Nokea
The home health nurse is providing teaching to a patient and family about how to use glargine and regular insulin safely. Which of the following actions by the patient indicates that the teaching has been successful?
- A. The patient administers the glargine 30-45 minutes before eating each meal.
- B. The patient's family fills the syringes weekly and stores them in the refrigerator.
- C. The patient draws up the regular insulin and then the glargine in the same syringe.
- D. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
Correct Answer: D
Rationale: Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals, while glargine is given once daily.
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A patient with type 2 diabetes that is well-controlled with metformin develops an allergic rash to an antibiotic and the health care provider prescribes prednisone. Which of the following information should the nurse anticipate while the patient is taking the prednisone?
- A. A diet higher in calories
- B. Administration of insulin
- C. Development of acute hypoglycemia
- D. Appearance of a rash caused by metformin-prednisone interactions
Correct Answer: B
Rationale: Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not an adverse effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone but will not need a diet that is higher in calories.
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.
Amitriptyline is prescribed for a diabetic patient who has burning foot pain at night. Which of the following information should the nurse include when teaching the patient about the new medication?
- A. Amitriptyline will decrease the depression caused by your foot pain.
- B. Amitriptyline will correct some of the blood vessel changes that cause pain.
- C. Amitriptyline will improve sleep and make you less aware of nighttime pain.
- D. Amitriptyline will help prevent the transmission of pain impulses to the brain.
Correct Answer: D
Rationale: Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain. Tricyclics also improve sleep quality and are used for depression, but that is not the major purpose for their use in diabetic neuropathy. The blood vessel changes that contribute to neuropathy are not affected by tricyclics.
The nurse is teaching a patient with diabetes who rides a bicycle to work every day about morning administration of insulin. Which of the following sites should the nurse tell the patient to use to administer the morning insulin?
- A. Arm
- B. Thigh
- C. Buttock
- D. Abdomen
Correct Answer: D
Rationale: Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.
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.