucose monitoring systems still need to be calibrated. Boluses should not be given until the fingerstick confirms the blood glucose.

The RN and the LPN/LVN are working together to provide care for a patient hospitalized with dyspnea who requires all of these nursing actions. Which action is best accomplished by the RN?

Plan patient and family teaching regarding upcoming pulmonary function testing.

Which clinical condition is characterized by a flatness percussed over the lung fields?

Pleural effusion

While auscultating breath sounds, the nurse notes increased vocal resonance. Which condition is associated with this finding?

Pneumonia

A patient newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the patient and the patient's family?

Causes and treatment of hypoglycemia

Which are priority interventions for a diabetic patient to reduce modifiable risk factors associated with cardiovascular disease? Select all that apply.

Ceasing smoking Controlling hypertension Controlling hyperglycemia Controlling high triglycerides

A patient in acute respiratory distress from an asthma attack becomes more confused. Respirations remain rapid but are more shallow. The most recent blood gas results are pH 7.29, PaO 2 62 mm Hg, PaCO 2 56 mm Hg, HCO 3 -25 mEq/L. What is the nurse's priority intervention?

Call the Rapid Response Team.

The nurse is providing teaching about weight gain secondary to insulin resistance to a patient with type 1 diabetes. What actions by the patient can minimize this complication?

Calorie restriction

In reviewing the health care provider admission requests for a patient admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis?

NaHCO 3 is given for the acid-base imbalance of diabetic ketoacidosis, not the hyperglycemic-hyperosmolar state, which presents with hyperglycemia and absence of ketosis/acidosis. KCl 20 mEq for each liter of IV fluid will correct hypokalemia from diuresis. IV regular insulin at 2 units/hr will correct hyperglycemia. IV normal saline at 100 mL/hr will correct dehydration.Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.