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A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: Fasting blood glucose: 75 mg/dL, Postprandial blood glucose: 200 mg/dL, Hemoglobin A1c level: 5.5%. How should the nurse interpret these laboratory findings?
- A. Increased risk for developing ketoacidosis.
- B. Good control of blood glucose.
- C. Increased risk for developing hyperglycemia.
- D. Signs of insulin resistance.
Correct Answer: B
Rationale: These values (fasting glucose 75 mg/dL, A1c 5.5%) indicate good glycemic control in an intensified insulin regimen. Postprandial glucose of 200 mg/dL is slightly high but not indicative of ketoacidosis, hyperglycemia risk, or insulin resistance.
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An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition?
- A. Increased rate and depth of respiration.
- B. Extremity tremors followed by seizure activity.
- C. Oral temperature of 102°F (38.9°C).
- D. Severe orthostatic hypotension.
Correct Answer: A
Rationale: Kussmaul respirations (rapid, deep breathing) are a hallmark of diabetic ketoacidosis as the body attempts to compensate for metabolic acidosis by eliminating carbon dioxide. Tremors, fever, or orthostatic hypotension are not primary manifestations.
After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?
- A. I have so many complications, exercising is not recommended.
- B. I will exercise more frequently because I have so many complications.
- C. I used to run for exercise; I will start training for a marathon.
- D. I should look into swimming or water aerobics to get my exercise.
Correct Answer: D
Rationale: Swimming or water aerobics is a suitable exercise for clients with diabetic complications, as it minimizes foot injury risk. Vigorous exercise like marathon running or avoiding exercise altogether is not recommended.
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.
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.
A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this client's discharge education?
- A. Test your urine daily for ketones.
- B. Use only buffered insulin in your pump.
- C. Store the insulin in the freezer until you need it.
- D. Change the needle every 3 days.
Correct Answer: D
Rationale: Changing the needle every 3 days reduces infection risk with insulin pumps. Testing urine for ketones, using buffered insulin, or freezing insulin are not recommended practices.