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The nurse is caring for a patient with newly diagnosed type 1 diabetes who has received diet instruction. Which of the following patient statements indicate a need for additional instruction?
- A. I may have an occasional alcoholic drink if I include it in my meal plan.
- B. I will need a bedtime snack because I take an evening dose of NPH insulin.
- C. I may eat whatever I want, as long as I use enough insulin to cover the calories.
- D. I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia.
Correct Answer: C
Rationale: Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.
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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.
The nurse is teaching about meal coverage to a patient with diabetes who has just started on intensive insulin therapy. Which of the following types of insulin should the nurse discuss with the patient?
- A. Glargine
- B. Lispro
- C. Detemir
- D. NPH
Correct Answer: B
Rationale: Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
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.
After the nurse has finished teaching a patient about self-administration of the prescribed aspart insulin, which of the following patient actions indicate good understanding of the teaching?
- A. The patient avoids injecting the insulin into the upper abdominal area.
- B. The patient cleans the skin with soap and water before insulin administration.
- C. The patient places the insulin back in the freezer after administering the prescribed insulin dose.
- D. The patient pushes the plunger down and immediately removes the syringe from the injection site.
Correct Answer: B
Rationale: The use of an alcohol swab on the site before self-injection is no longer recommended. Routine hygiene such as washing with soap and rinsing with water is adequate. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.
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.