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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.
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Which of the following hormones are considered as counter-regulatory hormones? (Select all that apply.)
- A. Glucagon
- B. Insulin
- C. Epinephrine
- D. Growth hormone
- E. Cortisol
Correct Answer: A,C,D,E
Rationale: Other hormones (glucagon, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are often referred to as counter-regulatory hormones. Insulin is not a counter-regulatory hormone.
To evaluate the effectiveness of treatment for a patient with type 2 diabetes who is scheduled for a follow-up visit in the clinic, which of the following tests will the nurse plan to schedule for the patient?
- A. Urine dipstick for glucose
- B. Oral glucose tolerance test
- C. Fasting blood glucose level
- D. Glycosylated hemoglobin level
Correct Answer: D
Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90-120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control once diabetes has been diagnosed.
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.
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.
Which of the following questions by the nurse will help identify autonomic neuropathy in a patient with diabetes?
- A. Have you observed any recent skin changes?
- B. Do you notice any bloating feeling after eating?
- C. Do you need to increase your insulin dosage when you are stressed?
- D. Have you noticed any painful new ulcerations or sores on your feet?
Correct Answer: B
Rationale: Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions are also appropriate to ask, but would not help in identifying autonomic neuropathy.