Lewis Medical Surgical --Chapter 53 Diabetes

Which information provided by a nurse to a patient newly diagnosed with type 2 diabetes is

Accurate?

a. Insulin is not used to control 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 glucose levels with type 2 diabetes.

d. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic

coma.

ANS: C

For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve glucose

control. Insulin is frequently used for type 2 diabetes, complications are equally serious as for

type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or

after a patient develops complications such as frequent infections.

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL

(6.7 mmol/L). Which information will the nurse plan to teach the patient?

a. Self-monitoring of glucose

b. Using small doses of regular insulin

c. Lifestyle changes to lower the glucose

d. Effects of oral hypoglycemic medications

ANS: C

The patient's impaired fasting glucose indicates prediabetes, and the patient would be

counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient

with prediabetes does not require insulin or oral hypoglycemics for glucose control and does

not need to self-monitor glucose.

A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and

glucose control. Which behavior indicates a need for the nurse to 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.

ANS: D

When the patient is ketotic, exercise increase the glucose level; persons with type 1 diabetes

should be taught to avoid exercise when ketosis is present. Other recommendations include

(1) before exercise, if glucose 100 mg/dL, eat a 15-g carbohydrate snack. After 15 to 30 min,

recheck glucose levels. (2) Delay exercise if <100 mg/dL. Patients using drugs that place them

at risk for hypoglycemia should always carry a fast-acting source of carbohydrate, such as

glucose tablets or hard candies, when exercising. (3) Before exercise, if glucose 250 mg/dL

in a person with type 1 DM and ketones are present, delay vigorous activity until ketones are

gone. Drink fluids.

The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1

diabetes. Which finding would the nurse anticipate?

a. Anorexia

b. Weight loss

c. Dark colored urine

d. Craving sugary drinks.

ANS: B

Weight loss occurs because the body is no longer able to absorb glucose and starts to break

down protein and fat for energy. The patient is thirsty but does not necessarily crave

sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the

classic symptom of polyuria, urine will be very dilute.

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. Fasting blood glucose

b. Glycosylated hemoglobin

c. Oral glucose tolerance test

d. Urine dipstick for glucose and ketones

ANS: B

The glycosylated hemoglobin (A1C) test shows the overall control of glucose over 90 to 120

days. A fasting level indicates only the glucose level at one time. Urine glucose testing is not

an accurate reflection of glucose level and does not reflect the glucose over a prolonged time.

Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring

glucose control after diabetes has been diagnosed.

The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass

index (BMI) of 32 kg/m2. Which goal in the plan of care 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.

ANS: A

The complications of diabetes are related to elevated glucose and the most important patient

outcome is the reduction of glucose to near-normal levels. A BMI of 30.9/kg/m2 or above is

considered obese, so the other outcomes are appropriate but are not as high in priority.

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. Which

advice would the clinic nurse plan to give the patient?

a. Increase the morning dose of NPH insulin (Novolin N).

b. Check glucose level before, during, and after swimming.

c. Time the morning insulin injection to peak while swimming.

d. Delay eating the noon meal until after finishing the swimming.

ANS: B

The exercise will affect glucose, and the patient will need to monitor glucose carefully to

determine the need for changes in diet and insulin administration. Because exercise tends to

decrease glucose, patients are advised to eat before exercising. Increasing the morning NPH or

timing the insulin to peak during exercise may lead to hypoglycemia, especially with the

increased exercise.

Which statement by the person who has newly diagnosed type 1 diabetes indicates a need for additional instruction from the nurse?

a. ―I will need a bedtime snack because I take an evening dose of NPH insulin.‖

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

c. ―I can have an occasional beverage with alcohol if I include it in my meal plan.‖

d. ―I will eat something at meal times to prevent hypoglycemia, even if I am not

hungry.‖

ANS: B

Planning to use additional insulin to ―balance out‖ unhealthy diet choices is not effective for

glucose control or overall health. Patients who are using insulin therapy have considerable

flexibility in diet choices and can plan occasional alcohol beverages in their diet. Planning

snacks and meal intake to coordinate with insulin doses indicates good understanding of the

diet instruction.

Which nursing action is most important in assisting an older patient who has diabetes to

engage in moderate daily exercise?

a. Determine what types of activities the patient enjoys.

b. Remind the patient that exercise improves 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.

ANS: A

Because consistency with exercise is important, assessment for the types of exercise that the

patient finds enjoyable is the most important action by the nurse in ensuring adherence to an

exercise program. Reminding about the benefits of exercise, teaching about exercise effects on

glucose, and identifying moderate intensity exercises may be helpful but are not the most

important in improving adherence.

Which patient statement to the nurse indicates a need for additional instruction in

administering insulin?

a. ―I should inject the insulin into a muscle that I plan to exercise vigorously.‖

b. ―I can buy the 0.5-mL syringes because the line markings are easier to see.‖

c. ―I do not need to aspirate the plunger to check for blood before injecting insulin.‖

d. ―I should draw up the regular insulin first, after injecting air into the NPH bottle.‖

. ANS: A

Caution the patient about injecting into a site that will be exercised. For example, injecting

into the thigh and then going jogging could increase circulation and increase the rate of insulin

absorption, causing hypoglycemia. Patient statements about low-vision syringes, avoiding

aspiration, and the correct process for combining insulins are accurate and indicate that no

additional instruction is needed.

Which patient action indicates accurate understanding of the nurse's teaching about

administration of aspart (NovoLog) insulin?

a. The patient cleans the skin with soap and water before the injection.

b. The patient avoids injecting the insulin into the upper abdominal area.

c. The patient stores the insulin in the freezer between prescribed doses.

d. The patient pushes the plunger down while removing the syringe from the

injection site.

ANS: A

Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The patient

should leave the syringe in place for about 5 seconds after injection to be sure that all the

insulin has been injected. The upper abdominal area is one of the preferred areas for insulin

injection.

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse

anticipate the highest risk for hypoglycemia?

a. 10:00 AM

b. 12:00 AM

c. 2:00 PM

d. 4:00 PM

ANS: A

The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for

hypoglycemia at the other listed times, although hypoglycemia may occur.

Which patient action indicates an accurate understanding of the nurse's 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 restarts it each morning.

d. The patient plans a diet with more calories than usual when using the pump.

ANS: A

In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a

bolus after each meal, with the dosage depending on the oral intake. The insertion site should

be changed every 2 or 3 days. The pump will deliver a basal insulin rate 24 hours a day. There

is more flexibility in diet and exercise when an insulin pump is used, but it does not provide

for consuming a higher calorie diet.

A patient who has diabetes is starting on intensive insulin therapy. Which type of insulin will

the nurse explain for mealtime coverage?

a. Lispro (Humalog)

b. Glargine (Lantus)

c. Detemir (Levemir)

d. NPH (Humulin N)

ANS: A

Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive

insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.

Which information about glyburide would the nurse include when teaching a patient who has

type 2 diabetes?

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 glucose level is low.

d. Glyburide should not be used for 48 hours after receiving IV contrast media.

ANS: B

The sulfonylureas stimulate the production and release of insulin from the pancreas. If the

glucose level is low, the patient should contact the health care provider before taking

glyburide because hypoglycemia can occur with this class of medication. Metformin should

be held for 48 hours after administration of IV contrast media, but this is not necessary for

glyburide. Glyburide does not affect glucagon secretion.

The nurse has been teaching a patient who has type 2 diabetes about managing glucose levels and taking glipizide (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 won't cause complications because I don't need insulin.‖

ANS: 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. Statements about maintaining a consistent dose of glipizide, the effects of other

medications on glucose, and possible needs for insulin during acute illness are accurate and

indicate good understanding of the use of glipizide.

A patient who takes metformin (Glucophage) to manage type 2 diabetes developed an allergic rash from an unknown cause and the health care provider prescribed prednisone. Which

change in the plan of care at would the nurse anticipate?

a. The patient may need a diet higher in calories while receiving prednisone.

b. The patient may develop acute hypoglycemia while taking the prednisone.

c. The patient may require administration of insulin while taking prednisone.

d. The patient may have rashes caused by metformin-prednisone interactions.

ANS: C

Glucose levels increase when patients are taking corticosteroids, and insulin may be required

to control glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse

effect caused by taking metformin and prednisone simultaneously. The patient may have an

increased appetite when taking prednisone but will not need a diet that is higher in calories.

A hospitalized patient who has diabetes 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. Which nursing action would be the best way to prevent the

patient from experiencing hypoglycemia?

a. Plan to decrease the evening dose of insulin.

b. Save the lunch tray for the patient's later return.

c. Request that if testing is further delayed, the patient must eat lunch first.

d. Send a glass of orange juice to the patient in the diagnostic testing area.

ANS: C

The action of NPH insulin peaks 4 to 12 hours after injection, which can result in

hypoglycemia. Consistency for mealtimes assists with regulation of glucose, so the best

option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure

is likely to cause hypoglycemia. Decreasing the insulin dose later that day will not prevent

hypoglycemia from the peak of the NPH dose. A glass of juice will keep the patient from

becoming hypoglycemic temporarily but will cause a rapid rise in glucose because of the

rapid absorption of the simple carbohydrate in these items.

Which action by the patient who is self-monitoring blood glucose indicates a need for

additional teaching?

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.

ANS: B

The patient is taught to choose a puncture site at the side of the finger pad because there are

fewer nerve endings along the side of the finger pad. The other patient actions indicate that

teaching has been effective.

The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action would the nurse take first?

a. Assess the patient's perception of what it means to have diabetes.

b. Ask the patient's family to participate in the diabetes education program.

c. Demonstrate how to check glucose using the patient's blood glucose monitor.

d. Discuss the need for the patient to actively participate in diabetes management.

ANS: A

Before planning teaching, the nurse would assess the patient's interest in and ability to

self-manage the diabetes. After assessing the patient, the other nursing actions may be

appropriate, but planning needs to be specific to each patien

An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome (HHS). Which action would the nurse anticipate taking?

a. Giving 50% dextrose

b. Inserting an IV catheter

c. Initiating O2 by nasal cannula

d. Administering glargine (Lantus) insulin

ANS: B

HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular

insulin is administered, not a long-acting insulin. There is no indication that the patient

requires O2. Concentrated dextrose solutions will increase the patient's glucose and would be

Contraindicated

A 26-yr-old female who has 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 reports a glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog)

insulin. Which action would the nurse advise the patient to take?

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 contact the clinic if it rises.

d. Decrease carbohydrates until glycosylated hemoglobin is less than 7%.

ANS: C

Infection and other stressors increase glucose levels and the patient will need to test glucose

frequently, treat elevations appropriately with lispro insulin, and call the health care provider

if glucose levels continue to be elevated. Discontinuing the glargine will contribute to

hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or

caloric intake is not appropriate because the patient will need more calories when ill.

Glycosylated hemoglobin testing is not used to evaluate short-term alterations in glucose.

The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6 AM

glucose is 230 mg/dL. Which action would the nurse teach the patient to take?

a. Check the glucose during the night.

b. Avoid snacking right before bedtime.

c. Increase the rapid-acting insulin dose.

d. Administer a larger dose of long-acting insulin.

ANS: A

If the Somogyi effect is causing the patient's increased morning glucose level, the patient will

experience hypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced,

rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night.

Which action would the nurse take after a 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.

ANS: B

Rebound hypoglycemia can occur after glucagon administration, but having a meal containing

complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and

nonfat milk will elevate glucose rapidly, but the cheese and crackers will stabilize glucose.

Administration of IV glucose might be used in patients who were unable to take in nutrition

orally. The patient should be assessed for symptoms of hypoglycemia after glucagon

administration.

Which question during the assessment of a patient who has diabetes 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?‖

ANS: A

Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling

for the patient. Asking about skin changes, insulin dosages, and foot lesions would not help in

identifying autonomic neuropathy.

Which information would the nurse include in teaching a patient who has peripheral arterial

disease, type 2 diabetes, and sensory neuropathy of the feet and legs?

a. Choose flat-soled leather shoes.

b. Set heating pads on a low temperature.

c. Use a callus remover for corns or calluses.

d. Soak feet in warm water for an hour each day.

ANS: A

The patient is taught to avoid open-toe, open-heel, and high-heel shoes. Leather shoes are

preferred to plastic ones. The feet should be washed, but not soaked, in warm water daily.

Heating pad use should be avoided. Commercial callus and corn removers should be avoided.

The patient should see a specialist to treat these problems.

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?

a. The patient's glucose level is 174 mg/dL.

b. The patient is scheduled for a chest x-ray in an hour.

c. The patient has gained 2 lb (0.9 kg) in the past 24 hours.

d. The patient's estimated glomerular filtration rate is 42 mL/min.

ANS: D

The glomerular filtration rate indicates possible renal impairment, and metformin should not

be used in patients with significant renal impairment. The other findings are not

contraindications to the use of metformin.

A patient who has diabetes and reports burning foot pain at night receives a new prescription. Which information would the nurse teach the patient about the purpose of amitriptyline?

a. Amitriptyline decreases the depression caused by your foot pain.

b. Amitriptyline helps prevent transmission of pain impulses to the brain.

c. Amitriptyline corrects some of the blood vessel changes that cause pain.

d. Amitriptyline improves sleep and makes you less aware of nighttime pain.

. ANS: B

Tricyclic antidepressants (TCAs) decrease the transmission of pain impulses to the spinal cord

and brain. TCAs also improve sleep quality and are used for depression, but that is not the

major purpose for their use in diabetic neuropathy. TCAs do not affect the blood vessel

changes that contribute to neuropathy.

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram.

Which information would the nurse anticipate might lead to rescheduling the test?

a. The patient's glucose is 128 mg/dL.

b. The patient's most recent A1C was 7.5%.

c. The patient took the prescribed metformin today.

d. The patient took the prescribed enalapril 4 hours ago.

ANS: C

To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary

angiogram and should not be used for 48 hours after IV contrast media are administered. The

other patient data do not indicate any need to reschedule the procedure.

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 with the mix of insulins weekly.

c. The patient discards the open vials of glargine and regular insulin after 4 weeks.

d. The patient draws up the regular insulin and then the glargine in the same syringe.

ANS: C

Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with

other insulins or prefilled and stored. Short-acting regular insulin is administered before

meals, and glargine is given once daily.

. A patient with diabetes rides a bicycle to and from work every day. Which site would the

nurse teach the patient to use to administer the morning insulin?

a. Thigh

b. Buttock

c. Abdomen

d. Upper arm

ANS: C

Patients should be taught not to administer insulin into a site that will be exercised vigorously

because exercise will increase the rate of absorption. The thigh, buttock, and arm are all

exercised by riding a bicycle

The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia).

Which information would the nurse anticipate resulting in the health care provider

discontinuing the medication?

a. The patient's blood pressure is 154/92.

b. The patient has a history of emphysema.

c. The patient reports chest pressure when walking.

d. The patient's morning glucose level is 96 mg/dL.

ANS: D

Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health

care provider and expect orders to discontinue the medication. A glucose level of 96 mg/dL

indicates a positive effect from the medication. Hypertension and a history of emphysema do

not contraindicate this medication.

The nurse is taking a health history from a 29-yr-old patient at the first prenatal visit. The

patient reports that she has no personal history of diabetes, but her mother has diabetes. Which

action will the nurse plan to take?

a. Schedule the patient for a fasting glucose level.

b. Teach the patient about administering regular insulin.

c. Teach about an increased risk for fetal problems with gestational diabetes.

d. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.

ANS: A

Patients with a family history of diabetes are at high risk for gestational diabetes and should

be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be

used to check for diabetes, but it would be done before the twenty-fourth week. Teaching

plans would depend on the outcome of a fasting glucose test and other tests.

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of

732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health

care provider would the nurse implement first?

a. Place the patient on a cardiac monitor.

b. Administer IV potassium supplements.

c. Ask the patient about home insulin doses.

d. Start an insulin infusion at 0.1 units/kg/hr.

ANS: A

Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and

ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring.

Because potassium must be infused over at least 1 hour, the nurse would initiate cardiac

monitoring before infusion of potassium. Insulin would not be administered without cardiac

monitoring because insulin infusion will further decrease potassium levels. Discussion of

home insulin and possible causes can wait until the patient is stabilized.

A patient with diabetic ketoacidosis is brought to the emergency department. Which

prescribed action would the nurse implement first?

a. Infuse 1 L of normal saline rapidly.

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.

ANS: A

The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis

(DKA), and the priority is to infuse IV fluids. Insulin can be given after the infusion of normal

saline is initiated. Sodium bicarbonate may be given for severe acidosis (pH <7.0) after fluids

are initiated.

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection

has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded

and sweaty. Which action would the nurse take first?

a. Infuse dextrose 50% by slow IV push.

b. Administer 1 mg glucagon subcutaneously.

c. Obtain a glucose reading using a finger stick.

d. Have the patient drink 4 ounces of orange juice.

ANS: C

The patient's clinical manifestations are consistent with hypoglycemia, and the initial action

should be to check the patient's glucose with a finger stick or order a stat glucose. If the

glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice.

Glucagon or dextrose 50% might be given if the patient's symptoms become worse or if the

patient is unconscious.

A female patient is scheduled for an oral glucose tolerance test. Which information from the

patient's health history is important for the nurse to communicate to the health care provider regarding interpreting the result of this test?

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.

ANS: A

Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values.

Exercise and a family history of diabetes both can affect glucose but will not lead to

misleading information from the OGTT. History of previous pregnancies may provide

informational about gestational glucose tolerance but will not lead to misleading information

from the OGTT.

Which laboratory value reported by the assistive personnel (AP) indicates an urgent need for the nurse to assess the patient?

a. Bedtime glucose of 140 mg/dL

b. Noon glucose of 52 mg/dL

c. Fasting glucose of 130 mg/dL

d. 2-hr postprandial glucose of 220 mg/dL

ANS: B

The nurse should assess the patient with a glucose level of 52 mg/dL for symptoms of

hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice.

The other values are within an acceptable range or not immediately dangerous for a patient

with diabetes.

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action

can the nurse delegate to a licensed practical/vocational nurse (LPN/VN)?

a. Communicate the glucose level and insulin dose to the circulating nurse in surgery.

b. Discuss the reason for insulin therapy during the immediate postoperative period.

c. Administer the prescribed lispro (Humalog) insulin before transporting the patient

to surgery.

d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the

postoperative period.

ANS: C

LPN/LVN education and scope of practice includes administration of insulin. Communication

about patient status with other departments, planning, and patient teaching are skills that

require RN education and scope of practice.

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider?

a. Hemoglobin A1C level of 6.2%

b. Heart rate at rest of 58 beats/min

c. Blood pressure of 140/88 mmHg

d. High-density lipoprotein (HDL) level of 65 mg/dL

ANS: C

To decrease the incidence of macrovascular and microvascular problems in patients with

diabetes, the blood pressure should be kept in normal range. An A1C less than 6.5%, a low

resting heart rate (consistent with regular aerobic exercise in a young adult), and an HDL level

of 65 mg/dL all indicate that the patient's diabetes and risk factors for vascular disease are

well controlled.

A 30-yr-old patient has a new diagnosis of type 2 diabetes. When would the nurse recommend the patient schedule a dilated eye examination?

a. Every 2 years

b. Every 6 months

c. As soon as available

d. At the age of 39 years

ANS: C

Because many patients have some diabetic retinopathy when they are first diagnosed with

type 2 diabetes, a dilated eye examination is recommended at the time of diagnosis and

annually thereafter.

Which patient statement indicates that the nurse's teaching about exenatide (Byetta) 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.‖

ANS: C

Because exenatide slows gastric emptying, oral medications would be taken at least 1 hour

before the exenatide to avoid slowing absorption. Exenatide is injected and increases feelings

of satiety. Hypoglycemia can occur with this medication.

A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been

placed on metformin (Glucophage) therapy, the home health nurse makes a visit. Which

finding would the nurse promptly discuss with the health care provider?

a. Hemoglobin A1C level is 7.9%.

b. Glomerular filtration rate is decreased.

c. Last eye examination was 18 months ago.

d. Patient has questions about the prescribed diet.

ANS: B

The decrease in renal function may indicate a need to adjust the dose of metformin or change

to a different medication. In older patients, the goal for A1C may be higher in order to avoid

complications associated with hypoglycemia. The nurse will plan to schedule the patient for

an eye examination and address the questions about diet, but the area for prompt intervention

is the patient's decreased renal function

The nurse has administered 4 oz of orange juice to an alert patient whose glucose was 62

mg/dL. Fifteen minutes later, the glucose is 67 mg/dL. Which action would the nurse take

Next?

a. Give the patient 4 to 6 oz more orange juice.

b. Administer the PRN glucagon (Glucagon) 1 mg IM.

c. Have the patient eat some peanut butter with crackers.

d. Notify the health care provider about the hypoglycemia.

ANS: A

The ―rule of 15‖ indicates that administration of quickly acting carbohydrates should be done

two or three times for a conscious patient whose glucose remains less than 70 mg/dL before

notifying the health care provider. More complex carbohydrates and fats may be used after the

glucose has stabilized. Glucagon should be used if the patient's level of consciousness

decreases so that oral carbohydrates can no longer be given.

Which nursing action can the nurse delegate to experienced assistive personnel (AP) who are working in the diabetic clinic?

a. Measure the ankle-brachial index.

b. Check for changes in skin pigmentation.

c. Assess for unilateral or bilateral foot drop.

d. Ask the patient about symptoms of depression.

ANS: A

Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial

index is a procedure that can be done by AP who have been trained in the procedure. The

other assessments should be done by the registered nurse (RN).

After change-of-shift report, which patient will the nurse assess first?

a. A 19-yr-old patient with type 1 diabetes who was admitted with dawn phenomenon

b. A 60-yr-old patient with type 1 diabetes whose most recent glucose reading was

230 mg/dL

c. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and

reports burning foot pain

d. A 35-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor

skin turgor and dry oral mucosa.

ANS: D

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. The other

patients also need assessment and intervention but do not have life-threatening complications.

After change-of-shift report, which patient would the nurse assess first?

a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12%

b. A 23-yr-old patient with type 1 diabetes who has a glucose of 40 mg/dL

c. A 50-yr-old patient who uses exenatide and is reporting acute abdominal pain

d. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202

mg/dL

ANS: B

Because the brain requires glucose to function, untreated hypoglycemia can cause

unconsciousness, seizures, and death. The nurse will rapidly assess and treat the patient with

low glucose. The other patients also have symptoms that require assessments or interventions,

but they are not at immediate risk for life-threatening complications.

To monitor for complications in a patient with 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. Blood pressure

c. Serum creatinine

d. Urine for microalbuminuria

e. Complete blood count (CBC)

f. Monofilament testing of the foot

ANS: B, C, D, F

Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament

testing of the foot are recommended at least annually to screen for possible microvascular and

macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the patient

with diabetes presents with symptoms of respiratory or infectious problems but are not

routinely included in screening.