Harry George (Room 401): VCE Quiz Lesson 22 Diabetes Mellitus (Part 1 And Part 2)

Quiz | Lesson 22 | Diabetes Mellitus, Part 1 Question 1 1 / 1 pts Exercise 2 - Virtual Hospital Activity Sign in to work at Pacific View Regional Hospital for Period of Care 1. (Note: If you are already in the virtual hospital from a previous exercise, click on Leave the Floor and then on Restart the Program to get to the sign-in window.) From the Patient List, select Harry George (Room 401). Click on Go to Nurses’ Station. Click on Chart and then on 401. Click on History and Physical. Exercise 2 - Question 1 What risk factors for diabetes are noted in Harry George’s history? Question 2 1 / 1 pts Exercise 2 - Question 2 Describe the history of his present illness. Question 3 1 / 1 pts Exercise 2 - Question 3 What is the relationship between the infection in Harry George’s foot and his diabetes mellitus? Question 4 1 / 1 pts Click on Laboratory Reports. Exercise 2 - Question 4 Harry George's blood glucose level on admission was ______ mg/dL. 380 Question 5 1 / 1 pts Exercise 2 - Question 5 What abnormalities in his urinalysis results can be attributed to diabetes? Explain the relationship. Question 6 1 / 1 pts Click on Emergency Department. Exercise 2 - Question 6 What factor in Harry George’s recent history most likely contributed to his hyperglycemia? (Hint: Read the emergency department physician’s notes for 1345.) Question 7 1 / 1 pts Click on Nursing Admission. Exercise 2 - Question 7 Listed below are clinical manifestations of diabetes mellitus identified in the textbook. For each manifestation, indicate (Yes or No) whether each manifestation is usually present in type 2 diabetes. Then indicate (with Yes or No) whether it is usually present in type 2 diabetes. Question 8 1 / 1 pts Exercise 2 - Question 8 To what extent does Harry George fit the typical picture of a patient with type 2 diabetes mellitus? Question 9 1 / 1 pts Click on Return to Nurses’ Station. Click on 401 to enter Harry George’s room. Click on Patient Care and then on Nurse-Client Interactions. Select and view the video titled 0735: Symptom Management. (Note: Check the virtual clock to see whether enough time has elapsed. You can use the fast-forward feature to advance the time by 2-minute intervals if the video is not yet available. Then click again on Patient Care and on Nurse-Client Interactions to refresh the screen.) Exercise 2 - Question 9 What does Harry George tell the nurse about his appetite? Your Answer: Question 10 1 / 1 pts Exercise 2 - Question 10 What diet has been ordered for the patient? (Hint: Review his chart.) Question 11 1 / 1 pts Exercise 2 - Question 11 Describe the principles of this diet. Question 12 1 / 1 pts Exercise 2 - Question 12 How might the patient’s alcohol intake affect his blood glucose levels? Question 13 1 / 1 pts Exercise 3 - Virtual Hospital Activity Sign in to work at Pacific View Regional Hospital for Period of Care 2. (Note: If you are already in the virtual hospital from a previous exercise, click on Leave the Floor and then on Restart the Program to get to the sign-in window.) From the Patient List, select Harry George (Room 401). Click on Go to Nurses’ Station. Click on Chart and then on 401. Click on Physician's Orders. Exercise 3 - Question 1 What test is ordered that can be used to determine Harry George’s control of diabetes mellitus? Describe the purpose of this test. How often should it be done? Question 14 1 / 1 pts Click on Laboratory Reports. Exercise 3 - Question 2 What were the results of this test for Harry George? Based on these results, evaluate and explain how well his diabetes is controlled. Question 15 1 / 1 pts Exercise 3 - Question 3 What implication does Harry George’s level of glycemic control have for his future? Question 16 1 / 1 pts Click on Return to Nurses’ Station. Click on 401 at the bottom of the screen. Click on Patient Care and then on Physical Assessment. Exercise 3 - Question 4 Perform a head-to-toe assessment on Harry George, focusing on the areas listed below. Document any abnormal results. Head & Neck Chest Back & Spine Upper Extremities Abdomen Pelvic Lower Extremities Question 17 1 / 1 pts Click on EPR and Login. Choose 401 from the Patient drop-down menu and Neurologic from the Category drop-down menu. Exercise 3 - Question 5 Below, document any abnormal information obtained from the neurologic assessment completed on Monday at 1835. Question 18 1 / 1 pts Select Cardiovascular from the Category drop-down menu. Exercise 3 - Question 6 Below, document any abnormal information obtained from the cardiovascular assessment completed on Monday at 1835. Question 19 1 / 1 pts Exercise 3 - Question 7 Describe the following potential long-term complications for diabetes mellitus. Cardiovascular disease Cerebrovascular disease Retinopathy (nonproliferative and proliferative) Peripheral vascular disease Neuropathy Nephropathy Erectile dysfunction Cerebrovascular disease Retinopathy (nonproliferative and proliferative) Peripheral vascular disease Neuropathy Nephropathy Erectile dysfunction Question 20 1 / 1 pts Exercise 3 - Question 8 Does Harry George exhibit signs or symptoms that would alert you to the possibility of any of the long-term complications noted in question 7? If so, explain. Question 21 1 / 1 pts Exercise 3 - Question 9 What interventions, including patient teaching, would you plan to offer Harry George for prevention of injury secondary to reduced sensation in his left foot? VCE Quiz Diabetes Mellitus, Part 2 Diabetes Mellitus, Part 2 Exercise 2 - Virtual Hospital Activity • Sign in to work at Pacific View Regional Hospital for Period of Care 1. (Note: If you are already in the virtual hospital from a previous exercise, click on Leave the Floor and then on Restart the Program to get to the sign-in window.) • From the Patient List, select Harry George (Room 401). • Click on Go to Nurses’ Station. • Click on Chart and then on 401. • Click on Emergency Department. Exercise 2 - Question 1 What two medications were ordered to control Harry George’s diabetes? Include the dose and route for each. Question 2 / 1 pts Exercise 2 - Question 2 How would you give the IV insulin? (Hint: You can access the Drug Guide by clicking on the Drugicon in the lower left corner of the screen in the Nurses’ Station.) Question 3 / 1 pts Exercise 2 - Question 3 Find the Emergency Department physician's progress notes for Monday at 1345. What does the physician plan to order for the sliding scale insulin coverage? Question 4 / 1 pts • Click on Physician’s Orders. Exercise 2 - Question 4 Look at the orders for Monday at 1345. What was the actual sliding scale insulin order? Question 5 / 1 pts • Click on Return to Nurses' Station. • Click on Kardex and then on 401 to access the correct record. Exercise 2 - Question 5 According to the Kardex, how often should the capillary blood glucose be tested? Question 6 / 1 pts • Click on Return to Nurses’ Station. • Click on MAR and then on 401 for Harry George’s records. Exercise 2 - Question 6 According to the MAR, when should the insulin sliding scale be administered? What was the time of this order? Question 7 / 1 pts Exercise 2 - Question 7 What would you do regarding the inconsistencies identified above? Question 8 / 1 pts Exercise 2 - Question 8 What problems might occur if Harry George does not receive insulin at bedtime? Question 9 / 1 pts • Click on Return to Nurses' Station. • Click on 401 at the bottom of the screen. • Click on Clinical Alerts. Exercise 2 - Question 9 What is the clinical alert for 0730? Question 10 / 1 pts Prepare and administer the sliding scale insulin for this glucose level by following these steps: • Click on Medication Room on the bottom of the screen. • Click on MAR or on Review MAR at any time to verify how much insulin to administer based on sliding scale. (Hint: You must click on the correct room number within the MAR. Remember to look at the patient name on the MAR to make sure you have the correct patient's records.) Click on Return to Medication Room after reviewing the correct MAR. • Click on Unit Dosage and then on drawer 401 for Harry George’s medications. • Select Insulin Regular, put medication on tray, and then close the drawer. • Click on View Medication Room. • Click on Preparation and choose the correct medication to administer. Click on Prepare. • Click on Next, choose the correct patient to administer this medication to, and click on Finish. • You can click on Review Your Medications and then on Return to Medication Room when ready. Once you are back in the Medication Room, you may go directly to Harry George’s room by clicking on 401 at the bottom of the screen. • Click on Patient Care. • Click on Medication Administration and follow the steps in the Administration Wizard to complete the insulin administration. Exercise 2 - Question 10 How much insulin should be administered? Question 11 / 1 pts Exercise 2 - Question 11 What is the preferred site of administration for fastest absorption? Question 12 / 1 pts Exercise 2 - Question 12 List the expected onset, peak, and duration for the insulin you just administered. What actual times would you expect the onset, peak, and duration for Harry George, based on giving the insulin at 0730? Expected length of time: • Onset • Peak • Duration Actual Time After 0730 Dose: • Onset • Peak • Duration Question 13 / 1 pts Exercise 2 - Question 13 At what time would Harry George be at most risk for hypoglycemia? Describe the signs and symptoms that would indicate this acute complication. Question 14 / 1 pts Exercise 2 - Question 14 While you are preparing to administer Harry George’s insulin, he asks you why he is taking this because he did not use insulin at home. How would you answer this? Question 15 / 1 pts Exercise 2 - Question 15 For what side effects should you monitor Harry George related to his insulin regimen? Question 16 / 1 pts Exercise 3 - Virtual Hospital Activity • Sign in to work at Pacific View Regional Hospital for Period of Care 4. (Note: If you are already in the virtual hospital from a previous exercise, click on Leave the Floor and then on Restart the Program to get to the sign-in window.) • Click on Chart and then on 401 for Harry George's chart. (Remember: You are not able to visit patients or administer medications during Period of Care 4. You are able to review patient records only.) • Click on Nurses' Notes. Exercise 3 - Question 1 Read the notes for Wednesday at 1730. What does the patient say regarding glyburide? Question 17 / 1 pts Exercise 3 - Question 2 How would you respond to the patient's demands? Question 18 / 1 pts Exercise 3 - Question 3 How often did Harry George take the glyburide at home? Question 19 / 1 pts Exercise 3 - Question 4 Why do you think this was increased in the hospital? What concerns might you have regarding this increase? (Hint: This patient is also receiving insulin.) Question 20 / 1 pts Exercise 3 - Question 5 What classification of oral hypoglycemic does glyburide belong to? (Hint: For help, click on the Drug Guide located on the counter in the Nurses' Station.) Question 21 / 1 pts Exercise 3 - Question 6 For what side effects of glyburide should you assess Harry George? Question 22 / 1 pts Exercise 3 - Question 7 What specific patient teaching points should you give this patient regarding glyburide? Exercise 3 - Question 8 List the date and time, blood glucose levels, and insulin doses received since Harry George's admission. (Hint: There are eight. You will need to access the chart and review the expired MARs to obtain the sliding scale doses.) Question 24 / 1 pts Exercise 3 - Question 9 Based on Harry George’s pattern of blood glucose levels, would you evaluate his current therapy as effective? If not, how might the physician further treat his diabetes? Question 25 / 1 pts Exercise 3 - Question 10 If you were reviewing the chart orders and the EPR on Wednesday evening and found the information recorded in the table in question 8, what would you be ethically and legally bound to report?