Nclex question: Diabetes Mellitus

Nclex question: Diabetes Mellitus

rocel_sanchez- Save Psychiatric Mental Health Nursing N...50 terms schwabaccaPreview 75 Free NCLEX Questions - c/o Brilli...75 terms carey47Preview Diabetes Mellitus NCLEX Style Ques...Teacher 36 terms ssandholmPreview

STD NC

52 terms sar 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 :Changes in diet and exercise may control blood glucose levels in type 2 diabetes.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.DIF: Cognitive Level: Understand (comprehension) REF: 1166-1167 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 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-lifestyle changes to lower blood glucose.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-The patient increases daily exercise when ketones are present in the urine.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?

• "Are you anorexic?"
• "Is your urine dark colored?"
• "Have you lost weight lately?"
• "Do you crave sugary drinks?"

ANS: C-"Have you lost weight lately?"

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?

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

ANS: D-Glycosylated hemoglobin level

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?

• The patient will reach a glycosylated hemoglobin level of less than 7%.
• The patient will follow a diet and exercise plan that results in weight loss.
• The patient will choose a diet that distributes calories throughout the day.
• The patient will state the reasons for eliminating simple sugars in the diet.

ANS: A-The patient will reach a glycosylated hemoglobin level of less than 7%.

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.

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-"I can choose any foods, as long as I use enough insulin to cover the calories." 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.In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take?

• Determine what type of activities the patient enjoys.
• Remind the patient that exercise will improve self-esteem.
• Teach the patient about the effects of exercise on glucose level.
• Give the patient a list of activities that are moderate in intensity.

ANS: A-Determine what type of activities the patient enjoys.

Because consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions will also be implemented but are not the most important in improving compliance Which statement by the patient indicates a need for additional instruction in administering insulin?

• "I need to rotate injection sites among my arms, legs, and abdomen each day."
• "I can buy the 0.5 mL syringes because the line markings will be easier to see."
• "I should draw up the regular insulin first after injecting air into the NPH bottle."
• "I do not need to aspirate the plunger to check for blood before injecting insulin."

ANS: A-"I need to rotate injection sites among my arms, legs, and abdomen each day." Rotating sites is no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other patient statements are accurate and indicate that no additional instruction is needed Which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin?

• The patient avoids injecting the insulin into the upper abdominal area.
• The patient cleans the skin with soap and water before insulin administration.
• The patient stores the insulin in the freezer after administering the prescribed dose.
• The patient pushes the plunger down while removing the syringe from the injection site.

ANS: B-The patient cleans the skin with soap and water before insulin administration.Cleaning the skin with soap and water or with alcohol is acceptable. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.

A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia?

a. 10:00 AM

b. 12:00 AM

c. 2:00 PM

d. 4:00 PM

ANS: A-10:00 AM

The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump?

• The patient programs the pump for an insulin bolus after eating.
• The patient changes the location of the insertion site every week.
• The patient takes the pump off at bedtime and starts it again each morning.
• The patient plans for a diet that is less flexible when using the insulin pump.

ANS: A-The patient programs the pump for an insulin bolus after eating.

In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used. The pump will deliver a basal insulin rate 24 hours a day.Which information will the nurse include when teaching a 50-year-old patient who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)?

• Glyburide decreases glucagon secretion from the pancreas.
• Glyburide stimulates insulin production and release from the pancreas.
• Glyburide should be taken even if the morning blood glucose level is low.
• Glyburide should not be used for 48 hours after receiving IV contrast media.

ANS: B-Glyburide stimulates insulin production and release from the pancreas.

The sulfonylureas 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 class 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.A 32-year-old patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?

• Lispro (Humalog)
• Glargine (Lantus)
• Detemir (Levemir)
• NPH (Humulin N)

ANS: A-Lispro (Humalog)

Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.