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The nurse is assessing a patient for diabetes at a clinic who has a fasting plasma glucose level of 6.7 mmol/L. Which of the following information should the nurse include in the plan of care?
- A. Self-monitoring of blood glucose
- B. Use of low doses of regular insulin
- C. Lifestyle changes to lower blood glucose
- D. Effects of oral hypoglycemic medications
Correct Answer: C
Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counselled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.
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A patient who has type 1 diabetes plans to take a swimming class daily at 1:00 P.M. Which of the following instructions should the nurse teach to the patient?
- A. Check glucose level before, during, and after swimming.
- B. Delay eating the noon meal until after the swimming class.
- C. Increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
- D. Time the morning insulin injection so that the peak occurs while swimming.
Correct Answer: A
Rationale: The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.
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.
Which of the following actions should the nurse take first when teaching a patient who is newly diagnosed with type 2 diabetes about home management of the disease?
- A. Ask the patient's family to participate in the diabetes education program.
- B. Assess the patient's perception of what it means to have diabetes mellitus.
- C. Demonstrate how to check glucose using capillary blood glucose monitoring.
- D. Discuss the need for the patient to participate actively in diabetes management.
Correct Answer: B
Rationale: Before planning education, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.
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.
The nurse obtains the following information about a patient before administration of metformin. Which of the following findings indicate a need to contact the health care provider before giving the metformin?
- A. The patient's blood glucose level is 9.2 mmol/L.
- B. The patient's blood urea nitrogen (BUN) level is 21.4 mmol/L.
- C. The patient is scheduled for a chest x-ray in an hour.
- D. The patient has gained 1 kg since yesterday.
Correct Answer: B
Rationale: The BUN indicates impending renal failure and metformin should not be used in patients with renal or hepatic impairment. The other findings are not contraindications to the use of metformin.