Question 11 Just after being admitted to the emergency department for symptoms of influenza the patient loses consciousness. His wife reports that he is diabetic but has not taken his oral medications for a “couple of days.†Which nursing interventions are indicated? 1. Check the patient’s blood glucose using a finger stick monitor. 2. Place 1.5 tubes of 40% glucose gel under the patient’s tongue. 3. Obtain intravenous access. 4. Administer 50% dextrose subcutaneously. 5. Administer regular insulin subcutaneously. Question 12 A patient with type 2 diabetes reports that she can always tell when her blood sugar is low because “my fingers tingle.†How should the nurse interpret this information? 1. This is a central nervous system effect of hypoglycemia. 2. The patient is experiencing increased blood glucose rather than decreased blood glucose. 3. This patient is developing hypoglycemia unawareness. 4. This is a common catecholamine effect of hypoglycemia. Question 13 A patient with long-standing type 2 diabetes may be developing diabetic ketoacidosis. Which assessment findings would the nurse evaluate as supporting that diagnosis? 1. A sweet smell to the breath 2. Ketonuria 3. Blood pH of 7.48 4. WBC of 28,000 5. Potassium of 3.4 mEq/L Question 14 A patient is brought to the emergency department by her son who reports that she was recently diagnosed with diabetes and “is not acting like herself†today. Which additional findings would the nurse consider as suggesting hyperglycemic hyperosmolar state? 1. The son reports his mother’s diabetes is type 2. 2. The patient’s plasma glucose reading is 638 mg/dL. 3. The patient’s bicarbonate level is 14. 4. The patient’s blood pH is 7.28. 5. The patient is 60 years of age. Question 15 A patient diagnosed with hyperglycemic hyperosmotic syndrome (HHS) will be started on rehydration fluids. How will the nurse anticipate managing this treatment? 1. Initial treatment will be with rapidly infused lactated Ringer’s solution. 2. Once the patient’s blood glucose has decreased to around 200 mg/dL a glucose containing solution will be used for the remaining hydration. 3. The patient will be encouraged to drink as much fluid as possible. 4. The nurse will monitor the patient’s lungs for signs of overload. 5. The fluid used for resuscitation will contain insulin. Question 16 Despite the inherent risks, the patient with diabetic ketoacidosis will be given sodium bicarbonate to reverse severe metabolic acidosis. How does the nurse expect to administer this medication? 1. In enema form 2. As a 50 mL bolus injection intravenously 3. Along with potassium chloride 4. Over at least an 8-hour period Question 17 A patient will receive insulin as treatment for diabetic ketoacidosis. The patient weighs 225 pounds and has a pretreatment serum glucose of 288 mg/dL. Which prescription would the nurse be comfortable administering? 1. Administer regular insulin 102 units/hr by intravenous infusion. 2. Administer NPH insulin 20 units twice daily. 3. Administer regular insulin intravenously at 10 units/hr. 4. Administer regular insulin 100 units in 1000 mL NS at 28.8 mL/hr. Question 18 The nurse comes to the cardiac patient’s room to administer subcutaneous insulin. The patient says, “I have always taken pills for my diabetes. Am I getting worse?†What should the nurse consider when formulating a response to this question? 1. Some cardiac diseases cause oral antidiabetic medications to be less effective. 2. The stress of illness makes it difficult to control glucose with oral medications. 3. The changes associated with hospitalization make it difficult to control glucose with oral medications. 4. The patient will likely need to take insulin to control glucose even after release from the hospital. 5. Once discharged the patient can use urine dipstick measurements to guide insulin therapy. Question 19 A patient with diabetic retinopathy is admitted to the intensive care unit. Which nursing interventions are indicated? 1. Keep the room light dimmed. 2. Provide a braille board for communication. 3. Offer frequent reorientation to the environment. 4. Limit visitors to immediate family only. Question 20 The patient with diabetic neuropathy has been admitted to the intensive care unit after major abdominal surgery. Which nursing intervention is indicated because of this neuropathy? 1. Keep the skin clean and dry. 2. Place the arms and legs in the patient’s position of comfort. 3. Instruct the patient to cough and take deep breaths every 2 hours. 4. Place a warming blanket under the patient to prevent hypothermia.