A few weeks after an 82-year-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider?
Last eye examination was 18 months ago
Patient states they are scheduled for a CT scan with contrast dye the next day
Hemoglobin A1C level is 7.9%
Patient has questions about the prescribed diet
The Correct Answer is B
Choice A reason: Last eye examination was 18 months ago is not a finding that requires immediate attention from the health care provider. However, the nurse should remind the patient of the importance of regular eye examinations, as diabetes can increase the risk of eye problems, such as cataracts, glaucoma, and diabetic retinopathy. The American Diabetes Association (ADA) recommends that patients with type 2 diabetes have a comprehensive eye examination at least once every two years¹.
Choice B reason: Patient states they are scheduled for a CT scan with contrast dye the next day is a finding that should be promptly discussed with the health care provider. Metformin is a medication that lowers the blood glucose level by reducing the liver's production of glucose and increasing the cells' sensitivity to insulin. Metformin can interact with contrast dye, which is a substance that is injected into the veins to enhance the visibility of organs and tissues in imaging tests, such as CT scans. Contrast dye can impair the kidney function and increase the risk of lactic acidosis, a rare but serious condition where the blood becomes too acidic due to the accumulation of lactic acid. Lactic acidosis can cause symptoms such as nausea, vomiting, abdominal pain, muscle weakness, and breathing difficulties. To prevent this complication, the ADA recommends that patients stop taking metformin at the time of or before the imaging procedure, and resume it 48 hours after the procedure, only if the kidney function is normal².
Choice C reason: Hemoglobin A1C level is 7.9% is not a finding that needs urgent discussion with the health care provider. Hemoglobin A1C is a test that measures the average blood glucose level over the past two to three months. It reflects how well the diabetes is controlled over time. The ADA recommends that most patients with type 2 diabetes aim for a hemoglobin A1C level of less than 7%, as this can reduce the risk of diabetes complications, such as heart disease, kidney disease, nerve damage, and eye damage. A hemoglobin A1C level of 7.9% indicates that the patient's blood glucose level is slightly above the target range, and may need some adjustment in the medication, diet, or exercise plan. However, this is not an emergency situation, and the nurse can review the patient's self-monitoring records, medication adherence, and lifestyle factors, and provide education and support as needed.
Choice D reason: Patient has questions about the prescribed diet is not a finding that warrants immediate communication with the health care provider. However, the nurse should address the patient's questions and concerns, and provide clear and consistent information about the dietary recommendations for type 2 diabetes. A healthy diet for type 2 diabetes should include a variety of foods, such as vegetables, fruits, whole grains, lean proteins, low-fat dairy, and healthy fats. The patient should also limit the intake of added sugars, refined carbohydrates, saturated fats, trans fats, and sodium. The nurse can help the patient plan their meals and snacks, and use tools such as carbohydrate counting, portion control, or the plate method to balance their food choices and blood glucose levels..
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Lispro (Humalog) is a type of insulin that is used for mealtime coverage. It is a rapid-acting insulin that starts to work within 15 minutes, peaks in about an hour, and lasts for 2 to 4 hours. It mimics the natural insulin response to food intake, and helps to lower the blood glucose level after meals. The nurse will discuss using lispro for mealtime coverage, and instruct the patient to inject it within 15 minutes before or after eating.
Choice B reason: NPH (Humulin N) is a type of insulin that is not used for mealtime coverage. It is an intermediate-acting insulin that starts to work within 2 to 4 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours. It provides a steady background of insulin throughout the day, and helps to control the blood glucose level between meals and overnight. The nurse will discuss using NPH for basal coverage, and instruct the patient to inject it once or twice a day, usually in the morning and/or evening.
Choice C reason: Detemir (Levemir) is a type of insulin that is not used for mealtime coverage. It is a long-acting insulin that starts to work within 1 to 2 hours, has no peak, and lasts for up to 24 hours. It provides a constant level of insulin throughout the day, and helps to maintain the blood glucose level at a stable range. The nurse will discuss using detemir for basal coverage, and instruct the patient to inject it once or twice a day, depending on the individual needs.
Choice D reason: Glargine (Lantus) is a type of insulin that is not used for mealtime coverage. It is a long-acting insulin that starts to work within 1 to 2 hours, has no peak, and lasts for up to 24 hours. It provides a constant level of insulin throughout the day, and helps to maintain the blood glucose level at a stable range. The nurse will discuss using glargine for basal coverage, and instruct the patient to inject it once a day, usually at the same time every day.
Correct Answer is C
Explanation
Choice A reason: This statement is false. 3% Sodium Chloride is a hypertonic solution that can cause fluid overload, hypernatremia, and cellular dehydration. It is not indicated for a patient with nausea, vomiting, and Salmonella infection, who is likely to have fluid and electrolyte losses.
Choice B reason: This statement is false. Dextrose 10% in water is a hypotonic solution that can cause fluid shifts, hyponatremia, and cellular edema. It is not indicated for a patient with nausea, vomiting, and Salmonella infection, who is likely to have fluid and electrolyte losses.
Choice C reason: This statement is true. 0.9% Sodium Chloride with 40 mEq Potassium (KCl) is an isotonic solution that can maintain fluid and electrolyte balance. It is indicated for a patient with nausea, vomiting, and Salmonella infection, who is likely to have fluid and electrolyte losses, especially sodium and potassium.
Choice D reason: This statement is false. Lactated Ringers is an isotonic solution that can maintain fluid and electrolyte balance, but it also contains lactate, which can be converted to bicarbonate in the liver. It is not indicated for a patient with nausea, vomiting, and Salmonella infection, who may have metabolic acidosis due to diarrhea and lactate accumulation.
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