Nokea
Which of the following questions by the nurse will help identify autonomic neuropathy in a patient with diabetes?
- A. Have you observed any recent skin changes?
- B. Do you notice any bloating feeling after eating?
- C. Do you need to increase your insulin dosage when you are stressed?
- D. Have you noticed any painful new ulcerations or sores on your feet?
Correct Answer: B
Rationale: Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions are also appropriate to ask, but would not help in identifying autonomic neuropathy.
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A patient with type 1 diabetes who is on glargine and lispro insulin has called the clinic to report symptoms of a sore throat, cough, fever, and blood glucose level of 11.7 mmol/L. Which of the following information should the nurse tell the patient?
- A. Use only the lispro insulin until the symptoms of infection are resolved.
- B. Monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
- C. Decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
- D. Limit intake of calorie-containing liquids until the glucose is less than 6.7 mmol/L.
Correct Answer: B
Rationale: Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin is not used to test for short-term alterations in blood glucose.
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.
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.
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.
The nurse is assessing a patient for diabetes at a clinic who has a fasting plasma glucose level of 6.7 mmol/L. Which of the following information should the nurse include in the plan of care?
- A. Self-monitoring of blood glucose
- B. Use of low doses of regular insulin
- C. Lifestyle changes to lower blood glucose
- D. Effects of oral hypoglycemic medications
Correct Answer: C
Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counselled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.