Diabetes Quiz Evolve

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective? 1 "I should massage my feet and legs with oil or lotion." 2 "I should apply heat intermittently to my feet and legs." 3 "I should eat foods high in protein and carbohydrate kilocalories." 4 "I should control my blood glucose with diet, exercise, and medication."

"I should control my blood glucose with diet, exercise, and medication." RationaleControlling the diabetes decreases the risk of infection; this is the best prevention. Oil or lotion that is not completely absorbed may provide a warm, moist environment for bacterial growth. Coexisting neuropathy may result in injury from heat application. Protein, carbohydrates, and fats must be in an appropriate balance; high carbohydrate intake can provide too many calories.

A 17-year-old adolescent was recently found to have type 2 diabetes mellitus. What information will the nurse include when providing education to the family? 1 "Your teen will need insulin injections for the rest of her life." 2 "The most important interventions are good nutrition and portion control." 3 "This is a condition where the body produces antibodies against its own cells." 4 "This condition causes weight loss and increased appetite, thirst, and urination."

2 Most children with type 2 diabetes are overweight or at risk for becoming overweight. With nutritional intervention to promote proper weight, the condition may often be managed with diet and exercise alone. A lifelong insulin regimen; the production of antibodies against the child's own cells; and weight loss with increased appetite, thirst, and urination are all typical of type 1 diabetes.

An adolescent with a BMI of 30 reports fatigue, frequent urination, and a tingling sensation on the feet. The adolescent is then diagnosed with type 2 diabetes mellitus. Which nursing interventions would be appropriate? Select all that apply. 1. Bariatric surgery 2. Physical activities 3. Dietary restrictions 4. Dietary counseling 5. Behavior modification

2,4,5

A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1 "I will take the drug with food." 2 "I must swallow my medication whole and not crush or chew it." 3 "I will notify my doctor if I develop muscular or abdominal discomfort." 4 "I will stop taking metformin for 24 hours before and after having a test involving dye."

4 Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, Metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

A nurse is teaching a young adolescent with type 2 diabetes about nutritional needs. Which statement demonstrates that the adolescent understands what was taught? 1 "I can have low-fat, low-cal candy bars." 2 "Regular soft drinks are better than diet ones." 3 "It's okay for me to eat one slice of pizza at a party." 4 "My fasting blood sugar should be no higher than 150 mg/dL (8.3 mmol/L)."

Pizza contains complex carbohydrates and protein; even a child with type 2 diabetes may include a slice in the diet on special occasions. Although candy bars can be low in fat and calories, they may still have a high simple sugar content, which is contraindicated. Diet, not regular, soft drinks are preferred for an individual with type 2 diabetes; regular soft drinks are high in simple sugars. The euglycemic fasting blood glucose should be 70 to 105 mg/dL (3.9 to 5.8 mmol/L).

A nurse is caring for a client who has a 20-year history of type 2 diabetes. The nurse should assess for what physiologic changes associated with a long history of diabetes? 1 Blurry, spotty, or hazy vision 2 Arthritic changes in the hands 3 Hyperactive knee and ankle jerk reflexes 4 Dependent pallor of the feet and lower legs

1 Blurry, spotty, or hazy vision; floaters or cobwebs in the visual field; and cataracts or complete blindness can occur as a result of diabetes. Diabetic retinopathy is characterized by abnormal growth of new blood vessels in the retina (neovascularization). More than 60% of clients with type 2 diabetes have some degree of retinopathy after 20 years. Arthritic changes of the hands are not a usual complication associated with diabetes mellitus. Clients who are diabetic have peripheral neuropathy, which is characterized by hypoactive, not hyperactive, reflexes. Peripheral vascular disease is indicated by dependent rubor with pallor on elevation, not dependent pallor.

A client is diagnosed as having type 2 diabetes. What is a priority teaching goal for the client? 1 To perform foot care daily 2 To administer insulin as prescribed 3 To test urine for both sugar and acetone 4 To identify pending hypoglycemia or hyperglycemia

4 Knowledge of the signs and treatment for hypoglycemia or hyperglycemia is critical to the client's health and well-being and essential for survival. Although performing foot care daily is important, it is not the priority. The client has type 2 diabetes, which is usually controlled by oral hypoglycemics. Self-serum glucose monitoring is more accurate than sugar and acetone urine measurements to identify serum glucose levels.

A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information? 1 "Eat your usual breakfast." 2 "Have clear liquids for breakfast." 3 "Take your medication before the test." 4 "Do not ingest anything before the test."

4

A 67-year-old man with type 2 diabetes sadly confides in the nurse that he has been unable to have an erection for several years. What is the best response by the nurse? 1 "At your age sex isn't that important." 2 "Sex isn't everything it's cracked up to be." 3 "You sound upset about not being able to have an erection." 4 "Maybe it's time for you to speak to your primary healthcare provider about this."

3.

An obese client with type 2 diabetes asks about the intake of alcohol or special "dietetic" food in the diet. What should the nurse include in teaching? 1 Alcohol can be consumed, with its calories counted in the diet. 2 Unlimited amounts of sugar substitutes can be used as desired. 3 Alcohol should not be used in cooking because it adds too many calories. 4 Special "dietetic" foods are needed because many regular foods cannot be used.

1 In the overweight individual with type 2 diabetes, occasional alcohol can be ingested with caloric substitution for equivalent fat exchanges in the diet because it is metabolized like fat. Moderation is vital; sugar substitutes may not be used in unlimited quantities, and they must be accounted for in the dietary calculations. Alcohol can be used as long as it is accounted for in the diet. The statement that special "dietetic" foods are needed because many regular foods cannot be used is untrue; regular foods can be used in the diet of individuals with diabetes.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. What should the nurse advise the client? Select all that apply. 1 Avoid solid food. 2 Take the oral medication. 3 Drink fluids throughout the day. 4 Monitor capillary glucose levels. 5 Do not take medication until tolerating food.

2,3,4 Physiologic stress increases gluconeogenesis, requiring continued pharmacologic therapy despite an inability to eat; fluids prevent dehydration; monitoring of glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic agent may precipitate hyperglycemia. Food intake should be attempted to prevent acidosis. Delaying an oral hypoglycemic agent may precipitate hyperglycemia.

A client with type 2 diabetes develops gout, and allopurinol is prescribed. The client is also taking metformin and an over-the-counter nonsteroidal antiinflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do? 1 Decrease the daily dose of NSAIDs. 2 Limit fluid intake to one quart a day. 3 Take the medication on an empty stomach. 4 Monitor blood glucose levels more frequently.

4 Allopurinol can potentiate the effect of oral hypoglycemics, causing hypoglycemia; the blood glucose level should be monitored more frequently. NSAIDs can be taken concurrently with allopurinol. A daily fluid intake of 2500 to 3000 mL will limit the risk of developing renal calculi. Allopurinol should be taken with milk or food to decrease gastrointestinal irritation.

When assessing the laboratory values of a client with type 2 diabetes, what would the nurse expect the results to reveal? 1 Ketones in the blood but not in the urine 2 Glucose in the urine but not in the blood 3 Urine and blood positive for glucose and ketones 4 Urine negative for ketones and positive glucose in the blood

4 The reason for the lack of ketonuria in type 2 diabetes is unknown. One theory is that extremely high hyperglycemia and hyperosmolarity levels block the formation of ketones, stimulating lipogenesis rather than lipolysis. Ketones in the blood but not in the urine do not occur with type 2 diabetes. Glucose in the urine but not in the blood is impossible; if glycosuria is present, there must first be a level of glucose in the blood exceeding the renal threshold of 160 to 180 mg/dL (8.9 to 10 mmol/L). Urine and blood positive for glucose and ketones are expected in type 1 diabetes.

A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? 1 Stimulates the pancreas to produce insulin 2 Accelerates the liver's release of stored glycogen 3 Increases glucose transport across the cell membrane 4 Lowers blood glucose in the absence of pancreatic function

1 Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.

A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes, and the other client has type 2 diabetes. When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes what clinical presentation about type 1? 1 Onset of the disease is slow. 2 Excessive weight is a contributing factor. 3 Complications are not present at the time of diagnosis. 4 Treatment involves diet, exercise, and oral medications.

3 Rationale: Clinical presentation of type 1 diabetes is characterized by acute onset, and therefore there is no time to develop the long-term complications that are common with long-standing disease; 20% of newly diagnosed clients with type 2 diabetes demonstrate complications because the diabetes has gone undetected for an extended period of time. Clinical presentation of type 1 diabetes is rapid, not slow, as pancreatic beta cells are destroyed by an autoimmune process; in type 2 diabetes, the body is still producing some insulin, and therefore the onset of signs and symptoms is slow. In type 1 diabetes, clients are generally lean or have an ideal weight; 80% to 90% of clients with type 2 diabetes are overweight. Type 1 diabetes requires diet control, exercise, and subcutaneous administration of insulin, not oral medications; oral medications are used for type 2 diabetes because some insulin is still being produced.

A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra tablet should be taken before exercise. What is the best response by the nurse? 1 "You will need to decrease your exercise." 2 "An extra tablet will help your body use glucose correctly." 3 "When taking medicine, your diet will not be affected by exercise." 4 "No, but you should observe for signs of hypoglycemia while exercising."

4 Exercise improves glucose metabolism; with exercise there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy.

The health care provider prescribes an oral hypoglycemic for the client with type 2 diabetes. What will the nurse need to consider when developing the teaching plan? 1 Oral hypoglycemics work by decreasing absorption of carbohydrates. 2 Oral hypoglycemics work by stimulating the pancreas to produce insulin. 3 Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. 4 Clients with type 2 diabetes do not need to be concerned about serious adverse effects from oral hypoglycemics.

3 Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the drug prescribed. Oral hypoglycemic drugs can have serious adverse effects.

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. What information does the nurse include when teaching the client about the addition of insulin? 1 "You will need a higher serum glucose level while on bed rest." 2 "The stress of surgery may cause uncontrollable periods of hypoglycemia." 3 "With insulin, dosage can be adjusted to your changing needs during recovery from surgery." 4 "The possibility of surgical complications is greater when a client takes oral hypoglycemics."

3 There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible. The occurrence of acidosis is greater when the client is receiving exogenous insulin. The stress of surgery will precipitate hyperglycemia, which is best controlled with exogenous insulin.

A 12-year-old child with type 2 diabetes is scheduled for abdominal surgery. Which factors are most important for the nurse to consider during the postoperative period? Select all that apply. 1 Infection will likely occur at the surgical site. 2 Ketoacidosis frequently occurs later in the postoperative period. 3 The blood glucose level will increase because of the stress of surgery. 4 Urine test results are the most useful gauge of diabetic control after surgery. 5 Diabetic control is usually maintained with insulin after surgery.

3,4. The stress of surgery causes the release of epinephrine and glucocorticoids, which increase the blood glucose level. Most individuals with type 2 diabetes who control their diabetes through diet and exercise require insulin during the recovery period. Although the child with diabetes is at risk for infection, surgical aseptic technique should prevent infection. Ketoacidosis is associated with type 1, not type 2, diabetes. Urine test results are affected by many variables and therefore are not reliable indicators of the blood glucose level.