Adult Health Chapter 49 Diabetes Mellitus EAQ Questions

Which complication of diabetes can cause hypoglycemic unawareness? A. Diabetic neuropathy B. Diabetic dermopathy C. Diabetic ketoacidosis D. Diabetic nephropathy

A Autonomic neuropathy is a type of diabetic neuropathy. Autonomic neuropathy can affect all the systems in the body leading to hypoglycemic unawareness. Diabetic dermopathy may cause acanthosis nigricans and necrobiosis lipoidica diabeticorum. Diabetic ketoacidosis may cause dehydration, metabolic acidosis, and electrolyte disturbance. Diabetic nephropathy leads to reduction in the glomerular filtration rate of the kidneys.

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges

A Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

The nurse is assigned to care for a patient with type 2 diabetes. To encourage the patient to become an active participant in his or her care, what action should the nurse take? A. Assess the patient's understanding of the disease B. Make a list of food restrictions for proper diabetes management C. Refer the patient to a nutritionist D. Set long-term goals to decrease the risk of complications

A For teaching to be effective, the first step is assessing the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. Food restrictions, nutritionist referral, and setting long-term goals can occur once the nurse is confident the patient understands what it means to have diabetes.

The nurse has taught a patient who was admitted with diabetes, cellulitus, and osteomyelitis about the principles of foot care. The nurse determines that additional teaching is necessary when the patient makes which statement? A. "Taking a hot bath every day will help with my circulation." B. "I should avoid walking barefoot at all times." C. "I should look at the condition of my feet every day." D. "I need a podiatrist to treat my ingrown toenails."

A Hot water may injure tissue related to decreased sensation and should be avoided. Patients with diabetes mellitus should inspect the feet daily for broken areas that are at risk for delayed wound healing, avoid walking barefoot, and have a podiatrist for foot care.

Which complication of diabetes can be treated with hyperbaric oxygen? A. Diabetic foot ulcers B. Diabetic nephropathy C. Neuropathic arthropathy D. Peripheral vascular disease

A Hyperbaric oxygen is used for wound healing in diabetic foot ulcers. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used in the treatment of diabetic nephropathy. Neuropathic arthropathy results in ankle and foot changes and increases the chances of developing foot ulcers. Peripheral vascular disease is one of the macrovascular complications of diabetes. Management includes smoking cessation and control of hypertension.

Laboratory results have been obtained for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

A Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

What is a risk factor associated with macrovascular complications of diabetes mellitus? A. Obesity B. Seizures C. Hypovolemia D. Adrenal insufficiency

A Obesity increases the risk for blood vessel and cardiovascular disease. Hypoglycemia, if untreated, results in seizures and coma. Hypovolemia, due to excessive dehydration, may lead to shock. Patients with adrenal insufficiency may have minimal glycogen stores and may not respond to glucagon therapy.

The nurse observes a return demonstration by a patient who is learning how to mix regular insulin and NPH insulin in the same syringe. Which action by the patient indicates the need for further teaching? A. Withdrawing the NPH insulin first B. Injecting air into the NPH insulin bottle first C. Removing air bubbles after drawing up the first insulin D. Injecting an amount of air equal to the desired dose of insulin

A Regular insulin is always withdrawn first so it will not become contaminated with the NPH insulin. Injecting air into the NPH bottle first, removing air bubbles after drawing up the regular insulin, and injecting air equal to the desired dose of insulin are correct actions in regard to the mixture of regular and NPH insulin.

Which complication can be monitored by annual screening using a monofilament? A. Diabetic neuropathy B. Diabetic retinopathy C. Diabetic dermopathy D. Diabetic nephropathy

A Sensory neuropathy is a type of diabetic neuropathy in which loss of protective sensation (LOPS) is common. LOPS may lead to lower extremity amputation. Therefore, annual screening using a monofilament is important in monitoring the patient for diabetic neuropathy. Diabetic retinopathy is monitored by annual fundoscopic examination. Examining the skin changes is important in diabetic patients to monitor for diabetic dermopathy. Serum creatinine and urinalysis for microalbuminuria help to monitor for diabetic nephropathy.

A patient with diabetes mellitus has a neurogenic bladder leading to urinary retention. How is the Credé maneuver performed to help the patient completely empty the bladder? A. By performing mild massage downward over the lower abdomen and bladder B. By performing mild massage downward over the upper abdomen and bladder C. By performing moderate massage downward over the lower abdomen and bladder D. By performing moderate massage downward over the upper abdomen and bladder

A The Credé maneuver involves mild massage downward over the lower abdomen and bladder with low pressure. This massage helps in relaxing the lower abdominal muscles, which may in turn help in complete bladder emptying. The upper abdomen is not involved in the Credé maneuver. Moderate massage on the lower or upper abdomen involves applying high pressure, so reflux of urine may occur and result in renal infection.

The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision

A The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

The nurse provides dietary instructions to a patient with type 1 diabetes mellitus. Which statement made by the patient indicates a need for further teaching? A. "If I go over my calories, I can just increase my insulin." B. "I'll need a bedtime snack, because I take an evening dose of NPH insulin." C. "I can have an occasional low-calorie dessert as long as I include it in my meal plan." D. "I should eat meals at the scheduled times, even if I'm not hungry, to prevent hypoglycemia."

A The goal of dietary therapy for the patient with diabetes mellitus is to attain and maintain an ideal body weight and a stable blood glucose level. Each patient should be prescribed a specific caloric intake and insulin regimen to help him or her achieve this goal. Insulin dosage should not be increased to account for an increased caloric intake. A bedtime snack for people taking evening NPH insulin, planning for an occasional low-calorie dessert, and eating at scheduled times are all part of correct diabetes management.

The nurse is evaluating the teaching session on nutrition for the newly diagnosed diabetic patient. Which statement indicates an understanding of the teaching? A. "When my blood sugar is less than 70 mg/dL, I will take 15 grams of a fast-acting carbohydrate, such as orange juice, and recheck in 15 minutes." B. "When my blood sugar is less than 70 mg/dL I will drink 8 ounces of milk and recheck in 15 minutes." C. "I will eat a few hard candies when my blood sugar is less than 70 and recheck in 15 minutes." D. "When my blood sugar is less than 70 mg/dL, I will take 3 to 4 sugar tablets and recheck in 30 minutes."

A The patient understands the need for a fast acting sugar and the need to recheck in 15 minutes. Milk is not a fast-acting carbohydrate, so it will take longer for the low blood sugar to stabilize. The patient's statement about the hard candies does not indicate that the patient understands the need for 15 to 20 grams of carbohydrates. Rechecking blood sugar in 30 minutes is waiting too long to check blood sugar.

One of the unlicensed assistive personnel (UAP) reports to the nurse that a patient with diabetes is slow to respond, pale, and diaphoretic. What is the nurse's priority intervention? A. Obtain a bedside glucose reading. B. Ask patient to drink 4 ounces of orange juice. C. Ask the unlicensed assistive personnel (UAP) to obtain a set of vital signs. D. Administer 50 mL of 50% dextrose intravenously.

A The patient with diabetes is exhibiting signs and symptoms of hypoglycemia. The priority intervention at this time is to validate assessment findings with a bedside glucose reading. Although vital signs may add to assessment data findings, they are not as much a priority as validating hypoglycemia and initiating treatment. Because the patient is experiencing a change in level of consciousness, management of the hypoglycemia via oral nourishment is contraindicated. If the patient has an existing intravenous (IV) line, then treatment of documented hypoglycemia with intravenous dextrose may be indicated.

The nurse is caring for a patient admitted to the health care facility with type 1 diabetes. What leads to type 1 diabetes? A. Autoimmune destruction of pancreatic β-cells B. Presence of unresponsive insulin receptors C. Decrease in the production of insulin D. Inappropriate glucose production by the liver

A Type 1 diabetes is caused by autoimmune destruction of the pancreatic β-cells, resulting in a total absence of insulin production. Type 2 diabetes mellitus is caused by unresponsive insulin receptors, decrease in the production of insulin, inappropriate glucose production by the liver, or altered production of hormones and cytokines by adipose tissue. Text Reference - p. 1155

What is the primary defect factor associated with type 1 diabetes mellitus? A. Absent or minimal insulin production B. Alteration in production of adipokines C. Decreased insulin production over time and insulin resistance D. Abnormal increase in insulin production by the pancreas over time

A Type 1 diabetes mellitus is a result of the absence or minimal production of insulin by the pancreas. Alteration in production of adipokines, decreased insulin production over time, and insulin resistance are the defect factors associated with type 2 diabetes mellitus. An abnormal increase in the insulin over time does not cause diabetes.

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8 AM. The nurse instructs the patient to fast for what period of time? A. At least eight hours B. 4 AM on the day of the test C. After dinner the evening before the test D. 7 AM on the day of the test

A Typically a patient is prescribed to be nothing by mouth (NPO) for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8 AM should not have any food or beverages containing any calories after midnight. It is not necessary to fast longer than eight hours; 4 AM and 7 AM would not allow for sufficient time to fast for morning laboratory testing.

The nurse is caring for a patient in an outpatient diabetes clinic. Which statement by the patient indicates an understanding of the teaching? A. "I will be sure to measure my finger stick blood glucose level four times a day, and more frequently when I am ill." B. "When I am ill, I will eliminate my Lantus insulin and only cover my finger stick blood glucose if it is over 250." C. "When I am ill, I will continue to take my Lantus insulin only." D. "When I am ill I will only take my rapid acting insulin."

A When a patient with diabetes is ill, it is recommended he or she continues checking blood sugar every four hours and more frequently to prevent hyperglycemia and hypoglycemia during illness. The diabetic patient should adhere to the sick day rules, which indicate to continue with your basal dosing of insulin and continue to correct a finger stick blood sugar greater than 200. The patient also should be checking urine ketones for two blood sugars over 250 in a row.

What are components of metabolic syndrome? Select all that apply. A. Abdominal obesity B. Elevated glucose levels C. Elevated blood pressure D. Low levels of triglycerides E. Increased levels of high-density lipoproteins (HDL)

A, B, C The components of metabolic syndrome are abdominal obesity, elevated glucose levels, and elevated blood pressure. Low levels of triglycerides and increased levels of HDL are not components of metabolic syndrome.

Which complication of diabetes mellitus can be monitored by fundus photography? A. Neuropathy B. Retinopathy C. Nephropathy D. Dermatopathy

B Fundus photography helps to examine the interior surface of the eye (fundus). Therefore, fundus photography helps to detect the microvascular damage caused by chronic hyperglycemia to the retina, known as retinopathy. Neuropathy can be monitored by a comprehensive foot examination. Diabetic nephropathy can be monitored by checking for microalbuminuria and serum creatinine. Dermatopathy can be monitored by frequent skin examinations.

Which statement by a patient shows ineffective learning about diabetes management? A. "I will exercise daily." B. "I will drink fruit juices daily." C. "I will walk wearing shoes daily." D. "I will have yearly influenza vaccination."

B Having fruit juices daily does not help in diabetes management, because it contains sugars that are easily absorbed. Exercising daily helps to maintain good health. Wearing shoes daily will avoid injuries to feet, which is important, because wound healing is delayed in diabetic patients. Diabetic patients have weakened immune systems and are more prone to flu. Therefore, annual vaccination against influenza is required.

Which patient will not respond to glucagon? A. Patient with cerebral edema B. Patient with alcoholic liver disease C. Patient with chronic hyperglycemia D. Patients with peripheral vascular disease

B Patients with alcohol-related hepatic disease may have minimal glycogen stores and will not respond to glucagon. Cerebral edema is related to a rapid decrease in the blood glucose levels. Patients with chronic hyperglycemia may develop chronic complications of diabetes mellitus. Peripheral vascular disease is one of the macrovascular complications of diabetes.

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I am lucky my shoes fit so nice and tight because they give me firm support." D. "When I am allowed up out of bed, I should check the shower water with my toes."

B Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. The patient should not walk barefoot. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.

Which factor is most associated with type 1 diabetes mellitus? A. Obesity B. Viral infection C. Sedentary lifestyle D. High-carbohydrate diet

B Type 1 diabetes mellitus is caused due to a complete pancreatic shutdown. One of the many causes is a viral infection that may trigger production of antibodies against the pancreas. Obesity, sedentary lifestyle, and intake of a high-carbohydrate diet may increase the risk for type 2 diabetes mellitus.

Which drug may result in weight gain as a side effect? A. Biguanides B. Meglitinides C. Dopamine agonist D. Dipeptidyl peptidase-4 inhibitors

B Weight gain is a common side effect seen with meglitinides. Biguanides, dopamine agonists, and dipeptidyl peptidase-4 inhibitors may not result in weight gain.

Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis? A. Electrolytes B. Insulin therapy C. Sodium bicarbonate D. Intravenous (IV) fluids

B When the body cannot utilize glucose for energy, it burns fat for energy resulting in the production of ketones. Insulin therapy is useful for reducing the serum ketone levels. Electrolytes are given to correct the electrolyte imbalance. Sodium bicarbonate is given to treat metabolic acidosis. IV fluids are indicated for correction of dehydration.

A patient who was recently diagnosed with type 2 diabetes mellitus completed a teaching session about disease management. Which statement by the patient indicates understanding of type 2 diabetes mellitus? A. "I will always be able to manage my diabetes with pills." B. "As I get older, I will be able to decrease my diabetes medicine." C. "If I become ill, I will need to check my blood sugar more frequently." D. "As long as I take my medication, I do not have to follow a diabetic diet."

C Illness may increase blood glucose on people with type 2 diabetes. Diabetes is a progressive disease and as time goes on, patients with diabetes type 2 may need to increase oral medications or begin insulin therapy. Nutritional therapy is an integral part of diabetes management.

A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? A. Central apnea B. Hypoventilation C. Kussmaul respirations D. Cheyne-Stokes respirations

C In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

An patient, admitted with type 1 diabetes, asks the nurse what "type 1" means. What is the nurse's best response? A. "There is decreased insulin secretion, cellular resistance to insulin that is produced, or both." B. "An increased amount of adipose tissue has led to an insufficient amount of insulin being produced." C. "The body produces autoantibodies that destroy beta cells in the pancreas." D. "The insulin being made is not used by the tissues properly, leading to high blood sugar."

C In type 1 diabetes mellitus, the pancreas is unable to make any insulin and the patient will require life-long exogenous insulin to control blood sugars. There is no cellular resistance and insulin secretion is absent, not decreased. Patients with type 1 diabetes are typically very thin; adipose tissue does not result in a decreased insulin production. It cannot be used by the tissues and cells because none is being produced.

The nurse is teaching the caregiver about the manifestations of hypoglycemia in the diabetic patient. What should the caregiver identify as a manifestation of hypoglycemia? A. Increase in urination B. Abdominal cramps C. Nervousness and tremors D. Nausea and vomiting

C Nervousness and tremors, cold, clammy skin, and numbness of the fingers and toes are some of the manifestations of hypoglycemia for which the caregiver should watch out in the patient. An increase in urination, abdominal cramps, and nausea and vomiting are manifestations of hyperglycemia.

Which drug is used for treating neurogenic bladder? A. Valsartan B. Gabapentin C. Bethanechol D. Amitryptyline

C Neurogenic bladder may develop as a sensation in the inner bladder wall causing urinary retention. A cholinergic agonist drug such as bethanechol is used for treating this condition. Valsartan is an angiotensin receptor blocker that is used in patients with diabetes and microalbuminuria. Gabapentin is an antiseizure medication used for treating neuropathic pain. Amitryptyline is a tricyclic antidepressant used in the treatment of neuropathic pain.

What is the pathophysiologic cause of type 1 diabetes mellitus? A. Insulin resistance of the body tissues B. Decreased mass count of pancreatic β cells C. Autoimmune destruction of pancreatic β cells D. Fatigued pancreatic β cells due to overproduction of insulin

C Pancreatic β cells are the main source of insulin production in the body. Autoimmune destruction of pancreatic β cells results in minimal or no production of insulin. Absence of insulin is the factor associated with type 1 diabetes mellitus. Insulin resistance is the condition where insulin is produced by the pancreas but its uptake is resisted by the tissues. This factor is associated with type 2 diabetes mellitus. A decreased mass count of pancreatic β cells and fatigued pancreatic β cells produce insufficient insulin for the normal metabolism, so these factors are associated with type 2 diabetes.

What is the cause of microaneurysms in nonproliferative retinopathy? A. Retinal edema B. Neurovascularization C. Blood vessels occlusion D. Intraretinal hemorrhages

C Partial occlusion of small blood vessels in the retina causes microaneurysyms in the capillary walls. Retinal edema is caused by leakage of the capillary fluids from the walls of microaneurysms. Occlusion of retinal capillaries leads to neurovascularization, which is the formation of new blood vessels to supply the retina with blood. Intraretinal hemorrhages may occur due to leakage of the capillary fluids from microaneurysms. Text Reference - p. 1181

Which is an insulin-dependent tissue? A. Brain B. Kidney C. Skeletal muscle D. Red blood cells

C Skeletal muscles have specific receptors, which are activated by insulin that permit the transportation of glucose into the cells. The brain, kidney, and red blood cells do not have receptors; instead they require only a specific amount of glucose for normal functioning.

Which complication of diabetes can be diagnosed by the ankle-brachial index? A. Diabetic neuropathy B. Diabetic nephropathy C. Peripheral arterial disease D. Hyperosmolar hyperglycemic syndrome

C The ankle-brachial index is used to diagnose peripheral arterial disease. Diabetic neuropathy is diagnosed based on the symptoms and by examining the patient's lower extremities. Increased serum creatinine, decreased glomerular filtration rate, and albuminuria is indicative of diabetic nephropathy. Hyperosmolar hyperglycemic syndrome is suspected if the blood glucose levels are more than 600 mg/dL, with a marked increase in serum osmolality.

Which symptom reported by a patient would lead the nurse to suspect early undiagnosed type 2 diabetes? A. Blurred vision B. Gradual weight gain C. A wound that will not heal D. Insomnia

C Type 2 diabetes presents with vague complaints including fatigue, frequent infections, and delayed wound healing. Blurred vision is a late symptom of uncontrolled diabetes. The patient will present with weight loss. Insomnia is not related to symptoms of undiagnosed diabetes.

To determine how well a patient's diabetes mellitus has been controlled over the past two to three months, what assessment parameter should the nurse review? A. Fasting blood glucose B. Oral glucose tolerance C. Glycosylated hemoglobin D. Random fingerstick blood glucose

C When the glucose level is increased, glucose molecules attach to hemoglobin in the red blood cells (RBCs). This attachment lasts for the life of the RBC, two to three months. Monitoring the numbers of these attachments makes it possible to assess the average blood glucose for the previous two to three months. Fasting blood glucose, oral glucose tolerance, and random fingerstick blood glucose tests are used to measure the current blood glucose level, which is different from the glycosylated hemoglobin level.

Which statement of the diabetic patient suggests the need for additional learning about foot care? A. "I will wear only padded socks." B. "I will wash my feet daily with gentle soap." C. "I will check my feet for swelling and cuts every day." D. "I will give a hot water bottle treatment to my feet daily."

D A patient suffering from severe diabetes may have sensory neuropathy. Hot water is not recommended, because the patient will not be able to sense the degree of warmth of the water and may get burns. Using padded socks will protect the patient from cuts. Washing the feet daily with gentle soap will reduce the risk of infection. By checking for swelling and cuts every day, the patient can get timely treatment if needed.

A patient with diabetes experiences hypoglycemia. What does the nurse educate the patient that a cause of this condition may be? A. Mild illness with fever B. Insufficient injection of insulin C. Overeating at a family holiday dinner D. Exercise without a carbohydrate-based snack

D Exercise without a carbohydrate-based snack could result in hypoglycemia. Mild illness, insufficient insulin dosage, and overeating are situations that would cause hyperglycemia, or an increased blood glucose level.

Which is a symptom of autonomic neuropathy? A. Aphasia B. Glaucoma C. Paresthesias D. Gastroparesis

D Gastroparesis is delayed gastric emptying, which is one of the complications of autonomic neuropathy. Aphasia is one of the severe neurologic manifestations of hyperosmolar hyperglycemic syndrome. Glaucoma may occur due to diabetic retinopathy. Paresthesias is seen in sensory neuropathy.

Which blood glucose level indicates hyperglycemia? A. 60 to 70 mg/dL B. 80 to 110 mg/dL C. 100 to 125 mg/dL D. 200 to 250 mg/dL

D Hyperglycemia is a condition in which the blood glucose level is greater than 200 mg/dL. If the blood glucose level ranges from 60 to 70 mg/dL, it indicates hypoglycemia. The blood glucose level is considered normal if it ranges from 80 to 110 mg/dL. The blood glucose level ranges from 100 to 125 mg/dL in prediabetes. Text Reference - p. 1157

The nurse is reviewing diabetic self-care management with a patient newly diagnosed with diabetes. The patient is in need of further education when stating to the nurse: A. "I am going to check my feet for pressure areas every morning before I take a bath." B. "I need to be careful on how I cut my toenails. I should not cut down the corners of the nail." C. "I have scheduled an eye examination with an ophthalmologist for next week. I will need to have an annual eye exam." D. "To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath."

D Patients with diabetes are at great risk for skin breakdown because of peripheral vascular problems and peripheral neuropathy. Patients should avoid using rubbing alcohol on skin to prevent tissue damage. The best way to prevent foot ulcers is prevention and early detection. Inspecting the feet every day for cuts, abrasions, pressure areas, or sores is a good practice. Toenails should be cut with the rounded contour of the nail and not cut down the corners of the nail. Another complication of diabetes is retinopathy. Patients with a history of diabetes should have an eye examination annually by an ophthalmologist.

The nurse is teaching a patient with type 2 diabetes about exercise as a method to control blood glucose levels. The nurse knows the patient understands when the patient elicits which exercise plan? A. "I want to go fishing for 30 minutes each day. I will drink fluids and wear sunscreen." B. "I will go running each day when my blood sugar is too high to bring it back to normal." C. "I will plan to keep my job as a teacher because I get a lot of exercise every school day." D. "I will take a brisk 30-minute walk five days per week and do resistance training three times a week."

D The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity five days per week and resistance training three times a week. Brisk walking is moderate activity. Fishing and teaching are light activity and running is considered vigorous activity.

Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis? A. Polyuria B. Hypokalemia C. Cerebral edema D. Metabolic acidosis

Incorrect fluid replacement especially with hypotonic fluids may cause a sudden drop in serum sodium resulting in cerebral edema. Polyuria is a manifestation of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Hypokalemia may be seen with severe dehydration. Metabolic acidosis is observed with diabetic ketoacidosis due to fluid losses.