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A client with type 2 diabetes is informed of being unable to have a pancreatic transplant and asks the nurse why this is. Which reason would the nurse provide to the client?
- A. Increased risk for urologic complications
- B. Need for exocrine enzymatic drainage
- C. Underlying problem of insulin resistance
- D. Need for lifelong immunosuppressive therapy
Correct Answer: C
Rationale: Clients with type 2 diabetes have insulin resistance, which a pancreas transplant does not address, as the issue lies in tissue response rather than insulin production. Urologic complications and exocrine drainage are not primary reasons, and while immunosuppressive therapy is required, it is not specific to type 2 diabetes.
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The nurse is providing information about foot care to a client with diabetes. Which instruction would the nurse include?
- A. Wash your feet in hot water every day.
- B. Use a razor to remove corns or calluses.
- C. Be sure to apply a moisturizer to feet daily.
- D. Wear well-fitting comfortable rubber shoes.
Correct Answer: C
Rationale: The nurse should advise the client to apply a moisturizer to the feet daily to prevent dryness and cracking, which can lead to infections. Using warm, not hot, water is recommended to avoid burns due to potential reduced sensation. Razors should be avoided to prevent injury and infection. Well-fitting shoes are important, but rubber shoes can cause perspiration and increase infection risk.
The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?
- A. Increases ability for glucose to get into the cell and lowers blood sugar
- B. Creates an overall feeling of well-being and lowers risk of depression
- C. Decreases need for pancreas to produce more cells
- D. Decreases risk of developing insulin resistance and hyperglycemia
Correct Answer: A
Rationale: Exercise enhances glucose uptake by increasing transmembrane glucose transporters in muscles, lowering blood sugar levels. While it may improve well-being and reduce insulin resistance, the primary benefit for diabetes management is improved glucose transport into cells.
A client asks why pancreas transplantation is not an option offered to all insulin-dependent clients with diabetes. Which is the best response by the nurse?
- A. Type 1 diabetes can be managed in most clients with insulin.
- B. Pancreas transplant is becoming more common.
- C. There is a long waiting list to receive a new pancreas.
- D. For every transplant, two deceased donors are needed.
Correct Answer: A
Rationale: Type 1 diabetes is manageable with insulin, and the risks of lifelong immunosuppression from transplantation often outweigh benefits. Pancreas transplants are not increasingly common, waiting lists are not the primary issue, and only one donor is needed.
A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?
- A. Metformin
- B. Glyburide
- C. Repaglinide
- D. Glipizide
Correct Answer: A
Rationale: Metformin, a biguanide, enhances insulin sensitivity in tissues, improving glucose uptake. Glyburide, glipizide (sulfonylureas), and repaglinide (meglitinide) stimulate insulin release from the pancreas, not tissue sensitivity.
A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA?
- A. Give prescribed antiemetics.
- B. Begin fluid replacements.
- C. Administer prescribed dose of insulin.
- D. Administer bicarbonate to correct acidosis.
Correct Answer: B
Rationale: In DKA, correcting dehydration and electrolyte imbalances with fluid replacement is the first priority to stabilize the patient before addressing hyperglycemia with insulin. Antiemetics and bicarbonate are secondary, and insulin requires a physician's order.