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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.
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A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor?
- A. Increased caloric intake during the first trimester
- B. Changes in osmolality and fluid balance
- C. The effects of hormonal changes during pregnancy
- D. Overconsumption of carbohydrates during the first two trimesters
Correct Answer: C
Rationale: Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality.
A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best response?
- A. Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years.
- B. The cause is not known for sure but it is thought to have something to do with ketoacidosis.
- C. The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years.
- D. Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels.
Correct Answer: C
Rationale: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.
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.
Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control?
- A. A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
- B. A patient who never deviates from her prescribed dose of insulin
- C. A patient who adheres closely to a meal plan and meal schedule
- D. A patient who eliminates carbohydrates from his daily intake
Correct Answer: C
Rationale: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.
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.