Nokea
The nurse is caring for a patient who received aspart insulin at 8:00 A.M. Which of the following times is most important for the nurse to monitor for symptoms of hypoglycemia?
- A. 9:00 A.M.
- B. 1:30 A.M.
- C. 4:00 P.M.
- D. 8:00 P.M.
Correct Answer: A
Rationale: The rapid-acting insulins peak in 60-90 minutes. The patient is not at a high risk for hypoglycemia at the other listed times although hypoglycemia may occur.
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Which of the following information about a patient who receives rosiglitazone is most important for the nurse to report immediately to the health care provider?
- A. The patient's blood pressure is 159/92.
- B. The patient has a history of emphysema.
- C. The patient's noon blood glucose is 4.7 mmol/L.
- D. The patient has chest pressure when ambulating.
Correct Answer: D
Rationale: Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. There is no urgent need to discuss the other data with the health care provider.
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.
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 is teaching the patient to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. Which of the following statements by the patient indicates a need for additional instruction?
- A. I need to rotate injection sites among my arms, legs, and abdomen each day.
- B. I will buy the 0.5 mL syringes because the line markings will be easier to see.
- C. I should draw up the regular insulin first after injecting air into the NPH bottle.
- D. I do not need to aspirate the plunger to check for blood before injecting insulin.
Correct Answer: A
Rationale: Rotating sites are no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other patient statements are accurate and indicate that no additional instruction is needed.
The nurse is preparing to assess a patient who is pregnant and has no personal history of diabetes but does have a parent with diabetes. Which of the following actions should the nurse plan to take on this initial prenatal visit?
- A. Teach about appropriate use of regular insulin.
- B. Discuss the need for a fasting blood glucose level.
- C. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.
- D. Provide education about increased risk for fetal problems with gestational diabetes.
Correct Answer: B
Rationale: Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be used to check for diabetes, but it would be done before the twenty-fourth week. The other actions may also be needed (depending on whether the patient develops gestational diabetes), but they are not the first actions that the nurse should take.