NURS 166 ~ Ticket to Class

SLS Scenario 32 ~ Arthur Harris

Name____________________________________________
Date_____________________________________________

Lewis, et al
Medical-Surgical Nursing: Assessment and Management of Clinical Problems,10th Edition

Chapter 8: Pain: Pain Assessment | pp. 107-110; Pain Treatment | pp. 110-122
Chapter 11: Inflammation and Wound Healing: Healing Process | pp. 165-166
Chapter 23: Integumentary Problems; Skin Infections and Infestations | pp. 413-417
Chapter 31: Assessment of Cardiovascular: Assessment of CV System | pp. 663-669
Chapter 48: Diabetes Mellitus | pp. 1120-1155

Before class: Review the scenario, RN to RN report, use clinical worksheet to organize
pertinent pateint information, and be ready to participate.

Ticket to class Questions:

1. Describe a teaching plan for self-monitoring of blood glucose.

2. List the clinical manifestations of hyperglycemia and hypoglycemia.

3. List 4 long-term complications of diabetes mellitus.

Ticket to class multiple choice questions:

1. Diabetes mellitus can best be described as a:
A.  chronic illness related to abnormal insulin production. 
B.  chronic illness related to excessive glucose metabolism.
C.  chronic disease related to thyroid metabolism.
D.  disorder in which the body attacks glucose storage cells.

2. You are caring for a patient who has developed a wound on his foot that cultures positive
for Streptococcus pyogenes. He has edema surrounding the wound and also has chills and a
fever. Which bacterial skin infection do you suspect?
A.  Folliculitis  Carbuncle
B.  Cellulitis   Impetigo

3. You are caring for a patient with type 1 diabetes. During assessment of the patient you
obtain a finger-stick glucose reading. If his glucose reading is 400, what presenting symptoms
would you expect?
A.  Hypertension and tachycardia
B.  Diaphoresis and hunger
C.  Polyuria and polydipsia 
D.  Constipation and decreased urine output

4. You are caring for an elderly patient with a history of diabetes currently admitted for
cellulitis and started on antibiotic therapy. He is running a fever and has a loss of
appetite. What impact could this admission have on the regulation of his diabetes?
A.  Patient may experience hypoglycemia due to increased metabolism
caused by illness.
B.  Stress of illness and hospitalization may cause patient to experience
hyperglycemia.
C.  Patient may experience decreased urine output due to elevated glucose
levels.
D.  Patient will need to have insulin discontinued until after his
hospitalization.

5. You are caring for a patient with diabetes mellitus and are preparing to administer
his daily insulin. His morning glucose level indicates that he needs an additional amount
of insulin. You are mixing intermediate-acting insulin (NPH) and short acting insulin
(regular) in the same syringe. What is your rationale for drawing up the regular insulin
first?
A.  To prevent contamination of the NPH with the regular
B.  To prevent contamination of the regular with the NPH 
 C.  To secure the correct dosage of the short acting insulin
D.  To prevent an inaccurate concentration of the mixture

6. For a patient who suffers from diabetes, what is the condition in which the circulating
supply of insulin is insufficient and glucose cannot be used for energy?
A.  Hyperosmolar hyperglycemic syndrome
B.  Insulin shock
C.  Diabetic ketoacidosis 
D.  Hypoglycemic unawareness

7. You are the nurse caring for a 54-year-old homeless man with a history of diabetes
and emphysema admitted with Cellulitis of his leg. He was taking glyburide prior to
admission and is now started on sliding scale insulin. Which element from his history
would be most responsible for his current diagnosis?
A.  Vascular insufficiency related to diabetes mellitus 
B.  Decreased peripheral oxygen related to emphysema
C.  Poor nutrition related to homeless lifestyle
D.  Decreased peripheral circulation caused by pulmonary hypertension

8. You are the nurse caring for a 54-year-old postoperative male patient admitted with
diabetes and cellulitis of the lower extremity. You are assessing his peripheral vascular
system. For which assessment finding would you notify the appropriate health care
provider?
A.  Pedal pulses of 64 and bounding
B.  Capillary refill of 5 seconds
C.  Warm skin surface on toes
D.  Weaker foot pressure with the left foot

9. You are caring for a patient admitted with cellulitis. His appetite is poor. He has an IV
of normal saline and is receiving intermediate-acting insulin and fast-acting insulin on a
sliding scale. He is feeling lightheaded, slightly confused, and diaphoretic. What do you
suspect is causing the patient's current symptoms?
A.  Hypoglycemia 
B.  Diabetic ketoacidosis
C.  Septicemia
D.  Osteomyelitis