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A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient about self-administration of insulin in the home setting. The nurse should teach the patient to do which of the following?
- A. Avoid using the same injection site more than once in 2 to 3 weeks.
- B. Avoid mixing more than one type of insulin in a syringe.
- C. Cleanse the injection site thoroughly with alcohol prior to injecting.
- D. Inject at a 45 angle.
Correct Answer: A
Rationale: To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90 angle. Cleansing the injection site with alcohol is optional.
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The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurses most appropriate action?
- A. Teach the patient about actions to slow the progression of nephropathy.
- B. Ensure that the patient receives a comprehensive assessment of liver function.
- C. Determine whether the patient has been using expired insulin.
- D. Administer a fluid challenge and have the test repeated.
Correct Answer: A
Rationale: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the patients liver function is not likely affected. There is no indication for the use of a fluid challenge.
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 nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of insulin can be stored at room temperature before it goes bad. What would be the nurses best answer?
- A. If you are going to use up the vial within 1 month it can be kept at room temperature.
- B. If a vial of insulin will be used up within 21 days, it may be kept at room temperature.
- C. If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature.
- D. If a vial of insulin will be used up within 1 week, it may be kept at room temperature.
Correct Answer: A
Rationale: If a vial of insulin will be used up within 1 month, it may be kept at room temperature.
A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients at this class?
- A. Low fat generally indicates low sugar.
- B. Protein should constitute 30% to 40% of caloric intake.
- C. Most calories should be derived from carbohydrates.
- D. Animal fats should be eliminated from the diet.
Correct Answer: C
Rationale: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.
An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?
- A. Administration of antihypertensive medications
- B. Administering sodium bicarbonate intravenously
- C. Reversing acidosis by administering insulin
- D. Fluid and electrolyte replacement
Correct Answer: D
Rationale: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).