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A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?
- A. A 29-year-old Caucasian.
- B. A 32-year-old African-American.
- C. A 40-year-old Asian-American.
- D. A 48-year-old American Indian.
Correct Answer: D
Rationale: Diabetes is more prevalent among African Americans, Hispanics, and American Indians, with risk increasing with age. A 48-year-old American Indian is at the highest risk due to both ethnic predisposition and age.
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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 cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, 'I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing.' How should the nurse respond?
- A. Following-Drug regimen more closely would have prevented this.
- B. One acute rejection episode does not mean that you will lose the new organs.
- C. Dialysis is a viable treatment option for you and may save your life.
- D. Since you are on the national registry, you can receive a second transplantation.
Correct Answer: B
Rationale: An acute rejection episode does not necessarily lead to organ loss, as immunosuppressive therapy can often manage it. Blaming the client, emphasizing dialysis, or discussing retransplantation is not supportive or accurate in this context.
A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin?
- A. 800
- B. 1600
- C. 2000
- D. 2300
Correct Answer: B
Rationale: NPH insulin peaks 4"?12 hours after administration (0700), so 1600 is within the peak time for potential hypoglycemia. 0800 is too early, and 2000/2300 are too late.
A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first?
- A. Document the finding in the client's chart.
- B. Assess tactile sensation in the client's hands.
- C. Examine the client's feet for signs of injury.
- D. Notify the health care provider.
Correct Answer: C
Rationale: Diabetic neuropathy is common in long-standing diabetes, increasing the risk of injury in areas with decreased sensation, such as the feet. Examining the feet for signs of injury is the priority to prevent complications like infections or ulcers. Documentation, assessing hand sensation, and notifying the provider should follow after the initial assessment.
After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
- A. The lower abdomen is the best location because it is closest to the pancreas.
- B. I can reach my thigh the best, so I will use the different areas of my thighs.
- C. By rotating the sites in one area, my chance of having a reaction is decreased.
- D. Changing injection sites from the thigh to the arm will change absorption rates.
Correct Answer: A
Rationale: The abdominal site has the fastest insulin absorption due to its blood supply, not proximity to the pancreas. The other statements are accurate regarding site rotation and absorption rates.