Nokea
The nurse has completed teaching a patient with type 2 diabetes about taking gliclazide. Which of the following patient statements indicate a need for additional teaching?
- A. Other medications besides the gliclazide may affect my blood sugar.
- B. If I overeat at a meal, I will still take just the usual dose of medication.
- C. When I become ill, I may have to take insulin to control my blood sugar.
- D. My diabetes is not as likely to cause complications as if I needed to take insulin.
Correct Answer: D
Rationale: The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of gliclazide.
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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.
Which of the following information about a patient who receives rosiglitazone is most important for the nurse to report immediately to the health care provider?
- A. The patient's blood pressure is 159/92.
- B. The patient has a history of emphysema.
- C. The patient's noon blood glucose is 4.7 mmol/L.
- D. The patient has chest pressure when ambulating.
Correct Answer: D
Rationale: Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. There is no urgent need to discuss the other data with the health care provider.
The nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis and the patient reports feeling anxious, nervous, and sweaty. Which of the following actions should the nurse take first?
- A. Administer 1 mg glucagon subcutaneously.
- B. Obtain a glucose reading using a finger stick.
- C. Have the patient drink 120 mL of orange juice.
- D. Give the scheduled dose of lispro insulin.
Correct Answer: B
Rationale: The patient's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the patient's symptoms become worse or if the patient is unconscious. Administration of lispro would drop the patient's glucose further.
Which of the following actions by a patient with type 1 diabetes indicates that the nurse should implement teaching about exercise and glucose control?
- A. The patient always carries hard candies when engaging in exercise.
- B. The patient goes for a vigorous walk when the glucose is 11.1 mmol/L.
- C. The patient has a peanut butter sandwich before going for a bicycle ride.
- D. The patient increases daily exercise when ketones are present in the urine.
Correct Answer: D
Rationale: When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic patients should be taught to avoid exercise when ketosis is present. The other statements are correct.
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.