Lewis diabetes
In which order will the nurse prepare NPH 20 units and regular insulin 2 units using the same syringe?
1) Rotate NPH vial 2) Inject 20 units of air into NPH vial 3) Inject 2 units of air into regular insulin vial 4) Withdraw regular insulin 5) Withdraw 20 units of NPH
Which question during the assessment of a diabetic patient will help the nurse identify autonomic neuropathy? a) Do you feel bloated after eating? b) Have you seen any skin changes? c) Do you need to increase your insulin dosage when you are stressed? d) Have you noticed any painful new ulcerations or sores on your feet?
A Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient.
A 27 y/o patient admitted w/ DKA has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the HCP should the nurse take first? a) Place the patient on a cardiac monitor b) Administer IV potassium supplements c) Obtain urine glucose and ketone levels d) Start an insulin infusion at 0.1 units/kg/hr
A Hypokalemia can lead to potentially fatal dysrhythmias such as v-tach and v-fib, which would be detected w/ ECG monitoring.
A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is most important for the nurse to communicate to the HCP? a) The patient uses oral contraceptives b) The patient runs several days a week c) The patient has been pregnant three times d) The patient has a family history of diabetes
A Oral contraceptive use may falsely elevate oral glucose tolerance test values.
A 32 y/o patient w/ 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 Rapid or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy.
A 38 y/o 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 NPH insulin d) time the morning insulin injection so that the peak occurs while swimming
A The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration.
A 54 y/o patient is admitted w/ DKA. Which admission order should the nurse implement first? a) Infuse 1 L of normal saline per hour b) Give sodium bicarbonate 50 mEq IV push c) Administer regular insulin 10 U by IV push d) Start a regular insulin infusion at 0.1 units/kg/hr
A The most urgent problem is the hypovolemia associated w/ DKA, and the priority is to infuse IV fluids.
A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? a) 10:00 AM b) 12:00 AM c) 2:00 PM d) 4:00 PM
A The rapid-acting insulins peak in 1-3 hours.
The nurse has administered 4oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. 15 minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next? a) Give the patient 4-6 oz more orange juice b) Administer the PRN glucagon 1 mg IM c) Have the patient eat some peanut butter w/ crackers d) Notify the HCP about the hypoglycemia
A The rule of 15 indicates that administration of quickly acting carbs should be done 2-3 times for a conscious patient whose glucose remains less than 70 mg/dL before notifying the HCP.
A 34 y/o has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye exam a) every 2 years b) as soon as possible c) when the patient is 39 years old d) within the first year after diagnosis
B Because many patients have some diabetic retinopathy when they are first diagnosed w/ type 2 diabetes, a dilated eye exam is recommended at the time of diagnosis and annually thereafter.
After change-of-shift report, which patient should the nurse assess first? a) 19 y/o w/ type 1 diabetes who has an A1C of 12% b) 23 y/o w/ type 1 diabetes who has a blood glucose of 40 mg/dL c) 40 y/o who is pregnancy and whose oral glucose tolerance test is 202 mg/dL d) 50 y/o who uses exenatide (Byetta) and is complaining of acute abdominal pain
B Because the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness, seizures, and death.
Which patient action indicates good understanding of the nurse's 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 w/ 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 Cleaning the skin w/ soap and water or w/ alcohol is acceptable.
An unresponsive patient w/ type 2 diabetes is brought to the ED and diagnosed w/ hyperosmolar hyperglycemia 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 HHS is initially treated w/ large volumes of IV fluids to correct hypovolemia.
Which action should the nurse take after a 36 y/o patient treated w/ 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 Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia.
Which lab value reported to the nurse by the UAP indicates the most urgent need for the nurse's assessment of the patient? a) Bedtime glucose of 140 mg/dL b) Noon blood glucose of 52 mg/dL c) Fasting blood glucose of 130 mg/dL d) 2hr postprandial glucose of 220 mg/dL
B The nurse should assess the patient w/ a blood glucose level of 52 mg/dL for symptoms of hypoglycemia and give the patient a carb-containing beverage such as orange juice.
Which information will the nurse include when teaching a 50 y/o patient who has type 2 diabetes about glyburide? 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 The sulfonylureas stimulate the production and release of insulin from the pancreas.
An active 28 y/o male w/ type 1 diabetes is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy? a) A1C level 6.2% b) BP 146/88 mmHg c) HR at rest 58 bpm d) HDL level of 65 mg/dL
B To decrease the incidence of macrovascular and microvascular problems in patients w/ diabetes, the goal BP is usually 130/80.
A diabetic patient who has reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline (Elavil)? a) It decreases the depression caused by your foot pain b) It helps prevent transmission of pain impulses to the brain c) It corrects some of the blood vessel changes that cause pain d) It improves sleep and makes you less aware of nighttime pain
B Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain.
To monitor for complications in a patient w/ type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? a) Chest x-ray b) BP c) Serum creatinine d) Urine for microalbuminuria e) CBC f) Monofilament testing of the foot
B, C, D, F BP, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible miscrovascular and macrovascular complications of diabetes.
When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the HCP prescribes prednisone. The nurse will anticipate that 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 Glucose levels are increased when patients are taking corticosteroids, and insulin may be required to control blood glucose.
A 26 y/o patient w/ type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite her 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 then 120 mg/dL c) monitor blood glucose every 4 hours and notify the clinic if it continues to rise d) decreased intake of carbohydrates until A1C is less than 7%
C Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately w/ lispro insulin, and call the HCP if glucose levels continue to be elevated.
The nurse determines a need for additional instruction when the patient w/ 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'm not hungry
C Most patients w/ type 1 diabetes need to plan diet choices very carefully.
A 26 y/o patient w/ diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to administer the morning insulin? a) thigh b) buttock c) abdomen d) upper arm
C Patients should be taught not to administer insulin into a site that will be exercise because exercise will increase the rate of absorption.
After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective a) I may feel hungrier than usual when I take this medicine b) I will not need to worry about hypoglycemia with the Byetta c) I should take my daily aspirin at least an hour before the Byetta d) I will take the pill at the same time I eat breakfast in the morning
C Since exenatide slows gastric emptying, oral medications should be taken at least an hour before the exenatide to avoid slowing absorption.
A few weeks after an 82 y/o w/ a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss w/ the HCP? a) A1C is 7.9% b) Last eye exam was 18 months ago c) GFR rate is decreased d) Patient has questions about the prescribed diet
C The decrease in renal function may indicate a need to adjust the dose of metformin or change to a different medication.
A patient who was admitted w/ DKA secondary to a UTI has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a) Infuse dextrose 50% by slow IV push b) Administer 1 mg glucagon SW c) Obtain a glucose reading using a finger stick d) Have the patient drink 4oz of orange juice
C The patient's clinical manifestations are consistent w/ hypoglycemia and the initial action should be to check the patient's glucose w/ a finger stick or order a stat blood glucose.
After change-of-shift report, which patient will the nurse assess first? a) 19 y/o w/ type 1 diabetes who was admitted w/ possible dawn phenomenon b) 35 y/o w/ type 1 diabetes whose most recent blood glucose reading was 230 mg/dL c) 60 y/o w/ HHS who has poor skin turgor and dry oral mucosa d) 68 y/o w/ type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain
C The patient's diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for signs of shock and determine whether increased fluid infusion is needed.
A 48 y/o male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL. 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 The patient's impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes.
What information is most important for the nurse to report to the HCP before a patient w/ type 2 diabetes is prepare for a coronary angiogram? a) The patient's most recent A1C was 6.5% b) The patient's admission blood glucose is 128 mg/dL c) The patient took the prescribed metformin (Glucophage) today d) The patient took the prescribed captopril (Capoten) this morning
C To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogram and should not be used for 48 hours after IV contrast media are administered.
The nurse is assessing a 22 y/o 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 daily? d) Do you crave sugary drinks?
C Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy.
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to a) save the lunch tray for the patient's return later to the unit b) ask the diagnostic testing area staff to start a 5% dextrose IV c) send a glass of milk or orange juice to the patient in diagnostic testing area d) request that if testing is further delayed, the patient be returned to the unit to eat
D Consistency for mealtimes assists w/ regulation of blood glucose, so the best option is for the patient to have lunch at the usual time.
Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful? a) The patient administers the glargine 30 minutes before each meal b) The patient's family prefills the syringes w/ the mix of insulins weekly c) The patient draws up the regular insulin then the glargine in the same syringe d) The patient disposes of the open vials of glargine and regular insulin after 4 weeks
D Insulin can be stored at room temperature for 4 weeks.
The nurse is interviewing a new patient w/ diabetes who receives rosiglitazone (Avandia) through a restricted access medication program. What is most important for the nurse to report immediately to the HCP? a) The patient's BP is 154/92 b) The patient has a history of a emphysema c) The patient's blood glucose is 86 mg/dL d) The patient has chest pressure when walking
D Rosiglitazone can cause myocardial ischemia.
A patient w/ type 2 diabetes is schedules 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 Hgb level
D The A1C test shows the overall control of glucose over 90-120 days.
Which finding indicates a need to contact the HCP before the nurse administers metformin (Glucophage)? a) The patient's blood glucose level is 174 mg/dL b) The patient has gained 2lb (0.6 kg) since yesterday c) The patient is scheduled for a chest x-ray in an hour d) The patient's BUN is 52 mg/dL
D The BUN indicates possible renal failure, and metformin should not be used in patients w/ renal failure.
The nurse has been teaching a patient w/ type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? a) If I overeat a meal, I will still take the usual dose of medication b) Other medications beside the Glucotrrol may affect my blood sugar c) When I'm ill, I may have to take insulin to control my blood sugar d) My diabetes won't cause complications because I don't need insulin
D The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin.
A 28 y/o male patient w/ 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 When the patient is ketotic, exercise may result in an increase in blood glucose level.
