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A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address?
- A. Signs and symptoms of diabetic nephropathy
- B. Management of diabetic ketoacidosis
- C. Effects of surgery and pregnancy on blood sugar levels
- D. Recognition of hypoglycemia and hyperglycemia
Correct Answer: D
Rationale: It is imperative that newly diagnosed patients know the signs and symptoms and management of hypoand hyperglycemia. The other listed topics are valid points for education, but are not components of the patients immediate survival skills following a new diagnosis.
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A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the patients ability to prepare and self-administer insulin?
- A. Ask the patient to describe the process in detail.
- B. Observe the patient drawing up and administering the insulin.
- C. Provide a health education session reviewing the main points of insulin delivery.
- D. Review the patients first hemoglobin A1C result after discharge.
Correct Answer: B
Rationale: Nurses should assess the patients ability to perform diabetes related self-care as soon as possible during the hospitalization or office visit to determine whether the patient requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the patient about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.
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 medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur?
- A. Patients who are obese and who have no known history of diabetes
- B. Patients with type 1 diabetes and poor dietary control
- C. Adolescents with type 2 diabetes and sporadic use of antihyperglycemics
- D. Middle-aged or older people with either type 2 diabetes or no known history of diabetes
Correct Answer: D
Rationale: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes.
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 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor?
- A. Increased caloric intake during the first trimester
- B. Changes in osmolality and fluid balance
- C. The effects of hormonal changes during pregnancy
- D. Overconsumption of carbohydrates during the first two trimesters
Correct Answer: C
Rationale: Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality.