TERM 4 Ch 64 Care of Patients with Diabetes Mellitus

The nurse is teaching a client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? 1 "I should begin exercising for at least an hour a day." 2 "I should monitor my diet." 3 "If I lose weight, I may not need to use the insulin anymore." 4 "Weight loss can be a sign of diabetic ketoacidosis."

"I should begin exercising for at least an hour a day." For long-term maintenance of major weight loss, large amounts of exercise (7 hr/wk) or moderate or vigorous aerobic physical activity may be helpful, but the client must start slowly. Monitoring the diet is key to type 2 diabetes management. Weight loss can minimize the need for insulin and can also be a sign of diabetic ketoacidosis.

The nurse is providing discharge teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a Medic-Alert bracelet? 1 "If I become hyperglycemic, it is a medical emergency." 2 "If I become hypoglycemic, I could become unconscious." 3 "Medical personnel may need confirmation of my insurance." 4 "I may need to be admitted to the hospital suddenly."

"If I become hypoglycemic, I could become unconscious." Hypoglycemia is the most common cause of medical emergency in clients with diabetes. A Medic-Alert bracelet is helpful if the client becomes hypoglycemic and is unable to provide self-care. Hyperglycemia is not a medical emergency unless it is acidosis; people with diabetes tolerate mild hyperglycemia routinely. Insurance information and information needed for hospital admission do not appear on a Medic-Alert bracelet.

Which statement about prediabetes is correct? 1 It is a form of type 1 diabetes that tends to occur in people over age 50 years who are slender. 2 It describes an overweight person with insulin-dependent diabetes. 3 It involves an inability to respond to insulin or make sufficient insulin in the pancreas. 4 It describes people at risk for type 2 diabetes who have a fasting glucose level of 100-125 mg/dL.

It describes people at risk for type 2 diabetes who have a fasting glucose level of 100-125 mg/dL. An individual with a fasting glucose level between 100 and 125 mg/dL has prediabetes, which is associated with an increased risk for developing type 2 diabetes. Type 1 diabetes is usually diagnosed in people younger than 30 years of age and is associated with the absence of insulin. Individuals with type 1 diabetes are always insulin-dependent; those with type 2 diabetes may become insulin-dependent as the beta cells lose function and/or insulin resistance worsens. The person with type 1 diabetes is dependent on insulin for glucose transport as the pancreas is unable to produce endogenous insulin. These individuals may also be overweight and have metabolic syndrome, a risk for cardiovascular disease. Insulin resistance and/or decreased secretion of insulin by pancreatic beta cells are characteristic of type 2 diabetes.

In teaching a client about the prevention of complications from type 2 diabetes mellitus, which instruction does the nurse include? 1 Avoid hypoglycemic episodes. 2 Maintain a hemoglobin A1c level less than 6%. 3 Try to eat in the morning before taking insulin. 4 Keep morning blood glucose under 150 mg/dL.

Maintain a hemoglobin A1c level less than 6%. Maintaining glycosylated hemoglobin levels below 6% delays the onset of retinopathy, nephropathy, and neuropathy in clients with type 2 diabetes mellitus. A strong relationship exists between microvascular complications and blood glucose levels. For every percentage point decrease in HbA1c (hemoglobin A1c), there is a 25-30% reduction in the risk for kidney and eye complications. Avoiding hypoglycemia will prevent fainting or symptoms such as tremor, diaphoresis, tachycardia, and others, but not complications from diabetes. Eating prior to taking insulin will prevent hypoglycemia, but not diabetes complications. Normoglycemia in the morning is a desired goal.

The nurse is teaching a client about the manifestations and emergency treatment of hypoglycemia. In assessing the client's knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates a correct understanding of hypoglycemia management? 1 "I should drink a glass of water." 2 "I should eat three graham crackers." 3 "I should give myself 1 mg of glucagon." 4 "I should sit down and rest."

"I should eat three graham crackers." Eating three graham crackers is a correct management strategy for mild hypoglycemia. Water or resting does not remedy hypoglycemia. Glucagon should be administered only in cases of severe hypoglycemia.

Which of these clients with diabetes does the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit? 1 58-year-old with sensory neuropathy who needs teaching about foot care 2 68-year-old with diabetic ketoacidosis who has an IV running at 250 mL/hr 3 70-year-old who needs blood glucose monitoring and insulin before each meal 4 76-year-old who was admitted with fatigue and shortness of breath

70-year-old who needs blood glucose monitoring and insulin before each meal A nurse from the labor/delivery unit would be familiar with blood glucose monitoring and insulin administration because clients with type 1 and gestational diabetes are frequently cared for in the labor/delivery unit. The 58-year-old with sensory neuropathy, the 68-year-old with diabetic ketoacidosis, and the 76-year-old with fatigue and shortness of breath all have specific teaching or assessment needs that are better handled by nurses more familiar with caring for older adults with diabetes.

A client has been newly diagnosed with diabetes mellitus. Which factors does the nurse emphasize should be monitored regularly by the client to prevent and detect complications of the disease? Select all that apply. 1 Vision 2 Hepatic function 3 Kidney function 4 Hemoglobin A1c 5 Feet 6 Urine

Vision Kidney function Hemoglobin A1c Feet Urine Diabetes affects vision in multiple ways (e.g., retinopathy), so vision must be monitored. Diabetes results in nephropathy, so kidney function as well as urine (for microalbuminuria) should be monitored. Inspection of the feet is important to detect injury caused by a lack of sensation due to neuropathy. Hemoglobin A1c levels should be monitored and kept below 7%. The liver is not affected by diabetes alone.

Which assessment finding is identified as a risk for type 2 diabetes mellitus (DM) and cardiovascular disease (CVD)? 1 Body mass index less than 25 kg/m2 2 Waist circumference of 40 inches or more 3 Fasting blood glucose level of 90 mg/dL 4 Blood pressure of 120/80 mm Hg

Waist circumference of 40 inches or more Abdominal obesity, indicated by a waist circumference of 40 inches or more in men and 35 inches or more for women, is a risk factor for type 2 DM and CVD.The risk for CVD is reduced if the body mass index is maintained at less than 25 kg/m2. A fasting blood glucose level of 90 mg/dL, a systolic BP of 120 mm Hg, and a diastolic BP of 80 mg Hg are normal findings. A fasting blood glucose level of 100 mg/dL or more, or drug treatment for hyperglycemia or hypertension, increases the risk for type 2 DM and CVD.

While teaching a client about insulin injection technique, the nurse explains that injecting into which area will cause the insulin to be most rapidly absorbed? 1 Thigh 2 Deltoid 3 Buttocks 4 Abdomen

Abdomen Insulin absorption is fastest when it is injected in the abdomen, followed by the deltoid, thigh, and buttocks.

A client newly diagnosed with diabetes is being instructed when to perform blood glucose monitoring. At what times does the nurse instruct the client to check blood glucose? Select all that apply. 1 After eating 2 After eating 3 Frequently if you are ill 4 If you are thirsty and urinate frequently 5 One hour after taking a rapid-acting insulin

After eating Frequently if you are ill If you are thirsty and urinate frequently Assessment of premeal blood glucose and additional monitoring are performed for symptoms of hyperglycemia (manifested by polydipsia, polyuria, polyphagia), hypoglycemia, suspected hypoglycemic unawareness, when ill, before and after exercise, when diabetes medications have been adjusted or to evaluate medications (e.g., steroids) that may alter blood glucose levels, or during preconception planning and pregnancy.

The nurse is providing discharge teaching to a client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching? 1 "I can break in my shoes by wearing them all day." 2 "I need to monitor my feet daily for blisters or skin breaks." 3 "I should never go barefoot." 4 "I should quit smoking."

"I can break in my shoes by wearing them all day." Shoes should be properly fitted and worn for a few hours a day to break them in, with frequent inspection for irritation or blistering. People with diabetes have decreased peripheral circulation, so even small injuries to the feet must be managed early. Going barefoot is contraindicated. Tobacco use further decreases peripheral circulation in a client with diabetes.

The nurse is teaching a client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective? 1 "I should go barefoot in my house so that my feet are exposed to air." 2 "I must inspect my shoes for foreign objects before putting them on." 3 "I will soak my feet in warm water to soften calluses before trying to remove them." 4 "I must wear canvas shoes as much as possible to decrease pressure on my feet."

"I must inspect my shoes for foreign objects before putting them on." To avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on. Diabetic clients should not go barefoot because foot injuries can occur. To avoid injury or trauma, a callus should be removed by a podiatrist, not by the client. The diabetic client must wear firm support shoes to prevent injury.

A client recently diagnosed with type 2 diabetes mellitus states, "I don't understand how I got diabetes. I don't eat sugary foods." How does the nurse respond? 1 "Type 2 diabetes is an autoimmune disease." 2 "Individuals with type 2 diabetes are probably born with it." 3 "Type 2 diabetes is caused by resistance to insulin or an inability to make sufficient insulin." 4 "Individuals with type 2 diabetes are typically young and their pancreas is immature."

"Type 2 diabetes is caused by resistance to insulin or an inability to make sufficient insulin." Type 2 diabetes mellitus (DM) is a progressive disorder in which the person has a combination of insulin resistance and decreased secretion of insulin by pancreatic beta cells. Insulin resistance develops from obesity and physical inactivity in a genetically susceptible person. Heredity does play a major role in the development of type 2 DM, but the nurse cannot assume that is why this client developed type 2 DM; the specific causes of type 2 DM are not known, although there are many genetic and nongenetic causes. Most clients with type 2 DM are obese, with an increased rate of obesity occurring in younger people.

Which conditions are typical features of metabolic syndrome? Select all that apply. 1 Abdominal obesity 2 Hyperglycemia 3 Hypertension 4 Hyperlipidemia 5 Atherosclerosis

-Abdominal obesity -Hyperglycemia -Hypertension -Hyperlipidemia Features of metabolic syndrome include abdominal obesity, hyperglycemia, hypertension, and hyperlipidemia. Atherosclerosis can result from any of the features of metabolic syndrome and increases risk for stroke, coronary heart disease, and early death.

What techniques should a client with diabetes use to administer insulin injections? Select all that apply. 1 Inject insulin on the thigh for faster absorption. 2 Avoid injecting insulin on scarred sites. 3 Inject insulin into a different anatomic site every day. 4 Avoid injecting within a 2-inch radius around the navel. 5 Grasp a fold of the skin and inject insulin subcutaneously.

-Avoid injecting insulin on scarred sites. -Avoid injecting within a 2-inch radius around the navel. -Grasp a fold of the skin and inject insulin subcutaneously. Scarred sites are less sensitive to pain, but are not preferred for insulin injections because insulin absorption is slow. When injecting insulin into the abdomen, avoid a 2-inch radius around the navel. Insulin is injected subcutaneously in a fold of the skin at an angle of 90 degrees. An angle of 45 degrees is appropriate for a thin client to prevent intramuscular (IM) injection, which has a faster absorption rate and is not used for routine insulin use. Insulin is absorbed fastest when injected into the abdomen, followed by the deltoid, thigh, and buttocks. The client must rotate injection sites to prevent lipohypertrophy (increased fat deposits in the skin) and lipoatrophy (loss of fatty tissue). However, rotation within one anatomic site is preferred to rotation from one area to another to prevent day-to-day changes in absorption.

What are the actions of incretin hormones? Select all that apply. 1 Increase insulin secretion 2 Inhibit glucagon secretion 3 Slow the rate of gastric emptying 4 Promote hyperglycemia 5 Promote gluconeogenesis

-Increase insulin secretion -Inhibit glucagon secretion -Slow the rate of gastric emptying Actions of incretin hormones that are secreted in response to the presence of food in the stomach include increasing insulin secretion, inhibiting glucagon secretion, and slowing the rate of gastric emptying, thereby preventing hyperglycemia after meals. Hyperglycemia is caused by a lack of insulin. It would be counterproductive to promote gluconeogenesis (the conversion of proteins to glucose), as there is already adequate glucose.

A client with type 1 diabetes mellitus received regular insulin subcutaneously at 7:00 AM. The client should be monitored for hypoglycemia at which time? 1 7:30 AM 2 11:00 AM 3 2:00 PM 4 7:30 PM

11:00 AM Onset of regular insulin is ½-1 hour; peak is 2-4 hours. Therefore 11:00 AM is the anticipated onset time for regular insulin received at 7:00 AM. For regular insulin received at 7:00 AM, 7:30 AM, 2:00 PM, and 7:30 PM are not the anticipated peak times.

A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family? 1 Causes and treatment of hyperglycemia 2 Causes and treatment of hypoglycemia 3 Dietary control 4 Guidelines for exercise

Causes and treatment of hypoglycemia The causes and treatment of hypoglycemia must be understood by the client and family to manage the client's diabetes effectively. The causes and treatment of hyperglycemia is a topic for secondary teaching and is not the priority for the client with diabetes. Dietary control and guidelines for exercise are important, but are not the priority in this situation.

The nurse has just taken a change-of-shift report on a group of clients on the medical-surgical unit. Which client does the nurse assess first? 1 Client taking repaglinide (Prandin) who has nausea and back pain 2 Client taking glyburide (Diabeta) who is dizzy and sweaty 3 Client taking metformin (Glucophage) who has abdominal cramps 4 Client taking pioglitazone (Actos) who has bilateral ankle swelling

Client taking glyburide (Diabeta) who is dizzy and sweaty The client taking glyburide (Diabeta) who is dizzy and sweaty has symptoms consistent with hypoglycemia and should be assessed first because this client displays the most serious adverse effect of antidiabetic medications. Although the client taking repaglinide who has nausea and back pain requires assessment, the client taking glyburide takes priority. Metformin may cause abdominal cramping and diarrhea, but the client taking it does not require immediate assessment. Ankle swelling is an expected side effect of pioglitazone.

A client has 0700 fingerstick blood glucose readings of 353-286 for 3 mornings in a row, and the nurse is concerned the client may have dawn phenomenon. Which finding is consistent with this phenomenon? 1 Postprandial glucose elevations 2 Early morning glucose elevations 3 Bedtime hypoglycemia unless a snack is eaten 4 Morning glucose elevations preceded by hypoglycemia during the night

Early morning glucose elevations Dawn phenomenon results from a nighttime release of growth hormone causing blood glucose elevations around 5-6 AM. This is resolved by administering more insulin for the overnight period. All individuals have some degree of postprandial glucose elevation; release of insulin from the pancreas or exogenous insulin resolves this issue. Somogyi phenomenon is early morning hyperglycemia secondary to nighttime hypoglycemia. A client may develop hypoglycemia at bedtime if sufficient calories are not consumed relative to the dinner/evening insulin prescription.

A client has just been diagnosed with diabetes. Which factor is most important for the nurse to assess in the client before providing instruction about the disease and its management? 1 Current lifestyle 2 Educational and literacy level 3 Sexual orientation 4 Current energy level

Educational and literacy level A large amount of information must be synthesized; typically written instructions are given. The client's educational and literacy level is essential information. Although lifestyle should be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the client to provide self-care. Although energy level will influence the ability to exercise, it is not essential.

NPH and Regular insulin is ordered for a client with type 1 diabetes. Which action by the nurse is correct? 1 Administer both insulins at 0800. 2 Give two thirds of the daily dose before breakfast and one third before the evening meal. 3 Administer both insulins with the evening meal. 4 Administer both insulins at bedtime.

Give two thirds of the daily dose before breakfast and one third before the evening meal. Multiple-component insulin therapy combines short- and intermediate-acting insulin injected twice daily. Two thirds of the daily dose is given before breakfast and one third before the evening meal. Single daily injection protocols require insulin injection only once daily. This protocol may include one injection of intermediate- or long-acting insulin or a combination of short and intermediate-acting insulin. Intensified regimens include a basal dose of intermediate- or long-acting insulin and a bolus dose of short- or rapid-acting insulin designed to bring the next blood glucose value into the target range.

Which of the following is the process of converting proteins to glucose? 1 Ketogenesis 2 Glycogenesis 3 Gluconeogenesis 4 Proteolysis

Gluconeogenesis Gluconeogenesis is the conversion of proteins to glucose. Ketogenesis is the conversion of fats to acids. The production and storage of glycogen is known as glycogenesis and proteolysis is the breakdown of protein.

What measure should the caregiver of a client with diabetes take to treat moderate hypoglycemia? 1 Provide half a cup of fruit juice. 2 Offer 4 cubes, or teaspoons, of sugar. 3 Provide 15 g of carbohydrate and then take additional cheese 10 to 15 minutes after. 4 Subcutaneously inject 1 mg of glucagon.

Provide 15 g of carbohydrate and then take additional cheese 10 to 15 minutes after. When treating moderate hypoglycemia, the client must be given 15 to 30 g of rapidly absorbed carbohydrate, followed by low-fat milk or cheese after 10 to 15 minutes. The client with mild hypoglycemia usually has a blood glucose level of less than 60 mg/dL. It may be treated by offering the client half a cup of fruit juice, or 4 cubes or teaspoons of sugar. In severe hypoglycemia, blood glucose is usually less than 20 mg/dL. The client may be unconscious or unable to swallow; the client should be administered 1 mg of glucagon as a subcutaneous or intramuscular injection.

The nurse is administering metformin (Glucophage) to a client with type 2 diabetes prior to breakfast. Which finding during administration requires further follow-up by the nurse? 1 Premeal blood glucose level of 120 2 Pulse oximetry reading of 95% at 7 AM 3 Episode of diarrhea overnight 4 Scheduled angiogram of the leg later today

Scheduled angiogram of the leg later today Metformin should be held for 48 hours prior to studies requiring iodinated contrast material; therefore, the nurse should get an order to hold the metformin for today and search the medical record to determine if the client received the medication the day before because the procedure may need to be postponed. Blood glucose levels range from 70-110 mg/dL. While this is slightly elevated, this is not unexpected in a client with diabetes; the nurse should give the medication and continue to monitor the client's blood glucose. A pulse oximetry reading of 95% is normal. A side effect of metformin is diarrhea; one episode does not require intervention.

What is an important feature of the glycosylated hemoglobin A1c (HbA1c) test? 1 It determines the average blood glucose levels of the previous 14 days. 2 The results are not altered by eating habits 24 hours before the test. 3 The client must drink a 75-g glucose load an hour before the test. 4 The client must not have any caloric intake for at least 8 hours before the test

The results are not altered by eating habits 24 hours before the test. Glycosylated hemoglobin A1c (HbA1c) test results are not altered by eating habits the day before the test. Glucose binds to hemoglobin through a process called glycosylation. The glycosylated hemoglobin A1c (HbA1c) test is a good indicator of the average blood glucose level during the previous 120 days—the life span of red blood cells. Glycosylated serum albumin (GSA), glycosylated serum protein (GSP), and fructosamine determine blood glucose levels during the previous 14 days. The diagnosis of gestational diabetes mellitus is based on the oral glucose tolerance test, in which the client must drink a 75-g glucose load an hour before the test. The client must not have any caloric intake for at least 8 hours before the fasting plasma glucose test to prevent falsely elevated values.

Which explanation best assists a client in differentiating type 1 diabetes from type 2 diabetes? 1 Most clients with type 1 diabetes are born with it. 2 People with type 1 diabetes are often obese. 3 Those with type 2 diabetes make insulin, but in inadequate amounts. 4 People with type 2 diabetes do not develop typical diabetic complications.

Those with type 2 diabetes make insulin, but in inadequate amounts. People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for complications, especially cardiovascular complications.

The nurse is teaching a client about the movement of glucose in the body. Arrange the sequence of events that take place when blood glucose levels drop. 1. Insulin secretion stops and glucagon is released. 2. Glycogenolysis and gluconeogenesis takes place. 3. Lipolysis, or the breakdown of fat, takes place. 4. Proteolyis, or the breakdown of proteins, takes place.

When blood glucose levels fall, insulin secretion stops and glucagon is released. Glucagon prevents hypoglycemia by triggering the release of glucose from cell storage sites. Glucagon causes the release of glucose from the liver. Glycogen is broken down to glucose in the liver during the process of glycogenolysis; similarly, amino acids are broken down to glucose in the process of gluconeogenesis. When liver glucose is unavailable, lipolysis and proteolysis provide fuel for energy.

The nurse is instructing a client who has been newly diagnosed with diabetes mellitus. Which intervention does the nurse teach the client that will help prevent microvascular complications of diabetes? 1 "Do not walk without shoes." 2 "Avoid urinating frequently." 3 "Have your eyes checked annually." 4 "Keep your blood sugar in good control."

"Keep your blood sugar in good control." Control of blood glucose prevents both microvascular and macrovascular complications. Wearing shoes will prevent injuries that can lead to infection or amputation due to macrovascular complications and poor blood flow. Retinopathy, a microvascular complication, occurs in most clients with type 2 diabetes after 20 years; an eye exam will detect the retinopathy, but not prevent it. Urinating frequently is a symptom of hyperglycemia and is beyond the client's control.

A diabetic client has a glycosylated hemoglobin (A1C) level of 9.4%. What does the nurse say to the client regarding this finding? 1 "Keep up the good work." 2 "This is not good at all." 3 "What are you doing differently?" 4 "You need more insulin."

"What are you doing differently?" Assessing the client's regimen or changes he or she may have made is the basis for formulating interventions to gain control of blood glucose. A1C levels for diabetic clients should be less than 7; a value of 9.4 shows poor control over the past 3 months. Telling the client this is not good, although true, does not take into account problems that the client may be having with the regimen and sounds like scolding. Although it may be true that the client needs more insulin, an assessment of the client's regimen is needed before decisions are made about medications.

Which statements about the etiology and genetic risk for diabetes mellitus are correct? Select all that apply. 1 Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors. 2 Type 1 diabetes results from genetic susceptibility. 3 Viral infections may act as a trigger for type 1 diabetes. 4 Metabolic syndrome is a known cause for type 1 diabetes. 5 Pancreatic beta cells are destroyed in type 2 diabetes.

-Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors. -Type 1 diabetes results from genetic susceptibility. -Viral infections may act as a trigger for type 1 diabetes. Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors. Type 1 diabetes results from genetic susceptibility that may be triggered by a viral infection. Metabolic syndrome is the presence of metabolic factors known to increase risk for type 2 diabetes and cardiovascular disease. Pancreatic beta cells are destroyed in type 1 diabetes, but may be dysfunctional in type 2 diabetes.

A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (A1C) is 8.2%. Which action does the nurse plan to take next? 1 Instruct the client to continue with the current diet and metformin use. 2 Discuss the need to check blood glucose several times every day. 3 Talk about the possibility of adding rapid-acting insulin to the regimen. 4 Ask the client about current dietary intake and medication use.

Ask the client about current dietary intake and medication use. The nurse's first action should be to assess whether the client is adherent to the currently prescribed diet and medications. The client's current diet and medication use have not been successful in keeping glucose in the desired range. Checking blood glucose more frequently and/or using rapid-acting insulin may be appropriate, but this will depend on the assessment data. The A1C indicates that the client's average glucose level is not in the desired range, but discussing the need to check blood glucose several times every day assumes that the client is not compliant with the therapy and glucose monitoring. The nurse should not assume that adding insulin, which must be prescribed by the provider, is the answer without assessing the underlying reason for the treatment failure.

Which client taking metformin does the nurse consider at highest risk for lactic acidosis? 1 Client who is receiving dialysis 2 Client who has hyperglycemia 3 Client who is also taking oral contraceptives 4 Client who is also taking warfarin (Coumadin)

Client who is receiving dialysis The client receiving dialysis has kidney failure, which poses a high risk for lactic acidosis. The client is taking metformin for hyperglycemia; while lactic acidosis is a side effect of metformin, hyperglycemia alone does not increase the risk for acidosis. Clients taking oral contraceptives are typically at risk for deep vein thrombosis/pulmonary embolism. Clients taking warfarin are at risk for bleeding and potential hypoglycemia when taking a sulfonylurea drug with warfarin.

Which outcome is essential for the nurse to include in the plan of care for a client who has been newly diagnosed with diabetes mellitus? 1 Emphasizing the importance of daily foot inspection 2 Ensuring the client recognizes the signs and symptoms of hypoglycemia 3 Ensuring that the family or caregiver can administer insulin prior to client discharge 4 Teaching the client to recognize how many carbohydrate units may be consumed with each meal

Ensuring the client recognizes the signs and symptoms of hypoglycemia Some symptoms of hypoglycemia include diaphoresis, tremor, anxiety, confusion, hunger, loss of consciousness, and even seizure and brain damage; therefore, it is essential for the client to recognize these symptoms and intervene immediately in order to prevent severe hypoglycemia. Diabetes education is complex and the nurse must first distinguish and emphasize survival skills information from the material the client can learn after discharge. Inspecting the feet daily is important to detect early signs of tissue damage, especially when neuropathy is present; however, it does not take priority over learning to recognize and treat hypoglycemia. The client who needs insulin will return-demonstrate insulin administration; it is not essential the family do so prior to discharge. The client's diet may be based on units of carbohydrate measurement; this does not take priority over managing hypoglycemia, which is potentially life-threatening.

A client recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the client the proper use of the machine? 1 Day of discharge 2 On admission 3 When the client states readiness 4 While performing the test in the hospital

While performing the test in the hospital Teaching the client about the operation of the machine while performing the test in the hospital is the best way for the client to learn. The teaching can be reinforced before discharge. Instructing the client on the day of admission or the day of discharge would be overwhelming to the client because of all of the other activities taking place that day. The client may never feel ready to learn this daunting task; the nurse must be more proactive.