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A nurse is inspecting the feet of a client with diabetes and finds a tack sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding?
- A. In diabetes, the autonomic nerves are affected.
- B. Motor neuropathy causes muscles to weaken and atrophy.
- C. High blood sugar decreases blood circulation to nerves.
- D. Nephropathy is a common complication of diabetes mellitus.
Correct Answer: C
Rationale: Diabetic neuropathy, caused by high blood sugar reducing nerve blood flow, leads to loss of sensation, explaining the client's unawareness of the tack. Autonomic neuropathy affects organs, motor neuropathy causes muscle weakness, and nephropathy affects kidneys, not peripheral sensation.
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The nurse is caring for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). Which assessment finding should the nurse address immediately?
- A. Hypotension
- B. Blood pH 7.38
- C. Mental changes
- D. Fever
Correct Answer: A
Rationale: Hypotension in HHNKS indicates significant fluid loss from the extracellular compartment, requiring urgent correction to prevent coma or death. A normal pH (7.38) is not a concern, and while mental changes and fever are symptoms, they are less immediately life-threatening than fluid imbalance.
The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order?
- A. Provides best information on the body's ability to maintain normal blood functioning
- B. Best indicator for the nutritional state of the client.
- C. Is less costly than performing daily blood sugar test
- D. Reflects the amount of glucose stored in hemoglobin over past several months
Correct Answer: D
Rationale: Glycosylated hemoglobin (HbA1c) measures glucose bound to hemoglobin over its 120-day lifespan, reflecting long-term glucose control. It does not assess overall blood functioning, nutritional status, or cost relative to daily testing, which is still necessary for insulin-dependent clients.
Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus?
- A. With diabetes, drinking more results in more urine production.
- B. Increased ketones in the urine promote the manufacturing of more urine.
- C. High sugar pulls fluid into the bloodstream, which results in more urine production.
- D. The body's requirement for fuel drives the production of urine.
Correct Answer: C
Rationale: High blood glucose levels increase blood osmolality, pulling fluid into the vascular system, which leads to increased urine production (polyuria) as the kidneys attempt to excrete excess glucose. This triggers thirst (polydipsia), not vice versa. Ketones and fuel requirements do not directly cause polyuria.
The nurse is teaching an older client how to self-administer insulin. Which of the following would be most helpful to the client who is having difficulty drawing up the correct dosage of insulin in the syringe?
- A. Syringe magnifier
- B. Insulin pen
- C. Jet injector
- D. Insulin pump
Correct Answer: A
Rationale: A syringe magnifier is a cost-effective and simple tool to help older clients with visual or dexterity issues accurately draw insulin doses. Insulin pens require precise dialing, which may be challenging, and jet injectors and insulin pumps are more complex and costly, potentially unsuitable for older clients.
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?
- A. Glargine
- B. Regular
- C. NPH
- D. Lente
Correct Answer: B
Rationale: Regular insulin is used intravenously for DKA due to its rapid onset and ability to be infused continuously. Glargine, NPH, and Lente are long- or intermediate-acting insulins administered subcutaneously, unsuitable for acute DKA management.