Nokea
A diagnosis of hyperglycemic hyperosmolar state (HHS) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. Which of the following actions should the nurse anticipate?
- A. Give 50% dextrose as a bolus.
- B. Insert a large-bore IV catheter.
- C. Initiate oxygen by nasal cannula.
- D. Administer glargine insulin.
Correct Answer: B
Rationale: 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 oxygen. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.
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Which of the following patient teaching information is most important for the nurse to communicate to a patient with gestational diabetes?
- A. Delivery will not affect blood glucose levels.
- B. Exercise should be avoided in the last month of pregnancy.
- C. Monitoring of blood glucose can stop as soon as the baby is delivered.
- D. A postpartum OGTT will be done at 2 months.
Correct Answer: D
Rationale: Women should be screened postpartum to determine their glucose status. The 2008 CDA guidelines recommend a 75-g oral glucose tolerance test (OGTT) be done between 6 weeks and 6 months postpartum. Delivery may affect blood glucose levels. Exercise is not to be avoided. Monitoring of blood glucose will continue into the postpartum period until levels are within normal limits.
The nurse is caring for a patient with diabetes who received 34 units of NPH insulin at 7:00 A.M. and is away from the nursing unit, awaiting diagnostic testing when lunch trays are distributed. Which of the following actions is best to prevent hypoglycemia?
- A. Save the lunch tray to be provided upon the patient's return to the unit.
- B. Call the diagnostic testing area and ask that a 5% dextrose IV be started.
- C. Ensure that the patient drinks a glass of orange juice at noon in the diagnostic testing area.
- D. Request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.
Correct Answer: D
Rationale: Consistency for mealtimes assists with regulation of blood 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. Administration of an IV solution is unnecessarily invasive for the patient. A glass of juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in this item.
Which of the following information about a patient who receives rosiglitazone is most important for the nurse to report immediately to the health care provider?
- A. The patient's blood pressure is 159/92.
- B. The patient has a history of emphysema.
- C. The patient's noon blood glucose is 4.7 mmol/L.
- D. The patient has chest pressure when ambulating.
Correct Answer: D
Rationale: Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. There is no urgent need to discuss the other data with the health care provider.
The nurse is assessing a patient for diabetes at a clinic who has a fasting plasma glucose level of 6.7 mmol/L. Which of the following information should the nurse include in the plan of care?
- A. Self-monitoring of blood glucose
- B. Use of low doses of regular insulin
- C. Lifestyle changes to lower blood glucose
- D. Effects of oral hypoglycemic medications
Correct Answer: C
Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counselled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.
The home health nurse is providing teaching to a patient and family about how to use glargine and regular insulin safely. Which of the following actions by the patient indicates that the teaching has been successful?
- A. The patient administers the glargine 30-45 minutes before eating each meal.
- B. The patient's family fills the syringes weekly and stores them in the refrigerator.
- C. The patient draws up the regular insulin and then the glargine in the same syringe.
- D. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
Correct Answer: D
Rationale: 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, while glargine is given once daily.