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Which of the following laboratory values, noted by the nurse when reviewing the chart of a hospitalized patient with diabetes, indicates the need for rapid assessment of the patient?
- A. Hb A1C of 5.8%.
- B. Noon blood glucose of 2.9 mmol/L.
- C. Hb A1C of 6.9%.
- D. Fasting blood glucose of 7.2 mmol/L.
Correct Answer: B
Rationale: The nurse should assess the patient with a blood glucose level of 2.9 mmol/L for symptoms of hypoglycemia as the normal range is 4-6 mmol/L. The other values are within an acceptable range for a diabetic patient.
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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.
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.
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 nurse is admitting a patient with diabetic ketoacidosis (DKA) who has a serum potassium level of 2.9 mmol/L. Which of the following actions prescribed by the health care provider should the nurse take first?
- A. Infuse regular insulin at 20 units/hour.
- B. Place the patient on a cardiac monitor.
- C. Administer IV potassium supplements.
- D. Obtain urine glucose and ketone levels.
Correct Answer: B
Rationale: Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Since potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring, since insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the patient's care.
Which of the following information should the nurse include when teaching a patient who has type 2 diabetes about glyburide?
- A. Glyburide decreases glucagon secretion from the pancreas.
- B. Glyburide stimulates insulin production and release from the pancreas.
- C. Glyburide should be taken even if the morning blood glucose level is low.
- D. Glyburide should not be used for 48 hours after receiving IV contrast media.
Correct Answer: B
Rationale: The sulphonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking the glyburide because hypoglycemia can occur with this category of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide.