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A patient who has type 1 diabetes plans to take a swimming class daily at 1:00 P.M. Which of the following instructions should the nurse teach to the patient?
- A. Check glucose level before, during, and after swimming.
- B. Delay eating the noon meal until after the swimming class.
- C. Increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
- D. Time the morning insulin injection so that the peak occurs while swimming.
Correct Answer: A
Rationale: The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.
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The nurse obtains the following information about a patient before administration of metformin. Which of the following findings indicate a need to contact the health care provider before giving the metformin?
- A. The patient's blood glucose level is 9.2 mmol/L.
- B. The patient's blood urea nitrogen (BUN) level is 21.4 mmol/L.
- C. The patient is scheduled for a chest x-ray in an hour.
- D. The patient has gained 1 kg since yesterday.
Correct Answer: B
Rationale: The BUN indicates impending renal failure and metformin should not be used in patients with renal or hepatic impairment. The other findings are not contraindications to the use of metformin.
The nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis and the patient reports feeling anxious, nervous, and sweaty. Which of the following actions should the nurse take first?
- A. Administer 1 mg glucagon subcutaneously.
- B. Obtain a glucose reading using a finger stick.
- C. Have the patient drink 120 mL of orange juice.
- D. Give the scheduled dose of lispro insulin.
Correct Answer: B
Rationale: The patient's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the patient's symptoms become worse or if the patient is unconscious. Administration of lispro would drop the patient's glucose further.
The nurse is admitting a patient with type 2 diabetes for an outpatient coronary arteriogram. Which of the following information obtained by the nurse is most important to report to the health care provider before the procedure?
- A. The patient's admission blood glucose is 7.1 mmol/L.
- B. The patient's most recent Hb A1C was 6.5%.
- C. The patient took the prescribed metformin today.
- D. The patient took the prescribed captopril this morning.
Correct Answer: C
Rationale: To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogram and should not be used for 48 hours after IV contrast media are administered. The other patient data will also be reported but do not indicate any need to reschedule the procedure.
The nurse is caring for a patient who has just been diagnosed with type 2 diabetes and has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which of the following patient goals is most important?
- A. The patient will have a glycosylated hemoglobin level of less than 7%
- B. The patient will have a diet and exercise plan that results in weight loss.
- C. The patient will choose a diet that distributes calories throughout the day.
- D. The patient will state the reasons for eliminating simple sugars in the diet.
Correct Answer: A
Rationale: The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.
Which of the following actions is most important for the nurse to take in order to assist a patient with diabetes to engage in moderate daily exercise?
- A. Remind the patient that exercise will improve self-esteem.
- B. Determine what type of exercise activities the patient enjoys.
- C. Give the patient a list of activities that are moderate in intensity.
- D. Teach the patient about the effects of exercise on glucose level.
Correct Answer: B
Rationale: Since consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions will also be implemented but are not the most important in improving compliance.