Question 1

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy?

Accepted Answer

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.

Question 2

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?

Accepted Answer

The patient's clinical manifestations are consistent with hypoglycemia,and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low,the patient should ingest a rapid-acting carbohydrate,such as orange juice. Glucagon or dextrose 50% might be given if the patient's symptoms become worse or if the patient is unconscious.

Question 3

When a patient with type 2 diabetes is admitted for a cholecystectomy,which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

Accepted Answer

LPN/LVN education and scope of practice includes administration of insulin. Communication about patient status with other departments,planning,and patient teaching are skills that require RN education and scope of practice.

Question 4

The nurse is taking a health history from a 29-yr-old pregnant patient at the first prenatal visit. The patient reports that she has no personal history of diabetes,but her mother has diabetes. Which action will the nurse plan to take?

Accepted Answer

Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be used to check for diabetes,but it would be done before the twenty-fourth week. Teaching plans would depend on the outcome of a fasting blood glucose test and other tests.

Question 5

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test?

Accepted Answer

To avoid lactic acidosis,metformin should be discontinued a day or 2 before the coronary angiogram and should not be used for 48 hours after IV contrast media are administered. The other patient data will also be reported but do not indicate any need to reschedule the procedure.

Question 6

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

Accepted Answer

Rebound hypoglycemia can occur after glucagon administration,but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood glucose rapidly,but the cheese and crackers will stabilize blood glucose. Administration of IV glucose 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.

Question 7

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA)has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first?

Accepted Answer

Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation,which would be detected with electrocardiogram (ECG)monitoring. Because 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 because insulin infusion will further decrease potassium levels. Discussion of home insulin and possible causes can wait until the patient is stabilized.

Question 8

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?

Accepted Answer

The BUN indicates possible renal failure,and metformin should not be used in patients with renal failure. The other findings are not contraindications to the use of metformin.

Question 9

A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin?

Accepted Answer

Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh,buttock,and arm are all exercised by riding a bicycle.

Question 10

The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?

Accepted Answer

If the Somogyi effect is causing the patient's increased morning glucose level,the patient will experience hypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced,rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night.

Question 11

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test?

Accepted Answer

Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT)values. Exercise and a family history of diabetes both can affect blood glucose but will not lead to misleading information from the OGTT. History of previous pregnancies may provide informational about gestational glucose tolerance but will not lead to misleading information from the OGTT.

Question 12

The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication?

Accepted Answer

Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. A blood glucose level of 86 mg/dL indicates a positive effect from the medication. Hypertension and a history of emphysema do not contraindicate this medication.

Question 13

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first?

Accepted Answer

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 done after the infusion of normal saline is initiated.

Question 14

A 26-yr-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus)and lispro (Humalog)insulin. The nurse advises the patient to

Accepted Answer

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 testing is not used to evaluate short-term alterations in blood glucose.

Question 15

Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful?

Accepted Answer

Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals,and glargine is given once daily.

Question 16

A patient who has diabetes and reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline ?

Accepted Answer

Tricyclic antidepressants (TCAs)decrease the transmission of pain impulses to the spinal cord and brain. TCAs 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 TCAs.

Question 17

Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP)indicates an urgent need for the nurse's assessment of the patient?

Accepted Answer

The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms of hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice. The other values are within an acceptable range or not immediately dangerous for a patient with diabetes.

Question 18

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider?

Accepted Answer

To decrease the incidence of macrovascular and microvascular problems in patients with diabetes,the goal blood pressure is usually 130/80 mm Hg. An A1C less than 6.5%,a low resting heart rate (consistent with regular aerobic exercise in a young adult),and an HDL level of 65 mg/dL all indicate that the patient's diabetes and risk factors for vascular disease are well controlled.

Question 19

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to

Accepted Answer

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 O?. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.

Question 20

Which information will the nurse include in teaching a female patient who has peripheral arterial disease,type 2 diabetes,and sensory neuropathy of the feet and legs?

Accepted Answer

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.

Quiz 48: Diabetes Mellitus

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy?

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?

When a patient with type 2 diabetes is admitted for a cholecystectomy,which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN) ?

The nurse is taking a health history from a 29-yr-old pregnant patient at the first prenatal visit. The patient reports that she has no personal history of diabetes,but her mother has diabetes. Which action will the nurse plan to take?

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test?

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first?

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage) ?