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A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient?
- A. Examine feet weekly for redness, blisters, and abrasions.
- B. Avoid the use of moisturizing lotions.
- C. Avoid hot-water bottles and heating pads.
- D. Dry feet vigorously after each bath.
Correct Answer: C
Rationale: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.
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A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis?
- A. Infection
- B. Acute pain
- C. Acute confusion
- D. Impaired urinary elimination
Correct Answer: A
Rationale: Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function.
A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply.
- A. Leukocytosis
- B. Glycosuria
- C. Dehydration
- D. Hypernatremia
- E. Hyperglycemia
Correct Answer: B,C,D,E
Rationale: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.
A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote?
- A. Always carry a form of fast-acting sugar.
- B. Perform exercise prior to eating whenever possible.
- C. Eat a meal or snack every 8 hours.
- D. Check blood sugar at least every 24 hours.
Correct Answer: A
Rationale: The following teaching points should be included in information provided to the patient on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.
A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address?
- A. Signs and symptoms of diabetic nephropathy
- B. Management of diabetic ketoacidosis
- C. Effects of surgery and pregnancy on blood sugar levels
- D. Recognition of hypoglycemia and hyperglycemia
Correct Answer: D
Rationale: It is imperative that newly diagnosed patients know the signs and symptoms and management of hypoand hyperglycemia. The other listed topics are valid points for education, but are not components of the patients immediate survival skills following a new diagnosis.
A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient?
- A. Make sure to stick to your normal diet.
- B. Try to eat small amounts of carbs, if possible.
- C. Ensure that you check your blood glucose every hour.
- D. For now, check your urine for ketones every 8 hours.
Correct Answer: B
Rationale: For prevention of DKA related to illness, the patient should attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours.