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26 terms paige_stansberry Preview Chapte 16 terms bria A nurse is teaching a client with diabetes mellitus who asks, “Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL (3.3 mmol/L)?” How would the nurse respond?

• “Glucose is the only fuel used by the body to produce the energy that it needs.”
• “Your brain needs a constant supply of glucose because it cannot store it.” c. “Without a minimum level of glucose, your body does not make

red blood cells.”

• “Glucose in the blood prevents the formation of lactic acid and prevents acidosis.”
• “Your brain needs a constant supply of glucose because it cannot store it.”

Rationale: Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body’s circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the patient to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.The nurse is assessing a client for risk of developing metabolic syndrome. Which risk factor is associated with this health condition?

• Hypotension
• Hyperthyroidism
• Abdominal obesity
• Hypoglycemia
• Abdominal obesity

Rationale: The client at risk for metabolic syndrome typically has hypertension, abdominal obesity, hyperlipidemia, and hyperglycemia.

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?

• “At my age, I should continue seeing the ophthalmologist as I usually do.”
• “I will see the eye doctor when I have a vision problem and yearly after age 40.”
• “My vision will change quickly. I should see the ophthalmologist twice a year.”
• “Diabetes can cause blindness, so I should see the ophthalmologist yearly.”
• “Diabetes can cause blindness, so I should see the ophthalmologist yearly.”

Rationale: Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What action would the nurse take first?

• Document the finding in the client’s chart.
• Assess tactile sensation in the client’s hands.
• Examine the client’s feet for signs of injury.
• Notify the primary health care provider.
• Examine the client’s feet for signs of injury.

Rationale: Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse would inspect them for any signs of injury. After assessment, the nurse would document findings in the client’s chart. Testing sensory perception in the hands may or may not be needed. The primary health care provider can be notified after assessment and documentation have been completed.A nurse cares for a client who has a family history of diabetes mellitus. The client states, “My father has type 1 diabetes mellitus. Will I develop this disease as well?” How would the nurse respond?

• “Your risk of diabetes is higher than the general population, but it may not occur.”
• “No genetic risk is associated with the development of type 1 diabetes mellitus.”
• “The risk for becoming a diabetic is 50% because of how it is inherited.”
• “Female children do not inherit diabetes mellitus, but male children will.”
• “Your risk of diabetes is higher than the general population, but it may not occur.”

Rationale: Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client’s plan of care to delay the onset of microvascular and macrovascular complications?

• “Maintain tight glycemic control and prevent hyperglycemia.”
• “Restrict your fluid intake to no more than 2 L a day.”
• “Prevent hypoglycemia by eating a bedtime snack.”
• “Limit your intake of protein to prevent ketoacidosis.”
• “Maintain tight glycemic control and prevent hyperglycemia.”

Rationale: Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for patients with diabetes. Preventing hypoglycemia and ketosis, although important, is not as important as maintaining daily glycemic control.

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?

• A 19-year-old Caucasian
• A 22-year-old African American
• A 44-year-old Asian American
• A 58-year-old American Indian
• A 58-year-old American Indian

Rationale: Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle age places this patient at highest risk.A nurse teaches a patient about self-monitoring of blood glucose levels. Which statement would the nurse include in this client’s teaching to prevent bloodborne infections?

• “Wash your hands after completing each test.”
• “Do not share your monitoring equipment.”
• “Blot excess blood from the strip with a cotton ball.”
• “Use gloves when monitoring your blood glucose.”
• “Do not share your monitoring equipment.”

Rationale: Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client would be taught to avoid sharing any equipment, including the lancet holder. The client would also be taught to wash his or her hands before testing. He or she would not need to blot excess blood away from the strip or wear gloves.A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol).Which statement would the nurse include in this client’s teaching?

• “Change positions slowly when you get out of bed.”
• “Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs).”
• “If you miss a dose of this drug, you can double the next dose.”
• “Discontinue the medication if you develop a urinary infection.”
• “Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs).”

Rationale: NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.After teaching a patient with type 2 diabetes mellitus who is prescribed nateglinide, the nurse assesses the client’s understanding. Which statement made by the patient indicates a correct understanding of the prescribed therapy?

• “I’ll take this medicine during each of my meals.”
• “I must take this medicine in the morning when I wake.”
• “I will take this medicine before I go to bed.”
• “I will take this medicine immediately before I eat.”
• “I will take this medicine immediately before I eat.”

Rationale: Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the client’s blood glucose levels causing hypoglycemia.The medication should be taken before meals instead of during meals.

A nurse cares for a patient who is prescribed pioglitazone. After 6 months of therapy, the client reports that he has a new onset of ankle edema.What assessment question would the nurse take?

• “Have you gained unexpected weight this week?”
• “Has your urinary output declined recently?”
• “Have you had fever and achiness this week?”
• “Have you had abdominal pain recently?”
• “Have you gained unexpected weight this week?”

Rationale: Thiazolidinediones (including pioglitazone) can cause cardiovascular adverse effects including health failure which is manifested by peripheral edema and unintentional weight gain. The client should have been taught to weigh every week and report sudden increases in weight.A nurse cares for a client with diabetes mellitus who asks, “Why do I need to administer more than one injection of insulin each day?” How would the nurse respond?

• “You need to start with multiple injections until you become more proficient at self-injection.”
• “A single dose of insulin each day would not match your blood insulin levels and your food intake patterns.
• “A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates.”
• “A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock.”
• “A single dose of insulin each day would not match your blood insulin levels and your food intake patterns.

Rationale: Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the patient decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the client’s risk of insulin shock.After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching?

• “The lower abdomen is the best location because it is closest to the pancreas.”
• “I can reach my thigh the best, so I will use the different areas of my thighs.” c. “By rotating the sites in one area, my chance of having a

reaction is decreased.”

• “Changing injection sites from the thigh to the arm will change absorption rates.”
• “The lower abdomen is the best location because it is closest to the pancreas.”

Rationale: After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching? a. “The lower abdomen is the best location because it is closest to the pancreas.” b. “I can reach my thigh the best, so I will use the different areas of my thighs.” c. “By rotating the sites in one area, my chance of having a reaction is decreased.” d. “Changing injection sites from the thigh to the arm will change absorption rates.” A nurse reviews the laboratory test values for a client with a new diagnosis of diabetes mellitus type 2. Which A1C value would the nurse expect?

• 5.0%
• 5.7%
• 6.2%
• 7.4%
• 7.4%

Rationale: A client is diagnosed with diabetes if the client’s A1C is 6.5% or greater. All listed values are below that level except for 7.4%.