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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.
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The nurse is admitting a patient with diabetic ketoacidosis (DKA) who has a serum potassium level of 2.9 mmol/L. Which of the following actions prescribed by the health care provider should the nurse take first?
- A. Infuse regular insulin at 20 units/hour.
- B. Place the patient on a cardiac monitor.
- C. Administer IV potassium supplements.
- D. Obtain urine glucose and ketone levels.
Correct Answer: B
Rationale: Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Since potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring, since insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the patient's care.
After the nurse has finished teaching a patient about self-administration of the prescribed aspart insulin, which of the following patient actions indicate good understanding of the teaching?
- A. The patient avoids injecting the insulin into the upper abdominal area.
- B. The patient cleans the skin with soap and water before insulin administration.
- C. The patient places the insulin back in the freezer after administering the prescribed insulin dose.
- D. The patient pushes the plunger down and immediately removes the syringe from the injection site.
Correct Answer: B
Rationale: The use of an alcohol swab on the site before self-injection is no longer recommended. Routine hygiene such as washing with soap and rinsing with water is adequate. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.
The nurse is preparing to assess a patient who is pregnant and has no personal history of diabetes but does have a parent with diabetes. Which of the following actions should the nurse plan to take on this initial prenatal visit?
- A. Teach about appropriate use of regular insulin.
- B. Discuss the need for a fasting blood glucose level.
- C. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.
- D. Provide education about increased risk for fetal problems with gestational diabetes.
Correct Answer: B
Rationale: Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be used to check for diabetes, but it would be done before the twenty-fourth week. The other actions may also be needed (depending on whether the patient develops gestational diabetes), but they are not the first actions that the nurse should take.
The nurse is teaching the patient to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. Which of the following statements by the patient indicates a need for additional instruction?
- A. I need to rotate injection sites among my arms, legs, and abdomen each day.
- B. I will buy the 0.5 mL syringes because the line markings will be easier to see.
- C. I should draw up the regular insulin first after injecting air into the NPH bottle.
- D. I do not need to aspirate the plunger to check for blood before injecting insulin.
Correct Answer: A
Rationale: Rotating sites are no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other patient statements are accurate and indicate that no additional instruction is needed.
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.