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A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a fruity odor. Which action should the nurse take?
- A. Encourage the client to use an incentive spirometer.
- B. Increase the client's intravenous fluid flow rate.
- C. Consult the provider to test for ketoacidosis.
- D. Perform meticulous pulmonary hygiene care.
Correct Answer: C
Rationale: A fruity breath odor is a sign of ketoacidosis, common post-surgery due to stress-induced insulin suppression. Consulting the provider to test for ketoacidosis is the priority. Spirometry, increasing fluids, or pulmonary hygiene do not address this issue.
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After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?
- A. At my age, I should continue seeing the ophthalmologist as I usually do.
- B. I will see the eye doctor when I have a vision problem and yearly after age 40.
- C. My vision will change quickly, I should see the ophthalmologist twice a year.
- D. Diabetes can cause blindness, so I should see the ophthalmologist yearly.
Correct Answer: D
Rationale: Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist at diagnosis and at least yearly thereafter to monitor for retinopathy.
A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet should the nurse decrease?
- A. Carbohydrates
- B. Proteins
- C. Fats
- D. Total calories
Correct Answer: B
Rationale: Restricting dietary protein to 0.8 g/kg/day is recommended for clients with microalbuminuria to slow progression to renal failure. Carbohydrates, fats, or total calories do not need specific reduction in this context.
A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this client's teaching to prevent injury?
- A. Examine your feet using a mirror every day.
- B. Rotate your insulin injection sites every week.
- C. Check your blood glucose level before each meal.
- D. Use a bath thermometer to test the water temperature.
Correct Answer: D
Rationale: Clients with reduced sensation are at risk for burns from hot bathwater. Using a thermometer to check water temperature prevents injury. Daily foot checks, site rotation, and glucose monitoring are important but do not directly prevent burns.
A nurse cares for a client who has a family history of diabetes mellitus. The client states, 'My father has type 1 diabetes mellitus. Will I develop this disease as well?' How should the nurse respond?
- A. Your risk of diabetes is higher than the general population, but it may not occur.
- B. No genetic risk is associated with the development of type 1 diabetes mellitus.
- C. The risk for becoming diabetic is 50% because of how it is inherited.
- D. Female children do not inherit diabetes mellitus, but male children will.
Correct Answer: A
Rationale: Risk for type 1 diabetes is influenced by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Having a parent with type 1 diabetes increases the risk, but environmental factors also play a role, so not everyone with these genes develops diabetes. The other statements are inaccurate.
A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take?
- A. Assess for pain or burning with urination.
- B. Review the client's liver function study results.
- C. Instruct the client to increase water intake.
- D. Test a sample of urine for occult blood.
Correct Answer: B
Rationale: Thiazolidinediones like pioglitazone can affect liver function. Dark urine may indicate liver impairment due to increased bilirubin. Reviewing liver function studies is the priority. Assessing for urinary symptoms, increasing water intake, or testing for occult blood are not directly related to this issue.