Which Statement Indicates That a Client with Diabetes Mellitus Understands Proper Foot C Care

1) A nu rse i s de ve lo pi ng a te ac hi ng plan f or a cl ie nt w it h diabet es mell it us . A c li en t with d ia be te s melli tu s sh ou ld 1 use commercial preparations to remove corns. 2 cut the toenails by rounding edges. 3 wash and inspect the feet daily. 4 walk barefoot at least once each day. Answer 3 A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed straight across. Clients with diabetes mellitus should never walk barefoot. 2) Which wo ul d be in cl uded in the tea ch ing pla n for a client diagnose d with d iabetes melli tu s? 1 An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. 2 Sugar is found only in dessert foods. 3 The only diet change needed in the treatment of diabetes is to stop eating sugar. 4 Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued. Answer 1 Diabetic retinopathy is the leading cause of blindness among people between 20 and 74 years of age in the United States; it occurs in both type 1 and type 2 diabetes. When blood glucose is well controlled, the potential for complications of diabetes is reduced. Several types of foods contain sugar, including cereals, sauces, salad dressings, fruits, and fruit juices. It is not feasible, nor advisable, to remove all sources of sugar from the diet. If the diabetes had been well controlled without insulin before the period of acute stress causing the need for insulin, the client may be able to resume previous methods for control of diabetes when the stress is resolved. 3) A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? 1 How to control blood glucose through lifestyle modification with diet and exercise 2 How to self-inject insulin 3 How to monitor ketones daily 4 How to recognize signs of diabetic ketoacidosis Answer 1 Persons at high risk for type 2 diabetes receive standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo, or an intensive program of lifestyle modifications. The 16-lesson curriculum of the intensive program of lifestyle modifications focuses on reducing weight by more than 7% of initial body weight and moderate-intensity physical activity. It also includes behavior modification strategies designed to help clients achieve the goals of weight reduction and participation in exercise. These findings demonstrate that type 2 diabetes can be prevented or delayed in persons at high risk for the disease. 4) An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? 1 A faulty heater 2 Autonomic neuropathy 3 Peripheral neuropathy 4 Sudomotor neuropathy Answer 3 As the neuropathy progresses, the feet become numb. In addition, a decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) and a decreased sensation of light touch may lead to an unsteady gait. Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections. 5) A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse would administer the insulin at which site as the preferred site? 1 Arms 2 Thighs 3 Abdomen 4 Upper buttock Answer 3 Although the arms, thighs, and lower back can be used, the preferred site insulin administration is the abdomen which allows more rapid absorption. 6) The greatest percentage of people have which type of diabetes? 1 Type 2 2 Type 1 3 Gestational 4 Impaired glucose tolerance Answers 1 Type 2 diabetes accounts for 90% to 95% of all diabetes. Type 1 accounts for 5% to 10% of all diabetes. Gestational diabetes has an onset during pregnancy. Impaired glucose tolerance is defined as an oral glucose tolerance test value between 140 mg/dL and 200 mg/dL. 7) A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? 1 "I'm thirsty all the time. I just can't get enough to drink." 2 "It seems like I have no appetite. I have to make myself eat." 3 "I have a cough and cold that just won't go away." 4 "I notice pain when I urinate." Answer 1 Classic signs and symptoms of diabetes mellitus are polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive appetite). Decreased appetite, lingering cough and cold, and pain on urination aren't related to diabetes. Decreased appetite reflects a GI disorder; cough and cold indicate an upper respiratory problem; and pain on urination suggests a urinary tract infection. 8) A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the: 1 adenohypophysis. 2 beta cells of the pancreas. 3 alpha cells of the pancreas. 4 parafollicular cells of the thyroid. Answer 2 The beta cells of the pancreas secrete insulin. The adenohypophysis, or anterior pituitary gland, secretes many hormones, such as growth hormone, prolactin, thyroid-stimulating hormone, corticotropin, follicle-stimulating hormone, and luteinizing hormone, but not insulin. The alpha cells of the pancreas secrete glucagon, which raises the blood glucose level. The parafollicular cells of the thyroid secrete the hormone calcitonin, which plays a role in calcium metabolism. 9) A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? 1 Maintenance of blood glucose levels between 180 and 200 mg/dl 2 Smoking reduction but not complete cessation 3 An eye examination every 2 years until age 50 4 Weight reduction through diet and exercise Answer 4 Type 2 diabetes is commonly obesity-related; therefore, weight reduction may enhance the normalization of the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke at all because of the increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy. 10.) When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: 1 "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." 2 "The circulation in your feet can help us determine how severe your diabetes is." 3 "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." 4 "It's easier to get foot infections if you have diabetes." Answer 3 The nurse should make the client aware that diabetes affects sensation in the feet and that he might hurt his foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infection or stating that the circulation in the client's feet indicates the severity of his diabetes doesn't provide the client with complete information. 11.) Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? 1 Ketones 2 Creatinine 3 Hemoglobin 4 Cholesterol Answer 1 Ketones are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not by-products of fat breakdown. 12.) A controlled type 2 diabetic client states, “The doctor said if my blood sugars remain stable, I may not need to take any medication.” Which response by the nurse is most appropriate? 1 "Diet, exercise, and weight loss can eliminate the need for medication." 2 "You will be placed on a strict low-sugar diet for better control." 3 "Some doctors do not treat blood sugar elevation until symptoms appear." 4 "You misunderstood the doctor. Let's ask for clarification." Answer 1 Dieting, exercise, and weight loss can control and/or delay the need for medication to treat type 2 diabetes mellitus in some clients. Because the client is controlling blood sugars, changing the diet is not indicated. Controlling blood glucose levels will prevent multisystem complications and should be the mainstay of treatment for diabetes mellitus. Although clarification is appropriate, stating the client misunderstood can close the line of communication between client and nurse. 13.) A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? 1 Finger 2 Upper arm 3 Thigh 4 Forearm Answer 1 Even though the fingertips have a higher number of nerve endings, this site provides the most accurate blood sugar reading. Alternate sites, such as upper arm, forearm, and thighs are regarded as lagging test sites and are not an option for people who require tight glucose control. 14.) A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results? 1 Less than 70 mg/dL (3.7 mmol/L) 2 Between 70 and 75 mg/dL (3.9 to 4.16 mmol/L) 3 Between 75 and 90 mg/dL (4.16 to 5.00 mmol/L) 4 95 mg/dL (5.27 mmol/L) Answer 1 Hypoglycemia means low (hypo) sugar in the blood (glycemia), and occurs when the blood glucose level falls to less than 70 mg/dL (3.7 mmol/L). Severe hypoglycemia is when glucose levels are less the 40 mg/dL (2.5 mmol/L). 15.) A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? 1 Inserting a feeding tube and providing tube feedings 2 Administering a 500-ml bolus of normal saline solution 3 Administering 1 ampule of 50% dextrose solution, per physician's order 4 Observing the client for 1 hour, then rechecking the fingerstick glucose level Answer 3 The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the muchneeded glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage. 16.) After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? 1 Serum potassium level 2 Serum calcium level 3 Serum sodium level 4 Serum chloride level Answer 1 The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias. 17.) A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client’s glycosylated hemoglobin test results. Which result would indicate to the nurse that the client’s blood glucose level has been well controlled? 1 6.5% 2 7.5% 3 8.0% 4 8.5% Answer 1 Normally, the level of glycosylated hemoglobin is less than 7%. Thus, a level of 6.5% would indicate that the client's blood glucose level is well controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dl. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months. 18.) A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client’s symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? 1 Assess the client's ability to take a deep breath 2 Assess the client's ability to move all extremities 3 Assess the client's breath odor 4 Assess for excessive sweating Answer 3 DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue, with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the client’s breath will help the nurse confirm the diagnosis. 19.) A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? 1 Recent weight gain of 20 lb (9.1 kg) 2 Failure to monitor blood glucose levels 3 Skipping insulin doses during illness 4 Crying whenever diabetes is mentioned Answer 4 A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus. 20.) Which statement indicates that a client with diabetes mellitus understands proper foot care? 1 "I'll schedule an appointment with my physician if my feet start to ache." 2 "I'll rotate insulin injection sites from my left foot to my right foot." 3 "I'll go barefoot around the house to avoid pressure areas on my feet." 4 "I'll wear cotton socks with well-fitting shoes." Answer 4 The client demonstrates understanding of proper foot care if he states that he'll wear cotton socks with well-fitting shoes because cotton socks wick moisture away from the skin, helping to prevent fungal infections, and well-fitting shoes help avoid pressure areas. Aching isn't a common sign of foot problems; however, a tingling sensation in the feet indicates neurovascular changes. Injecting insulin into the foot may lead to infection. The client shouldn't go barefoot. Doing so can cause injury. 21.) A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes? 1 increased thirst, hunger, and urination 2 Increased weight loss, dehydration, and fatigue 3 Loss of appetite, increased urination, and dehydration 4 Increased weight gain, appetite, and thirst Answer 1 The three classic symptoms of both types of diabetes mellitus are polyuria, polydipsia, and polyphagia. Weight loss, dehydration, and fatigue are additional symptoms. 22.) Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? 1 Blood glucose can be controlled through diet and exercise 2 Client is usually thin at diagnosis 3 Client is prone to ketosis 4 Clients demonstrate islet cell antibodies Answer 1 Oral hypoglycemic agents may improve blood glucose concentrations if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection. Individuals with type 2 diabetes do not demonstrate islet cell antibodies. 23.) A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: 1 hypoglycemia 2 polyuria 3 blurred vision 4 polydipsia Answer 1 The nurse should observe the client receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. 24.) The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? 1 Provides best information on the body's ability to maintain normal blood functioning 2 Best indicator for the nutritional state of the client 3 Is less costly than performing daily blood sugar test 4 Reflects the amount of glucose stored in hemoglobin over past several months. Answer 4 Hemoglobin A1c tests reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. This test provides a more accurate picture of overall glucose control in a client. Glycosylated hemoglobin test does not indicate normal blood functioning or nutritional state of the client. Self-monitoring with a glucometer is still encouraged in clients who are taking insulin or have unstable blood glucose levels. 25.) A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance? 1 glycosylated hemoglobin 2 hematocrit B1C 3 postprandial glucose 4 CAT scan Answer 1 Once a client with diabetes receives a treatment regimen to follow, the physician can assess the effectiveness of treatment and the client's compliance by obtaining a hemoglobin A1c test. The results of this test reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. Normally, the level of glycosylated hemoglobin is less than 7%. Amounts of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.