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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.
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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.
The nurse administers intramuscular glucagon to a patient who is unresponsive for treatment of hypoglycemia. Which of the following actions should the nurse take after the patient regains consciousness?
- A. Assess the patient for symptoms of hyperglycemia.
- B. Give the patient a snack of crackers and peanut butter.
- C. Have the patient drink a glass of orange juice or nonfat milk.
- D. Administer a continuous infusion of 5% dextrose for 24 hours.
Correct Answer: B
Rationale: Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. A starch snack is recommended. Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and crackers will stabilize blood sugar. Administration of glucose intravenously might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.
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 newly diagnosed type 2 diabetes mellitus who asks the nurse what 'type 2' means in relation to diabetes. Which of the following statements by the nurse about type 2 diabetes is correct?
- A. Insulin is not used to control blood glucose in patients with type 2 diabetes.
- B. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
- C. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma
- D. Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.
Correct Answer: D
Rationale: For some patients, changes in lifestyle are sufficient for blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.
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.