Nokea
The nurse is caring for a patient with diabetes who received 34 units of NPH insulin at 7:00 A.M. and is away from the nursing unit, awaiting diagnostic testing when lunch trays are distributed. Which of the following actions is best to prevent hypoglycemia?
- A. Save the lunch tray to be provided upon the patient's return to the unit.
- B. Call the diagnostic testing area and ask that a 5% dextrose IV be started.
- C. Ensure that the patient drinks a glass of orange juice at noon in the diagnostic testing area.
- D. Request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.
Correct Answer: D
Rationale: Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in this item.
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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 nurse is admitting a patient with type 2 diabetes for an outpatient coronary arteriogram. Which of the following information obtained by the nurse is most important to report to the health care provider before the procedure?
- A. The patient's admission blood glucose is 7.1 mmol/L.
- B. The patient's most recent Hb A1C was 6.5%.
- C. The patient took the prescribed metformin today.
- D. The patient took the prescribed captopril this morning.
Correct Answer: C
Rationale: To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogram and should not be used for 48 hours after IV contrast media are administered. The other patient data will also be reported but do not indicate any need to reschedule the procedure.
Which of the following actions by a patient with type 1 diabetes indicates that the nurse should implement teaching about exercise and glucose control?
- A. The patient always carries hard candies when engaging in exercise.
- B. The patient goes for a vigorous walk when the glucose is 11.1 mmol/L.
- C. The patient has a peanut butter sandwich before going for a bicycle ride.
- D. The patient increases daily exercise when ketones are present in the urine.
Correct Answer: D
Rationale: When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic patients should be taught to avoid exercise when ketosis is present. The other statements are correct.
The nurse is assessing a patient for diabetes at a clinic who has a fasting plasma glucose level of 6.7 mmol/L. Which of the following information should the nurse include in the plan of care?
- A. Self-monitoring of blood glucose
- B. Use of low doses of regular insulin
- C. Lifestyle changes to lower blood glucose
- D. Effects of oral hypoglycemic medications
Correct Answer: C
Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counselled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.
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.