Nokea
To evaluate the effectiveness of treatment for a patient with type 2 diabetes who is scheduled for a follow-up visit in the clinic, which of the following tests will the nurse plan to schedule for the patient?
- A. Urine dipstick for glucose
- B. Oral glucose tolerance test
- C. Fasting blood glucose level
- D. Glycosylated hemoglobin level
Correct Answer: D
Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90-120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control once diabetes has been diagnosed.
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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.
A patient with type 1 diabetes who is on glargine and lispro insulin has called the clinic to report symptoms of a sore throat, cough, fever, and blood glucose level of 11.7 mmol/L. Which of the following information should the nurse tell the patient?
- A. Use only the lispro insulin until the symptoms of infection are resolved.
- B. Monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
- C. Decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
- D. Limit intake of calorie-containing liquids until the glucose is less than 6.7 mmol/L.
Correct Answer: B
Rationale: Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin is not used to test for short-term alterations in blood glucose.
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 teaching a patient with diabetes who rides a bicycle to work every day about morning administration of insulin. Which of the following sites should the nurse tell the patient to use to administer the morning insulin?
- A. Arm
- B. Thigh
- C. Buttock
- D. Abdomen
Correct Answer: D
Rationale: Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.
The nurse administers intramuscular glucagon to a patient who is unresponsive for treatment of hypoglycemia. Which of the following actions should the nurse take after the patient regains consciousness?
- A. Assess the patient for symptoms of hyperglycemia.
- B. Give the patient a snack of crackers and peanut butter.
- C. Have the patient drink a glass of orange juice or nonfat milk.
- D. Administer a continuous infusion of 5% dextrose for 24 hours.
Correct Answer: B
Rationale: Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. A starch snack is recommended. Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and crackers will stabilize blood sugar. Administration of glucose intravenously might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.