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A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is likely to have minimal contact with the health care system. In order to ensure that the patient maintains adequate blood sugar control over the long term, the nurse should recommend which of the following?
- A. Participation in a support group for persons with diabetes
- B. Regular consultation of websites that address diabetes management
- C. Weekly telephone check-ins with an endocrinologist
- D. Participation in clinical trials relating to antihyperglycemics
Correct Answer: A
Rationale: Participation in support groups is encouraged for patients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on patients circumstances.
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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 diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADAs recommendations include?
- A. 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein
- B. 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein
- C. 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein
- D. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein
Correct Answer: D
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 come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.
A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?
- A. The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase.
- B. Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it.
- C. The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin.
- D. Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.
Correct Answer: D
Rationale: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not make glucose.
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.
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.