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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.
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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.
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.
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 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.