Nokea
The nurse is assessing a patient who is experiencing the onset of symptoms of type 1 diabetes. Which of the following questions is best for the nurse to ask?
- A. Have you lost any weight lately?
- B. How long have you felt anorexic?
- C. Is your urine unusually dark coloured?
- D. Do you crave fluids containing sugar?
Correct Answer: A
Rationale: Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.
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Which of the following laboratory values, noted by the nurse when reviewing the chart of a hospitalized patient with diabetes, indicates the need for rapid assessment of the patient?
- A. Hb A1C of 5.8%.
- B. Noon blood glucose of 2.9 mmol/L.
- C. Hb A1C of 6.9%.
- D. Fasting blood glucose of 7.2 mmol/L.
Correct Answer: B
Rationale: The nurse should assess the patient with a blood glucose level of 2.9 mmol/L for symptoms of hypoglycemia as the normal range is 4-6 mmol/L. The other values are within an acceptable range for a diabetic patient.
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.
The nurse is teaching about meal coverage to a patient with diabetes who has just started on intensive insulin therapy. Which of the following types of insulin should the nurse discuss with the patient?
- A. Glargine
- B. Lispro
- C. Detemir
- D. NPH
Correct Answer: B
Rationale: Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
The nurse is assessing a patient's technique of self-monitoring of blood glucose (SMBG) as part of diabetes management. Which of the following actions indicate a need for further teaching?
- A. Washes the puncture site using soap and warm water.
- B. Chooses a puncture site in the centre of the finger pad.
- C. Hangs the arm down for a minute before puncturing the site.
- D. Says the result of 6.1 mmol/L indicates good blood sugar control.
Correct Answer: B
Rationale: The patient is taught to choose a puncture site at the side of the finger pad. The other patient actions indicate that teaching has been effective.
A patient with type 1 diabetes who is on glargine and lispro insulin has called the clinic to report symptoms of a sore throat, cough, fever, and blood glucose level of 11.7 mmol/L. Which of the following information should the nurse tell the patient?
- A. Use only the lispro insulin until the symptoms of infection are resolved.
- B. Monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
- C. Decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
- D. Limit intake of calorie-containing liquids until the glucose is less than 6.7 mmol/L.
Correct Answer: B
Rationale: Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin is not used to test for short-term alterations in blood glucose.