Chapter 13 - Prioritization, Delegation,
and Assignment Questions And
Answers 100% verified 2023
The nurse is caring for an older patient with type 1
... [Show More] diabetes and diabetic retinopathy.
What is the nurse's *priority* concern for assessing this patient?
•Assess ability to measure and inject insulin and to monitor blood glucose levels
•Assess for damage to motor fibers, which can result in muscle weakness
•Assess which modifiable risk factors can be reduced
•Assess for albuminuria, which may indicate kidney disease - ANS-•Assess ability to
measure and inject insulin and to monitor blood glucose levels
•The older patient with diabetic retinopathy also has general age-related vision changes,
and the ability to perform self-care may be seriously affected. He or she may have
blurred vision, distorted central vision, fluctuating vision, loss of color perception, and
mobility problems resulting from loss of depth perception. When a patient has visual
changes, it is especially important to assess his or her ability to measure and inject
insulin and to monitor blood glucose levels to determine if adaptive devices are needed
to assist in self-management. The other options are important but are not specific to
diabetic retinopathy.
An older patient with type 2 diabetes has cardiovascular autonomic neuropathy (CAN).
Which instruction would the nurse provide for the unlicensed assistive personnel (UAP)
assisting the patient with morning care?
•Provide a complete bed bath for this patient
•Sit the patient up slowly on the side of the bed before standing
•Only let the patient wash his or her face and brush his or her teeth
•Be sure to provide rest periods between activities - ANS-•Sit the patient up slowly on
the side of the bed before standing
•CAN affects sympathetic and parasympathetic nerves of the heart and blood vessels. It
may lead to orthostatic (postural) hypotension and syncope (brief loss of consciousness
on standing) caused by failure of the heart and arteries to respond to position changes
by increasing heart rate and vascular tone. The nurse should be sure to instruct the
UAP to have the patient change positions slowly when moving from lying to sitting and
standing.
The nurse is preparing to review a teaching plan for a patient with type 2 diabetes
mellitus. To determine the patient's level of compliance with his prescribed diabetic
regimen, which value would the nurse be sure to review?
•Fasting glucose level
•Oral glucose tolerance test results
•Glycosylated hemoglobin (HgbA1c) level
•Fingerstick glucose findings for 24 hours - ANS-•Glycosylated hemoglobin (HgbA1c)
level
•The higher the blood glucose level is over time, the more glycosylated the hemoglobin
becomes. The HgbA1c level is a good indicator of the average blood glucose level over
the previous 120 days. Fasting glucose and oral glucose tolerance tests are important
diagnostic tools. Fingerstick blood glucose monitoring provides information that allows
adjustment of the patient's therapeutic regimen.
A patient has newly-diagnosed type 2 diabetes. Which task should the RN delegate to
an experienced unlicensed assistive personnel (UAP)?
•Arranging a consult with the dietitian
•Assessing the patient's insulin injection technique
•Teaching the patient to use a glucometer to monitor glucose at home
•Checking the patient's glucose level before each meal - ANS-•Checking the patient's
glucose level before each meal
•The experienced UAP would have been taught to perform tasks such as checking
pulse oximetry and glucose checks, and these actions would be part of his or her scope
of practice. Arranging for a consult with the dietitian is appropriate for the unit clerk.
Teaching and assessing require additional education and should be carried out by
licensed nurses.
A patient with newly diagnosed diabetes has peripheral neuropathy. Which key points
should the nurse include in the teaching plan for this patient? *Select all that apply.*
•"Clean and inspect your feet every day."
•"Be sure that your shoes fit properly."
•"Nylon socks are best to prevent friction on your toes from shoes."
•"Only a podiatrist should trim your toenails."
•"Report any nonhealing skin breaks to your health care provider (HCP)."
•"Use a thermometer to check the temperature of water before taking a bath." - ANS-
•"Clean and inspect your feet every day."
•"Be sure that your shoes fit properly."
•"Report any nonhealing skin breaks to your health care provider (HCP)."
•"Use a thermometer to check the temperature of water before taking a bath."
•Sensory alterations are the major cause of foot complications in patient with diabetes,
and patients should be taught to examine their feet on a daily basis. Properly fitted
shoes protect the patient from foot complications. Broken skin increases the risk of
infection. Cotton socks are recommended to absorb moisture. Using a bath
thermometer can prevent burn injuries. Patients, family, or HCPs may trim toenails.
An LPN/LVN is assigned to perform assessments on two patients with diabetes.
Assessments reveals all of these findings. Which finding would the RN instruct the
LPN/LVN to report *immediately*?
•Fingerstick glucose reading of 185 mg/dL (10.3 mmol/L)
•Numbness and tingling in both feet
•Profuse perspiration
•Bunion on the left great toe - ANS-•Profuse perspiration
•Profuse perspiration is a symptom of hypoglycemia, a complication of diabetes that
requires urgent treatment. A glucose level of 185 mg/dL (10.3 mmol/L) will need
coverage with sliding-scale insulin, but this is not urgent. Numbness and tingling, as well
as bunions, are related to the chronic nature of diabetes and are not urgent problems.
The plan of care for a patient with diabetes includes all of these interventions. Which
intervention should the nurse delegate to unlicensed assistive personnel (UAP)?
•Reminding the patient to put on well-fitting shoes before ambulating
•Discussing community resources for diabetic outpatient care
•Teaching the patient to perform daily foot inspection
•Assessing the patient's technique for drawing insulin into a syringe - ANS-•Reminding
the patient to put on well-fitting shoes before ambulating
•Reminding the patient to put on well-fitting shoes (after the nurse has taught the patient
about the importance of this action) is part of assisting with activities of daily living and
is within the education and scope of practice of the UAP. It is a safety measure that can
prevent injury. Discussing community resources, teaching, and assessing require a
higher level of education and are appropriate to the scope of practice of licensed
nurses.
A 58-year-old patient with type 2 diabetes was admitted to the acute care unit with a
diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation. When the
RN prepares a care plan for this patient, what would he or she be sure to include?
Select all that apply.
•Fingerstick blood glucose checks before meals and at bedtime
•Sliding-scale insulin dosing as prescribed
•Bed rest until the COPD exacerbation is resolved
•Teaching about the Atkins diet for weight loss
•Demonstration of the components of foot care
•Discussing the relationship between illness and glucose levels - ANS-•Fingerstick
blood glucose checks before meals and at bedtime
•Sliding-scale insulin dosing as prescribed
•Demonstration of the components of foot care
•Discussing the relationship between illness and glucose levels
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