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A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 500 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria?
- A. Serum sodium: 116 mg/dL.
- B. Serum creatinine: 1.6 mg/dL.
- C. Presence of urine ketone bodies.
- D. Serum osmolarity: 375 mOsm/kg.
Correct Answer: D
Rationale: Hyperglycemia causes hyperosmolarity of extracellular fluid, leading to polyuria from osmotic diuresis. The client's serum osmolarity is high, which correlates with polyuria. Serum sodium would be expected to be high due to dehydration, not low. Serum creatinine and urine ketone bodies are not directly related to polyuria in this context.
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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 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.
After teaching a client with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
- A. I need to have an annual appointment even if my glucose levels are in good control.
- B. Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick.
- C. I can still develop complications even though I do not have to take insulin at this time.
- D. If I have surgery or get very ill, I may have to receive insulin injections for a short time.
Correct Answer: B
Rationale: Clients with type 2 diabetes need annual checkups to monitor for complications, regardless of control method. The other statements are accurate regarding complication risks and potential insulin needs.
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.
After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
- A. I should increase my intake of vegetables with higher amounts of dietary fiber.
- B. My intake of saturated fats should be no more than 10% of my total calories.
- C. I should decrease my intake of protein and eliminate carbohydrates from my diet.
- D. My intake of water is not restricted by my treatment plan or medication regimen.
Correct Answer: C
Rationale: Eliminating carbohydrates is incorrect; complex carbohydrates should be included in a diabetic diet. Protein reduction may be needed with microalbuminuria, but not elimination. The other statements are correct.