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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.
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The nurse knows to administer acarbose, an alpha-glucosidase inhibitor, at which time?
- A. 30 minutes before breakfast
- B. With the first bite of each main meal
- C. 30 minutes after breakfast
- D. Once daily at bedtime
Correct Answer: B
Rationale: Acarbose is taken with the first bite of each main meal to inhibit carbohydrate digestion, reducing postprandial glucose spikes.
The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true?
- A. Insulin is never given intravenously.
- B. Only regular insulin can be administered intravenously.
- C. Insulin aspart or insulin lispro can be administered intravenously, but there must be a 50% dose reduction.
- D. Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration.
Correct Answer: B
Rationale: Only regular insulin is approved for IV administration, typically in emergencies like diabetic ketoacidosis, due to its predictable pharmacokinetics.
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.
The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct?
- A. Patients with type 2 diabetes will never need insulin.
- B. Oral antidiabetic drugs are safe for use during pregnancy.
- C. Pediatric patients cannot take insulin.
- D. Insulin therapy is possible during pregnancy if managed carefully.
Correct Answer: D
Rationale: Insulin is the preferred therapy for diabetes in pregnancy due to safety concerns with oral antidiabetic drugs. Type 2 patients may need insulin, and pediatric patients can use insulin.
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.