Pearson D 1 & 2
Which action by a parent of a 12-year-old child with a new diagnosis of type 1 diabetes indicates a need for further teaching? A. Scheduling a baseline exam with an ophthalmologist B. Counting carbohydrates with the child C. Allowing the child to check blood sugars D. Discouraging after-school sports
D
Minimum minutes of exercise per week for type 2
150
The nurse is caring for a client newly diagnosed with type 2 diabetes. Prior to any teaching about medications, the client informs the nurse, "I cannot give myself any injections." How should the nurse respond? A. "Type 2 can usually be managed with pills, diet, and exercise." B. "It is understandable to be upset about a new medical diagnosis." C. "Insulin administration helps with better blood glucose management." D. "Why do you think you will have to give your
A
The nurse is conducting a health fair to screen for type 2 diabetes. Which participant should the nurse consider to be at highest risk? A. 50-year-old office worker who sits at the computer B. 30-year-old nurse who works in an intensive care unit C. 60-year-old retired architect who works at job site D. 40-year-old kindergarten teacher who works in a classroom
A
The nurse is performing a physical assessment of a child. Which assessment finding should cause the nurse to suspect type 2 diabetes? A. Presence of acanthosis nigricans B. Pale mucous membranes C. Body mass index 21 kg/m Superscript 2 D. Blood pressure of 110/78 mmHg
A Acanthosis nigricans is a condition in which the skin is velvety in texture and brownish black in color with hyperkeratotic plaques; it is usually found in skin folds. This condition is often found in clients with type 2 diabetes and should be reported to the healthcare provider. A blood pressure reading of 110/78 mmHg is a normal finding as is a body mass index of 21 kg/m2. Pale mucous membranes could be a sign of anemia.
The nurse is teaching a group of clients newly diagnosed with type 1 diabetes. Which information should the nurse include in the teaching? A. "Schedule regular ophthalmology visits." B. "Have routine pedicures performed." C. "Monitor blood glucose levels weekly." D. "Take beta blockers daily to control blood pressure."
A The client with type 1 diabetes is at high risk for retinal damage. Therefore, the nurse would teach the client to schedule regular ophthalmology visits to monitor vision. The client would be prescribed angiotensin-converting enzyme (ACE) inhibitors to protect the kidneys from vascular damage. The nurse would NOT encourage the client to have regular pedicures due to possible injury that can occur from macrovascular and microvascular deficits. Blood glucose levels should be monitored several times a day, not once a week.
Which information should the school nurse provide when teaching a group of adolescents the risk factors for type 2 diabetes? A. Get sufficient exercise and activity. B. Limit the amount of protein intake. C. Monitor blood glucose levels. D. Increase carbohydrate intake.
A Frequently, children with type 2 diabetes develop the disease from a sedentary lifestyle and obesity. Therefore, the nurse would instruct the adolescents regarding the benefits of exercise and activity. Children should limit the amount of carbohydrates and include a normal amount of protein. They do not need to monitor blood glucose levels unless a diagnosis of type 2 diabetes is made.
The nurse is caring for a child with type 2 diabetes. Which item in this child's history should the nurse recognize as a risk factor for this disease? (Select all that apply.) A. Family history B. Race C. High-fat diet D. Sex E. Obesity
A B C E Obesity, a high-fat diet, a family history of diabetes mellitus, and race are risk factors for developing type 2 diabetes. Sex does not play a role in the risk for type 2 diabetes.
The nurse is teaching a group of young adults regarding nonmodifiable risk factors for the development of type 1 diabetes. Which statement indicates a need for further instruction? (SATA) A."Type 1 can be caused by exposure certain drugs and pollutants." B."Type 1 can be caused by a genetic disorder." C."Type 1 is caused by exposure to processing of metals and proteins." D."I can develop type 1 from an infection." E. "Type 1 causes an autoimmune reaction that destroys
A B D E According to the American Diabetes Association, type 1 diabetes is caused by autoimmune destruction of beta cells. Exposure to environmental triggers in individuals with certain genes may increase the risk. Environmental factors include exposure to an infection, certain drugs, and pollutants. Exposure to processing of metals contributes to the development of cirrhosis. Processing of proteins does not cause type 1 diabetes.
The nurse is taking a health history from a client who has type 1 diabetes. Which client symptom may indicate the development of complications? (Select all that apply.) A. Numbness in the feet B. Vision changes C. Quick wound healing D. Frequent voiding of urine E. Dizziness
A B D E Diabetes = slow wound healing
After performing a health history and physical assessment for a client, the nurse suspects type 2 diabetes. Which assessment finding is consistent with the nurse's suspicion? (Select all that apply.) A. Extreme thirst B. Hyperglycemia C. Decreased urination D. Acanthosis nigricans E. Hypertension
A B D E Symptoms that would lead the nurse to suspect the client has type 2 diabetes are extreme thirst, hyperglycemia, hypertension, and acanthosis nigricans (a condition in which the skin is velvety in texture and brownish black in color with hyperkeratotic plaques). A client with type 2 diabetes would have increased and not decreased urination.
The nurse is caring for a 15-year-old child newly diagnosed with type 2 diabetes. Which task should the nurse expect to be completed quarterly for this child? (Select all that apply.) A. Discuss alcohol, tobacco, and drug use. B. Measure fasting glucose levels. C. Make a foot assessment. D. Evaluate lipid levels. E. Review glucose records.
A B E When a child is diagnosed with type 2 diabetes, certain tasks should be scheduled quarterly and annually. Discussing alcohol, tobacco, and drug use, measuring fasting glucose levels, and reviewing glucose records are completed quarterly. Lipid levels should be evaluated upon diagnosis and annually. A foot assessment should be completed annually; quarterly would be too often.
The nurse is providing teaching to a client with a new diagnosis of type 1 diabetes. The nurse should instruct the client about incorporating which treatment to help manage the disease? (Select all that apply.) A. Exercise B. Fluid restriction C. Medication D. Nutrition E. Daily weight checking
A C D Clients with type 1 diabetes are treated with exercise, nutrition, and medication. Fluid restriction and daily weight checking are not part of the treatment plan for clients with type 1 diabetes.
A client with type 1 diabetes using intensive insulin therapy is being taught to monitor blood glucose levels. At which time should the nurse instruct the client to monitor glucose levels? (Select all that apply.) A. At bedtime B. After showering C. When symptoms of low glucose occur D. Before meals and snacks E. Before exercising
A C D E Glucose levels for clients using intensive insulin therapy should be assessed at bedtime, before exercising, before meals and snacks, and when symptoms of low blood glucose occur. There is no reason for the blood glucose to be checked after showering.
Which statement made by a client with type 1 diabetes shows an understanding of instruction provided regarding disease management SATA A."I should administer insulin during the day in multiple injections." B."I should count calories consumed to determine insulin needs for each day." C."I should trim my toenails at an angle to prevent cutting the skin." D."I should obtain blood glucose levels prior to each insulin injection." E."I should maintain my hemoglobin A1C levels at o
A D For better blood glucose control, the healthcare provider would instruct the client to administer insulin throughout the day in multiple injections and to obtain blood glucose levels prior to each injection. Hemoglobin A1C levels should be below 6.5%. The client should be instructed to count carbohydrates, not calories. Toenails should be cut straight across with a clipper and the edges and corners smoothed with an emery board. If the client is unable to see his feet or reach them easily, someone else can trim his nails. If the nails are very thick or ingrown, if toes overlap, or if circulation is poor, then a podiatrist should cut the client's toenails.
The nurse is caring for a child diagnosed with type 1 diabetes. The nurse should teach the child and parents that insulin dosing is based on which item? A. Diet B. Weight C. Age D. Urine output
A. Diet
The nurse is developing a teaching plan for carbohydrate counting for a client newly diagnosed with type 1 diabetes Which type of carbohydrate should the nurse instruct the client to restrict? A. Refined sugars B. Complex carbohydrates C. Dietary fructose D. Simple sugars
A. Refined sugars Refined sugars come from sugar cane and are used as natural sweeteners. The client should restrict the intake of refined sugars. Simple sugars are found in fruit, honey, and dairy products. Dietary fructose, which comes from dietary fruit and vegetable consumption, causes a slower rise in blood glucose levels. Complex carbohydrates come from peas, beans, whole grains, and vegetables.
A young client is admitted for lethargy and weight loss. Which clinical manifestation supports the nurse's suspicion of type 1 diabetes? (Select all that apply.) A. Polyuria B. Glucosuria C. Blurred vision D. Weight gain E. Fever
ABC Manifestations of type 1 diabetes are caused by the lack of insulin to transport glucose into the cells for energy. The resulting hyperglycemia leads to polyuria, glucosuria, and blurred vision. Polyuria occurs because water is drawn into the general circulation, increasing renal blood flow. Once the blood glucose exceeds the renal threshold, which is 180 mg/dL, glucose will spill into the urine. Blurred vision is caused by swelling of the lenses of the eyes in response to increased fluid volume. Clients with type 1 diabetes usually lose weight, because proteins and fats are metabolized for energy and water is lost in the urine. In addition, clients with type 1 diabetes are frequently unable to develop a fever when cellular fuel stores are depleted because of a lack of insulin.
A client is admitted with hyperosmolar hyperglycemic state (HHS) and a blood glucose level of 550 mg/dL. Which intervention should the nurse expect to include in the plan of care? (Select all that apply.) A. Provide education about type 2 diabetes . B. Give normal saline intravenously. C. Obtain blood for hemoglobin A1C. D. Monitor serum potassium levels. E. Assess level of orientation.
B D E HHS can cause changes to a client's level of consciousness ranging from lethargy to coma; therefore, the nurse should assess the client's level of orientation. The hyperosmolarity of the blood causes severe dehydration and depletion of electrolytes. Therefore, the priority care for a client with HHS is to provide isotonic or colloid solutions intravenously. Potassium is depleted, so it must not only be monitored, but also replaced. This client is acutely ill, so the hemoglobin A1C should be reviewed, but it is not a priority. Education should wait until the client's blood glucose level is stabilized and the client is alert enough to be receptive to the teaching.
The nurse is conducting discharge teaching with a client who has been newly diagnosed with type 1 diabetes. Which statement from the client indicates the need for additional teaching? A. "I need to stay hydrated during the day." B. "As long as I'm in my house, I can walk barefoot." C. "I need to be alert for infections." D. "It is important to test my blood sugar at least four times a day."
B Clients with diabetes should always wear shoes to protect their feet from injury. The client should be alert for infection or injuries, stay well hydrated, and test the blood glucose four times a day.
The nurse is caring for a client with a long-term history of type 1 diabetes who has developed peripheral vascular disease. The nurse is unable to palpate the client's pedal pulses and the skin is cold to the touch. Which long-term goal is most appropriate for this client? A.The client will remain free from infection. B. The client's skin integrity will remain intact. C. The client will remain free of injury. D. The client's fasting blood glucose levels will stay between 70 and
B The client has impaired circulation as evidenced by cold skin and absent pedal pulses that indicate a risk for impaired skin integrity due to gangrene. There is no evidence the client is at risk for injury or has an infection. Having fasting blood glucose levels in the normal range indicates good disease management, but it does not relate to the impaired circulation.
A teacher sends a child to the school nurse due to frequent thirst and urination. Upon assessment, the nurse suspects the child has type 1 diabetes. Which question should the nurse ask to gain data to support this suspicion? A. "Have you noticed any bruises on your legs?" B. "How is your appetite?" C. "When did you last see your healthcare provider?" D. "Do you play outside a lot?"
B Polydipsia, polyuria, and polyphagia are the three hallmark signs of type 1 diabetes. Therefore, the nurse would ask about the child's appetite. Playing outside is not related to the onset of type 1 diabetes. Asking when the child last saw the healthcare provider is irrelevant to the current situation. Bruising to the legs can be from injuries or another condition, not type 1 diabetes.
The nurse is managing care for a client weighing 165 pounds who was admitted for the treatment of diabetic ketoacidosis (DKA). Which intervention would be most appropriate for the nurse to include in the plan of care? (Select all that apply.) A. Provide a high-protein diet. B. Measure intake and output every hour. C. Give 100 mL of normal saline bolus. D. Place the client on a telemetry monitor. E. Administer sliding-scale regular insulin.
B D The nurse would calculate intake and output on an hourly basis to monitor renal status. The client would be placed on a telemetry monitor to monitor for dysrhythmias related to shifts in potassium levels. The client with DKA would be acutely ill and if able to eat, would be placed on a carbohydrate-controlled diet. The nurse would administer normal saline boluses at 20 mL/kg if hypobolemia is present. A volume of 100 mL is not sufficient. Insulin would be administered intravenously, not sliding scale.
The nurse is participating in a health fair and teaching the public about risk factors for type 1 diabetes. Which other condition increases the risk for the development of type 1 diabetes? A. Cystic fibrosis B. Celiac disease C. Obesity D. Muscular dystrophy
B- celiac is autoimmune. if autoimmune disorder is already present then risk for t1 is there as well Diabetes can develop at any age; however immune-mediated diabetes occurs more frequently in children and adolescents. Clients with type 1 diabetes often have an autoimmune disease such as celiac disease. Clients with type 1 diabetes do not present with obesity. Type 1 diabetes is not associated with cystic fibrosis or muscular dystrophy.
A patient asks the nurse if stress can be a potential cause of type 2 diabetes. Which response is most appropriate for the nurse to make? a. "Stress decreases the number of alpha cells in the pancreas, and increases the workload on the beta cells. "b. "Periods of stress cause increases in glycogen production by the adrenal cortex." c. "Stress is directly associated with decreased insulin tolerance." d. "The inhibition of beta cells to glucose is increased in periods of stress."
BStress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia
A client with blood glucose of 450 mg/dL is diagnosed with hyperosmolar hyperglycemic state (HHS). Which assessment finding should the nurse expect? A. Lower extremity edema B. Open wound to the foot C. Increase in urine output D. Capillary refill of 2 seconds
C
The nurse is developing a plan of care for a client with ineffective peripheral tissue perfusion related to microvascular changes. Which assessment finding supports this nursing diagnosis? A. Fasting blood glucose of 100 mg/dL B. Capillary refill of 3 seconds C. Absent pedal pulses D. Hemoglobin A1C of 6.4%
C
The nurse is caring for a child diagnosed with type 1 diabetes. The nurse should teach the child and parents that insulin dosing is based on which item? A. Urine output B. Weight C. Diet D. Age
C Insulin dose is based on diet, specifically carbohydrate intake. Insulin dose is not based on weight, age, or urine output.
The healthcare provider prescribes metformin for a client with newly diagnosed type 2 diabetes. Which information should the nurse provide to the client? A. This medication is only used in the adult population due to side effects. B. This medication is unsafe for use by pregnant and lactating women. C. This medication can take up to 3 months to show effectiveness. D. This medication is used for clients who are unable to inject insulin.
C Metformin is a relatively safe medication to use in the treatment of type 2 diabetes. However, it may take up to 3 months to show effectiveness. Metformin is used to stimulate insulin production, not used in place of insulin. It is safe for pregnant and lactating women and for children.
The nurse is teaching the parents of a child with a new diagnosis of type 1 diabetes. Which information should the nurse include regarding the pathophysiology of the disease? A. Hyperglycemia happens when 50% of alpha cells are damaged. B. Beta cells need help producing insulin. C. Beta cells are destroyed. D. Delta cell destruction causes type 1 diabetes.
C Type 1 diabetes has a slow onset and symptoms are evident when a sufficient number of beta cells are destroyed, causing hyperglycemia. Beta cells are functional and need medication to help with insulin production in type 2 diabetes. Hyperglycemia occurs because of beta cell destruction, not alpha or delta cell destruction.
The nurse preceptor is teaching a new graduate nurse about hypoglycemic agents used to treat type 2 diabetes. Which information should the preceptor include related to how these medications lower blood sugar? (Select all that apply.) A. Increase breakdown of insulin B. Stimulate hormones for hemodilution C. Increase uptake of glucose by cells D. Increase insulin secretion E. Prevent breakdown of glycogen
C D E Hypoglycemic agents are used to treat individuals with type 2 diabetes. These medications lower blood sugar by stimulating or increasing insulin secretion, preventing breakdown of glycogen to glucose by the liver, and increasing peripheral uptake of glucose by making cells less resistant to insulin. Peripheral uptake is uptake by muscles and fat in the arms and legs rather than in the trunk. Some hypoglycemic agents keep blood sugar low by blocking absorption of carbohydrates in the intestines. The most recent pharmacologic therapy in treating type 2 diabetes includes the incretin effect. Incretin hormones, which are hormones released from the gut endocrine cells during meals, play a significant role in insulin secretion. The medications to treat type 2 diabetes do not increase the breakdown of insulin or stimulate hormones for hemodilution.
The nurse is teaching the caregivers of an adolescent with a new diagnosis of type 2 diabetes what they should do every 3 months to monitor the disease. The adolescent is currently taking metformin. Which information should the nurse include? (Select all that apply.) A. Obtain an eye exam. B. Assess injection sites. C. Review blood glucose logs. D. Monitor hemoglobin A1C. E. Discuss alcohol and drug use.
C D E An adolescent with type 2 diabetes who takes metformin should monitor the hemoglobin A1C and blood glucose logs every 3 months. The nurse should also discuss alcohol and drug abuse and its effects on type 2 diabetes every 3 months. An eye exam should be obtained annually, not quarterly. The nurse need not assess injection sites because the adolescent does not use insulin. (uses metformin, oral drug, not insulin)
A client newly diagnosed with type 2 diabetes asks the nurse how to "get rid of" this disease. How should the nurse respond? A. "You will always have type 2 diabetes. You cannot get rid of it." B. "Type 2 diabetes cannot be cured. It will eventually progress to type 1 diabetes." C. "You seem concerned about this diagnosis and we will do our best to help you control it." D. "Type 2 diabetes can sometimes be eliminated by weight loss, diet, and exercise."
D
A client recently diagnosed with type 2 diabetes reports difficulty managing the disease. To which professional should the nurse refer the client for help with caloric intake? A. Personal trainer B. Social worker C. Primary healthcare provider D. Dietitian
D
The nurse is teaching a 5-year-old child with type 1 diabetes and the parents about ways to achieve better glucose control. Which statement by a parent shows successful teaching? A. "Our child will know when they can tolerate activity." B. "Our child will enjoy treats with other children only once a day." C. "Our child will be responsible for their own glucose testing." D. "Our child will let us monitor blood glucose when it needs to be done."
D
Which finding in the medical record indicates a client has good control of type 1 diabetes? A. Blood pressure 150/90 mmHg B. Free of amputations C. Fasting blood sugar 200 mg/dL D. Hemoglobin A1C 5.4%
D The finding that the client is maintaining a hemoglobin A1C of less than 6.5% indicates good diabetic control over the past 3 months. The client not having amputations indicates good peripheral circulation, but it does not indicate good disease management. Blood pressure of 150/90 mmHg is elevated, but it does not indicate good diabetes control. The fasting blood sugar should be under 126 mg/dL. The finding of 200 mg/dL is elevated.
The nurse is evaluating the plan of care for an obese client diagnosed with type 2 diabetes 6 months prior. Which finding indicates the client is successfully managing the disease? A. New foot wound with purulent drainage B. Hemoglobin A1C of 10.0% C. Fasting blood sugars averaging 150 mg/dL D. Weight loss of 40 pounds
D The obese client demonstrating a 40-pound weight loss over the past 6 months indicates improvement in dietary compliance with lowering carbohydrate intake and exercising. The normal hemoglobin A1C for a client with diabetes mellitus is less than or equal to 6.5%. Fasting blood glucose levels should be less than 100 mg/dL if the client has good control. A new foot wound with purulent drainage indicates an infection and poor circulation, so this does not show good glycemic control.
The nurse is teaching the parents of a child with a new diagnosis of type 1 diabetes. Which information should the nurse include regarding the pathophysiology of the disease? A. Beta cells need help producing insulin. B. Delta cell destruction causes type 1 diabetes. C. Hyperglycemia happens when 50% of alpha cells are damaged. D. Beta cells are destroyed.
D. Beta cells are destroyed
The nurse is caring for a child who is hospitalized for the treatment of diabetic ketoacidosis (DKA). The child's parents ask why their child is receiving potassium. Which response by the nurse is accurate? A. "Potassium is administered to treat acidosis." B. "Potassium is administered to treat cerebral edema." C. "Potassium is administered to decrease blood glucose levels." D. "Potassium is administered to treat hypokalemia."
D. Potassium is administered to treat hypokalemia Insulin, not potassium, is administered to decrease blood glucose levels. Sodium bicarbonate, not potassium, is a medication used to treat acidosis. Mannitol, not potassium, is a medication used to treat cerebral edema.
The nurse is caring for a client who received a daily intermediate-acting insulin dose at 0800 hours. At which time of the day should the nurse provide the client a snack to prevent hypoglycemia? A. 1400 hours B. 1800 hours C. 1100 hours. D. 2100 hours
Intermediate-acting (NPH) insulin peaks 6-8 hours after the injection. Therefore, the nurse would prepare a snack for the client beginning at 1400 hours. If the client received short-acting insulin (regular), the snack would be required between 1000 and 1100 hours. Giving a snack at 1800 hours or 2100 hours may be appropriate for long-acting insulins, but it is not appropriate for intermediate-acting insulins.
Which information should the nurse provide the client with type 2 diabetes? A. Increase carbohydrate consumption in the diet. B. Treat hyperglycemia with concentrated sweets. C. Inspect the feet on a daily basis for open sores. Your answer is correct. D. Include 100 minutes per week of activity and exercise.
The client should inspect both feet every day, using a mirror if needed, to look for open sores. Hypoglycemia, not hyperglycemia, is treated with 15 grams of concentrated carbohydrates. The client should include 150 minutes of activity and exercise per week. The client should decrease carbohydrate consumption.
The nurse is preparing a presentation on risk factors for type 2 diabetes. Which ethnic group should the nurse include as being amongst the highest diagnosed with this disease? A. Middle Eastern Americans B. Asian Americans C. Caucasian Americans D. American Indians
The ethnicities that have the highest incidence of type 2 diabetes mellitus include African Americans, Hispanics/Latinos, American Indians, Asian Americans, and Pacific Islanders. Obese individuals of Asian descent have a greater risk for type 2 diabetes at lower weights.
The nurse is teaching a group of older adults with type 2 diabetes. Which complication of the disease should the nurse include? (Select all that apply.) A. Polypharmacy B. Functional disabilities C. Pulmonary disease D. Cognitive impairment E. Autoimmune diseases
These include polypharmacy, or taking other medications that can increase the risk; functional disabilities that may lead to a slower, more sedentary lifestyle; and cognitive impairment. A diagnosis of type 2 diabetes does not place a client at higher risk of pulmonary or autoimmune disease.
FBG Levels should be
less than 100 mg/dL
