Nokea
A client is being discharged after being diagnosed with diabetes. The client is being taught how to monitor his blood glucose. After teaching the client, which statement indicates to the nurse that additional teaching is needed?
- A. I should prick the tip of my finger to get the blood.
- B. I should clean my finger with warm, soapy water.
- C. I should massage my finger to get a hanging drop of blood.
- D. I should avoid smearing the blood on the test strip.
Correct Answer: A
Rationale: The client should insert the lancet to prick the side of the finger, not the tip, because the side has more capillaries and fewer nerve endings. The finger should be washed with warm, soapy water and then dried before testing. The client should massage the finger to get a hanging drop of blood to be placed on the test strip. The client needs to avoid smearing the blood on the strip to prevent inaccurate readings.
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The nurse is assessing a client for risk factors associated with type 2 diabetes. Which of the following would the nurse identify?
- A. Younger age
- B. Impaired glucose tolerance
- C. Caucasian race
- D. Obesity
- E. History of gestational diabetes
Correct Answer: B,D,E
Rationale: A nurse should be able to identify all the risk factors for type 2 diabetes in a client. These include obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (African Americans, Hispanic Latino Americans, Native Americans, and some Asian Americans).
A client is receiving glipizide at a health care facility. The client is also prescribed an anticoagulant. The nurse would be alert for which of the following related to the interaction of these two drugs?
- A. Increased risk of lactic acidosis
- B. Risk of acute renal failure
- C. Increased risk for bleeding
- D. Increased hypoglycemic effect
Correct Answer: D
Rationale: The nurse should observe for increased hypoglycemic effect in the client as the effect of the interaction of sulfonylureas with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine-2 antagonists, meth Methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of lactic acidosis is an effect of the interaction of metformin with glucocorticoids. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. There is a risk of acute renal failure when iodinated contrast material used for radiologic studies is administered with metformin.
A client is receiving metformin (Glucophage). The nurse suspects that the client is developing lactic acidosis based on assessment of which of the following?
- A. Malaise
- B. Hypertension
- C. Tachypnea
- D. Abdominal pain
- E. Muscular pain
Correct Answer: A,C,D,E
Rationale: Symptoms of lactic acidosis include malaise, abdominal pain, tachypnea, shortness of breath, and muscular pain.
As part of the ongoing assessment of a client receiving insulin detemir, the nurse would suspect that the insulin is not effective based on assessment of which of the following?
- A. Increased thirst
- B. Increased urination
- C. Increased appetite
- D. Confusion
- E. Abdominal pain
Correct Answer: A,B,E
Rationale: If the insulin was not effective, the client would exhibit signs and symptoms of hyperglycemia including drowsiness, dim vision, thirst, nausea, vomiting, abdominal pain, loss of appetite, acetone breath, and excessive urination.
A nurse is preparing to administer a long-acting insulin to a client. Which of the following might the nurse administer?
- A. Insulin aspart (NovoLog)
- B. Insulin lispro (Humalog)
- C. Insulin glargine (Lantus)
- D. Insulin detemir (Levemir)
- E. Insulin glulisine (Apidra)
Correct Answer: C,D
Rationale: Insulin glargine (Lantus) and insulin detemir (Levemir) are long-acting insulins with a duration of 24 hours. Insulin aspart, lispro, and glulisine are rapid-acting insulins.