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A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best response?
- A. Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years.
- B. The cause is not known for sure but it is thought to have something to do with ketoacidosis.
- C. The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years.
- D. Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels.
Correct Answer: C
Rationale: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.
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An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?
- A. Administration of antihypertensive medications
- B. Administering sodium bicarbonate intravenously
- C. Reversing acidosis by administering insulin
- D. Fluid and electrolyte replacement
Correct Answer: D
Rationale: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).
A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the patient and will implement a program of health education. What is the nurses priority action?
- A. Ensure that the patient understands the basic pathophysiology of diabetes.
- B. Identify the patients body mass index.
- C. Teach the patient survival skills for diabetes.
- D. Assess the patients readiness to learn.
Correct Answer: D
Rationale: Before initiating diabetes education, the nurse assesses the patients (and familys) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.
A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the bodys need for insulin?
- A. Adequate sleep
- B. Low stimulation
- C. Exercise
- D. Low-fat diet
Correct Answer: C
Rationale: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.
A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor?
- A. Increased caloric intake during the first trimester
- B. Changes in osmolality and fluid balance
- C. The effects of hormonal changes during pregnancy
- D. Overconsumption of carbohydrates during the first two trimesters
Correct Answer: C
Rationale: Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality.
An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes?
- A. Ive always been a fan of sweet foods, but lately Im turned off by them.
- B. Lately, I drink and drink and cant seem to quench my thirst.
- C. No matter how much sleep I get, it seems to take me hours to wake up.
- D. When I went to the washroom the last few days, my urine smelled odd.
Correct Answer: B
Rationale: Classic clinical manifestations of diabetes include the three Ps: polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.