Type 2 Diabetes (Type 2 DM)
The nurse is condicucting a health fair to screen for type 2 DM. Which participant should the nurse consider to be at highest risk? A) 50yo office worker who sits at the computer B) 60yo retired architect who works at job site C) 30yo nurse who works in an ICU D) 40yo kindergartener teacher who works in a classroom
A) 50yo office worker who sits at the computer Rationale: A sedentary lifestyle is a risk factor for type 2 diabetes mellitus. The 50-year-old office worker who sits at the computer would be at highest risk for type 2 diabetes mellitus. All the other participants are physically active and are at lower risk.
After reviewing the population demographics for an urban community, the community health nurse determines that community members would benefit from teaching on type 2 diabetes mellitus in children. What findings support this nurse's conclusion? Select all that apply. A) 60% of community families have both parents diagnosed with type 2 diabetes mellitus. B) 35% of school-age children do not routinely receive the annual flu vaccination. C) 50% of children between the ages of 10 and 19 are African American. D) 25% of children between the ages of 10 and 19 are Hispanic. E) 75% of school-age children are raised in families where both parents are unemployed.
A, C, D Rationale: The risk factors for diabetes include race, ethnicity, and family history. Type 2 diabetes mellitus rates are greater among youth ages 10 to 19 with higher rates among U.S. minority populations than in non-Hispanic Whites. Frequency of obtaining the annual flu vaccination and socioeconomic status are not risk factors for the development of type 2 diabetes in children.
The nurse is caring for a child with type 2 DM. Which item in this child's history should the nurse recognize as a risk factor for disease? SATA A) Obesity B) Sex C) Race D) Family history E) High-fat diet
A, C, D, E Rationale: Obesity, a high-fat diet, a family history of diabetes mellitus, and race are risk factors for developing type 2 diabetes mellitus. Sex does not play a role in the risk for type 2 diabetes mellitus.
The parents of a child with type 2 DM call the urgent care center because the child's skin is clammy and diaphoretic. Which question should the nurse first ask the parents? A) "When did your child last have a meal or snack?" B) "Have you checked your child's blood sugar?" C) "What is your child's body temperature?" D) "Has your child been drinking a lot of water?"
B) "Have you checked your child's blood sugar?" Rationale: When the patient with diabetes mellitus develops cool and clammy skin, the nurse would immediately instruct the caregiver to obtain a blood glucose level. This would rule out hypoglycemia and lead to immediate treatment. Asking about body temperature would be appropriate, but it should not be the first question asked. Increased water consumption occurs with hyperglycemia, not hypoglycemia. The nurse would want to know how long it has been since the child last ate, but it is not the first question to ask.
Which information should the nurse provide the client with type 2 DM? A) Treat hyperglycemia with concentrated sweets B) Increase carb consumption in the diet C) Inspect your feet on a daily basis for open sores D) Include 100 minutes per week of activity and exercise
C) Inspect your feet on a daily basis for open sores Rationale: 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 HCP provider prescribes sitagliptin (Januvia) for a client with type 2 DM. For which potential side effect should the nurse monitor this client? A) Elevated blood lipid levels B) Hyperglycemia C) Pancreatitis D) Renal insufficiency
C) Pancreatitis Rationale: A potential side effect of sitagliptin (Januvia) is pancreatitis, and the client must be monitored for this. Sitagliptin (Januvia) does not cause elevated blood lipids, hyperglycemia, or renal insufficiency.
The HCP prescribes metformin (Glucophage) to a client with newly diagnosed type 2 DM. Which information should the nurse provide the lcient? A) This medication is unsafe for use by pregnant and lactating women. B) This medication is used for clients who are unable to inject insulin C) This medication can take up to 3 months to show effectiveness D) This medication is only used in the adult population due to side effects
C) This medication can take up to 3 months to show effectiveness rationale: Metformin (Glucophage) is a relatively safe medication to use in the treatment of type 2 diabetes mellitus. 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 evaluating the plan of care for an obese client diagnosed with type 2 DM 6 months prior. Which finding indicates the client is successfully managing the disease? A) A1C of 10% B) New foot wound with purulent drainage C) Weight loss of 40 lbs D) Fasting blood sugars averaging 150 mg/dL
C) Weight loss of 40lbs. Rationale: 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 6?6.5%. Fasting blood sugars 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, teaching a class to a group of community members about the importance of weight loss in decreasing the risk of type 2 DM, is asked why weight loss reduces the risk associated with the development of this health problem. Which response by the nurse is most appropriate? A) "Excess body weight impairs the body's release of insulin." B) "The amount of food taken in by those who are overweight requires more insulin to adequately metabolize, resulting in diabetes." C) "The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin." D) "Thin people are less likely to become diabetic."
A) "Excess body weight impairs the body's release of insulin." Rationale: Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. The amount of food taken in is not the issue as much as the excess body weight. The body does require more insulin with a greater food intake, but that does not necessarily result in diabetes. While obesity is a risk factor for the development of diabetes, this does not meet the question posed by the client. Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin.
The nurse is preparing a presentation on risk factors for type 2 DM. Which ethnic group should the nurse include as being amongst the highest diagnosed with this disease? A) American Indians B) Caucasian Americans C) Asian Americans D) African Americans
A) American Indians Rationale: The ethnicities that have the highest incidence of type 2 diabetes mellitus are the American Indians and Alaska Natives at 15.9%. Incidence rates for Asian Americans, African Americans, and Caucasian Americans are 9%, 13.2%, and 7.6%, respectively.
Which test is commonly used to screen for type 2 DM in the general population? A) Fasting plasma glucose B) Oral glucose tolerance test C) Urine ketone levels D) Serum cholesterol levels
A) Fasting plasma glucose Rationale: Tests used to screen for type 2 diabetes in the general population include fasting plasma glucose and glycated hemoglobin (A1C). Oral glucose tolerance tests are primary used for screening for gestational diabetes in pregnant women, although they can also be used for clients with suspected diabetes. Urine ketone levels and serum cholesterol levels are not used for screening. Urine ketone levels are used primarily to monitor clients with type 1 diabetes. Serum cholesterol levels are measured to assess the risk for cardiovascular disease, which may or may not be related to diabetes.
The nurse is performing a physical assessment of a child. Which assessment finding should cause the nurse to suspect type 2 DM? A) Presence of acanthosis nigricans B) BP 110/78 C) BMI 21 D) Pale mucous membranes
A) Presence of acanthosis nigricans Rationale: 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 mellitus 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; darkened mucous membranes could indicate type 2 diabetes mellitus.
The nurse is caring for an older adult patient with type 2 DM who is recovering from a colon resection for cancer. The patient is febrile, has increased urine output, and has a fasting blood glucose level of 650 mg/dL. Which complication of type 2 DM should the nurse suspect as occurring? A) Hyperosmolar hyperglycemic state (HHS) B) Peripheral vascular disease C) Acute renal failure D) Diabetic ketoacidosis (DKA)
A)Hyperosmolar hyperglycemic state (HHS) Rationale: This patient with type 2 diabetes mellitus is under stress related to surgery and now presents with a fever, increased urinary output, and elevated blood sugars. These symptoms indicate the onset of HHS. Diabetic ketoacidosis occurs in patients with type 1 diabetes mellitus. ARF would be manifested by decreased, not increased, urinary output. PVD occurs over years, not days.
Which suggestion should the nurse provide to a client with newly diagnosed type 2 DM regarding ways to increase activity? SATA A) Use a fitness tracker B) Take stairs at work C) Limit computer time D) Play card games at home E) Get a workout buddy
A, B, C, E Rationale: Clients with newly diagnosed type 2 diabetes mellitus should incorporate a minimum of 150 minutes of exercise and activity per week into their lives. The nurse can instruct the client to take the stairs at work, use a fitness tracker to set goals and monitor activity, limit computer time because it is sedentary, and get a friend to go to the gym to exercise. Playing card games is a sedentary activity.
A client is admitted with hyperosmolar hyperglycemic state (HHS) and a blood glucose level of 550. Which intervention should the nurse expect to include in the plan of care? SATA A) Assess level of orientation B) Provide education about type 2 DM C) Obtain blood for A1C D) Give normal saline IV E) Monitor serum potassium levels
A, D, E Rationale: 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 otes that a patient with no history of diabetes has a blood glucose level of 215. Which tests should the nurse expect the HCP to prescribe? A) Finger-stick blood glucose B) Hemoglobin A1C C) oral glucose tolerance test D) Urinalysis for ketones
B) Hemoglobin A1C Rationale: A hemoglobin A1C in conjunction with symptoms is used to diagnose type 2 diabetes mellitus. Other testing would include fasting blood glucose levels. Oral glucose tolerance tests are usually reserved for pregnant patients. Random fingerstick blood glucose is not used to diagnose for type 2 diabetes mellitus, but to monitor trends. Urine will be tested for ketones during diabetic ketoacidosis in patients with type 1 diabetes.
The nurse is caring for a 76-year-old client with type 2 diabetes who is recovering from surgery following a hip fracture. In addition to blood glucose level, what should the nurse recognize as a sign of hyperosmolar hyperglycemic state (HHS)? A) Excessive sweating B) Increased urine output C) Insomnia D) Edema
B) Increased urine output Rationale: Older adults with type 2 diabetes who have undergone a major surgery are at high risk for developing hyperosmolar hyperglycemic state (HHS). Symptoms of HHS include greatly elevated blood glucose levels, high plasma osmolarity, and altered level of consciousness. Other symptoms include increased urine output, dry skin and mucous membranes (not excessive sweating), extreme thirst, and lethargy (not insomnia). HHS leads to dehydration and fluid loss, not edema.
Type 2 DM is characterized by which underlying pathophysiology? A) Excessive insulin production B) Insulin resistance C) Inability of the pancreas to produce insulin D) Impaired insulin uptake
B) Insulin resistance Rationale: Type 2 diabetes occurs despite the availability of endogenous insulin, because insulin's functioning is impaired by insulin resistance. The level of insulin produced in type 2 diabetes varies; production could be increased or decreased, depending on the client. The pancreas is able to produce insulin, but the insulin cannot work properly due to insulin resistance. Glucose uptake, not insulin uptake, is impaired in type 2 diabetes.
The nurse is planning care for a client with type 2 DM. Which nursing diagnosis would be most appropriate for this client? A) Self Neglect B) Risk for Infection C) Risk for Decreased Cardiac Tissue Perfusion D) Impaired Tissue Integrity
B) Risk for Infection Rationale A client with diabetes mellitus is at the greatest risk for infection. No other information is given in the question with regard to risk for self neglect, ineffective tissue perfusion, or impaired tissue integrity as potential nursing diagnoses.
The nurse is caring for a 15yo child newly diagnosed with type 2 DM. Which task should the nurse expect to be completed quarterly for this child? SATA A) Refer for eye exam B) Discuss alcohol, tobacco and drug use C) Measure fasting glucose levels D) Review glucose records E) Make a foot assessment
B, C, D Rationale: When a child is diagnosed with type 2 diabetes mellitus, 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. Referral for an eye exam and a foot assessment should be completed annually; quarterly would be too often.
After performing a health history and physical assessment for a client, the nurse suspects type 2 DM. Which assessment finding is consistent with the nurse's suspicion? SATA A) Decreased urination B) Hypertension C) Hyperglycemia D) Extreme thirst E) Acanthosis nigricans
B, C, D, E Rationale: Symptoms that would lead the nurse to conclude the client has type 2 diabetes mellitus 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 mellitus would have increased and not decreased urination.
The nurse preceptor is teaching a new graduate nurse about hypoglycemic agents to treat type 2 DM. Which information should the preceptor include related to how these medications lower blood sugar? SATA A) Increase breakdown of insulin B) Increase uptake of glucose by cells C) Stimulate hormones for hemodilution D) Increase insulin secretion E) Prevent breakdown of glycogen
B, D, E Rationale: Hypoglycemic agents are used to treat individuals with type 2 diabetes mellitus. 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 mellitus includes the incretin effect. Incretin hormones, which are hormones released from the gut endocrine cells during meals, play a significant role in insulin secretion.
What collaborative interventions are likely to improve outcomes for an 11yo client with type 2 DM? SATA A) Weaning off oral medications B) Food intake based on age, sex, and physical activity C) Obtaining adequate rest and sleep D) Physical activity to be at least 30 to 60 minutes/day most of the days of the week E) Family participation in the lifestyle change
B, D, E Rationale: The child with type 2 diabetes mellitus will most likely be treated with oral hypoglycemic agents. Weaning off of these medications will not improve the client's long-term prognosis. The child with type 2 diabetes mellitus does not have a need for adequate rest and sleep to improve the long-term prognosis. Plans to improve the client's long-term prognosis should focus on food intake that is based on the client's age, sex, and physical activity, obtaining the required physical activity that is recommended for most days of the week, and family support to comply with lifestyle changes that the client needs.
The nurse is teaching a group of older adults with type 2 diabetes mellitus. Which complication of the disease should the nurse include? SATA A) Pulmonary disease B) Polypharmacy C) Autoimmune diseases D) Functional disabilities E) Cognitive impairment
B, D, E - Polypharm - Functional disability - Cognitive impairment Rationale: Older adults diagnosed with type 2 diabetes mellitus are at an increased risk of developing other complications as compared with younger clients. 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 mellitus does not place a client at higher risk of pulmonary or autoimmune disease.
The nurse is caring for a client newly diagnosed with type 2 DM. Prior to any teaching about medications, the client informs the nurse, "I cannot give myself any injections." How should the nurse respond? A) "It is understandable to be upset about a new medical diagnosis." B) "Why do you think you will have to give yourself injections?" C) "Type 2 DM can usually be managed with pills, diet, and exercise." D) "Insulin administration helps with better blood glucose management."
C) "Type 2 diabetes can usually be managed with pills, diet, and exercise." Rationale: The nurse should reassure the client with type 2 diabetes mellitus that the disease can be managed with oral hypoglycemic medications, diet, and exercise and may not require insulin. The nurse would not ask why the client thinks he would have to administer insulin. This is not therapeutic communication and is not the best way to obtain information. It is understandable for the client to be upset, but this statement does not alleviate the fears or provide information. Insulin administration helps with blood glucose management in type 1 diabetes mellitus.
A morbidly obese adult patient with type 2 DM has tried dietary modifications, oral hypoglycemic medications, and exercise, but has not seen any significant decrease in the hemoglobin A1C Which intervention should the nurse recommend that the patient explore to prevent long-term complications of type 2 DM? A) Short and long acting insulin B) Baby aspirin taken once a day C) Bariatric surgery D) Revising the current diabetic diet
C) Bariatric surgery Rationale: Patients who are morbidly obese and have uncontrolled type 2 diabetes mellitus may benefit from bariatric surgery. This surgery allows the patient to lose weight and diminish or eliminate diabetes. Short- and long-acting insulin, taking a baby aspirin, and revising the current diabetic diet will not prevent complications.
A client with blood glucose of 450 is diagnosed with hyperosmolar hyperglycemic state (HHS). Which assessment finding should the nurse expect? A) Open wound to the foot B) Capillary refill of 2 seconds C) Increase in urinary output D) Lower extremity edema
C) Increase in urinary output Rationale: A client in HHS would have an increase in urinary output due to the hyperosmolarity of the blood. Capillary refill should be less than 3 seconds. Lower extremity edema occurs from fluid volume overload. A client in HHS has a fluid volume deficit. An open wound to the foot is not directly related to HHS because it can come from an injury to the foot.
The nurse is teaching the caregivers of a teen with a new diagnosis of type 2 DM what they should do every 3 months to monitor the disease. The teen is currently taking metformin (Glucophage). Which information should the nurse include? SATA A) obtain on eye exam B) Assess injection sites C) Monitor A1C D) Review blood glucose logs E) Discuss alcohol and drug use
C, D, E Rationale: An adolescent with type 2 diabetes mellitus who takes metformin (Glucophage) 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 mellitus 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
The nurse is completing an assessment interview with an older adult client being seen for a yearly physical examination. Which client statement would indicate a possible diagnosis of diabetes? A) "I'm slightly winded when I walk up a flight of stairs, but it passes quickly." B) "I feel a bit tired by afternoon and take a 30 minute nap most days." C) "I sometimes have muscle aches in my upper legs at night." D) "I've been experiencing increased thirst during the past several months."
D) "I've been experiencing increased thirst during the past several months." Rationale: Excessive thirst can be associated with high glucose levels and may be a symptom of undiagnosed diabetes mellitus. Fatigue that responds to a short nap, having some muscle aches at night, and being slightly short of breath after walking up a flight of stairs with a quick recovery may be within the normal functioning of a healthy older client.
A client newly diagnosed with type 2 DM asks the nurse how to "get rid" of this disease. How should the nurse respond? A) "You will always have type 2 DM. You can't get rid of it." B) "Type 2 DM cannot be cured. It will eventually progress to type 1 DM. C) "You seem concerned about this diagnosis and we will do our best to help you control it." D) "Type 2 DM can sometimes be eliminated by weight loss, diet, and exercise."
D) "Type 2 DM can sometimes be eliminated by weight loss, diet, and exercise." Rationale: Type 2 diabetes occurs in people who live a sedentary lifestyle, are obese, and eat a high-carbohydrate diet. Therefore, the nurse would explain to the client that the disease may be eliminated with diet, exercise, and weight loss. The first statement stating the client will always have type 2 diabetes mellitus is inaccurate because the disease can be eliminated. Type 1 and type 2 diabetes mellitus are two separate disorders with commonalities. One type does not progress to the other. Although it is accurate that the client is concerned about the diagnosis, this response does not answer the client's question.
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) A1C of 6.4% D) Absent pedal pulses
D) Absent pedal pulses Rationale: Absence of pedal pulses indicates the peripheral tissue is not receiving adequate oxygenation and in turn is the basis of the nursing diagnosis Tissue Perfusion: Peripheral, Ineffective. A hemoglobin A1C of 6.4%, capillary refill of 3 seconds, and fasting blood glucose of 100 mg/dL are all normal findings. (NANDA-I ©2014)
A client recently diagnosed with type 2 DM reports difficulty managing the disease. To which professional should the nurse refer the client for help with caloric intake? A) Personal trainer B) Primary healthcare provider C) Social worker D) Dietician
D) Dietician Rationale: The dietitian would best be able to help the client develop meal plans and incorporate foods that the client likes. The social worker would help the client find community resources to meet financial needs. A personal trainer would help the client increase activity. The primary healthcare provider manages the disease process as well as the multidisciplinary healthcare team.
Which information should the school nurse provide when teaching a group of adolescents the risk factors type 2 DM. A) Monitor blood glucose levels B) Increase carb intake C) Limit the amount of protein D) Get sufficient exercise and activity
D) Get sufficient exercise and activity Rationale: Frequently, children with type 2 diabetes mellitus 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 mellitus is made.
A child with a new diagnosis of type 2 DM is started on an oral hypoglycemic medication. Which medication should the nurse expect the HCP to prescribe? A) Sitagliptin (Januvia) B) Exenatide (Byetta) C) Liraglutide (Victoza) D) Metformin (Glucophage)
D) Metformin (Glucophage) Rationale: Metformin (Glucophage) is the only oral hypoglycemic that is safe to use in children. The nurse would not expect any other oral hypoglycemic to be prescribed for type 2 diabetes mellitus, because their safe use has not been determined.
Which potential cause of type 2 DM influences insulin's ability to regulate glucose metabolism and uptake by the liver, skeletal muscles, and adipose tissue? A) Viral infection B) Exposure to toxins C) Young age D) Obesity
D) Obesity Rationale: In obesity, insulin has a decreased ability to influence glucose metabolism and uptake by the liver, skeletal muscles, and adipose tissue. Viral infections and chemical toxins are known triggers for type 1 diabetes, not type 2 diabetes. Older age, not young age, can increase cellular resistance to the effects of insulin and increase the risk of developing type 2 diabetes.
Which goal would be most appropriate to include in the nursing care of a client with type 2 DM? A) the client will record daily fat intakes B) The client will use hand hygiene when toileting C) The client will monitor fasting glucose levels D) The client will inspect feet at least once daily
D) The client will inspect feet at least once daily Rationale Clients with type 2 diabetes are at high risk for foot problems related to diabetic peripheral neuropathy. Therefore, an appropriate goal for clients with type 2 diabetes includes inspecting feet at least once daily. Clients with type 2 diabetes should record carbohydrate intake, not fat intake. Although fasting glucose levels are important, postprandial blood glucose levels provide the most useful information for evaluating glycemic control in clients with type 2 diabetes. Teaching proper hand hygiene may be appropriate when teaching clients with diabetes about insulin injections, but teaching hand hygiene when toileting is not specific for clients with type 2 diabetes.