LEVEL 2 - RNSG 1443 - EXAM 4
Which statement by a nurse to a patient newly diagnosed with 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. Chan...
LEVEL 2 - RNSG 1443 - EXAM 4
Which statement by a nurse to a patient newly diagnosed with 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. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
d. Type 2 diabetes is usually diagnosed when the patient is admitted with a
hyperglycemic coma
. - Answer- C
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve
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.
A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma
glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient
about
a. self-monitoring of blood glucose.
b. using low doses of regular insulin.
c. lifestyle changes to lower blood glucose.
d. effects of oral hypoglycemic medications. - Answer- C
The patients impaired fasting glucose indicates prediabetes, and the patient should
be counseled about lifestyle changes to prevent the development of type 2 diabetes.
The patient with prediabetes does not require insulin or oral hypoglycemics for
glucose control and does not need to self-monitor blood glucose.
A 28-year-old male patient with type 1 diabetes reports how he manages his
exercise and glucose control. Which behavior indicates that the nurse should
implement additional teaching?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when his glucose is 200 mg/dL.
c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine. -
Answer- D
When the patient is ketotic, exercise may result in an increase in blood glucose level.
Type 1 diabetic patients should be taught to avoid exercise when ketosis is present.
,The other statements are correct.
The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of
type 1 diabetes. Which question is most appropriate for the nurse to ask?
a. Are you anorexic?
b. Is your urine dark colored?
c. Have you lost weight lately?
d. Do you crave sugary drinks? - Answer- C
Weight loss occurs because the body is no longer able to absorb glucose and starts
to break down protein and fat for energy.
The patient is thirsty but does not necessarily crave sugar-containing fluids.
Increased appetite is a classic symptom of type 1 diabetes. With the classic
symptom of polyuria, urine will be very dilute.
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several
months from now. Which test will the nurse schedule to evaluate the effectiveness of
treatment for the patient?
a. Urine dipstick for glucose
b. Oral glucose tolerance test
c. Fasting blood glucose level
d. Glycosylated hemoglobin level - Answer- D
The glycosylated hemoglobin (A1C or HbA1C) test shows the overall control of
glucose over 90 to 120 days.
A fasting blood level indicates only the glucose level at one time. Urine glucose
testing is not an accurate reflection of blood glucose level and does not reflect the
glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose
diabetes, but is not used for monitoring glucose control once diabetes has been
diagnosed.
A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of
imbalanced nutrition: more than body requirements. Which goal is most important for
this patient?
a. The patient will reach a glycosylated hemoglobin level of less than 7%.
b. The patient will follow 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. -
Answer- A
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.
,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
a. give a bolus of 50% dextrose.
b. insert a large-bore IV catheter.
c. initiate oxygen by nasal cannula.
d. administer glargine (Lantus) insulin. - Answer- B
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 patients blood
glucose and would be contraindicated.
A 26-year-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
a. use only the lispro insulin until the symptoms are resolved.
b. limit intake of calories until the glucose is less than 120 mg/dL.
c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%. -
Answer- C
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.
Which action should the nurse take after a 36-year-old patient treated with
intramuscular glucagon for hypoglycemia regains consciousness?
a. Assess the patient for symptoms of hyperglycemia.
b. Give the patient a snack of peanut butter and crackers.
c. Have the patient drink a glass of orange juice or nonfat milk.
d. Administer a continuous infusion of 5% dextrose for 24 hours. - Answer- B
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.
Which question during the assessment of a diabetic patient will help the nurse
identify autonomic neuropathy?
a. Do you feel bloated after eating?
b. Have you seen any skin changes?
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? - Answer- A
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.
A 27-year-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?
a. Place the patient on a cardiac monitor.
b. Administer IV potassium supplements.
c. Obtain urine glucose and ketone levels.
d. Start an insulin infusion at 0.1 units/kg/hr. - Answer- A
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. Urine glucose and ketone levels are
not urgently needed to manage the patients care.
A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order
should the nurse implement first?
a. Infuse 1 liter of normal saline per hour.
b. Give sodium bicarbonate 50 mEq IV push.
c. Administer regular insulin 10 U by IV push.
d. Start a regular insulin infusion at 0.1 units/kg/hr. - Answer- A
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.
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