Type 1 Diabetes Mellitus Scenario Questions from Pearson
A patient with type 1 diabetes mellitus expresses interest in joining a gym and playing volleyball once a week. Which information should the nurse provide to the patient? ANSWER "Keep sessions short, because prolonged sessions cause hyperglycemia." "Exercise is good at a regular and moderate pace." "Limit fluid intake during exercise." "Exercise no more than 60 minutes a week."
"Exercise is good at a regular and moderate pace." The recommendation is to keep the exercise regular and moderate and to stay hydrated during exercise to prevent hypoglycemia or hyperglycemia. Brief, intense, or prolonged exercise can cause hypoglycemia.
A child is diagnosed with type 1 diabetes mellitus. The parents ask the nurse what could have caused this diagnosis because there is no history of diabetes on either family side. Which question should the nurse ask first to obtain more information? ANSWER "Does anyone in your family have lupus or Sjögren syndrome?" "Were either of you or anyone in the family adopted?" "What types of food does your child usually eat?" "Has your child been ill lately with a viral infection?"
"Has your child been ill lately with a viral infection?" Some viruses such as mumps, rubella, or the coxsackie virus can cause an abnormal autoimmune reaction that can cause type 1 diabetes mellitus. Dietary intake is questioned when working with the patient to count carbohydrates. Lupus or Sjögren syndrome is autoimmune diseases, but they are not related to the onset of type 1 diabetes mellitus. Asking about adoption will determine family history, but it is not the most reliable information regarding the cause of the diabetes.
The nurse is unable to palpate bilateral pedal pulses for a patient with type 1 diabetes mellitus. Based on this assessment finding, which question is most appropriate for the nurse to ask the patient? ANSWER "Have you had a hemoglobin A1C drawn lately?" "What have your blood glucose levels readings been?" "Have you had any changes in sensation of your feet?" "Have you taken any insulin to control your blood sugars?"
"Have you had any changes in sensation of your feet?" If pedal pulses are not palpable, the nurse should ask the patient about changes in sensation of the feet. This is indicative of impaired peripheral circulation. Although it is important to know the average blood glucose levels or the hemoglobin A1C, it does not directly relate to the absent pedal pulses. Damage done to the peripheral vascular system is irreversible; however, by intervening, the disease would not progress. Whether or not the patient has taken insulin does not directly affect the current inability to palpate pedal pulses.
The nurse is caring for an older adult who has a leg wound. The patient states the wound has been there for 6 months and has not healed. The nurse suspects the patient has diabetes mellitus. Based on this history, which question should the nurse ask? ANSWER "What remedies have you tried to heal the wound?" "What happened to cause the wound on your leg?" "Have you had increased thirst and urination?" "Can you tell me what you typically eat in a day?"
"Have you had increased thirst and urination?" A nonhealing wound is a sign of impaired circulation, which frequently happens in patients with type 1 diabetes mellitus. Therefore, the nurse would ask about further symptoms such as polyuria and polydipsia. Asking about wound care treatments, typical daily diet, and the cause of the wound would not provide any information about suspected diabetes mellitus.
The nurse is teaching a female patient about alcohol consumption and type 1 diabetes mellitus. Which patient statement indicates a need for further instruction? ANSWER "I should refrain from drinking wine coolers and fruity drinks." "I can drink 2 or 3 drinks every night without affecting my blood sugars." "If I have an alcoholic drink, I need to include this when carbohydrate counting." "I should drink alcohol with meals to slow down the absorption."
"I can drink 2 or 3 drinks every night without affecting my blood sugars." Female patients with type 1 diabetes mellitus should consume no more than one alcoholic beverage per day, because it can interfere with insulin and lead to severe hypoglycemia. Fruity drinks and wine coolers contain more carbohydrates and can raise blood glucose levels. All alcohol consumed should be included in carbohydrate intake for insulin dosing. The patient should drink alcohol with meals to slow the absorption rate.
The nurse is teaching a patient with new-onset diabetes mellitus about nutritional management of hypoglycemia and the 15/15 rule. Which patient statement indicates an understanding of the instruction provided? ANSWER "I should call my healthcare provider after eating 15 grams of carbohydrates." "If my blood sugar goes too low, I should eat 15 grams of carbohydrates." "With hypoglycemia, I should take my insulin after having a snack." "After 15 minutes have gone by, I should eat 15 more grams of carbohydrates."
"If my blood sugar goes too low, I should eat 15 grams of carbohydrates." The 15/15 rule refers to patients with hypoglycemia. Once hypoglycemia is detected, the person should consume 15 grams of carbohydrates and then wait 15 minutes and recheck the blood glucose level. If the blood sugar is still low, the cycle is repeated. The patient should not take insulin nor does the patient need to call the healthcare provider for only just one cycle.
Which instructions should the nurse include in the patient and family teaching for a 10-year-old child who is newly diagnosed with type 1 diabetes mellitus? ANSWER "It is not necessary to contact the healthcare provider when ill." "Insulin can be given without checking blood sugars." "Take all doses of insulin, even when ill, to prevent diabetic ketoacidosis." "You can skip checking your blood sugars when ill."
"Take all doses of insulin, even when ill, to prevent diabetic ketoacidosis." When children who have type 1 diabetes mellitus become ill, it is important for the insulin regimen to continue. This also includes checking blood glucose levels more frequently and urine for ketones. Insulin should never be administered without knowing the person's blood glucose level, because this can lead to severe hypoglycemia. The parents should contact the healthcare provider when the diabetic child is ill, because blood sugars are increasing and the child may not be eating.
An 82-year-old patient reports frequent bouts of nausea and indigestion, and numbness and tingling in their feet. Which response should the nurse make to the patient? ANSWER "These may be signs of renal failure. Let's get your kidneys checked." "These may be signs of hypertension. I'll check your blood pressure." "These are normal signs of aging. There is no need to worry." "These may be complications of diabetes mellitus. Let's get your blood sugar checked."
"These may be complications of diabetes mellitus. Let's get your blood sugar checked." Frequent bouts of nausea and indigestion may be a symptom of gastroparesis. Numbness and tingling in the feet may indicate neuropathy. Both of these conditions are complications of diabetes mellitus. Therefore, the patient should have their blood sugar checked to see whether it is elevated. Hypertension and renal failure typically do not result in the symptoms reported by the patient. In addition, these symptoms are not a result of the normal aging process, so they should not be ignored.
The nurse is working with a patient newly diagnosed with type 1 diabetes mellitus. The patient reports no family history of diabetes and asks about the etiology of the disease. Which response by the nurse is accurate? ANSWER "Type 1 diabetes mellitus occurs from side effects of some prescription medications." "Type 1 diabetes mellitus is related to an insufficient production of insulin to break down ketones." "Type 1 diabetes mellitus is frequently caused by an autoimmune reaction in the pancreas." "Type 1 diabetes mellitus happens due to poor dietary choices and a sedentary lifestyle."
"Type 1 diabetes mellitus is frequently caused by an autoimmune reaction in the pancreas." Type 1 diabetes mellitus (T1DM) can occur from an autoimmune reaction or a viral infection leading to beta cell destruction. Although T1DM may be classified as either an autoimmune or an idiopathic disorder, 90% of the cases are immune mediated. Type 2 diabetes mellitus (T2DM) happens from poor dietary choices, a sedentary lifestyle, and can occur from some prescription medications. A person with T1DM is unable to produce any insulin; T2DM can produce some, but not enough to meet the body's needs.
The nurse is teaching a patient with type 1 diabetes mellitus about carbohydrate counting. The patient is concerned because of a desire to stay with a low-carbohydrate ketogenic diet. Which instruction is most appropriate for the nurse to provide? ANSWER "Cutting back on carbohydrates is what caused your pancreas to fail. You should include carbohydrates in your diet." "I would discuss this with the healthcare provider. Most individuals with diabetes do not do well on fad diets." "You should not do a low-carbohydrate diet. As an individual with diabetes, carbohydrates should be 45-65% of your total intake." "It should be acceptable to manage a low-carbohydrate diet if you increase your consumption of protein."
"You should not do a low-carbohydrate diet. As an individual with diabetes, carbohydrates should be 45-65% of your total intake." Carbohydrates are essential for everyone, especially diabetic patients, because they provide energy. Carbohydrate counting is the main way that insulin doses are prescribed, and the disease is managed. Patients with type 1 diabetes should design their diet based on 45-65% carbohydrates. It is not acceptable to substitute protein for carbohydrates, because it will alter blood glucose levels. The nurse would want to discuss any dietary changes/fad diets with the healthcare provider, but this response does not provide the patient information. The nurse would not tell the patient that a ketogenic diet caused the type 1 diabetes. This is inaccurate and not therapeutic
The nurse is caring for several patients diagnosed with diabetes mellitus. Which patient should the nurse consider withholding the sliding-scale insulin dose? ANSWER A patient who is under severe stress A patient who receives parenteral nutrition A patient who has a blood sugar of 90 mg/dL A patient who receives corticosteroids
A patient who has a blood sugar of 90 mg/dL The patient with a blood glucose level of 90 mg/dL will not require a sliding-scale insulin dose. Administering insulin to this patient could cause hypoglycemia. The other patients would need a sliding-scale insulin dose, because parenteral nutrition, stress, and corticosteroids are all risk factors for hyperglycemia.
A 59-year-old patient is admitted to the hospital and reports of chest pain, dyspnea, polyuria, polydipsia, and polyphagia. The patient's glycosylated hemoglobin (A1C) is 9%. While the nurse is taking the patient's admission history, they inform about feeling numbness in their feet. Which assessment is the priority for the nurse to conduct? ANSWER Assessing the feet for injury Assessing the location of both kidneys Palpating the liver for enlargement Inspecting the eyes for cataracts
Assessing the feet for injury The patient has an elevated A1C and symptoms consistent with diabetes mellitus. In addition, they are reporting symptoms of peripheral neuropathy. These symptoms put the patient at a risk for developing foot ulcers. Liver disease is not an expected complication of diabetes mellitus. Although nephropathy and retinopathy such as cataracts are complications of diabetes mellitus, the patient is currently not reporting symptoms suggestive of these conditions
The nurse is teaching a group of parents at the elementary school about risk factors for children developing type 1 diabetes mellitus. Which risk factor should the nurse include? ANSWER Genetic predisposition High-fat diet Female gender Overweight
Genetic predisposition The major risk factor for children developing type 1 diabetes mellitus is mainly a genetic marker that determines immune responses. Being overweight and eating a high-fat diet are risk factors for type 2 diabetes mellitus. Gender is not a risk factor for developing type 1 diabetes mellitus in children.
A child presents with increased thirst, hunger, and urination. The nurse suspects the child has type 1 diabetes mellitus. Which assessment finding supports this suspicion? ANSWER HbA1C that is greater than or equal to 6.5% Fasting glucose less than 126 mg/dL Blood pressure of 130/90 mmHg Weight and height greater than 95th percentile for age
HbA1C that is greater than or equal to 6.5% An HbA1C that is greater than or equal to 6.5% is a diagnostic finding that confirms the diagnosis of diabetes mellitus in children. A fasting plasma glucose of 126 gm/dL or higher confirms the presence of diabetes. Weight, height, and blood pressure are not findings that support the diagnosis of diabetes mellitus in children.
The nurse is caring for a patient with type 1 diabetes mellitus who just became pregnant. Which assessment finding indicates an understanding by the patient of proper disease management during pregnancy? Monitoring blood glucose levels weekly Eating meals at different times each day Postprandial blood glucose of 250 mg/dL Hemoglobin A1C of 6.0%
Hemoglobin A1C of 6.0% When the nurse notices the patient has an Hgb A1C of 6.0%, it indicates the patient is maintaining good glycemic control. A postprandial blood sugar of 250 mg/dL is elevated and does not show good control of their diabetes mellitus. Blood sugar levels should be checked multiple times a day, not weekly. Eating meals at different times every day does not promote good control of blood glucose levels with insulin.
The nurse receives a telephone call from a parent stating their child took the prescribed insulin dose and did not eat enough. Based on this information, which condition should the nurse suspect to occur in the child? ANSWER Hypoglycemia Dawn phenomenon Somogyi phenomenon Hyperglycemia
Hypoglycemia When a patient takes too much insulin and does not eat enough carbohydrates to balance the dose, the patient is at risk for developing hypoglycemia. Hyperglycemia can occur from eating too many carbohydrates or not taking enough insulin. The Somogyi phenomenon is a combination of hypoglycemia during the night with the rebound hyperglycemia that occurs in the morning. The dawn phenomenon is an increase in blood glucose levels from 4-8 a.m. that is not a response to hypoglycemia.
A patient with type 1 diabetes mellitus is admitted for chronic complications. The nurse ensures that the patient's room is free of clutter, has a night-light, and checks the water temperature before bathing the patient. Which nursing diagnosis do these interventions address? ANSWER Pain, Acute Infection, Risk for Coping, Ineffective Injury, Risk for
Injury, Risk for These interventions address the potential problem of Injury, Risk for by creating a clear pathway, providing sufficient lighting, and preventing burns from water that is too hot. They do not address the potential problems of Pain, Acute; Coping, Ineffective; and Infection, Risk for. (NANDA-I © 2014)
The nurse is providing discharge teaching to a patient with type 1 diabetes mellitus about self-management of the disease. Which information should the nurse include in the patient teaching? ANSWER Insulin administration technique Rule of 20s Protein counting Daily urine testing for glucose
Insulin administration technique The nurse should teach the patient about self-injection of insulin. Urine is tested for ketones when ill, not on a routine basis. The nurse would instruct about carbohydrate, not protein, counting. The nurse would teach the patient about the 15/15 role, not rule of 20.
A patient has questions about surgery to replace the need to take insulin several times a day. Which surgical intervention can be considered for patients with diabetes mellitus? Islet cell transplantation Removing the spleen Removing the pancreas Replacing a part of the liver
Islet cell transplantation Islet cell transplantation; replacing, not removing the pancreas; and replacing, not removing, pancreatic cells are surgical interventions for patients with diabetes. Replacing a part of the liver will not correct insulin production. Healthy pancreas and pancreas having destroyed beta cells in diabetes mellitus type 1.
The nurse is caring for a patient who has new-onset type 1 diabetes mellitus and plans to incorporate some patient teaching during the day. Which assessment finding indicates a need for teaching about foot care? ANSWER Pedicures noted on both feet Negative Babinski reflex Diminished pedal pulses Blood glucose level of 140 mg/dL
Pedicures noted on both feet The priority is for the patient to be aware that the feet and legs may have an altered perception of touch and pain, which can lead to injuries to the feet that are not noticed. Therefore, when the nurse notices the patient has manicured toes, the nurse needs to teach the patient about proper foot care. Diminished pedal pulses could indicate impaired circulation or could be related to edema. A negative Babinski reflex is normal in the adult. Blood glucose levels of around 140 mg/dL are a little high, but not enough to cause concern.
The nurse is providing teaching to a patient newly diagnosed with type 1 diabetes mellitus. Which information should the nurse include about the regular monitoring of glucose levels? Urine testing will assist in measuring hypoglycemia. Self-monitoring of blood glucose is painless and noninvasive. Self-monitoring of blood glucose should occur 3-4 times a day. Urine testing is used only until glucose goals are achieved.
Self-monitoring of blood glucose should occur 3-4 times a day. Self-monitoring of blood glucose should occur 3 or more times a day with type 1 diabetes mellitus. Urine testing will not detect or measure hypoglycemia, but it will show ketones if the patient is severely hyperglycemic or during illness or pregnancy; it is not used only until glucose goals are achieved. Self-monitoring of blood glucose requires a patient to prick the finger to obtain blood, so this test is neither painless nor noninvasive. Lancet and blood glucose monitor for self-monitoring of blood glucose.
The nurse is planning care for a patient with type 1 diabetes mellitus and addressing the risk of infection. Which intervention will best assist in addressing this risk? Teaching the patient to use lukewarm water and soap for foot and skin care Promoting smoking cessation Instructing the patient to have an oral examination annually Monitoring sensation in extremities daily
Teaching the patient to use lukewarm water and soap for foot and skin care Teaching the patient good skin care by using lukewarm water and soap is an intervention that will address the potential problem of risk of infection. Instructing the patient to have an oral examination annually, promoting smoking cessation, and monitoring sensation in the extremities do not address the potential problem of risk of infection. The patient should have an oral examination every 4-6 months.
The nurse is reviewing fasting serum blood glucose levels on several children on a pediatric medical-surgical unit. For which child should the nurse expect to provide information about treatment options for type 1 diabetes mellitus? ANSWER The child with a fasting blood glucose of 120 mg/dL The child with a fasting blood glucose of 140 mg/dL The child with a fasting blood glucose of 100 mg/dL The child with a fasting blood glucose of 80 mg/dL
The child with a fasting blood glucose of 140 mg/dL Fasting blood glucose levels of 80 mg/dL, 100 mg/dL, and 120 mg/dL are considered normal. A fasting blood glucose greater than or equal to 126 mg/dL would contribute to a diagnosis of type 1 diabetes mellitus. A child with fasting blood glucose of 140 mg/dL meets this criterion.
The nurse notes small amounts of albumin in the urinalysis report of a patient with type 1 diabetes mellitus. Based on this finding, which assessment should the nurse conduct next? ANSWER Urine output Visual acuity Foot sensation Blood glucose
Urine output Microalbuminuria is the first indication of renal damage in patients with type 1 diabetes mellitus. Therefore, the nurse would assess the patient's urinary output. Also, the nurse should expect to implement a 24-hour urine test for creatinine clearance to detect the early onset of nephropathy. Foot ulcers would occur with peripheral vascular disease. The presence of albumin in the urine does not indicate a need to assess the blood sugar. Visual changes indicate retinopathy.
