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A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 38 mg/dL. The patient has just become unconscious. The nurse will anticipate which action to be next?
- A. Having the patient eat glucose tablets
- B. Having the patient consume fruit juice, a nondiet soft drink, or crackers
- C. Administering intravenous glucose (50% dextrose)
- D. Calling the lab to order a fasting blood glucose level
Correct Answer: C
Rationale: Unconscious patients with hypoglycemia require IV glucose (e.g., 50% dextrose) to rapidly restore blood sugar, as oral intake is not possible. Lab tests are not immediate priorities.
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A 55-year-old woman with type 2 diabetes has recently been placed on glipizide. She asks the nurse when the best time would be to take this medication. What is the nurse's best response?
- A. Take this medication in the morning, 30 minutes before breakfast.
- B. Take this medication in the evening with a snack.
- C. This medication needs to be taken after the midday meal.
- D. It does not matter what time of day you take this medication.
Correct Answer: A
Rationale: Glipizide, a sulfonylurea, is taken 30 minutes before breakfast to align insulin secretion with postprandial glucose rise, mimicking normal physiology.
The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?
- A. Basal dosing delivers a constant dose of insulin.
- B. With basal dosing, you can eat what you want and then give yourself a dose of insulin.
- C. Glargine insulin is given as a bolus with meals.
- D. Basal-bolus dosing is the traditional method of managing blood glucose levels.
Correct Answer: A
Rationale: Basal dosing, such as with glargine, provides a steady insulin level to maintain baseline glucose control. Glargine is not a bolus insulin, and basal-bolus is a modern approach.
A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs?
- A. Administer half the original dose.
- B. Withhold all medications as ordered.
- C. Contact the prescriber for further orders.
- D. Give the medication with a sip of water.
Correct Answer: C
Rationale: NPO status increases hypoglycemia risk with oral antidiabetic drugs, so the prescriber must be contacted for adjusted orders. Giving or withholding without guidance is unsafe.
A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation?
- A. The antibiotics may cause an increase in glucose levels.
- B. The corticosteroids may cause an increase in glucose levels.
- C. The patient's type 2 diabetes has converted to type 1.
- D. The hypoxia caused by the COPD causes an increased need for insulin.
Correct Answer: B
Rationale: Corticosteroids increase blood glucose by inducing insulin resistance and stimulating gluconeogenesis. Antibiotics, COPD hypoxia, or type 1 conversion are not the primary causes.
The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class?
- A. Glitazone
- B. Insulin
- C. Metformin
- D. Sulfonylurea
Correct Answer: B
Rationale: Sitagliptin, a DPP-4 inhibitor, is not typically combined with insulin due to lack of established safety and efficacy. It can be used with metformin, sulfonylureas, or glitazones.