NUR 390 Test 1 - Part 2 Modules 3 Questions With
Complete Solutions
A 26-yr-old female who has 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
reports a glucose level of 210 mg/dL despite taking her usual
glargine (Lantus) and lispro (Humalog) insulin. Which action
would the nurse advise the patient to take?
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 contact the clinic if
it rises.
d. Decrease carbohydrates until glycosylated hemoglobin is less
than 7%. - ANS: C
Infection and other stressors increase glucose levels and the
patient will need to test 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 glucose.
A 27-yr-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 would the nurse
implement first?
a. Place the patient on a cardiac monitor.
b. Administer IV potassium supplements.
c. Ask the patient about home insulin doses.
d. 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 would initiate cardiac monitoring before infusion of
potassium. Insulin would not be administered without cardiac
monitoring because insulin infusion will further decrease
potassium levels. Discussion of home insulin and possible
causes can wait until the patient is stabilized.
A 28-yr-old male patient with type 1 diabetes reports how he
manages his exercise and glucose control. Which behavior
indicates a need for the nurse to 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. - ANS: D
When the patient is ketotic, exercise increase the glucose level;
persons with type 1 diabetes should be taught to avoid exercise
when ketosis is present. Other recommendations include (1)
,before exercise, if glucose 100 mg/dL, eat a 15-g carbohydrate
snack. After 15 to 30 min, recheck glucose levels. (2) Delay
exercise if <100 mg/dL. Patients using drugs that place them at
risk for hypoglycemia should always carry a fast-acting source
of carbohydrate, such as
glucose tablets or hard candies, when exercising. (3) Before
exercise, if glucose 250 mg/dL in a person with type 1 DM and
ketones are present, delay vigorous activity until ketones are
gone. Drink fluids.
A 30-yr-old patient has a new diagnosis of type 2 diabetes.
When would the nurse recommend
the patient schedule a dilated eye examination?
a. Every 2 years
b. Every 6 months
c. As soon as available
d. At the age of 39 years - ANS: C
Because many patients have some diabetic retinopathy when
they are first diagnosed with type 2 diabetes, a dilated eye
examination is recommended at the time of diagnosis and
annually thereafter.
A 40-year-old patient with suspected acromegaly is seen at the
clinic. To assist in making the
diagnosis, which question would the nurse ask?
a. "Have you had a recent head injury?"
b. "Do you have to wear larger shoes now?"
c. "Isthere a family history of acromegaly?"
d. "Are you experiencing tremors or anxiety?" - ANS: B
Acromegaly causes an enlargement of the hands and feet. Head
injury and family history are not risk factors for acromegaly.
, Tremors and anxiety are not clinical manifestations of
acromegaly.
A female patient is scheduled for an oral glucose tolerance test.
Which information from the patient's health history is important
for the nurse to communicate to the health care provider
regarding interpreting the result of this test?
a. The patient uses oral contraceptives.
b. The patient runs several days a week.
c. The patient has been pregnant three times.
d. The patient has a family history of diabetes. - ANS: A
Oral contraceptive use may falsely elevate oral glucose tolerance
test (OGTT) values. Exercise and a family history of diabetes
both can affect glucose but will not lead to misleading
information from the OGTT. History of previous pregnancies
may provide
informational about gestational glucose tolerance but will not
lead to misleading information from the OGTT.
A few weeks after an 82-yr-old patient with a new diagnosis of
type 2 diabetes has been placed on metformin (Glucophage)
therapy, the home health nurse makes a visit. Which finding
would the nurse promptly discuss with the health care provider?
a. Hemoglobin A1C level is 7.9%.
b. Glomerular filtration rate is decreased.
c. Last eye examination was 18 months ago.
d. Patient has questions about the prescribed diet - ANS: B
The decrease in renal function may indicate a need to adjust the
dose of metformin or change to a different medication. In older
patients, the goal for A1C may be higher in order to avoid
complications associated with hypoglycemia. The nurse will
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