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

Answer and Explanation

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..

From gloves to dye for CT scans, supply shortages continue to stress hospitals - The Boston Globe

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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.

A. Patient stopped taking the medication 2 days ago B. Patient has not been taking the prescribed vitamin D C. Patient has bilateral 2+ pitting ankle edema D. Patient's blood pressure is 148/94 mm Hg

Correct Answer is A

Explanation

Choice A reason: Patient stopped taking the medication 2 days ago is the most important information to report to the health care provider. Prednisone is a corticosteroid medication that suppresses the immune system and reduces inflammation. Prednisone also affects the production of cortisol, a hormone that regulates the stress response, blood pressure, blood sugar, and metabolism. Prednisone should not be stopped abruptly, as this can cause adrenal insufficiency, a condition where the adrenal glands cannot produce enough cortisol. Adrenal insufficiency can cause symptoms such as fatigue, weakness, nausea, vomiting, low blood pressure, and hypoglycemia. The patient should be instructed to resume taking the prednisone and taper the dose gradually under the supervision of the health care provider.

Choice B reason: Patient has not been taking the prescribed vitamin D is not as important as choice A, but still requires further education by the nurse. Vitamin D is a fat-soluble vitamin that helps the body absorb calcium and phosphorus, and maintain bone health. Prednisone can interfere with the metabolism of vitamin D and cause bone loss, osteoporosis, and fractures. The patient should be advised to take the prescribed vitamin D supplement and eat foods rich in vitamin D, such as fatty fish, egg yolks, cheese, and fortified milk.

Choice C reason: Patient has bilateral 2+ pitting ankle edema is not as critical as choice A, but still needs to be monitored by the nurse. Ankle edema is swelling of the ankles due to fluid accumulation in the tissues. Prednisone can cause ankle edema by increasing the sodium and water retention in the body, and reducing the potassium excretion by the kidneys. The patient should be assessed for signs of fluid overload, such as weight gain, shortness of breath, and crackles in the lungs. The patient should also be encouraged to limit the intake of salt and fluids, and elevate the legs when sitting or lying down.

Choice D reason: Patient's blood pressure is 148/94 mm Hg is not as urgent as choice A, but still needs to be addressed by the nurse. Blood pressure is the force of blood against the walls of the arteries. Prednisone can increase the blood pressure by stimulating the renin-angiotensin-aldosterone system, a hormonal system that regulates the blood volume and pressure. The patient should be advised to check the blood pressure regularly, and report any readings above 140/90 mm Hg to the health care provider. The patient should also be counseled to follow a healthy lifestyle, such as exercising, quitting smoking, reducing stress, and eating a balanced diet low in sodium, fat, and cholesterol.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

Correct Answer is A

Explanation

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