What info will nurse include in teaching female pt who has peripheral arterial disease/DM-2/sensory neuropathy feet/legs

Choose flat-soled leather shoes.

The HCP suspects the Somogyi effect in a 50-yr-old pt w/6am blood glucose is 230 mg/dL. What action will nurse teach pt?

Check the blood glucose during the night.

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

Give the patient a snack of peanut butter and crackers.

A pt screened for DM at a clinic has a fasting plasma glucose level of 120 mg/dL. What should nurse teach the patient?

Lifestyle changes to lower blood glucose

A diabteic pt rcv'd 38 U NPH @ 7 AM. @ 1 PM the pt been away from nursing unit for 2 hrs. Best way prevent hypoglycemia?

Request that if testing is further delayed the patient will eat lunch first

Which pt action indicate accurate understanding of the nurse’s teaching aboutadministration of aspart (NovoLog) insulin?

The pt cleans the skin with soap and water before insulin administration.

A pt w/DM-2 is being prepared for elective coronary angiogram. Which info would nurse anticipate need to reschedule test

The patient took the prescribed metformin today.

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate?

Changes in diet and exercise may control blood glucose levels in type 2 DM.

Which patient action indicates an accurate understanding of the nurse’s teaching about the use of an insulin pump?

The patient programs the pump for an insulin bolus after eating.

Nurse is teaching pt w/DM-2 about managing blood glucose levels/taking glipizide. What indicates need for more teaching?

“My diabetes won’t cause complications because I don’t need insulin.”

The nurse preparing teach a 43-yr man newly Dx'd w/DM-2 about home management of disease. Which action nurse take first

Assess the patient’s perception of what it means to have diabetes.

26-yr female w/DM-1 sore throat/runny nose. Calls clinic about S/S w/FSBS 210 despite taken lispro & lantus Nurse advise

Monitor blood glucose every 4 hours and contact the clinic if it rises.

Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide?

Glyburide stimulates insulin production and release from the pancreas.

A pt w/DM reports burning foot pain at night rcvs a new Rx. What info should the nurse teach the pt about amitriptyline

Amitriptyline helps prevent transmission of pain impulses to the brain.

Nurse is interviewing new pt w/DM who takes Avandia. Which info would nurse anticipate resulting HCP D/C-ing medication

The patient has chest pressure when walking.

To monitor complications in patient w/DM-2, which tests will nurse in diabetic clinic schedule at least annually? (SATA)

Urine for microalbuminuria, Serum creatinine, Blood pressure, Monofilament testing of the foot

Nurse is assessing 55-yr-old female pt w/DM2 who has a BMI of 31 kg/m2. Which goal in the POC most important for this pt

The patient will reach a glycosylated hemoglobin level of less than 7%.

Which nursing action can the nurse delegate to experienced UAP who are working in the diabetic clinic?

Measure the ankle-brachial index.

Which action by pt indicates that the home health nurse’s teaching about glargine & regular insulin has been successful?

The pt discards the open vials of glargine & regular insulin after 4 weeks.

Which action by the patient who is self-monitoring blood glucose indicates a need for additional teaching?

Chooses a puncture site in the center of the finger pad.

Nurse is assessing a 22-yr-old pt w/onset of symptoms DM 1. To which question would nurse anticipate positive response?

“Have you lost weight lately?”

28-yr male pt w/DM 1, reports he how manages his exercise/glucose control. What behavior should the nurse instruct pt on

The patient increases daily exercise when ketones are present in the urine.

A 27-yr pt admitted w/DKA has serum glucose level of 732 mg/dL/serum K+ level of 3.1 mEq/L. Action HCP nurse take first?

Place the patient on a cardiac monitor.

When a patient w/type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to LPN?

Administer Rx lispro (Humalog) insulin before transporting th pt to surgery

After change-of-shift report, which patient should the nurse assess first?

A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg

Which patient statement to the nurse indicates a need for additional instruction in administering insulin?

I need to rotate injection sites among my arms, legs, and abdomen each day.

Which patient statement indicates that the nurse’s teaching about exenatide (Byetta) has been effective?

“I will not need to worry about hypoglycemia with the Byetta.”

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

“Do you feel bloated after eating?”

The nurse admin 4 oz orange juice to alert pt whose FSBS 62 mg/dL. 15 mins later, FSBS 67 What action nurse take next?

Give the patient 4 to 6 oz more orange juice.

A patient with DKA is brought to the ER. Which prescribed action should the nurse implement first?

Infuse 1 L of normal saline per hour.

Nurse is Hx from 29-yr pt at 1st prenatal visit. Pt reports no personal Hx of DM. Mom w/DM. What action does nurse take?

Schedule the patient for a fasting blood glucose level.

Which nursing action is most important in assisting an older pt who has diabetes to engage in moderate daily exercise?

Determine what types of activities the patient enjoys.

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

The patient’s estimated glomerular filtration rate is 42 mL/min.

After change-of-shift report, which patient will the nurse assess first?

60-yr pt w/hyprosmolar hyperglycemic syndrome por skn turgr dry oral mucosa

Pt admitted w/DKA secondary/UTI been weaned off insulin drip 30 min ago. Pt is lightheaded/sweaty. Action nurse take 1st

Obtain a glucose reading using a finger stick.

A pt who takes metformin manage DM-2 develops an allergic rash from unknown cause, HCP Rx prednisone. Nurse anticipates?

The patient may require administration of insulin while taking prednisone.

Which statement by the pt who has newly Dx type 1 diabetes indicates a need for additional instruction from the nurse?

I can choose any foods, as long as I use enough insulin to cover calories.”

A female pt scheduled for oral glucose tolerance test. What info from pt’s medi Hx is important for nurse HCP about test

The patient uses oral contraceptives.

A pt who has DM-1 plans to swim laps for 1 hour daily at 1:00 PM. Whatadvice should the clinic nurse plan to give the pt

Check glucose level before, during, and after swimming.

A few wks after 82-yr pt w/Dx DM-2 been placed on metformin therapy home health nurse finding should nurse tell HCP STAT

Glomerular filtration rate is decreased.

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MED SURG EXAM 5 CHAPTER 48 DIABETES MELLITUS

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Questions 48

Answers

1
A pt w/DM rides a bicycle to & from work daily. Which site should the nurse teach pt to use to administer a.m. insulin
Thigh
Buttock
Upper arm
Abdomen
2
What info will nurse include in teaching female pt who has peripheral arterial disease/DM-2/sensory neuropathy feet/legs
Use a callus remover for corns or calluses.
Soak feet in warm water for an hour each day.
Set heating pads on a low temperature.
Choose flat-soled leather shoes.
3
The HCP suspects the Somogyi effect in a 50-yr-old pt w/6am blood glucose is 230 mg/dL. What action will nurse teach pt?
Check the blood glucose during the night.
Increase the rapid-acting insulin dose.
Avoid snacking right before bedtime.
Administer a larger dose of long-acting insulin.
4
Which action should the nurse take after pt treated with intramuscular glucagon for hypoglycemia regains consciousness?
Have the patient drink a glass of orange juice or nonfat milk.
Assess the patient for symptoms of hyperglycemia.
Give the patient a snack of peanut butter and crackers.
Administer a continuous infusion of 5% dextrose for 24 hours.
5
A pt screened for DM at a clinic has a fasting plasma glucose level of 120 mg/dL. What should nurse teach the patient?
Effects of oral hypoglycemic medications
Lifestyle changes to lower blood glucose
Self-monitoring of blood glucose
Using low doses of regular insulin
6
A diabteic pt rcv'd 38 U NPH @ 7 AM. @ 1 PM the pt been away from nursing unit for 2 hrs. Best way prevent hypoglycemia?
Plan to discontinue the evening dose of insulin.
Send a glass of orange juice to the patient in the diagnostic testing area.
Request that if testing is further delayed the patient will eat lunch first
Save the lunch tray for the patient’s later return.
7
Which pt action indicate accurate understanding of the nurse’s teaching aboutadministration of aspart (NovoLog) insulin?
The pt cleans the skin with soap and water before insulin administration.
The pt stores insulin in the freezer after administering the prescribe dose
The pt pushes the plunger down while removing syringe from injection site
The patient avoids injecting the insulin into the upper abdominal area.
8
A pt w/DM-2 is being prepared for elective coronary angiogram. Which info would nurse anticipate need to reschedule test
The patient took the prescribed enalapril 4 hours ago.
The patient took the prescribed metformin today.
The patient’s most recent A1C was 7.5%.
The patient’s blood glucose is 128 mg/dL.
9
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate?
Type 2 DM is usually diagnosed when a pt is admitted in hyperglycemic coma
Complications of type 2 DM are less serious than those of type 1 diabetes.
Insulin is not used to control blood glucose in patients w/type 2 diabetes.
Changes in diet and exercise may control blood glucose levels in type 2 DM.
10
Which patient action indicates an accurate 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 plans a diet with more calories than usual when using the pump.
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.
11
Nurse is teaching pt w/DM-2 about managing blood glucose levels/taking glipizide. What indicates need for more teaching?
“My diabetes won’t cause complications because I don’t need insulin.”
“Other medications besides the Glucotrol may affect my blood sugar.”
“When I am ill, I may have to take insulin to control my blood sugar.”
“If I overeat at a meal, I will still take the usual dose of medication.”
12
The nurse preparing teach a 43-yr man newly Dx'd w/DM-2 about home management of disease. Which action nurse take first
Demonstrate how to check glucose using capillary blood glucose monitoring.
Assess the patient’s perception of what it means to have diabetes.
Ask the patient’s family to participate in the diabetes education program.
Discuss the need for patient to actively participate in diabetes management
13
26-yr female w/DM-1 sore throat/runny nose. Calls clinic about S/S w/FSBS 210 despite taken lispro & lantus Nurse advise
Monitor blood glucose every 4 hours and contact the clinic if it rises.
Use only the lispro insulin until the symptoms are resolved.
Limit intake of calories until the glucose is less than 120 mg/dL.
Decrease carbohydrates until glycosylated hemoglobin is less than 7%.
14
A pt receives aspart-NovoLog) insulin at 8:00 AM. At which time would the nurseanticipate highest risk for hypoglycemia?
12:00 am
2:00 pm
4:00 pm
10:00 am
15
Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide?
Glyburide stimulates insulin production and release from the pancreas.
Glyburide should be taken even if the morning blood glucose level is low.
Glyburide decreases glucagon secretion from the pancreas.
Glyburide should not be used for 48 hours after receiving IV contrast media
16
A pt w/DM reports burning foot pain at night rcvs a new Rx. What info should the nurse teach the pt about amitriptyline
Amitriptyline corrects some of the blood vessel changes that cause pain.
Amitriptyline helps prevent transmission of pain impulses to the brain.
Amitriptyline decreases the depression caused by your foot pain.
Amitriptyline improves sleep and makes you less aware of nighttime pain.
17
Which laboratory value reported by the unlicensed (UAP) indicates an urgent need for the nurse to assess the patient?
Noon blood glucose of 52 mg/dL
2-hr postprandial glucose of 220 mg/dL
Bedtime glucose of 140 mg/dL
Fasting blood glucose of 130 mg/dL
18
Nurse is interviewing new pt w/DM who takes Avandia. Which info would nurse anticipate resulting HCP D/C-ing medication
The patient’s blood pressure is 154/92.
The patient has chest pressure when walking.
The patient reports a history of emphysema.
The patient’s blood glucose is 86 mg/dL.
19
A 30-yr-old patient has new Dx of DM-2. When should the nurse recommend the patient schedule a dilated eye examination?
Every 2 years
Every 6 months
As soon as available
At the age of 39 years
20
To monitor complications in patient w/DM-2, which tests will nurse in diabetic clinic schedule at least annually? (SATA)
Urine for microalbuminuria
Serum creatinine
Blood pressure
Monofilament testing of the foot
21
A pt w/DM is starting on intensive insulin therapy. Which type insulin will the nurse discuss using as mealtime coverage
Detemir (Levemir)
Glargine (Lantus)
NPH (Humulin N)
Lispro (Humalog)
22
Nurse is assessing 55-yr-old female pt w/DM2 who has a BMI of 31 kg/m2. Which goal in the POC most important for this pt
The patient will reach a glycosylated hemoglobin level of less than 7%.
The patient will state the reasons for eliminating simple sugars the diet.
The patient will follow a diet and exercise plan that results weight loss.
The patient will choose diet that distributes calories throughout the day.
23
Which nursing action can the nurse delegate to experienced UAP who are working in the diabetic clinic?
Check for changes in skin pigmentation.
Measure the ankle-brachial index.
Ask the patient about symptoms of depression.
Assess for unilateral or bilateral foot drop.
24
Which action by pt indicates that the home health nurse’s teaching about glargine & regular insulin has been successful?
The pt discards the open vials of glargine & regular insulin after 4 weeks.
The patient’s family prefills the syringes with the mix of insulins weekly.
The pt draws up regular insulin and then the glargine in the same syringe.
The patient administers the glargine 30 minutes before each meal.
25
Which action by the patient who is self-monitoring blood glucose indicates a need for additional teaching?
Chooses a puncture site in the center of the finger pad.
Says the result of 120 mg indicates good blood sugar control.
Hangs the arm down for a minute before puncturing the site.
Washes the puncture site using warm water and soap.
26
Nurse is assessing a 22-yr-old pt w/onset of symptoms DM 1. To which question would nurse anticipate positive response?
“Are you anorexic?”
“Do you crave sugary drinks?”
“Have you lost weight lately?”
“Is your urine dark colored?”
27
28-yr male pt w/DM 1, reports he how manages his exercise/glucose control. What behavior should the nurse instruct pt on
The patient increases daily exercise when ketones are present in the urine.
The patient always carries hard candies when engaging in exercise.
The patient has a peanut butter sandwich before going for a bicycle ride.
The patient goes for a vigorous walk when his glucose is 200 mg/dL.
28
A 27-yr pt admitted w/DKA has serum glucose level of 732 mg/dL/serum K+ level of 3.1 mEq/L. Action HCP nurse take first?
Ask the patient about home insulin doses.
Place the patient on a cardiac monitor.
Administer IV potassium supplements.
Start an insulin infusion at 0.1 units/kg/hr.
29
When a patient w/type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to LPN?
Communicate FSBS level and insulin dose to the circulating nurse in surgery
Plan strategies to minimize risk for hypo/hyperglycemia during the postop
Discuss the reason for the use of insulin therapy during STAT postop period
Administer Rx lispro (Humalog) insulin before transporting th pt to surgery
30
After change-of-shift report, which patient should the nurse assess first?
A 50-yr-old pt who use exenatide (Byetta) is reporting acute abdominal pain
A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg
A 40-yr-old pt who is pregnant whose oral glucose tolerance test 202 mg/dL
A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12%
31
Which patient statement to the nurse indicates a need for additional instruction in administering insulin?
I can buy the 0.5-mL syringes because the line markings are easier to see.”
I do not need to aspirate plunger check for blood before injecting insulin
I need to rotate injection sites among my arms, legs, and abdomen each day.
I should draw regular insulin first after injecting air into the NPH bottle
32
Which patient statement indicates that the nurse’s teaching about exenatide (Byetta) has been effective?
“I will not need to worry about hypoglycemia with the Byetta.”
“I may feel hungrier than usual when I take this medicine.”
“I should take my daily aspirin at least an hour before the Byetta.”
“I will take the pill at the same time I eat breakfast in the morning.”
33
Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy?
“Do you need to increase your insulin dosage when you are stressed?”
“Have you noticed any painful new ulcerations or sores on your feet?”
“Do you feel bloated after eating?”
“Have you seen any skin changes?”
34
The nurse admin 4 oz orange juice to alert pt whose FSBS 62 mg/dL. 15 mins later, FSBS 67 What action nurse take next?
Give the patient 4 to 6 oz more orange juice.
Have the patient eat some peanut butter with crackers.
Notify the health care provider about the hypoglycemia.
Administer the PRN glucagon (Glucagon) 1 mg IM.
35
A patient with DKA is brought to the ER. Which prescribed action should the nurse implement first?
Infuse 1 L of normal saline per hour.
Administer regular insulin 10 U by IV push.
Start a regular insulin infusion at 0.1 units/kg/hr.
Give sodium bicarbonate 50 mEq IV push.
36
Nurse is Hx from 29-yr pt at 1st prenatal visit. Pt reports no personal Hx of DM. Mom w/DM. What action does nurse take?
Teach the patient about administering regular insulin.
Schedule oral glucose tolerance test for the twenty-fourth week pregnancy.
Schedule the patient for a fasting blood glucose level.
Teach about an increased risk for fetal problems with gestational diabetes.
37
An unresponsive pt w/DM-2 is brought to ER and diagnosed w/hyperosmolar hyperglycemia syndrome. Nurse anticipates doing?
Giving 50% dextrose
Inserting an IV catheter
Administering glargine (Lantus) insulin
Initiating O2 by nasal cannula
38
Which nursing action is most important in assisting an older pt who has diabetes to engage in moderate daily exercise?
Give the patient a list of activities that are moderate in intensity.
Determine what types of activities the patient enjoys.
Remind the patient that exercise improves self-esteem.
Teach the patient about the effects of exercise on glucose level.
39
Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?
The patient’s estimated glomerular filtration rate is 42 mL/min.
The patient’s blood glucose level 174 mg/dL
The patient has gained 2 lb (0.9 kg) in the past 24 hours.
The patient is scheduled for a chest x-ray in an hour.
40
After change-of-shift report, which patient will the nurse assess first?
60-yr pt w/hyprosmolar hyperglycemic syndrome por skn turgr dry oral mucosa
A 19-yr- patient with type 1 diabetes who was admitted with dawn phenomenon
A 35-yr-old pt with DM-1 most recent blood glucose reading was 230 mg/dL
A 68-yr pt DM-2 has severe peripheral neuropathy/reports burning foot pain
41
Pt admitted w/DKA secondary/UTI been weaned off insulin drip 30 min ago. Pt is lightheaded/sweaty. Action nurse take 1st
Obtain a glucose reading using a finger stick.
Have the patient drink 4 ounces of orange juice.
Administer 1 mg glucagon subcutaneously.
Infuse dextrose 50% by slow IV push.
42
A pt who takes metformin manage DM-2 develops an allergic rash from unknown cause, HCP Rx prednisone. Nurse anticipates?
The patient may develop acute hypoglycemia while taking the prednisone.
The patient may require administration of insulin while taking prednisone.
The patient may have rashes caused by metformin-prednisone interactions.
The patient may need a diet higher in calories while receiving prednisone.
43
Which statement by the pt who has newly Dx type 1 diabetes indicates a need for additional instruction from the nurse?
I can have occasional beverage with alcohol if include it in my meal plan.
I can choose any foods, as long as I use enough insulin to cover calories.”
I will eat something at meal times prevent hypoglycemia even if not hungry
“I will need a bedtime snack because I take an evening dose of NPH insulin.
44
A female pt scheduled for oral glucose tolerance test. What info from pt’s medi Hx is important for nurse HCP about test
The patient uses oral contraceptives.
The patient has been pregnant three times.
The patient runs several days a week.
The patient has a family history of diabetes.
45
An active 32-yr male w/DM-1 being seen at endocrine clinic. Indication is nurse to discuss possible Δ's in therapy w/HCP
High-density lipoprotein (HDL) level of 65 mg/dL
Heart rate at rest of 58 beats/min
Blood pressure of 140/88 mmHg
Hemoglobin A1C level of 6.2%
46
A pt who has DM-1 plans to swim laps for 1 hour daily at 1:00 PM. Whatadvice should the clinic nurse plan to give the pt
Increase the morning dose of NPH insulin (Novolin N).
Time the morning insulin injection to peak while swimming.
Delay eating the noon meal until after finishing the swimming.
Check glucose level before, during, and after swimming.
47
A pt w/DM2, scheduled for follow-up visit in 3 months. What test will the nurse schedule to evaluate effectiveness of Tx
Urine dipstick for glucose and ketones
Oral glucose tolerance test
Glycosylated hemoglobin
Fasting blood glucose
48
A few wks after 82-yr pt w/Dx DM-2 been placed on metformin therapy home health nurse finding should nurse tell HCP STAT
Hemoglobin A1C level is 7.9%.
Glomerular filtration rate is decreased.
Last eye examination was 18 months ago.
Patient has questions about the prescribed diet.

MED SURG EXAM 5 CHAPTER 48 DIABETES MELLITUS Flashcards | StudBud