Question
1. Sallie Smith, 42 years of age, is newly diagnosed with type 2 diabetes. During the patient education, the patient asks the nurse, “What should I do if I am sick and can’t eat; should I still take my medicine for the diabetes?”
a. What management strategies should the nurse provide the patient to deal with “sick days?”
2. Jerry Thomas is a 26-year-old type 1 diabetic. He was originally diagnosed at the age of 14, and currently manages his disease with an intensive regimen of insulin injections. Jerry is employed as a schoolteacher and soccer coach. He presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucoses, and is using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but today he is unable to even tolerate that, and comes to the clinic for evaluation of possible diabetic ketoacidosis (DKA).
a. Describe the pathophysiology of DKA and why it occurs in patients with type 1 diabetes.
b. Based on the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder?
c. The primary provider prescribes a complete metabolic panel, and Jerry’s blood glucose is 425. Other lab values include a serum sodium of 152, serum potassium of 3.0, and BUN of 64. What is your assessment of these results?
d. Explain why it is important for Jerry to continue to take his insulin even though his oral intake is decreased.
3. A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan?
a. Instruct the patient to limit activity and weekly exercise
b. Glycemic control is adequate; no changes are needed
c. Refer the patient to a diabetes educator because the result reflects poor glycemic control
d. Hypoglycemia is a risk; teach the patient the symptoms
a. It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin
b. The order of drawing up insulin does not matter as long as the insulin is refrigerated
c. Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen
d. Draw up the clear regular insulin first, followed by the cloud NPH insulin
5. A patient is scheduled to start taking insulin glargine (Lantus). On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication?
a. Peak effect achieved in 2 to 4 hours
b. Mealtime coverage of blood glucose
c. Less frequent blood glucose monitoring
d. Blood glucose control for 24hours
6. Before administering metformin {Glucophage}, the nurse should notify the prescriber about which laboratory value?
a. Sodium (Na) level of 131 mEq/dl
b. Hemoglobin (Hgb) level of 9.5 gm/dl
c. Creatinine (Cr) level of 2.1 mg/dl
d. Platelet count of 120,000/mm
7. A nurse assesses a patient who is taking pramlintide {Smylin} with mealtime insulin. Which finding requires immediate follow-up by the nurse?
a. Pedal Edema
b. Skin Rash
c. Itching
d. Sweating
