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A patient with type 1 diabetes who is on glargine and lispro insulin has called the clinic to report symptoms of a sore throat, cough, fever, and blood glucose level of 11.7 mmol/L. Which of the following information should the nurse tell the patient?
- A. Use only the lispro insulin until the symptoms of infection are resolved.
- B. Monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
- C. Decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
- D. Limit intake of calorie-containing liquids until the glucose is less than 6.7 mmol/L.
Correct Answer: B
Rationale: Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin is not used to test for short-term alterations in blood glucose.
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The nurse is admitting a patient with diabetic ketoacidosis. Which of the following prescriptions should the nurse implement first?
- A. Administer regular IV insulin 30 units.
- B. Infuse 1 L of normal saline per hour.
- C. Give sodium bicarbonate 50 mEq IV push.
- D. Start an infusion of regular insulin at 50 units/hour.
Correct Answer: B
Rationale: The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be accomplished after the infusion of normal saline is initiated.
Which of the following information should the nurse include when teaching a patient who has type 2 diabetes about glyburide?
- A. Glyburide decreases glucagon secretion from the pancreas.
- B. Glyburide stimulates insulin production and release from the pancreas.
- C. Glyburide should be taken even if the morning blood glucose level is low.
- D. Glyburide should not be used for 48 hours after receiving IV contrast media.
Correct Answer: B
Rationale: The sulphonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking the glyburide because hypoglycemia can occur with this category of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide.
The nurse is caring for a patient with newly diagnosed type 2 diabetes mellitus who asks the nurse what 'type 2' means in relation to diabetes. Which of the following statements by the nurse about type 2 diabetes is correct?
- A. Insulin is not used to control blood glucose in patients with type 2 diabetes.
- B. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
- C. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma
- D. Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.
Correct Answer: D
Rationale: For some patients, changes in lifestyle are sufficient for blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.
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.
Which of the following laboratory values, noted by the nurse when reviewing the chart of a hospitalized patient with diabetes, indicates the need for rapid assessment of the patient?
- A. Hb A1C of 5.8%.
- B. Noon blood glucose of 2.9 mmol/L.
- C. Hb A1C of 6.9%.
- D. Fasting blood glucose of 7.2 mmol/L.
Correct Answer: B
Rationale: The nurse should assess the patient with a blood glucose level of 2.9 mmol/L for symptoms of hypoglycemia as the normal range is 4-6 mmol/L. The other values are within an acceptable range for a diabetic patient.