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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.
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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.
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.
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.
The home health nurse is providing teaching to a patient and family about how to use glargine and regular insulin safely. Which of the following actions by the patient indicates that the teaching has been successful?
- A. The patient administers the glargine 30-45 minutes before eating each meal.
- B. The patient's family fills the syringes weekly and stores them in the refrigerator.
- C. The patient draws up the regular insulin and then the glargine in the same syringe.
- D. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
Correct Answer: D
Rationale: Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals, while glargine is given once daily.
The nurse is caring for a patient with type 2 diabetes who has sensory neuropathy of the feet and legs and peripheral arterial disease. Which of the following information will the nurse include in patient teaching?
- A. Choose flat-soled leather shoes.
- B. Set heating pads on a low temperature.
- C. Buy callus remover for corns or calluses.
- D. Soak the feet in warm water for an hour every day.
Correct Answer: A
Rationale: The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems.