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The nurse is teaching the patient to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. Which of the following statements by the patient indicates a need for additional instruction?
- A. I need to rotate injection sites among my arms, legs, and abdomen each day.
- B. I will buy the 0.5 mL syringes because the line markings will be easier to see.
- C. I should draw up the regular insulin first after injecting air into the NPH bottle.
- D. I do not need to aspirate the plunger to check for blood before injecting insulin.
Correct Answer: A
Rationale: Rotating sites are no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other patient statements are accurate and indicate that no additional instruction is needed.
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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.
A diagnosis of hyperglycemic hyperosmolar state (HHS) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. Which of the following actions should the nurse anticipate?
- A. Give 50% dextrose as a bolus.
- B. Insert a large-bore IV catheter.
- C. Initiate oxygen by nasal cannula.
- D. Administer glargine insulin.
Correct Answer: B
Rationale: HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.
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.
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.