Diabetes Mellitus Type 2
Since Alice is an older adult with a long history of uncontrolled blood glucose, foot care is important. The nurse determines that additional instructions are needed when the client makes which statement? "I should wash my feet daily with soap and warm water." "I'll know if I have injured my foot because it will be painful." "If my feet are cold, I should wear socks instead of using a heating pad." "I should always wear shoes to protect my feet from injury."
"I'll know if I have injured my foot because it will be painful." Complete or partial loss of sensation is common with peripheral neuropathy of diabetes. Clients may suffer from foot injury and ulceration without ever having pain. Feet must be inspected and washed daily. Heating pads should not be used on the feet due to loss of sensation. Using clinical judgment, we have evaluated outcomes of your teaching and recognized that further clarification is needed.
As part of Alice's comprehensive annual assessment, several laboratory studies are prescribed. Upon review of the values, the nurse recognizes that the client has metabolic syndrome. Which teaching topic should have the highest priority for this client? Performing daily aerobic exercise Eliminating red meat from the diet Consuming an adequate amount of complex carbohydrates Achieving a healthy BMI
Achieving a healthy BMI Metabolic syndrome is a set of abnormalities that includes elevated glucose levels, abdominal obesity, elevated blood pressure, high level triglycerides, and low levels of high-density lipoproteins (HDL). Regular physical activity and a healthy diet are important, but normalizing weight will have the biggest impact on these conditions. Using clinical judgment, we have prioritized hypotheses (i.e., pertinent data); making the connection between metabolic syndrome and a healthy BMI.
A nurse is admitting a client with suspected hyperosmolar hyperglycemia syndrome (HHS). When reviewing the client's health history, which is a contributing factor to the development of HHS? Select all that apply. Age 77 years Recovering from influenza Recent myocardial infarction Client is prescribed a daily calcium channel blocker Blood urea nitrogen (BUN) 7 mg/dL
Age 77 years Recovering from influenza Recent myocardial infarction Client is prescribed a daily calcium channel blocker HHS is common in clients with type 2 diabetes who are older than 60 years. Acute illness or undiagnosed type 2 diabetes are often the cause of HHS. In older clients, this syndrome can be triggered by an inability to replace fluids or increasing cognition problems. Calcium channel blockers impair the release of insulin and increase insulin resistance, resulting in hyperglycemia. BUN level is normal.
A nurse is admitting a client to the intensive care unit with suspected hyperosmolar hyperglycemia syndrome (HHS). Which laboratory finding should the nurse anticipate? Blood urea nitrogen (BUN) 35 mg/dL Blood pH 7.20 Serum creatine 0.8 mg/dL Serum potassium 3 mmol/
Blood urea nitrogen (BUN) 35 mg/dL pH 7.20 is indicative of diabetic ketoacidosis. Serum creatinine is normal and would be high in HHS due to dehydration. Serum potassium is low and is typically normal in HHS due to no acidosis. BUN is elevated due to dehydration.
A nurse is assessing a newly admitted client diagnosed with diabetes mellitus type 2. Which finding indicates the client's blood glucose may be low? Polyuria Fruity breath odor Ketones in the urine Diaphoresis
Diaphoresis Cold, clammy skin with profuse diaphoresis are symptoms of hypoglycemia. Other signs include: fatigue, irritability, excessive hunger, restlessness, and headache. Fruity breath odor, ketones in the urine, and polyuria are signs of hyperglycemia.
A nurse is teaching a group of clients at a community health fair about dietary approaches to prevent diabetes mellitus type 2. Which information should the nurse include in the teaching? Select all that apply. Decrease intake of complex carbohydrates. Skipping meals will aid in weight reduction. Limit saturated fat to 15% of caloric intake. Eat fish at least two times per week to add omega-3 fatty acids to the diet. Increase daily fiber intake.
Eat fish at least two times per week to add omega-3 fatty acids to the diet. Increase daily fiber intake. Fiber is a complex carbohydrate, which is digested slowly and helps maintain a normal blood glucose level. Omega-3 fatty acids can reduce cardiovascular risk and should be part of a healthy diet. Skipping meals is not an effective weight management strategy and can result in hypoglycemia. Complex carbohydrates are needed by the body to maintain normal blood glucose levels. Saturated fat intake should be limited to 7 - 10% of caloric intake
A nurse is planning discharge teaching for a client newly diagnosed with diabetes mellitus type 2. Which information should the nurse plan to discuss? Select all that apply. Eliminating sugar from the diet Establishing a daily exercise routine Eating a diet low in saturated and trans fats Encouraging a healthy diet that meets cultural needs and preferences Importance of maintaining a healthy body mass index (BMI)
Establishing a daily exercise routine Eating a diet low in saturated and trans fats Encouraging a healthy diet that meets cultural needs and preferences Importance of maintaining a healthy body mass index (BMI) A nutritionally adequate meal plan with appropriate serving sizes, reduced saturated and trans fat, and low carbohydrates can decrease calorie consumption and assist with healthy weight maintenance. A daily exercise routine will also assist with weight management as well as decrease insulin resistance. The body requires carbohydrates for energy. Eliminating sugar from the diet is not a goal for diabetes.
A nurse working in a healthcare clinic is assessing a 50-year-old client. What recommendation for routine diabetes screening should be included in the plan of care? Fasting blood glucose beginning at age 45 years, and every 3 years Hemoglobin A1C annually for all clients over age 50 Oral glucose tolerance test for all minority clients annually 2-hour post-prandial blood glucose testing for all clients with a body mass index (BMI) greater than 20
Fasting blood glucose beginning at age 45 years, and every 3 years Fasting blood glucose, hemoglobin A1C, or 2-hour oral glucose tolerance test should be considered for all clients beginning at age 45 years and repeated every 3 years. Testing is not recommended for clients based on a BMI of 20.
A nurse is caring for a client with diabetes mellitus type 2. Which statement indicates an understanding of the difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia syndrome (HHS)? DKA requires administration of bicarbonate to correct metabolic acidosis. Potassium replacement is not necessary in management of HHS. Intravenous (IV) dextrose is withheld in HHS until blood glucose levels reach normal. HHS requires greater fluid replacement to correct dehydration.
HHS requires greater fluid replacement to correct dehydration. The management of DKA is similar to HHS except that HHS requires greater fluid replacement because of the severe hyperosmolar state. Bicarbonate is not usually needed in DKA to correct acidosis because IV insulin will reverse the abnormal fat metabolism. Potassium deficit is possible in both conditions, requiring correction. In both conditions, IV dextrose administration is started when blood glucose levels fall to 250 mg/dL to prevent hypoglycemia.
A nurse is caring for a client newly diagnosed with diabetes mellitus type 2. Which most common oral glucose-lowering agent should the nurse anticipate being prescribed? Aspart Glyburide Acarbose Metformin
Metformin Biguanides (metformin) are most commonly used with diabetes mellitus type 2. They reduce glucose production by the liver and increase insulin sensitivity. Aspart (rapid-acting insulin) is not taken orally. Glyburide (sulfonylurea) and acarbose (alpha-glucosidase Inhibitor) are not the most commonly prescribed oral agents.
Alice is having difficulty managing blood glucose on oral glucose-lowering agents but wants to avoid using insulin. The provider prescribes a medication that will increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying. Which medication will the nurse anticipate being prescribed? pioglitazone canagliflozin sitagliptin exenatide
exenatide Exenatide is a glucagon-like peptide-1 receptor agonist used to increase insulin synthesis and release from the pancreas. It also inhibits glucagon secretion and slows gastric emptying. It must be injected subcutaneously every seven days. Sitagliptin is a DPP-4 inhibitor taken orally. Canagliflozin is an SGLT2 inhibitor taken orally. Pioglitazone is a thiazolidinediones taken orally.
Recognizing & Analyzing Cues Which statement by the nurse indicates an understanding of caring for an older adult diagnosed with type 2 diabetes? "Mild hyperglycemia is expected and does not need treatment until it exceeds 250 mg/dL." "A younger family member must be responsible for the care of the older adult client with diabetes." "It is harder to achieve strict glucose control in older clients." "Insulin is not prescribed to older clients who may have limited dexterity and vision."
"It is harder to achieve strict glucose control in older clients."' Older adult clients have more chronic conditions that may be treated with medications that impair insulin action. Hypoglycemic unawareness is more common, so these clients are more likely to suffer adverse consequences from blood glucose-lowering agents. Manifestations of long-term complications from diabetes take 10-20 years to develop Treatment is indicated for any serum glucose out of the normal range. Insulin may be needed for clients who do not respond to oral glucose-lowering agents, regardless of age. The client's needs rather than age determine the responsibility of others in care. Using clinical judgment, we have recognized and analyzed cues (i.e., assessment findings); making the connection between cues and type 2 diabetes.
A nurse is caring for client newly diagnosed with diabetes mellitus type 2 who has a blood glucose level of 48 mg/dL. The client is sleepy but arousable. Which action should the nurse perform first? Call the provider Provide a 15-gram simple carbohydrate snack Provide a complex carbohydrate and protein snack Monitor the client and recheck blood glucose in 15 minutes
Provide a 15-gram simple carbohydrate snack The client should be offered a 15-gram simple carbohydrate snack, such as fruit juice, milk, or regular soda to rapidly raise the blood glucose level. The client is hypoglycemic and continuing to monitor is not appropriate. A complex carbohydrate will digest slowly and not quickly raise the blood glucose. The provider should be contacted after the client's immediate needs have been met.
Alice tells the nurse that she understands the importance of keeping blood glucose close to normal to prevent complications and states, "I would like to do better." In planning care for Alice, what are appropriate therapies for the nurse to include? Select all that apply. Reinforcing use of a portable blood glucose monitor. Importance of eating meals at consistent times daily. Strategies to reduce sodium intake to lower blood pressure. Need to reduce physical activity until blood pressure is normalized. Teach the patient that if she takes herbal therapy, she will need more frequent blood glucose monitoring.
Reinforcing use of a portable blood glucose monitor. Importance of eating meals at consistent times daily. Strategies to reduce sodium intake to lower blood pressure. The client's blood pressure is elevated. Eating a low-salt diet could help, in conjunction with other strategies, to lower blood pressure. Since the client's blood glucose is poorly controlled, frequent monitoring may help with glucose awareness. Consistent mealtimes daily help to normalize blood glucose. Daily activity is an important strategy to lower insulin resistance. No herbal therapies should be used without first consulting with a healthcare provider. Using clinical judgment, we have taken action to care for this client by selecting therapies that maintain normal glucose levels.
A nurse in a clinic receives a phone call from a family member of a client diagnosed with type 2 diabetes. The family arrived home to find the client unconscious on the floor. After determining that a glucometer is not available, what action should the nurse take first? Ask the family member to call emergency services for an ambulance. Instruct the family member to serve the client a regular soda. Tell the family member to administer 1 mg of glucagon intramuscularly. Have the family member administer 10 units of regular insulin subcutaneously.
Tell the family member to administer 1 mg of glucagon intramuscularly. Hypoglycemia can cause brain damage and should be corrected immediately. Since the client is unconscious, the family member should administer glucagon. If the unconsciousness is caused by ketosis, a rise in glucose caused by the glucagon injection is not as dangerous as the low glucose level. After administration of glucagon, the client should be transported via ambulance to the hospital for ongoing treatment. Oral carbohydrates cannot be given to an unconscious client. Administering insulin is not appropriate without confirming the client's blood glucose level.
A nurse is providing discharge teaching to a client prescribed acarbose. Which information should the nurse include in the teaching? Select all that apply. This medication delays glucose absorption from the gastrointestinal tract. Effectiveness of this medication is measured by the 2-hour post-prandial glucose. Glucose production is decreased when taking this medication. Take the medication with the first bite of each meal. This medication cannot be taken by clients with a sulfa allergy.
This medication delays glucose absorption from the gastrointestinal tract. Effectiveness of this medication is measured by the 2-hour post-prandial glucose. Take the medication with the first bite of each meal. Acarbose is an alpha-glucosidase inhibitor that is taken with the first bite of each meal. Effectiveness is monitored with the 2-hour post-prandial glucose level. Glucose absorption is delayed from the GI tract with this medication. Sulfonylureas cannot be taken by clients with a sulfa allergy.
