Type I Diabetes (T1DM)

A teacher sends a child to the school nurse due to frequent thirst and urination. Upon assessment, the nurse suspects the child has type 1 DM. Which question should the nurse ask to gain data to support this suspicion? A) "How is your appetite?" B) "Have you noticed any bruises on your legs?" C) "When did you last see your HCP?" D) "Do you play outside a lot?"

A) "How is your appetite?" Rationale: Polydipsia,​ polyuria, and polyphagia are the three hallmark signs of type 1 diabetes mellitus.​ Therefore, the nurse would ask about the​ child's appetite. Playing outside is not related to the onset of type 1 diabetes mellitus. Asking when the child last saw the healthcare provider is irrelevant to the current situation. Bruising to the legs can be from injuries or​ leukemia, not type 1 diabetes mellitus.

The nurse is teaching a group of clients newly diagnosed with type 1 DM. Which information should the nurse include in the teaching? A) "Schedule your regular ophthalmology visits." B) "Monitor blood glucose levels weekly." C) "Take beta blockers daily to control BP." D) "Have routine pedicures performed."

A) "Schedule your regular ophthalmology visits." Rationale: The client with type 1 diabetes mellitus is at high risk for retinal damage.​ Therefore, the nurse would teach the client to schedule regular ophthalmology visits to monitor vision. The nurse would not encourage the client to have regular pedicures due to possible injury that can occur from macrovascular and microvascular deficits. Blood glucose levels should be monitored several times a​ day, not once a week. The client would be prescribed​ angiotensin-converting enzyme​ (ACE) inhibitors to protect the kidneys from vascular damage.

The nurse is working a health fair and teaching the public about risk factors for type 1 diabetes mellitus. Which ethnicity would the nurse include as having the highest risk in the United States? A) Caucasian American B) African American C) Asian American D) Hispanic

A) Caucasian American Rationale: Caucasian Americans have a higher risk of developing type 1 diabetes mellitus than Asian​ Americans, African​ Americans, or Hispanics.

The nurse is caring for a child diagnosed with type 1 DM. The nurse should teach the child and parents that insulin dosing is based on which item? A) Diet B) Urine output C) Age D) Weight

A) Diet Rationale: Rationale: Insulin dose is based on​ diet, specifically carbohydrate intake. Insulin dose is not based on​ weight, age, or urine output.

Which finding in the medical record indicates a client has good control of type 1 DM? A) Hemoglobin A1C 5.4% B) Fasting blood sugar 200 mg/dL C) Free of amputations D) BP 150/90

A) Hemoglobin A1C 5.4% Rationale: The finding that the client is maintaining a hemoglobin A1C of less than​ 6.5% indicates good diabetic control over the past 3 months. The client not having amputations indicates good peripheral​ circulation, but it does not indicate good disease management. Blood pressure of​ 150/90 mmHg is​ elevated, but it does not indicate good diabetes control. The fasting blood sugar should be under 125​ mg/dL. The finding of 200​ mg/dL is elevated.

The nurse is providing care to a client who is receiving treatment for DKA. Which possible pathophysiologic cause should the nurse identify for the altered metabolism the client is experiencing? A) Insulin deficiency B) Decreased gluconeogenesis C) Excess production of bicarb D) Hypo-osmolarity

A) Insulin deficiency Rationale: A client who is diagnosed with DKA will experience alterations in metabolism due to an insulin deficiency. Within the pathophysiology of diabetic ketoacidosis, the client will experience increased gluconeogenesis, a loss of bicarbonate, and hyperosmolarity.

The client with DM reports having difficulty trimming the toe nails because they are thick and ingrown. What should the nurse recommend to this client? A) Make an appointment with a podiatrist B) Offer to file the tops fo the nails to reduce thickness after cutting C) Cut the nails straight across with a clipper after a bath D) Make an appointment with a nail shop for a pedicure

A) Make an appointment with a podiatrist Rationale: The toenails of the client with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Cutting the nails across after the bath is correct for toenails that do not demonstrate the complications listed. The client with diabetes is at an increased risk for infection and should avoid situations in which this risk is increased, such as the nail shop pedicure. The nurse should not file the client's toenails to reduce thickness.

Which client complaint should alert the nurse to a possible hypoglycemic reaction? A) Tremors and double vision B) Anorexia and blurred vision C) Hot, dry skin and weakness D) Muscle cramps and elevated temperature (Saunders)

A) Tremors and double vision Rationale: Hypoglycemia presents with nervousness, irritability, and tremors. Hot dry skin is more likely to occur with hyperglycemia

The nurse is teaching a group of young adults regarding non-modifiable risk factors for the development of type 1 diabetes. Which attendee statement indicates a need for further instruction? SATA A) "Type 1 DM can be passed on from one recessive gene from one parent." B) "Type 1 DM is caused by exposure to processing of metals and proteins." C) "I can develop type 1 DM from bacterial infections." D) "There are genes such as the HLA-DR3 and HLADR4 genes that can cause type 1 DM." E) "Type 1 DM can be caused by exposure to excessive heat and temperatures."

A, B, C, E Rationale: Pregnant women with preexisting endocrine disorders such as hypothyroidism may need to change their dosage of hormone replacement therapy during the pregnancy. The nurse should consult with the provider to determine what dose is appropriate for the client. Hypothyroidism does not increase the risk for gestational diabetes or diabetes insipidus; these metabolic disorders are related to dysfunction of other endocrine glands, not the thyroid gland. The current recommendation is that all pregnant clients take a folic acid supplement to reduce the risk of neural tube defects.

The nurse is providing teaching to a client with a new diagnosis of type 1 DM. The nurse should instruct the client about incorporating which treatment to help manage the disease? SATA A) Medication B) Nutrition C) Fluid Restriction D) Daily weight checks E) Exercise

A, B, E - Medication - Nutrition - Exercise Rationale: Clients with type 1 diabetes mellitus are treated with​ exercise, nutrition, and medication. Fluid restriction and daily weight checking are not part of the treatment plan for clients with type 1 diabetes mellitus.

The nurse is conducting discharge teaching with a client who has been newly diagnosed with type 1 DM. Which statement from the client indicates the need for additional teaching? A) "It is important to test my blood sugar at least four times a day." B) "As long as I'm in my house, I can walk barefoot." C) "I need to stay hydrated during the day." D) "I need to be alert for infections."

B) "As long as I'm in my house, I can walk barefoot." Rationale: Clients with diabetes should always wear shoes to protect their feet from injury. The client should be alert for infection or​ injuries, stay well​ hydrated, and test the blood sugar four times a day.

A client has received a dose of regular insulin at 0700. When would the nurse likely anticipate the potential for a hypoglycemic reaction to occur? A) 0800 B) 1000 C) 1200 D) 1400 (Saunders)

B) 1000 Rationale: Regular insulin is rapid-acting with a peak action of 2 to 4 hours after injection. During the peak action of insulin is when hypoglycemic reactions are most likely to occur

A client informs the nurse that she has been taking acarbose (oral anti-diabetic) as prescribed. The nurse determines that a therapeutic effect of the medication has occurred if which lab value is noted? A) Lipase of 100units/L B) Sodium level of 140 mEq/L C) BUN of 15 mg/dL D) 2 hour post-prandial glucose of 120 mg/dL (Saunders)

B) Sodium level of 140 mEq/L Rationale: All values except for sodium are normal

Health promotion and prevention related to type 1 diabetes should include A) teaching clients at high risk how to prevent type 1 diabetes. B) teaching clients with type 1 diabetes how to prevent complications. C) providing clients with vaccinations against viruses that cause type 1 diabetes. D) referring clients to a nutritionist and exercise therapist.

B) Teaching clients with type 1 diabetes how to prevent complications Rationale: Currently, there is no known way to prevent type 1 diabetes. Therefore, prevention related to type 1 diabetes is related to preventing the short- and long-term complications of the disease process. Although vaccinations are available against some viruses that may trigger type 1 diabetes, vaccinations against all viruses are not available, and many other triggers exist that may cause type 1 diabetes in susceptible individuals. Nurses may refer clients to a nutritionist or exercise therapist after diagnosis, but proper nutrition or exercise will not prevent type 1 diabetes.

The nurse is planning care for a 4 year old newly diagnosed with type 1 DM. The child's mother appears unconcerned with the diagnosis and is complaining about the cost of medication, as three addition kids in the family have needs. On which nursing diagnosis should the nurse focus when planning this client's care? SATA A) Chronic Pain B) Deficient Knowledge C) Compromised Family Coping D) Risk for Unstable blood glucose Level E) Disturbed Body Image

B, C, D Rationale: Because the child is only 4 years old, the mother will need to learn how to provide the insulin injections; however, the mother is unconcerned with the diagnosis, likely due to Deficient Knowledge. The mother's complaint about the cost of medication and lack of concern about the diagnosis would cause the client to have a Risk for Unstable Blood Glucose Level, as it is unknown whether the mother is going to ensure the child has the required medication. The family has a total of four children and the mother is concerned with money for medication, as there are three additional children with needs. This could lead to Compromised Family Coping. There is no evidence to support the diagnoses of Chronic Pain or Disturbed Body Image with this client.

A young client is admitted for lethargy and weight loss. Which clinical manifestation supports the nurse's suspicion of diagnosis of type 1 DM? SATA A) Weight gain B) Blurred vision C) Polyuria D) Glucosuria E) Fever

B, C, D -Blurred Vision -Polyuria -Glucosuria Rationale: Manifestations of type 1 diabetes mellitus are caused by the lack of insulin to transport glucose into the cells for energy. The resulting hyperglycemia leads to​ polyuria, glucosuria, and blurred vision. Polyuria occurs because water is drawn into the general​ circulation, increasing renal blood flow. Once the blood glucose exceeds the renal​ threshold, which is 180​ mg/dL, glucose will spill into the urine. Blurred vision is caused by swelling of the lenses of the eyes in response to increased fluid volume. Clients with type 1 diabetes mellitus usually lose​ weight, because proteins and fats are metabolized for energy and water is lost in the urine. In​ addition, clients with type 1 diabetes mellitus are frequently unable to develop a fever when cellular fuel stores are depleted because of a lack of insulin.

The nurse is taking a health history from a client who has type 1 DM. Which client symptom may indicate the development of complications? SATA A) Quick wound healing B) Numbness in feet C) Vision changes D) Dizziness E) Frequent voiding of urine

B, C, D, E -Numbness - Vision changes - Dizziness - Frequent urination Rationale: Dizziness, vision​ changes, numbness in the​ feet, and frequent voiding of urine may indicate that the client has developed complications of type 1 diabetes mellitus. Clients with type 1 diabetes mellitus frequently experience prolonged wound​ healing; therefore, a report of quick wound healing would not indicate that the client has developed a complication of type 1 diabetes mellitus.

A client with type 1 DM is being taught to monitor her blood glucose level. Which factor affecting accurate glucose monitoring should the nurse include in the instruction? SATA A) Creatinine level B) High hematocrit level C) Low hematocrit level D) WBC count E) Medication overdoses

B, C, E -High HCT level - Low HCT level - Medication overdose Rationale: Factors that affect accurate glucose monitoring include medication​ overdoses, a low hematocrit​ level, and a high hematocrit level. The WBC count and creatinine levels do not affect accurate glucose monitoring.

The nurse is finalizing a plan of care for a school-age client newly diagnosed with type 1 DM. Which areas should the plan prioritize to achieve the maximum outcomes for this client? SATA A) Ways to minimize the number of school days missed B) Identification and referral to community resources C) Physical activities that limit exposure to injuries D) Self-management of glucose monitoring and medications E) Signs and Symptoms of hypoglycemia and action to take

B, D, E Rationale: Planning should prepare the child and the family for self-management of glucose monitoring and medications, signs and symptoms of hypoglycemia, and actions to take. Before discharge, the child and the family should be linked to the resources in the community that will support care of the child with diabetes. Minimizing the number of school days missed and activities that limit exposure to injuries are not immediate priorities for this client's plan.

*Possible Exam Question* The nurse is caring for a child who is hospitalized for the treatment of DKA. The child's parents ask why their child is receiving potassium. Which response by the nurse is accurate? A) "Potassium is administered to decrease blood glucose levels." B) "Potassium is administered to treat acidosis." C) "Potassium is administered to treat hypokalemia." D) "Potassium is administered to treat cerebral edema."

C) "Potassium is administered to treat hypokalemia." Rationale: Potassium is administered to treat hypokalemia.​ Insulin, not​ potassium, is administered to decrease blood glucose levels. Sodium​ bicarbonate, not​ potassium, is administered to treat acidosis.​ Mannitol, not​ potassium, is administered to treat cerebral edema.

*Possible Exam Question* The nurse is teaching a child with type 1 DM and his family about sick day guidelines. Which statement by the family indicates successful teaching? A.​"We will test for ketones when the blood glucose level reaches 180​ mg/dL." B."We will test for ketones when the blood glucose level reaches 160​ mg/dL." C."We will test for ketones when the blood glucose level reaches 240​ mg/dL." D."We will test for ketones when the blood glucose level reaches 200​ mg/dL."

C) "We will test for ketones when the blood glucose level reaches 240 mg/dL." Rationale: Blood glucose levels of 160​ mg/dL, 180​ mg/dL, and 200​ mg/dL are​ elevated, but they would not require testing for ketones. Once the blood glucose level exceeds 240​ mg/dL, the child and family should test the urine for ketones.

*Possible Exam Question* The nurse is teaching the parents of a child with a new diagnosis of type 1 DM. Which information should the nurse include regarding the pathophysiology of the disease? A) Delta cell destruction causes type 1 DM B) Hyperglycemia happens with 50% of alpha cells are damaged C) Beta cells are destroyed D) Beta cells need help producing insulin

C) Beta cells are destroyed Rationale: Type 1 diabetes mellitus has a slow onset and symptoms are not evident until​ 80-90% of beta cells are​ destroyed, causing hyperglycemia. Beta cells are functional and need medication to help with insulin production in type 2 diabetes mellitus. Hyperglycemia happens from beta cell​ destruction, not alpha or delta cell destruction.

The nurse is counseling a couple who is planning a pregnancy. The woman was diagnosed with type 1 DM when she was 14 yo. She is now 27. Which examination should the nurse prepare the woman to have before, during and after the pregnancy? A) Gastrointestinal exam for gastric hypotony B) Neural exam for diabetic peripheral neuropathy C) Eye exam for diabetic retinopathy D) Renal exam for urinary incontinence

C) Eye exam for diabetic retinopathy Rationale: Pregnant women with type 1 diabetes are at an increased risk for diabetic retinopathy. Women with type 1 diabetes who are planning a pregnancy should have eye examinations before the pregnancy, during each trimester, and for 1 year postpartum. Older adults, not pregnant women, are at increased risk for gastric hypotony and urinary incontinence related to type 1 diabetes. Pregnant women with type 1 diabetes are not at increased risk for diabetic peripheral neuropathy compared to other clients with type 1 diabetes.

A client who is newly diagnosed with type 1 DM has smoked for 30 years. When teaching the client on way to optimize health outcomes, what should the nurse explain about the effects of smoking and diabetes? A) Smoking is a major factor in the development of diabetic neuropathy B) Smoking increases insulin resistance C) Smoking accelerates atherosclerotic changes in blood vessels D) Smoking promotes weight gain

C) Smoking accelerates atherosclerotic changes in blood vessels Rationale: Smoking is especially unhealthy for diabetic clients because smoking accelerates the atherosclerotic effects that occur in blood vessels from elevated levels of blood glucose. Smoking is not associated with weight gain; in fact, people use weight gain as an excuse not to quit smoking. Poor glycemic control in diabetics is associated with the development of complications including diabetic neuropathy. Smoking does not affect insulin resistance.

The nurse is caring for a client with a long-term history of type 1 DM who has developed peripheral vascular disease. The nurse is unable to palpate the client's pedal pulses and the skin is cold to the touch. Which long-term goal is most appropriate for this client? A) The client's fasting blood glucose levels will stay between 70 & 110 mg/dL B) The client will remain free from infection C) The client's skin integrity will remain intact D) The client will remain free of injury

C) The client's skin integrity will remain intact Rationale: The client has impaired circulation as evidenced by cold skin and absent pedal pulses that indicate a risk for impaired skin integrity due to gangrene. There is no evidence the client is at risk for injury or has an infection. Having fasting blood glucose levels in the normal range indicates good disease​ management, but it does not relate to the impaired circulation.

Which type of infection has been implicated in destruction of pancreatic beta cells and thus causes type 1 diabetes? A) Fungal B) Parasitic C) Viral D) Bacterial

C) Viral Rationale: Triggers for the development of type 1 diabetes include genetic predisposition, environmental factors, viral infections, or chemical toxins. Fungal, parasitic, and bacterial infections have not been linked to the development of type 1 diabetes.

The nurse is managing care for a client weighing 165 lbs who was admitted for the treatment of DKA. Which intervention would be most appropriate for the nurse to include in the plan of care? SATA A) Give 100mL of normal saline bolus B) Provide a high-protein diet C) Measure intake and output every hour D) Place the client on a telemetry monitor E) Administer sliding-scale regular insulin

C, D - I&O q 1hr -telemetry monitor Rationale: The nurse would calculate intake and output on an hourly basis to determine fluid needs. The client would be placed on a telemetry monitor to monitor for dysrhythmias related to shifts in potassium levels. The client with DKA would be acutely ill and if able to​ eat, would be placed on a​ carbohydrate-controlled diet. The nurse would administer normal saline boluses at​ 10-20 mL/kg. A volume of 100 mL is not sufficient. Insulin would be administered​ intravenously, not sliding scale.

The nurse is planning care for a client admitted with DKA. On what should the nurse focus for this client's care? SATA A) Administration of oral glucose B) Monitoring for fluid volume overload C) Frequent BG monitoring D) IV fluid infusions E) Insulin infusion

C, D, E - frequent BG monitoring - IV fluids - Insulin infusion Rationale: For the client experiencing diabetic ketoacidosis, frequent blood sugar monitoring, IV fluids, and insulin drips for treatment mandate that the client be cared for in an intensive care environment until stabilized. The client will be dehydrated and most likely will not need treatment for fluid volume overload. Oral glucose should not be administered to the client with diabetic ketoacidosis.

A client newly diagnosed with type 1 diabetes mellitus tells the nurse that the diagnosis must be wrong because the client is not overweight, eats all of the time, and is thin. Which response by the nurse is most appropriate? A) "Thin people can be diabetic, too." B) "Your condition makes it impossible for you to gain weight." C) "Your lab tests indicate the presence of diabetes." D) "You are eating large quantities because your condition makes it difficult for your body to obtain energy from the foods taken in."

D) "You are eating large quantities because your condition makes it difficult for your body to obtain energy from the foods taken in." Rationale: The diabetic client is unable to obtain the needed glucose for the body's cells due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin. While the statement about diabetics being thin is correct, it does not answer the client. It is not impossible for diabetics to gain weight. Although the laboratory tests might indicate the presence of diabetes, this does not meet the client's needs for teaching.

The nurse is caring for a client who received a daily intermediate-acting insulin dose at 0800. At which time of the day should the nurse provide the client a snack to prevent hypoglycemia? A) 1800 B) 2100 C) 1100 D) 1400

D) 1400 Rationale: Intermediate-acting​ (NPH) insulin peaks 6-8 hours after the injection.​ Therefore, the nurse would prepare a snack for the client beginning at​ 2:00 p.m. If the client received short-acting insulin​ (regular), the snack would be required between 10 a.m. and​ 11:00 a.m. Giving a snack at​ 6:00 p.m. or​ 9:00 p.m. may be appropriate for​ long-acting insulins, but it is not appropriate for​ intermediate-acting insulins.

The nurse is preparing to teach a client who is newly diagnosed with type 1 DM on the preferred area to self-inject insulin. On which area should the nurse focus, based on insulin absorption rates? A) Deltoid B) Thigh C) HIp D) Abdomen

D) Abdomen Rationale: The rate of absorption and peak of action of insulin differ according to the site. The site that allows the most rapid absorption is the abdomen, followed by the deltoid muscle, then the thigh, and then the hip. Because of the rapid absorption, the abdomen is the recommended site.

Which action by a parent of a 12-year-old with type 1 DM indicates a need for further instruction? A) Counting carbs with the child B) Allowing the child to check blood sugars C) Scheduling a baseline exam with an ophthalmologist D) Discouraging after-school sports

D) Discouraging after-school sports Rationale: Exercise is a part of blood glucose and disease management.​ Therefore, the nurse should reeducate the parent to allow​ after-school sports. The parent should involve the​ 12-year-old child, so counting carbohydrates with the child and allowing the child to perform​ self-blood glucose monitoring is appropriate. Due to potential retinopathy that can occur with​ diabetes, it is appropriate for the parent to schedule an ophthalmic appointment to determine baseline visual acuity.

The nurse is developing a teaching plan for carbohydrate counting for a client newly diagnosed with type 1 DM. Which type of carbohydrate should the nurse instruct the client to restrict? A) Simple sugars B) Dietary fructose C) Complex carbohydrates D) Refined sugars

D) Refined sugars Rationale: Refined sugars come from sugar cane and are used as natural sweeteners. The client should restrict the intake of refined sugars. Simple sugars are found in​ fruit, honey, and dairy products. Dietary​ fructose, which comes from dietary fruit and vegetable​ consumption, causes a slower rise in blood glucose levels. Complex carbohydrates come from​ peas, beans, whole​ grains, and vegetables.

Which statement made by a client with type 1 DM indicates an understanding of instruction provided regarding disease management? SATA A) "I should count calories consumed to determine insulin needs for each day." B) "I should maintain my A1C levels at or below 8%." C) "I should trim my toenails at an angle to prevent cutting the skin." D) "I should obtain blood glucose levels prior to each insulin injection." E) "I should administer insulin during the day in multiple injections."

D, E Rationale: For better blood glucose​ control, the healthcare provider would instruct the client to administer insulin throughout the day in multiple injections and to obtain blood glucose levels prior to each injection. Hemoglobin A1C levels should be below​ 6.5%. The client should be instructed to count​ carbohydrates, not calories. Toenails should be cut straight across with a clipper and the edges and corners smoothed with an emery board. If the client is unable to see his feet or reach them​ easily, someone else can trim his nails. If the nails are very thick or​ ingrown, if toes​ overlap, or if circulation is​ poor, then a podiatrist should cut the​ client's toenails.