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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.
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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.
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.
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 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 caring for a patient who has just been diagnosed with type 2 diabetes and has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which of the following patient goals is most important?
- A. The patient will have a glycosylated hemoglobin level of less than 7%
- B. The patient will have a diet and exercise plan that results in weight loss.
- C. The patient will choose a diet that distributes calories throughout the day.
- D. The patient will state the reasons for eliminating simple sugars in the diet.
Correct Answer: A
Rationale: The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.