Ch. 37 Diabetes Mellitus and Its Complications
The nurse is assessing a client with type 2 diabetes mellitus (T2DM). Which sequence of events occurs in the pathophysiological process of the development of stage 3 T2DM?
...
In which order, from greatest to least, might the listed clients develop type 1 diabetes mellitus?
1. 14-year-old whose pancreatic beta-cell mass has decreased 75% 2. 7-year-old boy whose twin sister was recently diagnosed with T1DM 3. 3-year-old diagnosed with hepatitis A virus 4. 2-year-old who drinks three 8-oz glasses of cow's milk daily
Urbanization and a Westernized lifestyle have been established as risks for the development of type 2 diabetes mellitus (T2DM). Which statement explains this occurrence? (Select all that apply.)
A. "A sedentary lifestyle leads to central obesity." B. "A high-calorie diet leads to the increase of adipose tissue and free fatty acids."
A client is being tested for diabetes mellitus. Which diagnostic test result should the nurse expect for this client? (Select all that apply.)
A.Random glucose level is 200 mg/dL or higher. C. Fasting plasma glucose level is 126 mg/dL or higher on at least 2 occasions. E. HbA1c is 6.5% or greater.
Which instruction should the nurse provide a client about the pathophysiology of diabetes mellitus (DM)?
B. Diabetes mellitus eventually leads to increased free fatty acid production. In diabetes mellitus (DM), the ability of insulin to decrease lipolysis is impaired, leading to increased free fatty acid production. Insulin insufficiency will lead to episodes of hyperglycemia. Insulin resistance leads to decreased, not increased, glucose uptake by the muscles.
Which client is at risk for developing type 2 diabetes mellitus (T2DM)? (Select all that apply.)
A. 23-year-old Pima Indian living in the Southwest United States B. 45-year-old client whose parents have been diagnosed with T2DM, but who tries to follow a healthy diet D. 42-year-old Mexican American who is slightly overweight and lives a Westernized lifestyle E. 33-year-old client whose mother had gestational diabetes and was a high-birth-weight infant
The nurse is caring for a client with diabetes mellitus (DM). Which clinical manifestation might be related to the effects of polyuria? (Select all that apply.)
A. Hypotension C. Fatigue D. Glucosuria Polyuria in clients with diabetes mellitus (DM) is a result of osmotic diuresis, which can lead to dehydration and volume depletion. Clinical manifestations of diabetes mellitus that are related to the effects of polyuria include polyphagia, polydipsia, fatigue, weight loss, hypotension, tachycardia, and glucosuria
A client with type 2 diabetes mellitus (T2DM) has been diagnosed with hyperglycemic hyperosmolar syndrome (HHS). Which clinical manifestation should the nurse assess in the client? (Select all that apply.)
A. Severe dehydration C. Hemiparesis E. Electrolyte imbalances
A client is being evaluated for diabetes mellitus (DM). Which laboratory test should the nurse expect to be prescribed for this client? (Select all that apply.)
B. Fasting plasma glucose level (FPG) C. Random serum glucose level E. Glycosylated hemoglobin (HbA1c) level
Which risk factor for type 2 diabetes mellitus (T2DM) should the nurse assess in a client? (Select all that apply.)
B. Socioeconomic factors C. Obesity and physical inactivity E. African American descent Risk factors for type 2 diabetes mellitus (T2DM) include obesity and physical inactivity, genetics and family history, diet, socioeconomic factors, and education. Ethnic groups that are at high risk for T2DM include African Americans, American Indians, Hispanics, and Pima Indians.
A client with type 2 diabetes mellitus (T2DM) has a microalbuminuria level of 75 mg albumin/24 hr. Which client statement should the nurse address?
B. "Because I am having no symptoms and the lab result is only slightly elevated, there is not a need for treatment at this time." Aggressive treatment of even minor elevations in blood pressure can preserve kidney function and delay the progression of nephropathy. Diabetic nephropathy develops in several stages, with the first sign being an elevated microalbuminuria, although the client is typically asymptomatic. Glucose control and the duration of type 2 diabetes mellitus (T2DM) impact the development of diabetic nephropathy. As diabetic nephropathy progresses hypertension and severe proteinuria develop. Glomerular filtration rate (GFR) will decrease as serum creatinine increases. Eventually, the result is end-stage kidney failure, which requires dialysis.
The nurse prepares to care for a client with diabetes mellitus. Which statement should the nurse make to describe this disease process to the client?
B. "Diabetes is a group of metabolic disorders characterized by the inability to effectively metabolize carbohydrates, proteins, and fats." Diabetes mellitus (DM) is a group of metabolic disorders characterized by the inability to effectively metabolize carbohydrates, proteins, and fats as a result of defects in insulin secretion, insulin action, or both, which results in hyperglycemia. It affects the endocrine functions of the pancreas.
A client with type 1 diabetes mellitus (T1DM) is experiencing nausea, vomiting, fatigue, and abdominal pain. Which risk factor should the nurse most likely associate with this client?
D. Infection Nausea, vomiting, fatigue, and abdominal pain are clinical manifestations of diabetic ketoacidosis (DKA). DKA is characterized by hyperglycemia, metabolic acidosis, and ketonemia. A decrease in insulin due to missed doses or administering lower than prescribed doses can precipitate DKA. The most common precipitating factor in the development of DKA is infection.
A client with type 2 diabetes mellitus is diaphoretic, shaky, and very drowsy. Which measurement should the nurse expect to assess in this client?
C. Blood glucose 42 mg/dL Clinical manifestations of hypoglycemia are classified as autonomic nervous system (ANS) symptoms and neuroglycopenic symptoms. ANS symptoms include sweating, palpitations, tremors, and hunger. Neuroglycopenic symptoms result from lack of glucose to the central nervous system (CNS) and include difficulty speaking, visual disturbances, drowsiness, confusion, seizures, and coma.
Which is a finding from the Diabetes Prevention Program that impacts the way type 2 diabetes mellitus (T2DM) is treated?
C. The lifestyle intervention program was more successful at preventing T2DM than treatment with metformin. Lifestyle interventions decreased the incidence of type 2 diabetes mellitus (T2DM) by 58%, while treatment with metformin decreased the incidence of T2DM by 31%.
A client with type 2 diabetes mellitus (T2DM) has a glycosylated hemoglobin (HbA1c) level of 8.5%. Which interpretation about the test result is accurate?
C. The test result is above the recommended levels for HbA1c. HbA1c blood test reflects average blood glucose levels over a period of three months. For clients with diabetes, the recommended levels for HbA1c are between 6% and 7%, which corresponds to blood glucose levels of 120 to 140 mg/dL. The result of 8.5% is above the recommended level and corresponds to serum blood glucose levels of 200 mg/dL. HbA1c levels of 13% or higher are dangerously high, corresponding to serum blood glucose levels of 300 mg/dL or greater.
The nurse is instructing a client recently diagnosed with type 1 diabetes mellitus (T1DM) and decreased insulin production. Which explanation should the nurse use to help the client understand when insulin may be needed?
C. "After eating carbohydrates, insulin levels should rise to stimulate the body's use of glucose in tissue building." After eating carbohydrates, the client will be in the absorptive state. Insulin levels should rise to stimulate glucose uptake by the tissues, primarily muscle. The effect of the hormone insulin is tissue growth. Because insulin production has decreased and will eventually cease, it is during the absorptive state that insulin will be needed.
A client missed the midday meal and is now diaphoretic and confused. Because the nurse knows that the ratio of glucagon to insulin has increased in an effort to provide glucose to the brain and nervous tissue, which metabolic state is the client most likely in?
D. Postabsorptive During the postabsorptive state, glucose levels fall. The focus is on providing glucose to fuel the brain and nervous tissue. The ratio of glucagon to insulin increases, and free fatty acids are released from adipose tissue to be broken down for energy.
The nurse is teaching a client with type 1 diabetes mellitus (T1DM). Which client statement requires follow-up?
D. "As long as my blood sugar is under control, I do not need to follow up with my eye doctor." Even when blood glucose is under control, annual eye exams are necessary. If diabetic retinopathy is detected prior to the onset of symptoms, treatment can delay the progress of the disease and preserve vision.
The nurse is teaching a client with type 1 diabetes mellitus (T1DM) about the signs and symptoms of diabetic ketoacidosis (DKA). Which client statement indicates to the nurse that the teaching has been effective?
D. "Increased thirst may indicate that I need to check my blood glucose." Increased thirst indicates dehydration, possibly due to hyperglycemia and diabetic complications. Fluid volume depletion due to hyperglycemia results in weight loss. Hyperglycemia causes osmotic diuresis, which results in dehydration. Increased thirst is a compensatory mechanism for dehydration. Blurred vision and fatigue are clinical manifestations of hyperglycemic hyperosmolar syndrome (HHS). Blurred vision is a result of fluid accumulation in the lens in response to hyperglycemia. Fatigue occurs in response to altered metabolism of carbohydrates, proteins, and lipids.
