Chapter 48: Diabetes Mellitus Lewis: Medical-Surgical Nursing, 10th Edition

Chapter 48: Diabetes Mellitus Lewis: Medical-Surgical Nursing, 10th Edition unitedwestand34Teacher Save Lewis Medical Surgical --Chapter 53...48 terms PipersFeathers Preview

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Teacher 46 terms unitedwestand34 Preview Diabet Teacher ssa 41. A 30-yr-old patient has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye examination

• every 2 years.
• as soon as possible.
• when the patient is 39 years old.
• within the first year after diagnosis.

ANS: B

Because many patients have some diabetic retinopathy when they are first diagnosed with type 2 diabetes, a dilated eye examination is recommended at the time of diagnosis and annually thereafter. Patients with type 1 diabetes should have dilated eye examinations starting 5 years after they are diagnosed and then annually.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning

REF: 1149

MSC: NCLEX: Physiological Integrity

• Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?
• Insulin is not used to control blood glucose in patients with type 2 diabetes.
• Complications of type 2 diabetes are less serious than those of type 1 diabetes.
• Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
• Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.

ANS: C

For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.DIF: Cognitive Level: Understand (comprehension) REF: 1134 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

• The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse

anticipate a positive response?

• "Are you anorexic?"
• "Is your urine dark colored?"
• "Have you lost weight lately?"
• "Do you crave sugary drinks?"

ANS: C

Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment

REF: 1121

MSC: NCLEX: Physiological Integrity

• A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to

evaluate the effectiveness of treatment for the patient?

• Fasting blood glucose
• Oral glucose tolerance

c Glycosylated hemoglobin

• Urine dipstick for glucose

_ANS: C

The glycosylated hemoglobin (A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control after diabetes has been diagnosed.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning

REF: 1124

MSC: NCLEX: Physiological Integrity

• The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of

care is most important for this patient?

• The patient will reach a glycosylated hemoglobin level of less than 7%.
• The patient will follow a diet and exercise plan that results in weight loss.
• The patient will choose a diet that distributes calories throughout the day.
• The patient will state the reasons for eliminating simple sugars in the diet.

ANS: A

The complications of diabetes are related to elevated blood glucose and the most important patient outcome is the reduction of glucose to near-normal levels. A BMI of 30?9?kg/m2 or above is considered obese, so the other outcomes are appropriate but are not as high in priority.DIF: Cognitive Level: Analyze (analysis) REF: 1124 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

• A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. The clinic nurse will plan to teach the patient to
• check glucose level before, during, and after swimming.
• delay eating the noon meal until after the swimming class.
• increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
• time the morning insulin injection so that the peak occurs while swimming.

ANS: A

The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning

REF: 1132

MSC: NCLEX: Physiological Integrity

• The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following?
• "I will need a bedtime snack because I take an evening dose of NPH insulin."
• "I can choose any foods, as long as I use enough insulin to cover the calories."
• "I can have an occasional beverage with alcohol if I include it in my meal plan."
• "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."

ANS: B

Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation

REF: 1132

MSC: NCLEX: Physiological Integrity