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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.
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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.
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 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.
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.
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.