Week 4 - Diabetes and Cellulitis
The client with diabetes mellitus reports having difficulty trimming the toenails 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 of the nails to reduce thickness after cutting. C) Cut the nails straight across with a clipper after the bath. D) Make an appointment with a nail shop for a pedicure.
A
The nurse is caring for a client who receives vitamin B12 injections to control her peripheral neuropathy. The client tells the nurse that she recently started experiencing increased tingling in her fingers and toes, and she asks the nurse what this means. How should the nurse reply? A) "The tingling suggests that you are due for another injection." B) "The tingling means that the injections are not producing their intended effect." C) "The tingling is a common side effect of B12 injections." D) "The tingling is most likely unrelated to your injections."
A
The nurse is providing care to a client who is receiving treatment for diabetic ketoacidosis (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 bicarbonate D) Hypo-osmolarity
A
The nurse is providing discharge instructions to a client recovering from cellulitis. Which client statement indicates that this teaching has been effective? A) "I will monitor for signs of infection such as fever, chills, malaise, and redness or tenderness at the site." B) "If the lesion looks healed, I will stop taking the antibiotics so that I will not develop resistance to antibiotics." C) "If pustules develop, I will squeeze the lesion to remove the pus." D) "Drainage from the site is an expected finding, and I should not be concerned.
A
The nurse, teaching a class to a group of community members about the importance of weight loss in decreasing the risk of type 2 diabetes mellitus, is asked why weight loss reduces the risk associated with the development of this health problem. Which response by the nurse is most appropriate? A) "Excess body weight impairs the body's release of insulin." B) "The amount of food taken in by those who are overweight requires more insulin to adequately metabolize, resulting in diabetes." C) "The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin." D) "Thin people are less likely to become diabetic."
A
Which degree of alcohol use has been implicated in the development of alcohol-related neuropathy? A) Chronic and heavy B) Short term and light C) Intermittent and severe D) Acute and toxic
A
Which test is commonly used to screen for type 2 diabetes in the general population? A) Fasting plasma glucose B) Oral glucose tolerance test C) Urine ketone levels D) Serum cholesterol levels
A
The nurse is teaching a group of adolescents at a local high school about skin infections. Which students should the nurse identify as being at increased risk for developing cellulitis? Select all that apply. A) A student who plucks her eyebrows B) A student with diabetes C) A student who is a member of the golf team D) A student who squeezes pimples E) A student who applies moisturizer on a daily basis
A,B,D
After reviewing the population demographics for an urban community, the community health nurse determines that community members would benefit from teaching on type 2 diabetes mellitus in children. What findings support this nurse's conclusion? Select all that apply. A) 60% of community families have both parents diagnosed with type 2 diabetes mellitus. B) 35% of school-age children do not routinely receive the annual flu vaccination. C) 50% of children between the ages of 10 and 19 are African American. D) 25% of children between the ages of 10 and 19 are Hispanic. E) 75% of school-age children are raised in families where both parents are unemployed.
A,C,D
The nurse is teaching a client with cellulitis about ways to promote healing and avoid future infections. Which client statements indicate that the teaching has been effective? Select all that apply. A) "I should use antibiotic soap to cleanse my wound." B) "I must keep my wound completely dry between cleansings." C) "I should contact the doctor if I have a temperature of 99.5°F or higher." D) "I should avoid swimming in lakes when I have a wound." E) "I can stop taking antibiotics when the swelling subsides."
A,D
The nurse is planning care for an adolescent client recently diagnosed with Charcot-Marie-Tooth syndrome. Which intervention is the highest priority? A) Managing the client's chronic pain B) Reducing the client's risk for injury C) Addressing the client's perfusion problems D) Relaxing the client to reduce stress
B
The nurse is providing client teaching on Guillain-Barré syndrome. Which explanation for a client's false perception that socks are being worn is accurate? A) Confusion is a part of this disorder, so the client is simply confused as to whether socks are being worn. B) This disorder causes a change in sensation that makes the client feel as if socks are being worn. C) The medications used to treat this disorder cause the client to feel as if socks are being worn. D) Tactile hallucinations are part of this disorder, so the client is hallucinating that socks are present.
B
Type 2 diabetes mellitus is characterized by which underlying pathophysiology? A) Excessive insulin production B) Insulin resistance C) Inability of the pancreas to produce insulin D) Impaired insulin uptake
B
Which client's clinical manifestations are most consistent with Guillain-Barré syndrome? A) A 13-year-old client feels weakness in the feet, ankles, and legs. B) A 5-year-old client feels leg pain and wants to be carried. C) A 55-year-old client experiences a lack of hand strength. D) A 23-year-old client with peripheral neuropathy has poor glycemic control.
B
Which of the following statements regarding idiopathic neuropathy is true? A) Idiopathic neuropathy is hereditary in nature. B) Idiopathic neuropathy has no known cause. C) Idiopathic neuropathy is caused by nutritional deficits. D) Idiopathic neuropathy is caused by disease or illness.
B
The nurse is caring for a client who is hospitalized for cellulitis of the foot. Which nursing diagnoses should the nurse use to plan this client's care? Select all that apply. A) Social Isolation related to skin infection B) Impaired Skin Integrity related to skin infection C) Acute Pain related to skin infection D) Disturbed Sleep Pattern related to skin infection E) Powerlessness related to inability to control the infection
B,C
The nurse is planning care for a 4-year-old child newly diagnosed with type 1 diabetes mellitus. The child's mother appears unconcerned with the diagnosis and is complaining about the cost of medication, as three additional children in the family have needs. On which nursing diagnoses should the nurse focus when planning this client's care? Select all that apply. A) Chronic Pain B) Deficient Knowledge C) Compromised Family Coping D) Risk for Unstable Blood Glucose Level E) Disturbed Body Image
B,C,D
The nurse is finalizing a plan of care for a school-age client newly diagnosed with type 1 diabetes mellitus. Which areas should the plan prioritize to achieve the maximum outcomes for this client? Select all that apply. 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 actions to take
B,D,E
What collaborative interventions are likely to improve outcomes for an 11-year-old client diagnosed with type 2 diabetes mellitus? Select all that apply. A) Weaning off oral medications B) Food intake based on age, sex, and physical activity C) Obtaining adequate rest and sleep D) Physical activity to be at least 30 to 60 minutes per day most days of the week E) Family participation in the lifestyle change
B,D,E
A client receiving intravenous antibiotics for 3 days as treatment for cellulitis is being prepared for discharge. Which discharge order should the nurse anticipate for this client? A) Low-sodium diet prescribed B) Home healthcare aide for the client C) Oral antibiotics to be continued at home D) Orders for evaluation by physical therapy
C
A client who is newly diagnosed with type 1 diabetes has smoked for 30 years. When teaching the client on ways 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
A client with a long history of type 2 diabetes mellitus complains of occasional coldness and numbness in both hands and both feet. These complaints are suggestive of which condition? A) Idiopathic peripheral neuropathy B) Mononeuropathy C) Polyneuropathy D) Hereditary peripheral neuropathy
C
A nurse caring for a client with cellulitis can expect to collaborate with which other member of the healthcare team? A) Clinical psychologist B) Social worker C) Wound care specialist D) Respiratory therapist
C
The healthcare provider prescribes sitagliptin (Januvia) for a client with type 2 diabetes mellitus. For which potential side effect should the nurse monitor in this client? A) Elevated blood lipid levels B) Hyperglycemia C) Pancreatitis D) Renal insufficiency
C
The nurse is counseling a couple who is planning a pregnancy. The woman was diagnosed with type 1 diabetes when she was 14 years old. She is now 27. Which examination should the nurse prepare the woman to have before, during, and after the pregnancy? A) Gastrointestinal examination for gastric hypotony B) Neural examination for diabetic peripheral neuropathy C) Eye examination for diabetic retinopathy D) Renal examination for urinary incontinence
C
The nurse is planning teaching for a client diagnosed with diabetic neuropathy. What should the nurse include in this teaching? A) Set the water heater at 120°F. B) Avoid hand and foot massages. C) Use a mirror to inspect feet daily. D) Increase medication for pain as necessary
C
The nurse is providing teaching to a client at risk for acquired peripheral neuropathy. Which of the following activities should the nurse suggest the client modify or avoid to reduce the risk of this condition? A) Working as an automobile mechanic on weekends B) Playing tennis every Saturday C) Drinking one six-pack of beer per day D) Typing on the computer for several hours each day
C
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
The nurse is planning care for a client admitted with diabetic ketoacidosis (DKA). On what should the nurse focus for this client's care? Select all that apply. A) Administration of oral glucose B) Monitoring for fluid volume overload C) Frequent blood glucose monitoring D) Intravenous fluid infusions E) Insulin infusion
C,D,E
When providing care to a client with a wound, which evidence-based interventions should the nurse anticipate carrying out? Select all that apply. A) Keeping the wound dry B) Only covering the wound if a scab forms C) Ensuring that the wound remains moist D) Keeping the wound covered E) Teaching the client that proper wound management can reduce scarring
C,D,E
The nurse is completing an assessment interview with an older adult client being seen for a yearly physical examination. Which client statement would indicate a possible diagnosis of diabetes mellitus? A) "I'm slightly winded when I walk up a flight of stairs, but it passes quickly." B) "I feel a bit tired by mid-afternoon and take a 30-minute nap most days." C) "I sometimes have muscle aches in my upper legs at night." D) "I've been experiencing increased thirst during the past several months."
D
What organism is most commonly responsible for cellulitis? A) Staphylococcus epidermidis B) Streptococcus pneumoniae C) Streptococcus viridans D) Staphylococcus aureus
D
Which goal would be most appropriate to include in the nursing care plan of a client with type 2 diabetes? A) The client will record daily fat intake. B) The client will use hand hygiene when toileting. C) The client will monitor fasting glucose levels. D) The client will inspect feet at least once daily.
D
Which potential cause of type 2 diabetes influences insulin's ability to regulate glucose metabolism and uptake by the liver, skeletal muscles, and adipose tissue? A) Viral infection B) Exposure to toxins C) Young age D) Obesity
D
Which statement regarding risk factors for peripheral neuropathy is accurate? A) Extremely short people are at the highest level of risk for developing peripheral neuropathy. B) Height is a risk factor for women but not a proven risk factor for men. C) Height is a risk factor for men but not a proven risk factor for women. D) Risk for peripheral neuropathy is proportional to height for both men and woman.
D
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
On which region of the body would the nurse most expect to observe erysipelas? A) Abdomen B) Ankles C) Neck D) Back
B
The destruction of which types of cells in the islets of Langerhans cause type 1 diabetes mellitus? A) Alpha cells B) Beta cells C) Delta cells D) Gamma cells
B
The nurse is caring for a 76-year-old client with type 2 diabetes who is recovering from surgery following a hip fracture. In addition to blood glucose level, what should the nurse recognize as a sign of hyperosmolar hyperglycemic state (HHS)? A) Excessive sweating B) Increased urine output C) Insomnia D) Edema
B
The nurse is caring for a client who has been diagnosed with orbital cellulitis. Which assessment finding should the nurse anticipate? A) Sunken eyes B) Edema of the affected eye C) Increased acuity of the affected eye D) Elevated blood pressure
B
The nurse is planning care for a client with type 2 diabetes mellitus. Which nursing diagnosis would be most appropriate for this client? A) Self Neglect B) Risk for Infection C) Risk for Decreased Cardiac Tissue Perfusion D) Impaired Tissue Integrity
B
The nurse is preparing to teach a client who is newly diagnosed with type 1 diabetes mellitus 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
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
A client with peripheral neuropathy complains of leg aches and the inability to be comfortable. Which nursing diagnosis would be a priority for the client at this time? A) Anxiety B) Ineffective Peripheral Tissue Perfusion C) Ineffective Coping D) Chronic Pain
D
The nurse is caring for a client who is admitted with cellulitis of the foot. Which assessment findings support this diagnosis? A) Blood urea nitrogen (BUN) and creatinine B) Breath sounds C) Blood cultures D) Redness, pain, and edema at the site
D
