Week 6 Post-Lecture Quiz
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? A. Deep respirations and fruity odor to the breath B. Nervousness and tachycardia C. Diaphoresis and altered mental state D. Erythema toxicum rash and pruritus
A. Deep respirations and fruity odor to the breath Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.
An adolescent with a BMI of 30 reports fatigue, frequent urination, and a tingling sensation on the feet. The adolescent is then diagnosed with type 2 diabetes mellitus. Which nursing interventions would be appropriate? Select all that apply. A. Dietary counseling B. Behavior modification C. Bariatric surgery D. Dietary restrictions E. Physical activities
A. Dietary counseling B. Behavior modification E. Physical activities An adolescent with type 2 diabetes mellitus should engage in regular physical activity to reduce his or her weight and glucose levels. Dietary counseling helps to improve nutritional intake and decrease saturated fats and sugars. Behavior modification weight programs help adolescents identify and eliminate inappropriate eating behavior habits. Bariatric surgery is recommended for clients with morbid obesity (characterized by a BMI greater than 40). Dietary restriction should not be recommended because this action may cause a lot of nutrients.
A nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. What interventions should the nurse include to decrease the risk of complications? Select all that apply. A. Examine the feet daily B. Test bathwater with the toes before bathing C. Perform regular exercise D. Powder the feet after showering E. Visit the primary healthcare provider weekly F. Wear well-fitting shoes
A. Examine the feet daily C. Perform regular exercise F. Wear well-fitting shoes Clients with diabetes often have peripheral neuropathies and are unaware of discomfort or pain in the feet; the feet should be examined every night for signs of trauma. Well-fitting shoes prevent pressure and rubbing that can cause tissue damage and the development of ulcers. Daily exercise increases the uptake of glucose by the muscles and improves insulin use. Powdering the feet after showering may cause a pastelike residue between the toes that may macerate the skin and promote bacterial and fungal growth. Generally, visiting the primary healthcare provider weekly is unnecessary. Clients with diabetes often have peripheral neuropathy and are unable to accurately evaluate the temperature of bathwater, which can result in burns if the water is too hot.
A nurse working in the diabetes clinic is evaluating a client's success with managing the medical regimen. What is the best indication that a client with type 1 diabetes is successfully managing the disease? A. Stabilization of the serum glucose B. Adherence to the prescription for insulin C. Acquisition of knowledge about diabetes D. Reduction in excess body weight
A. Stabilization of the serum glucose A combination of diet, exercise, and medication is necessary to control the disease; the interaction of these therapies is reflected by the serum glucose level. Weight loss may occur with inadequate insulin. Acquisition of knowledge does not guarantee its application. Insulin alone is not enough to control the disease.
The primary healthcare provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. What is the goal of treatment with glucose levels for this client? A. 150 to 175 mg/dL (8.3 to 9.7 mmol/L) of blood B. 70 to 105 mg/dL (3.9 to 5.8 mmol/L) of blood C. 40 to 65 mg/dL (2.2 to 3.6 mmol/L) of blood D. 110 to 145 mg/dL (6.1 to 8.0 mmol/L) of blood
B. 70 to 105 mg/dL (3.9 to 5.8 mmol/L) of blood The range of 70 to 105 mg/dL (4 to 6 mmol/L) of blood is the expected range for blood glucose. The range of 40 to 65 mg/dL (2.2 to 3.6 mmol/L) of blood is indicative of hypoglycemia. The ranges 110 to 145 mg/dL (6.1 to 8.0 mmol/L) of blood and 150 to 175 mg/dL (8.3 to 9.7 mmol/L) of blood are indicative of hyperglycemia.
A client with diabetes is given instructions about foot care. Which statement made by the client shows effective learning? A. "I will trim my toenails before bathing." B. "I will soak my feet daily for one hour." C. "I will break in my new shoes over the course of several weeks." D. "I will examine my feet using a mirror at least once a week."
C. "I will break in my new shoes over the course of several weeks." A slower, longer period of time to break in new, stiff shoes will help prevent blisters and skin breakdown. The toenails should be trimmed by a podiatrist; they are usually trimmed after a foot bath when the nails are softer. Soaking the feet daily for one hour will cause maceration of the skin and should be avoided. Examining the feet using a mirror at least once a week is too infrequent; the client should examine the feet daily for signs of trauma.
A client with recently diagnosed diabetes states, "I feel bad. My spouse and I do not get along. It seems as though my spouse doesn't care about my diabetes." What is the nurse's best response? A. "It may be temporary because your spouse also needs time to adjust" B. "You don't get along with your spouse." C. "You are unhappy. I wonder, have you tried to talk to your spouse?" D. "I'm sorry. What can I do to make you feel better?"
C. "You are unhappy. I wonder, have you tried to talk to your spouse?" The response "You are unhappy. I wonder, have you tried to talk to your spouse?" identifies the client's feelings and accepts them but also points out the responsibility of the client to take action. Although the response "You don't get along with your spouse" identifies one of the client's concerns, the identification of the underlying feeling is more therapeutic. The response "I'm sorry. What can I do to make you feel better?" makes the nurse responsible for changing the situation, which is not appropriate or therapeutic. The response "It may be temporary because your spouse also needs time to adjust" denies the client's feelings and provides false reassurance.
A nurse is caring for an alert client with diabetes who is receiving an 1800-calorie diabetic diet. The client's blood glucose level is 30 mg/dL (3 mmol/L). The primary healthcare provider's protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate. What should the nurse do first? A. Give 25 mL dextrose 50% by slow intravenous (IV) push B. Provide 12 ounces (360 mL) of nondiet soda C. Ask the client to ingest one tube of glucose gel D. Have the client drink 8 ounces (240 mL) of fruit juice
C. Ask the client to ingest one tube of glucose gel One tube of glucose gel contains 15 g of carbohydrate and is the most appropriate intervention in this situation. Providing 12 ounces (360 mL) of nondiet soda is too much carbohydrate; 4 to 6 ounces (120 to 180 mL) is adequate. Administering dextrose by IV push is not appropriate for an alert client who is able to eat and drink. Having the client drink 8 ounces (240 mL) of fruit juice is too much carbohydrate; 4 to 6 ounces (120 to 180 mL) is adequate.
The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should not anticipate which symptom? A. Frequent bruising B. Ketonuria C. Hypoglycemia Dry mouth
C. Hypoglycemia Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM. Type 2 diabetes can affect blood circulation which makes it easier for the skin to bruise. Decreased blood flow to the area surrounding an injury prevents a wound from healing properly, resulting in the development of bruise-like lesions or spots. The presence of ketones in the urine happens due to a lack of available insulin. T1DM patients can often present with ketoacidosis (DKA) coma as the first manifestation in about 30% of patients. Losing a lot of fluids caused by frequent urination can lead to dehydration hence patients can develop dry mouth. People with diabetes are prone to dehydration. In those with diabetes, a person's blood glucose levels can become too high. The term for this is hyperglycemia, and it can cause a person to experience dry mouth.
A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? A. Hypoglycemic reaction B. Somogyi phenomenon C. Ketoacidosis D. Hyperosmolar nonketotic coma
C. Ketoacidosis Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat, causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.
