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A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching?
- A. When ill, avoid eating or drinking to reduce vomiting and diarrhea.
- B. Monitor your blood glucose levels at least every 4 hours while sick.
- C. If vomiting, do not use insulin or take your oral antidiabetic agent.
- D. Continue your prescribed exercise regimen even if you are sick.
Correct Answer: B
Rationale: Monitoring blood glucose every 4 hours during illness helps manage fluctuations. Continuing medications, eating as tolerated, and avoiding exercise during illness are also recommended, making the other options incorrect.
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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.
A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications?
- A. Maintain tight glycemic control and prevent hyperglycemia.
- B. Prevent hypoglycemia with insulin.
- C. Restrict your fluid intake to no more than 2 liters a day.
- D. Limit your intake of protein to prevent ketoacidosis.
Correct Answer: A
Rationale: Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control helps delay the onset of microvascular and macrovascular complications. Fluid restriction, preventing hypoglycemia, and limiting protein are not the primary strategies for this goal.
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 assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a fruity odor. Which action should the nurse take?
- A. Encourage the client to use an incentive spirometer.
- B. Increase the client's intravenous fluid flow rate.
- C. Consult the provider to test for ketoacidosis.
- D. Perform meticulous pulmonary hygiene care.
Correct Answer: C
Rationale: A fruity breath odor is a sign of ketoacidosis, common post-surgery due to stress-induced insulin suppression. Consulting the provider to test for ketoacidosis is the priority. Spirometry, increasing fluids, or pulmonary hygiene do not address this issue.
A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, 'Can I ask my niece to prefill my syringes and then store them for later use when I need them?' How should the nurse respond?
- A. Yes, prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up.
- B. Yes, syringes can be filled with insulin and stored for a month in a location that is protected from light.
- C. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes.
- D. No, insulin syringes cannot be prefilled and stored for any length of time outside of the container.
Correct Answer: A
Rationale: Insulin in prefilled plastic syringes is stable for up to 3 weeks when refrigerated, stored vertically with the needle up to prevent clogging. The other options are incorrect regarding storage duration, material, or stability.