M.12-2: Type 2 Diabetes Mellitus pearson
The diabetes nurse educator is teaching a patient the cause of type 2 diabetes mellitus. Which patient statement indicates an understanding of the instruction given? ANSWER "Type 2 diabetes mellitus is caused by inadequate insulin production." "Type 2 diabetes mellitus is caused by a complete destruction of beta cells." "Type 2 diabetes mellitus is caused by an overproduction of ketones." "Type 2 diabetes mellitus is related to a complete insulin deficiency."
"Type 2 diabetes mellitus is caused by inadequate insulin production." Type 2 diabetes mellitus is associated with a reduction in insulin production by pancreatic beta cells along with cellular resistance to insulin. Although the pancreas produces some insulin, enough to keep the body from breaking down fats into ketones, there is not enough to keep the patient's blood glucose level within normal limits. Type 1 diabetes results from an autoimmune process that destroys all pancreatic beta cells, resulting in a complete insulin deficiency. Patients with type 1 diabetes mellitus will start to break down free fatty acids and produce ketones if they do not receive insulin injections.
The nurse is caring for four patients. Which patient is at highest risk for the development of type 2 diabetes mellitus? ANSWER 70-year-old woman with congestive heart failure 35-year-old man with an autoimmune disease 15-year-old man who is thin and athletic 50-year-old wheelchair-bound woman who is obese
50-year-old wheelchair-bound woman who is obese Two major risk factors for type 2 diabetes mellitus are obesity and inactivity. Therefore, the 50-year-old wheelchair-bound patient with obesity is at highest risk for type 2 diabetes mellitus. The patient with the autoimmune disease and the patient who is thin and athletic may be at higher risk for type 1 diabetes mellitus. The patient with congestive heart failure is at risk for edema and fluid volume overload.
A client recently diagnosed with type 2 diabetes mellitus reports difficulty managing the disease. To which professional should the nurse refer the client for help with caloric intake? A. Dietitian B. Social worker C. Primary healthcare provider D. Personal trainer
A Rationale: The dietitian would best be able to help the client develop meal plans and incorporate foods that the client likes. The social worker would help the client find community resources to meet financial needs. A personal trainer would help the client increase activity. The primary healthcare provider manages the disease process as well as the multidisciplinary healthcare team.
The nurse is caring for a 15-year-old child newly diagnosed with type 2 diabetes mellitus. Which task should the nurse expect to be completed quarterly for this child? (Select all that apply.) A. Discuss alcohol, tobacco, and drug use. B. Measure fasting glucose levels. C. Review glucose records. D. Refer for an eye exam. E. Make a foot assessment.
A,B,C Rationale: When a child is diagnosed with type 2 diabetes mellitus, certain tasks should be scheduled quarterly and annually. Discussing alcohol, tobacco, and drug use, measuring fasting glucose levels, and reviewing glucose records are completed quarterly. Referral for an eye exam and a foot assessment should be completed annually; quarterly would be too often.
Which suggestion should the nurse provide to a client with newly diagnosed type 2 diabetes mellitus regarding ways to increase activity? (Select all that apply.) A. Take stairs at work. B. Limit computer time. C. Get a workout buddy. D. Use a fitness tracker. E.
A,B,C,D Rationale: Clients with newly diagnosed type 2 diabetes mellitus should incorporate a minimum of 150 minutes of exercise and activity per week into their lives. The nurse can instruct the client to take the stairs at work, use a fitness tracker to set goals and monitor activity, limit computer time because it is sedentary, and get a friend to go to the gym to exercise. Playing card games is a sedentary activity.
A morbidly obese adult patient with type 2 diabetes mellitus has tried dietary modifications, oral hypoglycemic medications, and exercise, but has not seen any significant decrease in the hemoglobin A1C. Which intervention should the nurse recommend that the patient explore to prevent long-term complications of type 2 diabetes mellitus? ANSWER Bariatric surgery Revising the current diabetic diet Short- and long-acting insulin Baby aspirin taken once a day
Bariatric surgery Patients who are morbidly obese and have uncontrolled type 2 diabetes mellitus may benefit from bariatric surgery. This surgery allows the patient to lose weight and diminish or eliminate diabetes. Short- and long-acting insulin, taking a baby aspirin, and revising the current diabetic diet will not prevent complications.
A patient with type 2 diabetes mellitus states, "I have increased hunger at the evening meal and know I'm eating more than I should." Which blood glucose level would be impacted by overeating at the evening meal? ANSWER Bedtime Midday Fasting Afternoon
Bedtime If the patient is consuming a larger evening dinner meal, the blood sugars would increase at bedtime. Elevated blood glucose levels at other times of the day would reflect other dietary changes with meals.v
The nurse is caring for a patient admitted with pneumonia who is receiving corticosteroids to decrease inflammation. Which laboratory value best validates hyperglycemia? ANSWER Blood glucose level of 140 mg/dL postprandial Bedtime blood glucose level of 120 mg/dL Blood glucose level of 150 mg/dL Fasting blood glucose level of 89 mg/dL
Blood glucose level of 150 mg/dL When the blood glucose level is 150 mg/dL, this indicates hyperglycemia. A fasting blood sugar level of of 89 mg/dL is normal. A postprandial blood sugar level of 140 mg/dL and a bedtime blood sugar level of 120 mg/dL are also normal.
The healthcare provider prescribes metformin (Glucophage) to a client with newly diagnosed type 2 diabetes mellitus. Which information should the nurse provide to the client? A. This medication is unsafe for use by pregnant and lactating women. B. This medication is only used in the adult population due to side effects. C. This medication is used for clients who are unable to inject insulin. D. This medication can take up to 3 months to show effectiveness.
D Rationale: Metformin (Glucophage) is a relatively safe medication to use in the treatment of type 2 diabetes mellitus. However, it may take up to 3 months to show effectiveness. Metformin is used to stimulate insulin production, not used in place of insulin. It is safe for pregnant and lactating women and for children.
Which information should the nurse provide the client with type 2 diabetes mellitus? A. Treat hyperglycemia with concentrated sweets. B. Include 100 minutes per week of activity and exercise. C. Increase carbohydrate consumption in the diet. D. Inspect your feet on a daily basis for open sores.
D Rationale: The client should inspect both feet every day, using a mirror if needed, to look for open sores. Hypoglycemia, not hyperglycemia, is treated with 15 grams of concentrated carbohydrates. The client should include 150 minutes of activity and exercise per week. The client should decrease carbohydrate consumption.
The parents of a child with type 2 diabetes mellitus call the urgent care center because the child's skin is clammy and diaphoretic. Which question should the nurse first ask the parents? ANSWER "Have you checked your child's blood sugar?" "What is your child's body temperature?" "When did your child last have a meal or snack?" "Has your child been drinking a lot of water?"
"Have you checked your child's blood sugar?" When the patient with diabetes mellitus develops cool and clammy skin, the nurse would immediately instruct the caregiver to obtain a blood glucose level. This would rule out hypoglycemia and lead to immediate treatment. Asking about body temperature would be appropriate, but it should not be the first question asked. Increased water consumption occurs with hyperglycemia, not hypoglycemia. The nurse would want to know how long it has been since the child last ate, but it is not the first question to ask.
The nurse is teaching a group of parents about ways to prevent type 2 diabetes mellitus in children. Which parent statement indicates a need for further teaching? ANSWER "I should have my child include 30 minutes of activity every day." "I should limit the amount of time my child spends watching television." "I should decrease the amount of sugared beverages in my child's daily diet." "I should monitor the amount of carbohydrates in my child's meals."
"I should decrease the amount of sugared beverages in my child's daily diet." A preventive measure to decrease the risk of developing type 2 diabetes mellitus during childhood is to completely eliminate, not just decrease, sugared beverages from the diet. Therefore, when the parent makes this statement, it indicates a need for further teaching. The statements about monitoring carbohydrate intake, 30 minutes of activity per day, and limiting television time are correct and do not indicate a need for further instruction.
The nurse is assessing the feet of a patient with type 2 diabetes mellitus and notes a sore on the left great toe. Which patient statement indicates a need for further teaching on diabetic foot care? ANSWER "I stubbed my toe the other day walking around the house in bare feet." "I check my feet on a daily basis, even using a mirror to look at areas I cannot see." "I refrain from trimming my own toenails. I regularly see the podiatrist." "I wear cotton or wool socks with my shoes to absorb the extra sweat."
"I stubbed my toe the other day walking around the house in bare feet." Patients with diabetes mellitus should never go barefoot or wear open-toed shoes, including flip-flops. Therefore, this action indicates a need for further teaching. The patient stating that a podiatrist trims the toenails is appropriate and would not lead to foot ulcer formation. Using a mirror to check the feet every day is good practice to look for sores. Cotton or wool socks wick excess perspiration from the feet to prevent maceration.
The nurse is teaching the caregivers of an adolescent with a new diagnosis of type 2 diabetes mellitus what they should do every 3 months to monitor the disease. The adolescent is currently taking metformin (Glucophage). Which information should the nurse include? (Select all that apply.) A. Discuss alcohol and drug use. B. Monitor hemoglobin A1C. C. Obtain an eye exam. D. Review blood glucose logs. E. Assess injection sites.
A,B,D Rationale: An adolescent with type 2 diabetes mellitus who takes metformin (Glucophage) should monitor the hemoglobin A1C and blood glucose logs every 3 months. The nurse should also discuss alcohol and drug abuse and its effects on type 2 diabetes mellitus every 3 months. An eye exam should be obtained annually, not quarterly. The nurse need not assess injection sites because the adolescent does not use insulin.
The nurse is caring for a child with type 2 diabetes mellitus. Which item in this child's history should the nurse recognize as a risk factor for this disease? (Select all that apply.) A. High-fat diet B. Family history C. Sex D. Obesity E. Race
A,B,D,E Rationale: Obesity, a high-fat diet, a family history of diabetes mellitus, and race are risk factors for developing type 2 diabetes mellitus. Sex does not play a role in the risk for type 2 diabetes mellitus.
A client is admitted with hyperosmolar hyperglycemic state (HHS) and a blood glucose level of 550 mg/dL. Which intervention should the nurse expect to include in the plan of care? (Select all that apply.) A. Assess level of orientation. B. Give normal saline intravenously. C. Provide education about type 2 diabetes mellitus. D. Obtain blood for hemoglobin A1C. E. Monitor serum potassium levels
A,B,E Rationale: HHS can cause changes to a client's level of consciousness ranging from lethargy to coma; therefore, the nurse should assess the client's level of orientation. The hyperosmolarity of the blood causes severe dehydration and depletion of electrolytes. Therefore, the priority care for a client with HHS is to provide isotonic or colloid solutions intravenously. Potassium is depleted, so it must not only be monitored, but also replaced. This client is acutely ill, so the hemoglobin A1C should be reviewed, but it is not a priority. Education should wait until the client's blood glucose level is stabilized and the client is alert enough to be receptive to the teaching.
The nurse preceptor is teaching a new graduate nurse about hypoglycemic agents used to treat type 2 diabetes mellitus. Which information should the preceptor include related to how these medications lower blood sugar? (Select all that apply.) A. Increase uptake of glucose by cells B. Increase insulin secretion C. Increase breakdown of insulin D. Stimulate hormones for hemodilution E. Prevent breakdown of glycogen
A,B,E Rationale: Hypoglycemic agents are used to treat individuals with type 2 diabetes mellitus. These medications lower blood sugar by stimulating or increasing insulin secretion, preventing breakdown of glycogen to glucose by the liver, and increasing peripheral uptake of glucose by making cells less resistant to insulin. Peripheral uptake is uptake by muscles and fat in the arms and legs rather than in the trunk. Some hypoglycemic agents keep blood sugar low by blocking absorption of carbohydrates in the intestines. The most recent pharmacologic therapy in treating type 2 diabetes mellitus includes the incretin effect. Incretin hormones, which are hormones released from the gut endocrine cells during meals, play a significant role in insulin secretion.
After performing a health history and physical assessment for a client, the nurse suspects type 2 diabetes mellitus. Which assessment finding is consistent with the nurse's suspicion? (Select all that apply.) A. Extreme thirst B. Decreased urination C. Hypertension D. Acanthosis nigricans E. Hyperglycemia
A,C,D,E Rationale: Symptoms that would lead the nurse to conclude the client has type 2 diabetes mellitus are extreme thirst, hyperglycemia, hypertension, and acanthosis nigricans (a condition in which the skin is velvety in texture and brownish black in color with hyperkeratotic plaques). A client with type 2 diabetes mellitus would have increased and not decreased urination.
The nurse is teaching a group of older adults with type 2 diabetes mellitus. Which complication of the disease should the nurse include? (Select all that apply.) A. Polypharmacy B. Pulmonary disease C. Autoimmune diseases D. Functional disabilities E. Cognitive impairment
A,D,E Rationale: Older adults diagnosed with type 2 diabetes mellitus are at an increased risk of developing other complications as compared with younger clients. These include polypharmacy, or taking other medications that can increase the risk; functional disabilities that may lead to a slower, more sedentary lifestyle; and cognitive impairment. A diagnosis of type 2 diabetes mellitus does not place a client at higher risk of pulmonary or autoimmune disease.
The nurse is caring for a client newly diagnosed with type 2 diabetes mellitus. Prior to any teaching about medications, the client informs the nurse, "I cannot give myself any injections." How should the nurse respond? A. "Type 2 diabetes mellitus can usually be managed with pills, diet, and exercise." B. "It is understandable to be upset about a new medical diagnosis." C. "Insulin administration helps with better blood glucose management." D. "Why do you think you will have to give yourself injections?"
A. "Type 2 diabetes mellitus can usually be managed with pills, diet, and exercise." Rationale: The nurse should reassure the client with type 2 diabetes mellitus that the disease can be managed with oral hypoglycemic medications, diet, and exercise and may not require insulin. The nurse would not ask why the client thinks he would have to administer insulin. This is not therapeutic communication and is not the best way to obtain information. It is understandable for the client to be upset, but this statement does not alleviate the fears or provide information. Insulin administration helps with blood glucose management in type 1 diabetes mellitus. Next Question
The nurse is caring for a child with a suspected diagnosis of type 2 diabetes mellitus. Which assessment finding specifically supports the diagnosis of type 2 diabetes mellitus versus type 1 diabetes mellitus? Polyuria Ketosis Acanthosis nigricans Fragile skin
Acanthosis nigricans Acanthosis nigricans, hyperpigmentation and thickening of the skin, is a clinical manifestation that occurs only in type 2 diabetes mellitus. Polyuria and ketosis are more likely to occur in patients who have type 1 diabetes mellitus. Fragile skin is usually a result of aging or treatment with steroids.
The nurse is planning care for a school-age child diagnosed with type 2 diabetes mellitus who will be seen every 3 months. Which task is a priority for the nurse to include in the plan of care every 12 months? ANSWER Administer a psychosocial assessment. Establish a baseline hemoglobin A1C. Assess dietary needs. Administer an influenza vaccine.
Administer an influenza vaccine. On a yearly basis the nurse should plan to administer an influenza vaccine for a child with type 2 diabetes mellitus. The nurse would draw labs to establish hemoglobin A1C and administer a psychosocial assessment during the initial visit after diagnosis. Assessing dietary needs would occur at the first visit after diagnosis.
A 12-year-old child with type 2 diabetes mellitus states, "I don't like outdoor activities, but I like to to play video games." Which suggestion should the nurse make to the parents to help increase the child's activity level? ANSWER Encourage walking or running outside every afternoon. Advise interactive video games that involve movement. Sign the child up for a neighborhood sports team. Punish the child when they choose not to exercise.
Advise interactive video games that involve movement. The nurse should encourage the child with type 2 diabetes mellitus who prefers to play video games to try interactive games that make them get up and move around. Although a neighborhood sports team would be ideal for encouraging activity, the child may not follow through due to a dislike for outdoor activities. The parents should not punish the child for not including activity.
A client with blood glucose of 450 mg/dL is diagnosed with hyperosmolar hyperglycemic state (HHS). Which assessment finding should the nurse expect? A. Lower extremity edema B. Increase in urinary output C. Capillary refill of 2 seconds D. Open wound to the foot
B Rationale: A client in HHS would have an increase in urinary output due to the hyperosmolarity of the blood. Capillary refill should be less than 3 seconds. Lower extremity edema occurs from fluid volume overload. A client in HHS has a fluid volume deficit. An open wound to the foot is not directly related to HHS because it can come from an injury to the foot.
The nurse is performing a physical assessment of a child. Which assessment finding should cause the nurse to suspect type 2 diabetes mellitus? A. Pale mucous membranes B. Presence of acanthosis nigricans C. Body mass index 21 kg/m2 D. Blood pressure of 110/78 mmHg
B Rationale: Acanthosis nigricans is a condition in which the skin is velvety in texture and brownish black in color with hyperkeratotic plaques; it is usually found in skin folds. This condition is often found in clients with type 2 diabetes mellitus and should be reported to the healthcare provider. A blood pressure reading of 110/78 mmHg is a normal finding as is a body mass index of 21 kg/m2. Pale mucous membranes could be a sign of anemia; darkened mucous membranes could indicate type 2 diabetes mellitus.
Which information should the school nurse provide when teaching a group of adolescents the risk factors for type 2 diabetes mellitus? A. Monitor blood glucose levels. B. Get sufficient exercise and activity. C. Limit the amount of protein intake. D. Increase carbohydrate intake.
B Rationale: Frequently, children with type 2 diabetes mellitus develop the disease from a sedentary lifestyle and obesity. Therefore, the nurse would instruct the adolescents regarding the benefits of exercise and activity. Children should limit the amount of carbohydrates and include a normal amount of protein. They do not need to monitor blood glucose levels unless a diagnosis of type 2 diabetes mellitus is made.
The nurse is preparing a presentation on risk factors for type 2 diabetes mellitus. Which ethnic group should the nurse include as being amongst the highest diagnosed with this disease? A. African Americans B. American Indians C. Asian Americans D. Caucasian Americans
B Rationale: The ethnicities that have the highest incidence of type 2 diabetes mellitus are the American Indians and Alaska Natives at 15.9%. Incidence rates for Asian Americans, African Americans, and Caucasian Americans are 9%, 13.2%, and 7.6%, respectively.
The nurse is evaluating the plan of care for an obese client diagnosed with type 2 diabetes mellitus 6 months prior. Which finding indicates the client is successfully managing the disease? A. New foot wound with purulent drainage B. Fasting blood sugars averaging 150 mg/dL C. Weight loss of 40 pounds D. Hemoglobin A1C of 10.0%
C Rationale: The obese client demonstrating a 40-pound weight loss over the past 6 months indicates improvement in dietary compliance with lowering carbohydrate intake and exercising. The normal hemoglobin A1C for a client with diabetes mellitus is 6?6.5%. Fasting blood sugars should be less than 100 mg/dL if the client has good control. A new foot wound with purulent drainage indicates an infection and poor circulation, so this does not show good glycemic control. OK
The nurse is developing a plan of care for a client with ineffective peripheral tissue perfusion related to microvascular changes. Which assessment finding supports this nursing diagnosis? A. Fasting blood glucose of 100 mg/dL B. Capillary refill of 3 seconds C. Absent pedal pulses D. Hemoglobin A1C of 6.4%
C Rationale: Absence of pedal pulses indicates the peripheral tissue is not receiving adequate oxygenation and in turn is the basis of the nursing diagnosis Tissue Perfusion: Peripheral, Ineffective. A hemoglobin A1C of 6.4%, capillary refill of 3 seconds, and fasting blood glucose of 100 mg/dL are all normal findings. (NANDA-I ©2014)
The nurse is conducting a health fair to screen for type 2 diabetes mellitus. Which participant should the nurse consider to be at highest risk? A. 60-year-old retired architect who works at job site B. 40-year-old kindergarten teacher who works in a classroom C. 50-year-old office worker who sits at the computer D. 30-year-old nurse who works in an intensive care unit
C. 50-year-old office worker who sits at the computer Rationale: A sedentary lifestyle is a risk factor for type 2 diabetes mellitus. The 50-year-old office worker who sits at the computer would be at highest risk for type 2 diabetes mellitus. All the other participants are physically active and are at lower risk.
A client newly diagnosed with type 2 diabetes mellitus asks the nurse how to "get rid of" this disease. How should the nurse respond? A. "You will always have type 2 diabetes mellitus. You cannot get rid of it." B. "Type 2 diabetes mellitus cannot be cured. It will eventually progress to type 1 diabetes." C. "You seem concerned about this diagnosis and we will do our best to help you control it." D. "Type 2 diabetes mellitus can sometimes be eliminated by weight loss, diet, and exercise."
D Rationale: Type 2 diabetes occurs in people who live a sedentary lifestyle, are obese, and eat a high-carbohydrate diet. Therefore, the nurse would explain to the client that the disease may be eliminated with diet, exercise, and weight loss. The first statement stating the client will always have type 2 diabetes mellitus is inaccurate because the disease can be eliminated. Type 1 and type 2 diabetes mellitus are two separate disorders with commonalities. One type does not progress to the other. Although it is accurate that the client is concerned about the diagnosis, this response does not answer the client's question.
An overweight patient with type 2 diabetes mellitus who takes an oral hypoglycemic medication just discovered that she is pregnant. Which collaborative treatment should the nurse expect? ANSWER Limit weight gain to between 10-20 pounds during the pregnancy. Adhere to strict carbohydrate counting and calorie restriction during pregnancy. Perform self-blood glucose testing once per week. Discontinue the oral hypoglycemic medication and prescribe insulin.
Discontinue the oral hypoglycemic medication and prescribe insulin. The patient has type 2 diabetes mellitus and is taking an oral hypoglycemic, which is often not safe during pregnancy. Therefore, the nurse anticipates the healthcare provider to discontinue this medication and prescribe the use of insulin. The patient taking insulin would need to watch her carbohydrate intake but does not require calorie restriction during pregnancy. The patient is overweight, not obese; therefore, weight gain during pregnancy should be 15-25 pounds. If the patient is prescribed insulin, blood glucose +3+6 monitoring would occur several times per day.
A pediatric patient with new-onset type 2 diabetes mellitus has been prescribed metformin (Glucophage). Which information should the nurse provide the parents regarding the use of this drug? ANSWER Monitor blood glucose levels several times a day. Stress the importance of monitoring urine for ketones. Drug effectiveness may take several weeks. The drug is only effective when combined with insulin.
Drug effectiveness may take several weeks. The nurse should instruct the patient and the parents that metformin (Glucophage) therapy takes several weeks to show improvement and that full glucose control may take up to 3 months. Therefore, the dose should not be adjusted right away. Blood glucose levels need to be performed several times a day when using insulin, not metformin. Metformin is effective when prescribed alone and does not require insulin to increase its effectiveness. Urine is tested for ketones in diabetic ketoacidosis or during sick days.
The nurse is providing teaching for an obese patient with a new diagnosis of type 2 diabetes mellitus. Which information should the nurse include that could eliminate the disease? ANSWER Check blood glucose levels daily. Follow a low-fat, low-calorie diet. Monitor urine for ketones. Take insulin with meals.
Follow a low-fat, low-calorie diet. Type 2 diabetes mellitus can be eliminated in obese patients by following a low-fat, low-calorie diet and incorporating exercise into the patient's lifestyle. Taking insulin, checking blood glucose levels, and monitoring urine for ketones help with disease management, not eradication.
The nurse notes that a patient with no history of diabetes has a blood glucose level of 215 mg/dL. Which test should the nurse expect the healthcare provider to prescribe? ANSWER Urinalysis for ketones Oral glucose tolerance test Hemoglobin A1C Fingerstick blood glucose
Hemoglobin A1C A hemoglobin A1C in conjunction with symptoms is used to diagnose type 2 diabetes mellitus. Other testing would include fasting blood glucose levels. Oral glucose tolerance tests are usually reserved for pregnant patients. Random fingerstick blood glucose is not used to diagnose for type 2 diabetes mellitus, but to monitor trends. Urine will be tested for ketones during diabetic ketoacidosis in patients with type 1 diabetes.
The nurse is caring for an older adult patient with type 2 diabetes mellitus who is recovering from a colon resection for cancer. The patient is febrile, has increased urine output, and has a fasting blood glucose level of 650 mg/dL. Which complication of type 2 diabetes mellitus should the nurse suspect is occurring? ANSWER Peripheral vascular disease (PVD) Hyperosmolar hyperglycemic state (HHS) Acute renal failure (ARF) Diabetic ketoacidosis (DKA)
Hyperosmolar hyperglycemic state (HHS) This patient with type 2 diabetes mellitus is under stress related to surgery and now presents with a fever, increased urinary output, and elevated blood sugars. These symptoms indicate the onset of HHS. Diabetic ketoacidosis occurs in patients with type 1 diabetes mellitus. ARF would be manifested by decreased, not increased, urinary output. PVD occurs over years, not days.
The nurse is teaching a group of young adults about the risk factors for type 2 diabetes mellitus. In relation to metabolic syndrome, which factor should the nurse include? ANSWER Weight loss Hypocholesterolemia Physically active Hypertension
Hypertension Metabolic syndrome is a constellation of risk factors that can put the patient at risk for type 2 diabetes mellitus and coronary artery disease. These risk factors include abdominal obesity, hypertension, triglyceridemia, hypercholesterolemia, and physical inactivity. Weight loss, physical activity, and hypocholesterolemia do not put the patient at risk for type 2 diabetes mellitus.
The nurse is assisting a patient with type 2 diabetes mellitus with meal planning. Which general rules should the nurse include in the plan? ANSWER Intake of 10 g of carbohydrate for every unit of regular insulin Intake of 20% fat Intake of 45-65% of carbohydrates Intake of 10% protein
Intake of 45-65% of carbohydrates The total daily kilocalorie intake recommendations are 45-65% carbohydrates, 15-20% protein, and 10% fat. An intake of 10 g of carbohydrate for every unit of regular insulin does not apply to type 2 diabetes mellitus. However, an intake of 15 g of carbohydrates for every unit of regular insulin would be a recommendation for type 1 diabetes mellitus.
A 10-year-old child is diagnosed with type 2 diabetes mellitus. Which nursing intervention should the nurse refrain from performing during outpatient office visits? ANSWER Emphasizing the importance of annual evaluations to monitor for potential complications Performing blood glucose monitoring and insulin injections Checking HbA1C levels to determine average blood glucose over the past 3 months Assessing height, weight, and BMI, and plot on an appropriate growth curve for age and gender
Performing blood glucose monitoring and insulin injections The nurse would not perform blood glucose monitoring nor would the nurse administer the insulin to the patient during outpatient office visits. Instead, the nurse would teach the patient how to perform these tasks. Checking HbA1C levels to determine average blood glucose over the past 3 months, emphasizing the importance of annual evaluations to monitor for potential complications and assessing height, weight, and BMI, and plotting them on an appropriate growth curve for age and gender would be appropriate interventions.
Which nursing assessment finding of a patient with type 2 diabetes mellitus may indicate the onset of microvascular complications? ANSWER Weight gain Microalbuminuria Prolonged capillary refill Morning hyperglycemia
Prolonged capillary refill A prolonged capillary refill indicates poor peripheral circulation and likely microvascular complications. Hyperglycemia can happen due to illness, surgery, or noncompliance. Weight gain occurs from consuming more calories than burned or from fluid volume excess. Microalbuminuria results from protein spilling into the urine from uncontrolled diabetes mellitus.
The nurse is caring for a 14-year-old patient with a diagnosis of type 2 diabetes mellitus whose hemoglobin A1C has not decreased. The patient reports difficulty following the diet at school. Which factor should the nurse investigate as a possible barrier to health maintenance? ANSWER The child is not at a developmental age to manage disease. The child is noncompliant with the medication regimen. The child is embarrassed about food restrictions among peers. The child does not understand proper food choices.
The child is embarrassed about food restrictions among peers. Adolescents have difficulty following dietary restrictions and making good food choices because of how it appears to their friends and peers. The child reports noncompliance with proper food choices at school, which therefore implies an understanding of the diet. The child does not report having difficulty with taking the medication. A 14-year-old child is at a developmental age where it is possible to manage the disease.
The nurse is developing a plan of care for a patient with new-onset type 2 diabetes mellitus and determines the patient has a nursing diagnosis of Deficit Knowledge related to new disease process. Which clinical finding indicates that the patient's goals have been met? ANSWER The patient has intact skin. The patient is free of infection. The patient is free of any type of injury. The patient demonstrates accurate blood glucose monitoring.
The patient demonstrates accurate blood glucose monitoring. The nurse develops a care plan for a diagnosis of Deficit Knowledge related to new disease process. When the patient demonstrates independent and accurate blood glucose monitoring, this indicates that the goals are met. This is unrelated to infection, injury, and skin integrity. (NANDA-I © 2014)
The nurse is reviewing the laboratory results for a patient who was diagnosed with type 2 diabetes mellitus 6 months prior and notices the patient has a hemoglobin A1C of 10%. Which inference should the nurse draw from the patient's results? ANSWER The patient is following the dietary restrictions set by the healthcare provider. The patient is most likely not compliant with the diabetic diet and medication. The patient has incorporated exercise into daily life and has lowered blood sugars. The patient has been ill, causing an alteration in the test result.
The patient is most likely not compliant with the diabetic diet and medication. A normal hemoglobin A1C should be 6-6.5% for a patient with type 2 diabetes mellitus. Therefore, a result of 10% indicates noncompliance with diet and medications and a lack of exercise. There is no indication that the patient has been sick, because this would be a short-term elevation in blood glucose levels, not an elevated A1C.
