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A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should prioritize which of the following assessments?
- A. Monitoring the patients neutrophil levels
- B. Assessing the patient for signs of impaired liver function
- C. Monitoring the patients level of consciousness and behavior
- D. Reviewing the patients creatinine and BUN levels
Correct Answer: D
Rationale: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patients renal function. This drug does not typically affect patients neutrophils, liver function, or cognition.
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A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient?
- A. Do not eliminate insulin when nauseated and vomiting.
- B. Report elevated glucose levels greater than 150 mg/dL.
- C. Eat three substantial meals a day, if possible.
- D. Reduce food intake and insulin doses in times of illness.
Correct Answer: A
Rationale: The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.
A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes?
- A. Ask the patient to describe an optimally healthy meal.
- B. Ask the patient to keep a food diary and review it with the nurse.
- C. Ask the patients family what he typically eats.
- D. Ask the patient to describe a typical days food intake.
Correct Answer: B
Rationale: Reviewing the patients actual food intake is the most accurate method of gauging the patients diet.
A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the bodys need for insulin?
- A. Adequate sleep
- B. Low stimulation
- C. Exercise
- D. Low-fat diet
Correct Answer: C
Rationale: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.
A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the patient and will implement a program of health education. What is the nurses priority action?
- A. Ensure that the patient understands the basic pathophysiology of diabetes.
- B. Identify the patients body mass index.
- C. Teach the patient survival skills for diabetes.
- D. Assess the patients readiness to learn.
Correct Answer: D
Rationale: Before initiating diabetes education, the nurse assesses the patients (and familys) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.
A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur?
- A. Patients who are obese and who have no known history of diabetes
- B. Patients with type 1 diabetes and poor dietary control
- C. Adolescents with type 2 diabetes and sporadic use of antihyperglycemics
- D. Middle-aged or older people with either type 2 diabetes or no known history of diabetes
Correct Answer: D
Rationale: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes.