Nokea
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.
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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 patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?
- A. A sulfonylurea
- B. A biguanide
- C. A thiazolidinedione
- D. An alpha glucosidase inhibitor
Correct Answer: B
Rationale: Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of insulin can be stored at room temperature before it goes bad. What would be the nurses best answer?
- A. If you are going to use up the vial within 1 month it can be kept at room temperature.
- B. If a vial of insulin will be used up within 21 days, it may be kept at room temperature.
- C. If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature.
- D. If a vial of insulin will be used up within 1 week, it may be kept at room temperature.
Correct Answer: A
Rationale: If a vial of insulin will be used up within 1 month, it may be kept at room temperature.
A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients at this class?
- A. Low fat generally indicates low sugar.
- B. Protein should constitute 30% to 40% of caloric intake.
- C. Most calories should be derived from carbohydrates.
- D. Animal fats should be eliminated from the diet.
Correct Answer: C
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 should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.
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.