DM Type 2
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. Prevent breakdown of glycogen E. Stimulate hormones for hemodilution
A. Increase uptake of glucose by cells B. Increase insulin secretion D. Prevent breakdown of glycogen 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.
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. Limit computer time. B. Take stairs at work. C. Play card games at home. D. Use a fitness tracker. E. Get a workout buddy.
A. Limit computer time. B. Take stairs at work. D. Use a fitness tracker. E. Get a workout buddy 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 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. Monitor serum potassium levels. B. Assess level of orientation. C. Obtain blood for hemoglobin A1C. D. Provide education about type 2 diabetes mellitus. E. Give normal saline intravenously.
A. Monitor serum potassium levels. B. Assess level of orientation. E. Give normal saline intravenously. 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 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. Capillary refill of 3 seconds B. Absent pedal pulses C. Hemoglobin A1C of 6.4% D. Fasting blood glucose of 100 mg/dL
B. Absent pedal pulses 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 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. Asian Americans B. Caucasian Americans C. American Indians D. African Americans
C. American Indians 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 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. "It is understandable to be upset about a new medical diagnosis." B. "Why do you think you will have to give yourself injections?" C. "Type 2 diabetes mellitus can usually be managed with pills, diet, and exercise." D. "Insulin administration helps with better blood glucose management."
C. "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.
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 used for clients who are unable to inject insulin. C. This medication is only used in the adult population due to side effects. D. This medication can take up to 3 months to show effectiveness.
D. This medication can take up to 3 months to show effectiveness. 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.
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. Acanthosis nigricans B. Decreased urination C. Hyperglycemia D. Extreme thirst E. Hypertension
A. Acanthosis nigricans C. Hyperglycemia D. Extreme thirst E. Hypertension 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. Cognitive impairment B. Pulmonary disease C. Functional disabilities D. Polypharmacy E. Autoimmune diseases
A. Cognitive impairment C. Functional disabilities D. Polypharmacy 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.
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. Primary healthcare provider C. Personal trainer D. Social worker
A. Dietitian 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 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. Family history B. Race C. High-fat diet D. Sex E. Obesity
A. Family history B. Race C. High-fat diet E. Obesity 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 with blood glucose of 450 mg/dL is diagnosed with hyperosmolar hyperglycemic state (HHS). Which assessment finding should the nurse expect? A. Increase in urinary output B. Lower extremity edema C. Open wound to the foot D. Capillary refill of 2 seconds
A. Increase in urinary output 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 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. Review blood glucose logs. B. Assess injection sites. C. Monitor hemoglobin A1C. D. Discuss alcohol and drug use. E. Obtain an eye exam.
A. Review blood glucose logs. C. Monitor hemoglobin A1C. D. Discuss alcohol and drug use. 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 conducting a health fair to screen for type 2 diabetes mellitus. Which participant should the nurse consider to be at highest risk? A. 50-year-old office worker who sits at the computer B. 40-year-old kindergarten teacher who works in a classroom C. 30-year-old nurse who works in an intensive care unit D. 60-year-old retired architect who works at job site
A. 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.
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. Refer for an eye exam. B. Discuss alcohol, tobacco, and drug use. C. Make a foot assessment. D. Review glucose records. E. Measure fasting glucose levels.
B. Discuss alcohol, tobacco, and drug use. D. Review glucose records. E. Measure fasting glucose levels 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 information should the school nurse provide when teaching a group of adolescents the risk factors for type 2 diabetes mellitus? A. Increase carbohydrate intake. B. Get sufficient exercise and activity. C. Monitor blood glucose levels. D. Limit the amount of protein intake.
B. Get sufficient exercise and activity. 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.
Which information should the nurse provide the client with type 2 diabetes mellitus? A. Increase carbohydrate consumption in the diet. B. Inspect your feet on a daily basis for open sores. C. Treat hyperglycemia with concentrated sweets. D. Include 100 minutes per week of activity and exercise.
B. Inspect your feet on a daily basis for open sores. 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 nurse is performing a physical assessment of a child. Which assessment finding should cause the nurse to suspect type 2 diabetes mellitus? A. Blood pressure of 110/78 mmHg B. Presence of acanthosis nigricans C. Pale mucous membranes D. Body mass index 21 kg/m2
B. Presence of acanthosis nigricans 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.
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. Fasting blood sugars averaging 150 mg/dL B. Weight loss of 40 pounds C. Hemoglobin A1C of 10.0% D. New foot wound with purulent drainage
B. Weight loss of 40 pounds 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.
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. "Type 2 diabetes mellitus cannot be cured. It will eventually progress to type 1 diabetes." B. "You will always have type 2 diabetes mellitus. You cannot get rid of it." C. "Type 2 diabetes mellitus can sometimes be eliminated by weight loss, diet, and exercise." D. "You seem concerned about this diagnosis and we will do our best to help you control it."
C. "Type 2 diabetes mellitus can sometimes be eliminated by weight loss, diet, and exercise." 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.
