Nokea
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.
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Which of the following actions should the nurse take first when teaching a patient who is newly diagnosed with type 2 diabetes about home management of the disease?
- A. Ask the patient's family to participate in the diabetes education program.
- B. Assess the patient's perception of what it means to have diabetes mellitus.
- C. Demonstrate how to check glucose using capillary blood glucose monitoring.
- D. Discuss the need for the patient to participate actively in diabetes management.
Correct Answer: B
Rationale: Before planning education, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.
Which of the following actions is most important for the nurse to take in order to assist a patient with diabetes to engage in moderate daily exercise?
- A. Remind the patient that exercise will improve self-esteem.
- B. Determine what type of exercise activities the patient enjoys.
- C. Give the patient a list of activities that are moderate in intensity.
- D. Teach the patient about the effects of exercise on glucose level.
Correct Answer: B
Rationale: Since consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions will also be implemented but are not the most important in improving compliance.
Which of the following patient teaching information is most important for the nurse to communicate to a patient with gestational diabetes?
- A. Delivery will not affect blood glucose levels.
- B. Exercise should be avoided in the last month of pregnancy.
- C. Monitoring of blood glucose can stop as soon as the baby is delivered.
- D. A postpartum OGTT will be done at 2 months.
Correct Answer: D
Rationale: Women should be screened postpartum to determine their glucose status. The 2008 CDA guidelines recommend a 75-g oral glucose tolerance test (OGTT) be done between 6 weeks and 6 months postpartum. Delivery may affect blood glucose levels. Exercise is not to be avoided. Monitoring of blood glucose will continue into the postpartum period until levels are within normal limits.
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 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.