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The nurse is caring for a patient who has just been diagnosed with type 2 diabetes and has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which of the following patient goals is most important?
- A. The patient will have a glycosylated hemoglobin level of less than 7%
- B. The patient will have a diet and exercise plan that results in weight loss.
- C. The patient will choose a diet that distributes calories throughout the day.
- D. The patient will state the reasons for eliminating simple sugars in the diet.
Correct Answer: A
Rationale: The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.
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A patient with type 2 diabetes that is well-controlled with metformin develops an allergic rash to an antibiotic and the health care provider prescribes prednisone. Which of the following information should the nurse anticipate while the patient is taking the prednisone?
- A. A diet higher in calories
- B. Administration of insulin
- C. Development of acute hypoglycemia
- D. Appearance of a rash caused by metformin-prednisone interactions
Correct Answer: B
Rationale: Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not an adverse effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone but will not need a diet that is higher in calories.
The nurse is admitting a patient with diabetic ketoacidosis. Which of the following prescriptions should the nurse implement first?
- A. Administer regular IV insulin 30 units.
- B. Infuse 1 L of normal saline per hour.
- C. Give sodium bicarbonate 50 mEq IV push.
- D. Start an infusion of regular insulin at 50 units/hour.
Correct Answer: B
Rationale: The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be accomplished after the infusion of normal saline is initiated.
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.
The nurse is caring for a patient with type 2 diabetes who has sensory neuropathy of the feet and legs and peripheral arterial disease. Which of the following information will the nurse include in patient teaching?
- A. Choose flat-soled leather shoes.
- B. Set heating pads on a low temperature.
- C. Buy callus remover for corns or calluses.
- D. Soak the feet in warm water for an hour every day.
Correct Answer: A
Rationale: The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems.
The health care provider suspects the Somogyi effect in a patient whose 7:00 A.M. blood glucose is 12.2 mmol/L. Which action should the nurse plan to take?
- A. Check the patient's blood glucose at 3:00 A.M.
- B. Administer a larger dose of long-acting insulin
- C. Educate about the need to increase the rapid-acting insulin dose.
- D. Remind the patient about the need to avoid snacking at bedtime.
Correct Answer: A
Rationale: If the Somogyi effect is causing the patient's increased morning glucose level, the patient will experience hypoglycemia between 2 and 4 A.M. The dose of insulin will be reduced, rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night.