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Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control?
- A. A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
- B. A patient who never deviates from her prescribed dose of insulin
- C. A patient who adheres closely to a meal plan and meal schedule
- D. A patient who eliminates carbohydrates from his daily intake
Correct Answer: C
Rationale: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.
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A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient?
- A. Do not eliminate insulin when nauseated and vomiting.
- B. Report elevated glucose levels greater than 150 mg/dL.
- C. Eat three substantial meals a day, if possible.
- D. Reduce food intake and insulin doses in times of illness.
Correct Answer: A
Rationale: The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.
A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes?
- A. Ask the patient to describe an optimally healthy meal.
- B. Ask the patient to keep a food diary and review it with the nurse.
- C. Ask the patients family what he typically eats.
- D. Ask the patient to describe a typical days food intake.
Correct Answer: B
Rationale: Reviewing the patients actual food intake is the most accurate method of gauging the patients diet.
The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurses most appropriate action?
- A. Teach the patient about actions to slow the progression of nephropathy.
- B. Ensure that the patient receives a comprehensive assessment of liver function.
- C. Determine whether the patient has been using expired insulin.
- D. Administer a fluid challenge and have the test repeated.
Correct Answer: A
Rationale: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the patients liver function is not likely affected. There is no indication for the use of a fluid challenge.
A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADAs recommendations include?
- A. 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein
- B. 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein
- C. 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein
- D. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein
Correct Answer: D
Rationale: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.
A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best response?
- A. Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years.
- B. The cause is not known for sure but it is thought to have something to do with ketoacidosis.
- C. The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years.
- D. Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels.
Correct Answer: C
Rationale: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.