Nokea
A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the bodys need for insulin?
- A. Adequate sleep
- B. Low stimulation
- C. Exercise
- D. Low-fat diet
Correct Answer: C
Rationale: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.
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A patient with a history of type I diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase of treatment?
- A. Monitoring the patient for dysrhythmias
- B. Maintaining and monitoring the patients fluid balance
- C. Assessing the patients level of consciousness
- D. Assessing the patient for signs and symptoms of venous thromboembolism
Correct Answer: B
Rationale: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.
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 diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient?
- A. Do not eliminate insulin when nauseated and vomiting.
- B. Report elevated glucose levels greater than 150 mg/dL.
- C. Eat three substantial meals a day, if possible.
- D. Reduce food intake and insulin doses in times of illness.
Correct Answer: A
Rationale: The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.
A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurses most plausible conclusion based on this assessment finding?
- A. The patient should withhold his next scheduled dose of insulin.
- B. The patient should promptly eat some protein and carbohydrates.
- C. The patients insulin levels are inadequate.
- D. The patient would benefit from a dose of metformin (Glucophage).
Correct Answer: C
Rationale: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin will not cause short-term resolution of hyperglycemia.
A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote?
- A. Always carry a form of fast-acting sugar.
- B. Perform exercise prior to eating whenever possible.
- C. Eat a meal or snack every 8 hours.
- D. Check blood sugar at least every 24 hours.
Correct Answer: A
Rationale: The following teaching points should be included in information provided to the patient on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.