Complications of Diabetes

Which statement of the diabetic patient suggests the need for additional learning about foot care?

A patient suffering from severe diabetes may have sensory neuropathy. Hot water is not recommended, because the patient will not be able to sense the degree of warmth of the water and may get burns. Using padded socks will protect the patient from cuts. Washing the feet daily with gentle soap will reduce the risk of infection. By checking for swelling and cuts every day, the patient can get timely treatment if needed.

A nurse is caring for a patient with diabetic ketoacidosis (DKA). The patient is on a continuous short-acting insulin infusion and receiving a continuous infusion of normal saline solution. The nurse understands that insulin causes an intracellular shift of potassium, water, and glucose to move into the intracellular space. The nurse has several things to observe, but what is the highest priority?

A patient with DKA is receiving a continuous insulin infusion, which causes potassium to move from the extracellular space to the intracellular space. This shift causes a decrease in the serum potassium level and can cause cardiac dysrhythmias; therefore, cardiac monitoring is the nurse's highest priority. Urine output is important to monitor for patients with DKA, but it is not the highest priority. Temperature is not relevant to monitoring patients with DKA. The respiratory rate is important to monitor, but it is not the highest priority.

After giving 6 oz. of orange juice to a patient with hypoglycemia, the nurse finds that the patient's blood glucose level is 65 mg/dL. Which nursing intervention would be the most appropriate in this situation?

A patient with a blood glucose level less than 70 mg/dL should be given 15 g of carbohydrates (5 to 6 oz. of fruit juice) initially. If the glucose is still less than 70 mg/dL and the patient is stable and conscious, then an additional 15 g of carbohydrates should be given. Dextrose (5 percent to 10 percent) is added to the fluid regimen in patients who are on treatment for diabetic ketoacidosis if the blood glucose level approaches 250 mg/dL. Administering 25 to 50 mL of 50% glucose intravenously and 1 mg IM glucagon is indicated for an unconscious patient or if the symptoms of hypoglycemia are worsening.

Which intervention will be beneficial for a patient with a blood glucose level of 250 mg/dL who is receiving treatment for hyperosmolar hyperglycemic syndrome?

A patient with hyperosmolar hyperglycemic syndrome whose blood glucose level approaches 250 mg/dL should receive IV fluids containing glucose to prevent hypoglycemia. NaCl 0.9 percent is administered in patients with diabetic ketoacidosis. Administering 0.1 u/kg/hr of insulin is indicated to correct hyperglycemia and hyperketonemia. IM glucagon is administered in hypoglycemic patients who are unconscious.

A patient with diabetes mellitus needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively?

A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1c below 7 percent, and coughing and deep breathing with splinting would be important for any type of surgery, but are not the priority with mitral valve replacement for this patient.

A nurse teaches a student nurse about pancreas transplantation. While caring for a patient whose pancreas has been transplanted, which instruction given by the student nurse strongly suggests ineffective learning?

After pancreatic transplantation, homeostasis of glucose level is achieved. There is no need for regular monitoring of the glucose level. Pancreatic transplantation helps in maintaining a normal glucose level, so exogenous insulin is not required. Many dietary restrictions can be lifted. Lifetime immunosuppression is very important to avoid organ rejection, which may happen after pancreatic transplantation.

A patient on an inpatient unit pushes the call button for the nurse. The nurse notices upon entering the patient's room that the patient is sweating profusely, pale, and anxious. The patient states, "I feel really dizzy and my vision is blurred." What intervention is the highest priority?

Any patient exhibiting signs and symptoms of hypoglycemia, such as diaphoresis, pallor, anxiety, visual disturbances, or dizziness, should have his or her blood glucose level checked immediately. Obtaining vital signs is not an immediate intervention that needs to be implemented. Having the patient lie flat is not an intervention that needs to be done immediately. Administering glucagon is not an intervention to be performed unless the patient is worsening or unconscious.

Which complication of diabetes can cause hypoglycemic unawareness?

Autonomic neuropathy is a type of diabetic neuropathy. Autonomic neuropathy can affect all the systems in the body leading to hypoglycemic unawareness. Diabetic dermopathy may cause acanthosis nigricans and necrobiosis lipoidica diabeticorum. Diabetic ketoacidosis may cause dehydration, metabolic acidosis, and electrolyte disturbance. Diabetic nephropathy leads to reduction in the glomerular filtration rate of the kidneys.

Which manifestation might the nurse suspect in a patient with diabetes whose serum osmolality is increased and blood glucose level is 610 mg/dL?

Blood glucose level more than 600 mg/dL indicates hyperosmolar hyperglycemic syndrome, which increases the serum osmolality and produces severe neurologic manifestations such as seizures. Acidosis is mainly associated with diabetic ketoacidosis. Fluid losses may cause mild deficits in potassium leading to hypokalemia but not hyperkalemia. Cerebral edema is a complication associated with rapid administration of intravenous fluids.

A patient whose laboratory report shows a blood glucose level of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 is on therapeutic management. At a follow-up visit, the patient has severe hypokalemia (2 mEq/L). Which therapeutic intervention might have caused severe hypokalemia in this patient?

Blood glucose of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 indicates that the patient has diabetic ketoacidosis. Administration of 0.1 U/kg/hr of insulin is responsible for the severe hypokalemia. Administration of 0.9 percent NaCl is useful for fluid restoration in patients with dehydration. Administration of 1 mg glucagon is beneficial for patients with severe hypoglycemia; 5 percent to 10 percent dextrose is added to the fluid regimen of diabetic ketoacidosis patients when blood sugar level approaches 250 mg/dL.

The urinalysis of a patient with diabetes mellitus that has a blood glucose level of 680 mg/dL reveals a minimal ketone level. Which other finding can the nurse observe in the reports?

Blood glucose of 680 mg/dL and a minimal amount of ketones in the urine indicate that the patient has hyperosmolar hyperglycemic syndrome; the patient will also have increased serum osmolality. Decreased blood pH is associated with diabetic ketoacidosis. Patients with hyperosmolar hyperglycemic syndrome may have milder potassium deficits (hypokalemia) due to fluid losses. Decreased serum bicarbonate is observed with diabetic ketoacidosis.

The nurse would encourage a patient with diabetes mellitus and coronary artery disease to limit intake of which of the following foods to help reduce the percentage of saturated fat in the diet?

Cheese and dairy products are higher in fat and calories than vegetables, fruit, enriched flour products, or poultry and should be limited.

Which other symptoms should be assessed in a hospitalized patient whose blood and urine tests indicate diabetic ketoacidosis (DKA)? Select all that apply.

DKA is caused by profound deficiency of insulin, characterized by hyperglycemia, ketosis, acidosis, and dehydration. Tachycardia in DKA results from inadequate blood supply to the tissues. A hypovolemic shock state is a result of acid accumulation. Kussmaul respirations, which involve rapid, deep breathing with dyspnea, are one of the characteristic symptoms of DKA. Orthostatic hypotension may occur because the body is unable to maintain an even distribution of fluids in its various compartments. Reduced bowel movements are not associated with DKA. Symptoms that mimic an alcohol intoxication state are present in a hypoglycemic condition.

Which symptoms may be observed in patients with diabetic ketoacidosis? Select all that apply.

Dehydration in patients with diabetic ketoacidosis results in hypovolemia, soft and sunken eyes, and sweet fruity odor of breath. Volume overload is common in diabetic patients with cardiac or renal compromise. Patients with diabetic ketoacidosis typically experience a rapid, deep breathing pattern known as Kussmaul respirations, not hypoventilation, as a means of correcting the acid-base imbalance caused by the condition.

Which conditions may lead to a coma in patients with diabetic ketoacidosis if left untreated? Select all that apply.

Dehydration, metabolic acidosis, and electrolyte imbalance may lead to a coma if untreated. Hypoglycemia and cerebral edema are not associated with coma in patients with diabetic ketoacidosis.

What should be the initial treatment for a patient with diabetic ketoacidosis who arrived at the hospital with clinical symptoms of dry mucous membranes, tachycardia, and orthostatic hypotension?

Dry mucous membranes, tachycardia, and orthostatic hypotension indicate severe dehydration. Infusion of 0.45 percent or 0.9 percent NaCl is given for fluid replacement to prevent dehydration. Infusion of 5 percent to 10 percent dextrose is given to prevent hypoglycemia. If the patient has severe hypoglycemia and is in an unconscious state, a subcutaneous injection of 1 mg glucagon or intravenous administration of 25 to 50 mL of 50 percent glucose is given.

Which medications does the nurse expect to be beneficial in a patient with diabetes mellitus who complains of numbness and a tingling sensation in the lower extremities? Select all that apply.

Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor that is used for treatment of sensory neuropathy in patients with diabetes. Gabapentin is an antiseizure medication that decreases the release of neurotransmitters that transmit pain in patients with neuropathy. Amitriptyline is a tricyclic antidepressant used in the treatment of sensory neuropathy. Losartan is an angiotensin receptor blocker used to delay the progression of kidney damage in patients with diabetes. Bethanechol is used for the treatment of neurogenic bladder, which is caused by autonomous neuropathy.

A patient with diabetes experiences hypoglycemia. What does the nurse educate the patient that a cause of this condition may be?

Exercise without a carbohydrate-based snack could result in hypoglycemia. Mild illness, insufficient insulin dosage, and overeating are situations that would cause hyperglycemia, or an increased blood glucose level.

Which complication of diabetes mellitus can be monitored by fundus photography?

Fundus photography helps to examine the interior surface of the eye (fundus). Therefore, fundus photography helps to detect the microvascular damage caused by chronic hyperglycemia to the retina, known as retinopathy. Neuropathy can be monitored by a comprehensive foot examination. Diabetic nephropathy can be monitored by checking for microalbuminuria and serum creatinine. Dermatopathy can be monitored by frequent skin examinations.

Which is a symptom of autonomic neuropathy?

Gastroparesis is delayed gastric emptying, which is one of the complications of autonomic neuropathy. Aphasia is one of the severe neurologic manifestations of hyperosmolar hyperglycemic syndrome. Glaucoma may occur due to diabetic retinopathy. Paresthesias is seen in sensory neuropathy.

Which statement by a patient shows ineffective learning about diabetes management?

Having fruit juices daily does not help in diabetes management, because it contains sugars that are easily absorbed. Exercising daily helps to maintain good health. Wearing shoes daily will avoid injuries to feet, which is important, because wound healing is delayed in diabetic patients. Diabetic patients have weakened immune systems and are more prone to flu. Therefore, annual vaccination against influenza is required.

Which complication of diabetes can be treated with hyperbaric oxygen? `

Hyperbaric oxygen is used for wound healing in diabetic foot ulcers. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used in the treatment of diabetic nephropathy. Neuropathic arthropathy results in ankle and foot changes and increases the chances of developing foot ulcers. Peripheral vascular disease is one of the macrovascular complications of diabetes. Management includes smoking cessation and control of hypertension.

After administering an intramuscular (IM) glucagon injection in an unconscious patient, why does the nurse turn the patient on the side?

IM glucagon is administered for hypoglycemia. Because nausea is a common reaction after glucagon injection, the patient should be turned to one side until gaining consciousness in order to prevent aspiration if vomiting occurs. Because the patient is unconscious, turning to the side will not promote the patient's comfort. The patient who is unconscious due to severe hypoglycemia will regain consciousness due to administration of the glucagon injection.

While caring for a patient showing signs of dawn phenomenon, the student nurse teaches the patient ways to avoid an increased level of blood glucose in the morning. Which instruction strongly suggests a need for further learning?

In dawn phenomenon, there is a rise in the blood glucose level in the night, which causes hyperglycemia in the morning. Therefore, the treatment for dawn phenomenon is increasing the insulin intake. If insulin is taken before sleeping at night, then it will help to normalize the blood glucose level in the morning. A regular check on the blood glucose level in the morning will help to know the medication time, amount, and diet plan for maintaining an appropriate glucose level in the blood.

A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find?

In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and unlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

What are the possible patient-specific reasons for selecting the intramuscular route for administering glucagon for treating hypoglycemia? Select all that apply.

In instances in which the patient has no intravenous access or is not alert enough to swallow, the best option is to administer 1 mg of glucagon by intramuscular or subcutaneous injection. Intramuscular injection in the site of the deltoid muscle will result in a quicker response. Glucagon stimulates a strong hepatic response to convert glycogen to glucose and, therefore, makes glucose rapidly available. The patient cannot make the choice for route of administration, because the patient is not alert. The intramuscular and intravenous doses are the same in volume.

Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis?

Incorrect fluid replacement especially with hypotonic fluids may cause a sudden drop in serum sodium resulting in cerebral edema. Polyuria is a manifestation of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Hypokalemia may be seen with severe dehydration. Metabolic acidosis is observed with diabetic ketoacidosis due to fluid losses.

The nurse is reviewing laboratory results for the patient with diabetes and coronary artery disease. Which laboratory result would help predict possible macrovascular disease as a complication of diabetes?

Increased low-density lipoprotein levels are associated with the macrovascular changes in diabetes mellitus. For this reason, the patient should limit the amount of fat in the diet. A decreased blood urea nitrogen or C-reactive protein is not clinically significant. An increased white blood cell count would indicate infection.

Which statement by the patient shows effective learning about insulin therapy?

Insulin should be discarded if any particles appear in the solution. The needle should be left in place for 5 seconds to ensure that all of the insulin dose has been injected, then the needle may be removed. The needle should be pushed straight into the pinched-up area. The injection site should be rotated in a single anatomical spot, such as the abdomen, for at least 1 week before using a different site to allow better insulin absorption.

The laboratory reports of a patient brought to the emergency department with the symptoms of dehydration show high glucose levels in the blood, large ketone bodies in the urine, decreased serum bicarbonate levels, and acidic pH of the blood. What nursing interventions would help stabilize the patient? Select all that apply.

Intravenous administration of short-acting insulin helps to stabilize the blood glucose levels. Intravenous administration of fluids and electrolytes may help to rectify the fluid electrolyte balance and normalize the blood pH. Administering glucagon, 50 percent glucose, and fast-acting carbohydrates increase the blood sugar level so these interventions are appropriate for hypoglycemia.

A nurse is reviewing the laboratory findings of a diabetic patient. What condition does the nurse suspect?

Laboratory findings of blood glucose level greater than 250 mEq/L, arterial blood pH less than 7.30, serum bicarbonate level less than 16 mEq/L, and the presence of moderate to large ketone bodies in the urine or serum indicate diabetic ketoacidosis. Diabetic retinopathy is microvascular damage to the retina; it may not be associated with these manifestations. Diabetic neuropathy is nerve damage due to diabetes mellitus. Diabetic nephropathy is damage to nephrons due to hyperglycemia.

Laboratory results have been obtained for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes?

Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include?

Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotence and slowed gastric emptying result from microangiopathy and neuropathy.

The nurse is conducting a teaching session about nephropathy as a complication of diabetes. Which information would be appropriate for the nurse to include in the session?

Microangiopathy occurs in diabetes mellitus. When the kidneys are affected, the patient has nephropathy. Maintaining control of blood sugar and blood pressure will decrease microvascular organ damage and help to preserve kidney function. Blindness occurs as a result of microvascular damage, not bleeding. Organ damage is caused from small vessel damage. Regardless of the treatment type, nephropathy can occur if blood sugars are not controlled properly.

Which population experiences the most disparity related to the amount of complications from diabetes?

Native Americans have a six times higher rate of end-stage renal disease and a four times higher rate of amputation than other ethnicities with diabetes, including white Americans, African Americans, and Hispanic Americans.

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.8 mEq/L. The nurse understands that a possible cause of hyperkalemia would be:

Nephropathy, a complication of diabetes, results in elevated potassium levels. Malnutrition does not cause sodium excretion accompanied by potassium retention; therefore, it is not a contributing factor in this patient's potassium level. Potassium is not affected by the body's immune system. Insulin causes a decrease in potassium by pushing it into the cells.

The nurse is teaching the caregiver about the manifestations of hypoglycemia in the diabetic patient. What should the caregiver identify as a manifestation of hypoglycemia?

Nervousness and tremors; cold, clammy skin; and numbness of the fingers and toes are some of the manifestations of hypoglycemia which the caregiver should watch for out in the patient. An increase in urination, abdominal cramps, and nausea and vomiting are manifestations of hyperglycemia.

Which drug is used for treating neurogenic bladder?

Neurogenic bladder may develop as a sensation in the inner bladder wall, causing urinary retention. A cholinergic agonist drug such as bethanechol is used for treating this condition. Valsartan is an angiotensin receptor blocker that is used in patients with diabetes and microalbuminuria. Gabapentin is an antiseizure medication used for treating neuropathic pain. Amitriptyline is a tricyclic antidepressant used in the treatment of neuropathic pain.

What is a risk factor associated with macrovascular complications of diabetes mellitus?

Obesity increases the risk for blood vessel and cardiovascular disease. Hypoglycemia, if untreated, results in seizures and coma. Hypovolemia, due to excessive dehydration, may lead to shock. Patients with adrenal insufficiency may have minimal glycogen stores and may not respond to glucagon therapy.

What is the cause of microaneurysms in nonproliferative retinopathy?

Partial occlusion of small blood vessels in the retina causes microaneurysms in the capillary walls. Retinal edema is caused by leakage of the capillary fluids from the walls of microaneurysms. Occlusion of retinal capillaries leads to neurovascularization, which is the formation of new blood vessels to supply the retina with blood. Intraretinal hemorrhages may occur due to leakage of the capillary fluids from microaneurysms.

Which process is related to nonproliferative retinopathy?

Partial occlusion of the small blood vessels in the retina causes microaneurysms in nonproliferative retinopathy. Hemorrhage is seen in proliferative retinopathy because of fragile, newly formed blood vessels. In proliferative retinopathy, the retinal capillaries become occluded, resulting in the formation of new vessels. This process is called neovascularization. Partial or complete retinal detachment occurs if the new blood vessels pull the retina while the vitreous contract.

A patient with type 1 diabetes mellitus has received a prescription for propranolol. What does the nurse recognize as the major concern for this patient?

Patients who are hypoglycemic experience a drop in blood glucose level below normal and most often complain of weakness, nervousness, tremors, and diaphoresis. Propranolol can mask hypoglycemia-induced tachycardia, thereby decreasing the diabetic patient's ability to sense a drop in blood sugar. Propranolol does not cause night sweats or require an increased insulin dosage. Diabetic and nondiabetic patients may notice a slight increase in blood sugar, but this is not as significant a priority as the patient's not being able to sense hypoglycemia.

Which patient will not respond to glucagon?

Patients with alcohol-related hepatic disease may have minimal glycogen stores and will not respond to glucagon. Cerebral edema is related to a rapid decrease in the blood glucose levels. Patients with chronic hyperglycemia may develop chronic complications of diabetes mellitus. Peripheral vascular disease is one of the macrovascular complications of diabetes.

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement?

Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. The patient should not walk barefoot. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.

What are the symptoms of peripheral arterial disease? Select all that apply.

Peripheral arterial disease causes decreased blood flow to the lower extremities. Cold feet, loss of hair, and dependent rubor are the signs of peripheral arterial disease. Urinary retention and bowel incontinence are symptoms of autonomic neuropathy.

A patient with a history of type 2 diabetes is diagnosed with heart failure. Which medication would be a poor choice for controlling the patient's diabetes?

Pioglitazone can worsen heart failure. Therefore, it should be avoided in diabetic patients with heart failure. Glyburide, acarbose, and nateglinide are not contraindicated in heart failure patients.

While caring for a patient with diabetic ketoacidosis, the nurse finds that the patient is experiencing rapid, deep breathing due to dyspnea. Which physiologic cause does the nurse suspect?

Rapid, deep breathing due to dyspnea is a characteristic feature of Kussmaul respirations, which occur due to metabolic acidosis. Altered pH balance in the body is responsible for metabolic acidosis. Dry mucous membranes are one of the manifestations of severe dehydration. Increased serum osmolality results in neurologic manifestations such as somnolence, coma, seizures, hemiparesis, and aphasia in patients with hyperosmolar hyperglycemic syndrome (HHS). Increased endogenous insulin secretion results in hypoglycemia.

The nurse advises a diabetic patient on insulin therapy who reports headaches on waking and night sweats to reduce the dose of insulin and have a bedtime snack. Which finding supports the nurse's instructions?

Reducing the dose of insulin and having a bedtime snack are the instructions given to a patient who is experiencing morning hyperglycemia. The Somogyi effect is characterized by morning hyperglycemia. If a patient is experiencing morning hyperglycemia, blood glucose levels between 2 AM and 4 AM will be low. The patient may report headaches on awakening and recall having night sweats or nightmares. A bedtime snack, a reduction in the dose of insulin, or both can help to prevent the Somogyi effect. Blood glucose levels of 60 mg/dL between 2 PM and 4 AM, blood glucose levels of 60 mg/dL between 2 AM and 4 PM, and blood glucose levels of 60 mg/dL between 2 PM and 4 PM are not associated with the Somogyi effect.

Which complication can be monitored by annual screening using a monofilament?

Sensory neuropathy is a type of diabetic neuropathy in which loss of protective sensation (LOPS) is common. LOPS may lead to lower extremity amputation. Therefore, annual screening using a monofilament is important in monitoring the patient for diabetic neuropathy. Diabetic retinopathy is monitored by annual fundoscopic examination. Examining the skin changes is important in diabetic patients to monitor for diabetic dermopathy. Serum creatinine and urinalysis for microalbuminuria help to monitor for diabetic nephropathy.

A patient with type 1 diabetes mellitus complains of severe dehydration, dry mouth, fever associated with chills, and fruity odor of the breath. What is the line of treatment? Select all that apply.

Severe dehydration, dry mouth, fever associated with chills, fruity odor of breath, and a burning sensation while urinating are the clinical manifestations of diabetic ketoacidosis. It is a complication of untreated type I diabetes mellitus. The line of treatment is to administer potassium, sodium bicarbonate, and 0.9 percent NaCl to correct the acid-base balance in the body. Monitoring serum calcium levels is not related to diabetes. A solution of 5 percent to 10 percent dextrose is given when the glucose levels approach 250 mg/dL.

The nurse is providing discharge instructions to a patient who has a neurogenic bladder. Which self-care activities would the patient identify to facilitate bladder emptying to help prevent urinary stasis and infection? Select all that apply.

Sitting to void, the Credé maneuver, and tightening the abdominal muscles when voiding all aid in fully emptying the bladder, which will help to prevent urinary stasis and infection. The patient should also empty the bladder every three hours. Fluid restriction will not aid in emptying the bladder.

The nurse is caring for a patient with newly diagnosed type 2 diabetes mellitus. Which symptoms indicate that the patient is experiencing hyperglycemia?

Symptoms of hyperglycemia, as seen in both forms of diabetes mellitus, include polydipsia, polyuria, polyphagia, and weight loss. Patients with hyperglycemia due to diabetes mellitus do not manifest weight gain, loss of appetite or oliguria, or bradycardia, but they may exhibit fatigue, tachycardia, and abdominal pain. Irritability and diaphoresis are manifestations of hypoglycemia (low blood sugar).

The nurse is instructing a diabetic patient who has infrequent voiding, difficulty voiding, and a weak stream of urine. Which action indicates the need for additional teaching?

The abdominal muscles should be tightened for complete voiding of the urine and to prevent urine stasis. Difficulty in voiding the urine in patients with diabetes is due to autonomic neuropathy. Emptying the bladder every three hours helps to prevent stasis and subsequent infections. Emptying the bladder in a sitting position helps to void the urine completely. Massaging downwards over the lower abdomen and bladder may promote complete bladder emptying.

Which complication of diabetes can be diagnosed by the ankle-brachial index?

The ankle-brachial index is used to diagnose peripheral arterial disease. Diabetic neuropathy is diagnosed based on the symptoms and by examining the patient's lower extremities. Increased serum creatinine, decreased glomerular filtration rate, and albuminuria is indicative of diabetic nephropathy. Hyperosmolar hyperglycemic syndrome is suspected if the blood glucose levels are more than 600 mg/dL, with a marked increase in serum osmolality.

Which statement of the patient with diabetes indicates ineffective learning about management of hypoglycemia?

The blood glucose level is less than 70 mg/dL in hypoglycemia. This is treated by ingesting 15 g of simple carbohydrate and rechecking the glucose levels 15 minutes later. If the levels are still below 70 mg/dL, the treatment is repeated two to three times. Overtreatment with large quantities of quick-acting carbohydrates should be avoided to prevent rapid fluctuation to hyperglycemia. If improvement is not observed, the primary health care provider should be contacted. Fats are present in candy bars and ice cream, which may slow down the absorption of glucose and delay the response to treatment.

The nurse is caring for a diabetic patient with neurogenic bladder. What should the nurse tell the patient about emptying the bladder?

The nurse should instruct the patient with neurogenic bladder to use the Credé maneuver to completely empty the bladder; the Credé maneuver involves mild downward massage over the lower abdomen and bladder. The nurse should also instruct the patient to empty the bladder every three hours in a sitting position to prevent stasis and subsequent infection. The patient should tighten the abdominal muscles and massage the lower abdomen downward to empty the bladder completely.

A nurse is caring for a 24-year-old woman with no available medical history. The patient states that she has been vomiting for two days and feels weak. She states that she cannot seem to drink enough water at home and urinates more than usual throughout the day. The laboratory results reveal an arterial blood pH of 7.28, sodium level of 155 mEq/L, potassium level of 3.5 mEq/L, serum glucose level of 550 mg/dL, sodium bicarbonate level of 10 mEq/L, and a high level of ketones in the urine. What will the nurse include in this patient's plan of care? Select all that apply.

The patient is experiencing diabetic ketoacidosis (DKA), which is defined by a serum glucose level over 250 mg/dL, an arterial blood pH lower than 7.30, a serum bicarbonate level less than 16 mEq/L, and a moderate to high level of ketones in the urine or serum. Treatment for a patient with DKA includes electrolyte replacement (in this case potassium), administration of IV fluids for dehydration, assessment of mental status, and assessment of blood glucose levels. The treatment for DKA is administration of short-acting insulin, not long-acting insulin.

Which intervention may help prevent further complications in an unconscious patient with a history of diabetes whose blood sugar level is found to be 65 mg/dL?

The patient should be immediately administered 25 to 50 mL of 50 percent glucose intravenously, which would rapidly raise the glucose concentration in the blood stream. An oral route of administration of fast-acting carbohydrate is not appropriate in an unconscious patient. Treatment with carbohydrate that contains fats, such as whole milk, should be avoided, because the fat will decrease the absorption of glucose and delay the response. Insulin is to be administered in patients with hyperglycemia.

A nurse is caring for a 62-year-old man with a history of hypertension and type 2 diabetes who has been admitted to the inpatient unit for pneumonia. The nurse enters the patient's room to complete an admission assessment and notices that the patient has slurred speech and right-sided weakness. After calling the rapid response team, what is the nurse's next action?

The patient's blood glucose levels in hyperosmolar hyperglycemic syndrome are high; they increase serum osmolality and produce severe neurologic manifestations, such as aphasia and hemiparesis. It is critical to check the patient's blood glucose level for correct diagnosis and treatment, because these signs and symptoms resemble those of a stroke. Obtaining vital signs is not the next action to take; that can happen later. Obtaining the crash cart is not necessary in this situation. Performing a neurologic assessment can be done, but it is not the next action the nurse should take.

Which drug does the nurse expect to be beneficial in a patient with type 2 diabetes who has the presence of albumin in the urine?

The presence of albumin in the urine indicates nephropathy in patients with diabetes. Angiotensin converting enzyme inhibitors such as lisinopril may delay the progression of nephropathy in diabetic patients. Duloxetine is a selective serotonin reuptake inhibitor that is used for symptomatic treatment of sensory neuropathy. Pregabalin is an antiseizure medication used for neuropathic pain in diabetic patients. Bethanechol is a cholinergic agonist that is indicated for the treatment of neurogenic bladder.

While reviewing the laboratory reports of a patient with type 2 diabetes mellitus, the nurse concludes that the patient has high risk for macrovascular complications. Which finding supports the nurse's conclusion?

The recommended LDL cholesterol level for patients with diabetes is less than 100 mg/dL. A higher LDL cholesterol may increase the risk of macrovascular complications such as cerebrovascular, cardiovascular, or peripheral vascular disease in patients with diabetes. The recommended target value of triglycerides less than 150 mg/dL is indicated in patients with diabetes. A target blood pressure of 130/80 mm Hg is recommended for diabetic patients to decrease the incidence of macrovascular complications. A patient with diabetes should have HDL cholesterol greater than 40 mg/dL in order to decrease the risk of macrovascular complications.

What instructions should the nurse give the patient with diabetes and numbness in the feet when teaching about diabetic foot care? Select all that apply.

Wearing shoes and socks helps to protect the feet from any sharp objects that may cause injury. Physical activities such as walking and exercises are advised for weight management and to improve circulation to the extremities. Protecting the feet from extreme temperatures prevents injury. Iodine should not be used for cleaning wounds because it may cause further localized tissue damage. The area between the toes should always be kept dry and application of creams and oil should be avoided.

Which drug may result in weight gain as a side effect?

Weight gain is a common side effect seen with meglitinides. Biguanides, dopamine agonists, and dipeptidyl peptidase-4 inhibitors may not result in weight gain.

Which treatment is useful in decreasing the serum ketone level in patients with diabetic ketoacidosis?

When the body cannot utilize glucose for energy, it burns fat for energy, resulting in the production of ketones. Insulin therapy is useful for reducing the serum ketone levels. Electrolytes are given to correct the electrolyte imbalance. Sodium bicarbonate is given to treat metabolic acidosis. IV fluids are indicated for correction of dehydration.

A patient's blood glucose level was found to be 65 mg/dL during a follow-up visit to learn about management of hypoglycemia. Which action of the patient might be responsible for this?

Whole milk contains a high fat content and will reduce glucose absorption, and it may cause hypoglycemia. Fruit and juice in the diet cause a sudden rise in blood glucose level, resulting in hyperglycemia for a short period of time. Performing moderate amounts of exercise may help to maintain steady blood glucose levels. Including large quantities of rapid-acting carbohydrates may cause a rapid fluctuation to hyperglycemia.