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A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration record includes the administration of regular insulin three times daily. Knowing that the patients lunch tray will arrive at 11:45, when should the nurse administer the patients insulin?
- A. 10:45
- B. 11:15
- C. 11:45
- D. 11:50
Correct Answer: B
Rationale: Regular insulin is usually administered 20-30 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.
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A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient?
- A. Examine feet weekly for redness, blisters, and abrasions.
- B. Avoid the use of moisturizing lotions.
- C. Avoid hot-water bottles and heating pads.
- D. Dry feet vigorously after each bath.
Correct Answer: C
Rationale: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.
A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes?
- A. Ask the patient to describe an optimally healthy meal.
- B. Ask the patient to keep a food diary and review it with the nurse.
- C. Ask the patients family what he typically eats.
- D. Ask the patient to describe a typical days food intake.
Correct Answer: B
Rationale: Reviewing the patients actual food intake is the most accurate method of gauging the patients diet.
A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply.
- A. Leukocytosis
- B. Glycosuria
- C. Dehydration
- D. Hypernatremia
- E. Hyperglycemia
Correct Answer: B,C,D,E
Rationale: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.
A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes?
- A. Fasting plasma glucose greater than or equal to 126 mg/dL
- B. Random plasma glucose greater than 150 mg/dL
- C. Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions
- D. Random plasma glucose greater than 126 mg/dL
Correct Answer: A
Rationale: Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.
A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment?
- A. Alterations in bile metabolism and release have likely caused hyperglycemia.
- B. Stress has likely caused an increase in the patients blood sugar levels.
- C. The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures.
- D. The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
Correct Answer: B
Rationale: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The patients need for insulin is unrelated to the action of bile, the patients overestimation of previous blood sugar control, or fluid imbalance.