Diabetic Complications - QUESTIONS

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kitty0303Preview Case 11 32 terms Ver 1. Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?

• Insulin is not used to control blood glucose in patients with type 2 diabetes.
• Complications of type 2 diabetes are less serious than those of type 1 diabetes.
• Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
• Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.

ANS: 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

• self-monitoring of blood glucose.
• using low doses of regular insulin.
• lifestyle changes to lower blood glucose.
• effects of oral hypoglycemic medications.

ANS: C

The patient's 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?

• The patient always carries hard candies when engaging in exercise.
• The patient goes for a vigorous walk when his glucose is 200 mg/dL.
• The patient has a peanut butter sandwich before going for a bicycle ride.
• The patient increases daily exercise when ketones are present in the urine.

ANS: 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.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?

• Urine dipstick for glucose
• Oral glucose tolerance test
• Fasting blood glucose level
• Glycosylated hemoglobin level

ANS: 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.The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following?

• "I can have an occasional alcoholic drink if I include it in my meal plan."
• "I will need a bedtime snack because I take an evening dose of NPH insulin."
• "I can choose any foods, as long as I use enough insulin to cover the calories."
• "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."

ANS: C

Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to

• save the lunch tray for the patient's later return to the unit.
• ask that diagnostic testing area staff to start a 5% dextrose IV.
• send a glass of milk or orange juice to the patient in the diagnostic testing area.
• request that if testing is further delayed, the patient be returned to the unit to eat.

ANS: D

Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these

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

• give a bolus of 50% dextrose.
• insert a large-bore IV catheter.
• initiate oxygen by nasal cannula.
• administer glargine (Lantus) insulin.

ANS: 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 patient's blood glucose and would be contraindicated.Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

• Assess the patient for symptoms of hyperglycemia.
• Give the patient a snack of peanut butter and crackers.
• Have the patient drink a glass of orange juice or nonfat milk.
• Administer a continuous infusion of 5% dextrose for 24 hours.

ANS: 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?

• "Do you feel bloated after eating?"
• "Have you seen any skin changes?"
• "Do you need to increase your insulin dosage when you are stressed?"
• "Have you noticed any painful new ulcerations or sores on your feet?"

ANS: 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.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?

• Choose flat-soled leather shoes.
• Set heating pads on a low temperature.
• Use callus remover for corns or calluses.
• Soak feet in warm water for an hour each day.

ANS: A

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

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

• Amitriptyline decreases the depression caused by your foot pain.
• Amitriptyline helps prevent transmission of pain impulses to the brain.
• Amitriptyline corrects some of the blood vessel changes that cause pain.
• Amitriptyline improves sleep and makes you less aware of nighttime pain.

ANS: B

Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain. Tricyclic antidepressants 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 tricyclic antidepressants.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?

• Place the patient on a cardiac monitor.
• Administer IV potassium supplements.
• Obtain urine glucose and ketone levels.
• Start an insulin infusion at 0.1 units/kg/hr.

ANS: 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 patient's care.A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?

• Infuse 1 liter of normal saline per hour.
• Give sodium bicarbonate 50 mEq IV push.
• Administer regular insulin 10 U by IV push.
• Start a regular insulin infusion at 0.1 units/kg/hr.

ANS: 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.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?

• Infuse dextrose 50% by slow IV push.
• Administer 1 mg glucagon subcutaneously.
• Obtain a glucose reading using a finger stick.
• Have the patient drink 4 ounces of orange juice.

ANS: C

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.