Type 1 Diabetes- Pearson questions
The nurse is taking a health history from a client who has type 1 diabetes mellitus. Which client symptom may indicate the development of complications? (Select all that apply.) A. Dizziness B. Numbness in the feet C. Quick wound healing D. Vision changes E. Frequent voiding of urine
A,B,D,E Rationale: Dizziness, vision changes, numbness in the feet, and frequent voiding of urine may indicate that the client has developed complications of type 1 diabetes mellitus. Clients with type 1 diabetes mellitus frequently experience prolonged wound healing; therefore, a report of quick wound healing would not indicate that the client has developed a complication of type 1 diabetes mellitus.
The nurse is teaching a group of young adults regarding nonmodifiable risk factors for the development of type 1 diabetes mellitus. Which attendee statement indicates a need for further instruction? (Select all that apply.) A. "Type 1 diabetes mellitus can be passed on from one recessive gene from one parent." B. "There are genes such as the HLA-DR3 and HLA-DR4 genes that can cause type 1 diabetes mellitus." C. "Type 1 diabetes mellitus can be caused by exposure to excessive heat and temperatures." D. "I can develop type 1 diabetes mellitus from bacterial infections." E. "Type 1 diabetes mellitus is caused by exposure to processing of metals and proteins."
A,C,D,E The individual with type 1 diabetes mellitus usually inherits the risk factor for the disorder from each parent. Environmental factors such as cold weather and exposure to a virus also contribute to the development of type 1 diabetes mellitus. The genes HLA-DR3 and HLA-DR4 have been identified in people with type 1 diabetes mellitus. Exposure to processing of metals contributes to the development of cirrhosis.
The nurse is providing teaching to a client with a new diagnosis of type 1 diabetes mellitus. 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. Daily weight checking E. Nutrition
A,C,E Clients with type 1 diabetes mellitus 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 mellitus.
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. Place the client on a telemetry monitor. B. Provide a high-protein diet. C. Give 100 mL of normal saline bolus. D. Measure intake and output every hour. E. Administer sliding-scale regular insulin.
A,D Rationale: The nurse would calculate intake and output on an hourly basis to determine fluid needs. 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 10-20 mL/kg. A volume of 100 mL is not sufficient. Insulin would be administered intravenously, not sliding scale.
Which statement made by a client with type 1 diabetes mellitus indicates an understanding of instruction provided regarding disease management? (Select all that apply.) A. "I should administer insulin during the day in multiple injections." B. "I should maintain my hemoglobin A1C levels at or below 8%." C. "I should count calories consumed to determine insulin needs for each day." D. "I should trim my toenails at an angle to prevent cutting the skin." E. "I should obtain blood glucose levels prior to each insulin injection."
A,E Rationale: 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 working a health fair and teaching the public about risk factors for type 1 diabetes mellitus. Which ethnicity would the nurse include as having the highest risk in the United States? A. Hispanic B. Caucasian American C. African American D. Asian American
B. Caucasian American Rationale: Caucasian Americans have a higher risk of developing type 1 diabetes mellitus than Asian Americans, African Americans, or Hispanics.
The nurse is caring for a client with a long-term history of type 1 diabetes mellitus 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 of injury. B. The client's skin integrity will remain intact. C. The client will remain free from infection. D. The client's fasting blood glucose levels will stay between 70 and 110 mg/dL.
B. The client's skin integrity will remain intact. Rationale: 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.
Which action by a parent of a 12-year-old child with a new diagnosis of type 1 diabetes mellitus indicates a need for further teaching? A. Counting carbohydrates with the child B. Allowing the child to check blood sugars C. Discouraging after-school sports D. Scheduling a baseline exam with an ophthalmologist
C. Discouraging after-school sports Rationale: Exercise is a part of blood glucose and disease management. Therefore, the nurse should reeducate the parent to allow after-school sports. The parent should involve the 12-year-old child, so counting carbohydrates with the child and allowing the child to perform self-blood glucose monitoring is appropriate. Due to potential retinopathy that can occur with diabetes, it is appropriate for the parent to schedule an ophthalmic appointment to determine baseline visual acuity.
Which finding in the medical record indicates a client has good control of type 1 diabetes mellitus? A. Blood pressure 150/90 mmHg B. Free of amputations C. Hemoglobin A1C 5.4% D. Fasting blood sugar 200 mg/dL
C. Hemoglobin A1C 5.4% Rationale: 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 125 mg/dL. The finding of 200 mg/dL is elevated.
The nurse is teaching a group of clients newly diagnosed with type 1 diabetes mellitus. Which information should the nurse include in the teaching? A. "Monitor blood glucose levels weekly." B. "Take beta blockers daily to control blood pressure." C. "Have routine pedicures performed." D. "Schedule regular ophthalmology visits."
D. "Schedule regular ophthalmology visits." Rationale: The client with type 1 diabetes mellitus is at high risk for retinal damage. Therefore, the nurse would teach the client to schedule regular ophthalmology visits to monitor vision. 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. The client would be prescribed angiotensin-converting enzyme (ACE) inhibitors to protect the kidneys from vascular damage.
The nurse is teaching a child with type 1 diabetes mellitus and his family about sick day guidelines. Which statement by the family indicates successful teaching? A. "We will test for ketones when the blood glucose level reaches 160 mg/dL." B. "We will test for ketones when the blood glucose level reaches 180 mg/dL." C. "We will test for ketones when the blood glucose level reaches 200 mg/dL." D. "We will test for ketones when the blood glucose level reaches 240 mg/dL."
D. "We will test for ketones when the blood glucose level reaches 240 mg/dL. Rationale: Blood glucose levels of 160 mg/dL, 180 mg/dL, and 200 mg/dL are elevated, but they would not require testing for ketones. Once the blood glucose level exceeds 240 mg/dL, the child and family should test the urine for ketones.
The nurse is caring for a client who received a daily intermediate-acting insulin dose at 8:00 a.m. At which time of the day should the nurse provide the client a snack to prevent hypoglycemia? A. 11:00 a.m. B. 9:00 p.m. C. 6:00 p.m. D. 2:00 p.m.
D. 2:00 p.m. Rationale: Intermediate-acting (NPH) insulin peaks 6-8 hours after the injection. Therefore, the nurse would prepare a snack for the client beginning at 2:00 p.m. If the client received short-acting insulin (regular), the snack would be required between 10 a.m. and 11:00 a.m. Giving a snack at 6:00 p.m. or 9:00 p.m. may be appropriate for long-acting insulins, but it is not appropriate for intermediate-acting insulins.
The nurse is conducting discharge teaching with a client who has been newly diagnosed with type 1 diabetes mellitus. Which statement from the client indicates the need for additional teaching? A. "It is important to test my blood sugar at least four times a day." B. "I need to stay hydrated during the day." C. "As long as I'm in my house, I can walk barefoot." D. "I need to be alert for infections."
C. "As long as I'm in my house, I can walk barefoot." Rationale: 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 sugar four times a day.
A client with type 1 diabetes mellitus is being taught to monitor her blood glucose level. Which factor affecting accurate glucose monitoring should the nurse include in the instruction? (Select all that apply.) A. Medication overdoses B. White blood cell (WBC) count C. Low hematocrit level D. Creatinine level E. High hematocrit level
A,C,E Rationale: Factors that affect accurate glucose monitoring include medication overdoses, a low hematocrit level, and a high hematocrit level. The WBC count and creatinine levels do not affect accurate glucose monitoring.
A young client is admitted for lethargy and weight loss. Which clinical manifestation supports the nurse's suspicion of diagnosis of type 1 diabetes mellitus? (Select all that apply.) A. Fever B. Blurred vision C. Weight gain D. Glucosuria E. Polyuria
B,D,E Rationale: Manifestations of type 1 diabetes mellitus 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 mellitus 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 mellitus are frequently unable to develop a fever when cellular fuel stores are depleted because of a lack of insulin.
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 mellitus. Which question should the nurse ask to gain data to support this suspicion? A. "When did you last see your healthcare provider?" B. "How is your appetite?" C. "Do you play outside a lot?" D. "Have you noticed any bruises on your legs?"
B. "How is your appetite?" Rationale: Polydipsia, polyuria, and polyphagia are the three hallmark signs of type 1 diabetes mellitus. Therefore, the nurse would ask about the child's appetite. Playing outside is not related to the onset of type 1 diabetes mellitus. Asking when the child last saw the healthcare provider is irrelevant to the current situation. Bruising to the legs can be from injuries or leukemia, not type 1 diabetes mellitus.
The nurse is caring for a child diagnosed with type 1 diabetes mellitus. The nurse should teach the child and parents that insulin dosing is based on which item? A. Weight B. Urine output C. Diet D. Age
C. Diet Rationale: Insulin dose is based on diet, specifically carbohydrate intake. Insulin dose is not based on weight, age, or urine output.
The nurse is developing a teaching plan for carbohydrate counting for a client newly diagnosed with type 1 diabetes mellitus. Which type of carbohydrate should the nurse instruct the client to restrict? A. Complex carbohydrates B. Dietary fructose C. Refined sugars D. Simple sugars
C. Refined sugars Rationale: 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.
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 treat hypokalemia." D. "Potassium is administered to decrease blood glucose levels."
C. "Potassium is administered to treat hypokalemia." Rationale: Potassium is administered to treat hypokalemia. Insulin, not potassium, is administered to decrease blood glucose levels. Sodium bicarbonate, not potassium, is administered to treat acidosis. Mannitol, not potassium, is administered to treat cerebral edema.
The nurse is teaching the parents of a child with a new diagnosis of type 1 diabetes mellitus. Which information should the nurse include regarding the pathophysiology of the disease? A. Delta cell destruction causes type 1 diabetes mellitus. B. Hyperglycemia happens when 50% of alpha cells are damaged. C. Beta cells need help producing insulin. D. Beta cells are destroyed.
D. Beta cells are destroyed. Rationale: Type 1 diabetes mellitus has a slow onset and symptoms are not evident until 80-90% of beta cells are destroyed, causing hyperglycemia. Beta cells are functional and need medication to help with insulin production in type 2 diabetes mellitus. Hyperglycemia happens from beta cell destruction, not alpha or delta cell destruction.
