Nokea
Which of the following hormones are considered as counter-regulatory hormones? (Select all that apply.)
- A. Glucagon
- B. Insulin
- C. Epinephrine
- D. Growth hormone
- E. Cortisol
Correct Answer: A,C,D,E
Rationale: Other hormones (glucagon, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are often referred to as counter-regulatory hormones. Insulin is not a counter-regulatory hormone.
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The nurse is assessing a patient's technique of self-monitoring of blood glucose (SMBG) as part of diabetes management. Which of the following actions indicate a need for further teaching?
- A. Washes the puncture site using soap and warm water.
- B. Chooses a puncture site in the centre of the finger pad.
- C. Hangs the arm down for a minute before puncturing the site.
- D. Says the result of 6.1 mmol/L indicates good blood sugar control.
Correct Answer: B
Rationale: The patient is taught to choose a puncture site at the side of the finger pad. The other patient actions indicate that teaching has been effective.
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 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.
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.
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.