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A nurse cares for a client who has type 1 diabetes mellitus. The client asks, 'Is it okay for me to have an occasional glass of wine?' How should the nurse respond?
- A. Drinking any wine or alcohol will increase your insulin requirements.
- B. Because of poor kidney function, people with diabetes should avoid alcohol.
- C. You should not drink alcohol because it will make you hungry and overeat.
- D. One glass of wine is okay with a meal and is counted as two fat exchanges.
Correct Answer: D
Rationale: Moderate alcohol, like one glass of wine with a meal, is acceptable for well-controlled diabetes and is counted as two fat exchanges. Alcohol does not directly increase insulin needs, affect kidney function in this context, or necessarily cause overeating.
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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.
A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has a capillary blood glucose of 33 mg/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first?
- A. Administer 1 mg of intramuscular glucagon.
- B. Encourage the client to drink orange juice.
- C. Insert a new intravenous access line.
- D. Administer 25 mL dextrose 50% (D50) IV push.
Correct Answer: A
Rationale: The client's severe hypoglycemia (blood glucose 33 mg/dL) and unresponsiveness require immediate treatment. Intramuscular glucagon is the priority since the IV line is infiltrated, and oral intake is not feasible. Inserting a new IV or administering D50 IV can follow once access is restored.
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 about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections?
- A. Wash your hands after completing each test.
- B. Do not share your monitoring equipment.
- C. Wipe excess blood from the strip with a cotton ball.
- D. Use gloves when monitoring your blood glucose.
Correct Answer: B
Rationale: Sharing monitoring equipment can transmit bloodborne infections like hepatitis B, which can survive in dried blood. Not sharing equipment is critical. Washing hands before testing, not after, is recommended. Wiping blood with a cotton ball or using gloves is not standard practice for preventing infections.
After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional education?
- A. If I develop an infection, I should stop taking my corticosteroid.
- B. If I have pain over the transplant site, I will call the surgeon immediately.
- C. I should avoid people who are ill or who have an infection.
- D. I should take my cyclosporine exactly the way I was taught.
Correct Answer: A
Rationale: Stopping corticosteroids during an infection without consulting the transplant physician can endanger the graft. The other statements are correct, as pain may indicate rejection, avoiding infections is crucial, and adherence to cyclosporine is essential.