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Which of the following information about a patient who receives rosiglitazone is most important for the nurse to report immediately to the health care provider?
- A. The patient's blood pressure is 159/92.
- B. The patient has a history of emphysema.
- C. The patient's noon blood glucose is 4.7 mmol/L.
- D. The patient has chest pressure when ambulating.
Correct Answer: D
Rationale: Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. There is no urgent need to discuss the other data with the health care provider.
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Which of the following patient actions indicate a good understanding of the nurse's teaching about the use of an insulin pump?
- A. The patient changes the site for the insertion site every week.
- B. The patient programs the pump to deliver an insulin bolus after eating.
- C. The patient takes the pump off at bedtime and starts it again each morning.
- D. The patient states that diet will be less flexible when using the insulin pump.
Correct Answer: B
Rationale: In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used. The pump will deliver a basal insulin rate 24 hours a day.
The nurse is teaching about meal coverage to a patient with diabetes who has just started on intensive insulin therapy. Which of the following types of insulin should the nurse discuss with the patient?
- A. Glargine
- B. Lispro
- C. Detemir
- D. NPH
Correct Answer: B
Rationale: Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
The nurse is admitting a patient with diabetic ketoacidosis. Which of the following prescriptions should the nurse implement first?
- A. Administer regular IV insulin 30 units.
- B. Infuse 1 L of normal saline per hour.
- C. Give sodium bicarbonate 50 mEq IV push.
- D. Start an infusion of regular insulin at 50 units/hour.
Correct Answer: B
Rationale: The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be accomplished after the infusion of normal saline is initiated.
Amitriptyline is prescribed for a diabetic patient who has burning foot pain at night. Which of the following information should the nurse include when teaching the patient about the new medication?
- A. Amitriptyline will decrease the depression caused by your foot pain.
- B. Amitriptyline will correct some of the blood vessel changes that cause pain.
- C. Amitriptyline will improve sleep and make you less aware of nighttime pain.
- D. Amitriptyline will help prevent the transmission of pain impulses to the brain.
Correct Answer: D
Rationale: Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain. Tricyclics also improve sleep quality and are used for depression, but that is not the major purpose for their use in diabetic neuropathy. The blood vessel changes that contribute to neuropathy are not affected by tricyclics.
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.