Nokea
The nurse is caring for a patient with newly diagnosed type 2 diabetes mellitus who asks the nurse what 'type 2' means in relation to diabetes. Which of the following statements by the nurse about type 2 diabetes is correct?
- A. Insulin is not used to control blood glucose in patients with type 2 diabetes.
- B. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
- C. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma
- D. Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.
Correct Answer: D
Rationale: For some patients, changes in lifestyle are sufficient for blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.
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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.
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.
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.
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.
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.