Nokea
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.
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A nurse is teaching a client with diabetes mellitus who asks, 'Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?' How should the nurse respond?
- A. Glucose is the only fuel used by the body to produce the energy that it needs.
- B. Your brain needs a constant supply of glucose because it cannot store it.
- C. Without a minimum level of glucose, your body does not make red blood cells.
- D. Glucose in the blood prevents the formation of lactic acid and prevents acidosis.
Correct Answer: B
Rationale: Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse should educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not directly involved in the production of red blood cells. Glucose in the blood does not directly prevent lactic acid formation.
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 is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted?
- A. Serum potassium level has increased.
- B. Blood osmolarity has decreased.
- C. Glasgow Coma Scale score is unchanged.
- D. Urine remains negative for ketone bodies.
Correct Answer: C
Rationale: An unchanged Glasgow Coma Scale score indicates no improvement in consciousness, suggesting inadequate fluid replacement in HHS. Increased potassium, decreased osmolarity, and negative ketones are expected or not indicative of treatment failure.
A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: Insulin glargine: 12 units daily at 1800, Regular insulin: 6 units QID at 0600, 1200, 1800, 2400. Based on the client's medication administration record, which action should the nurse take?
- A. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.
- B. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin.
- C. Draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together.
- D. Inject first the glargine and then the regular insulin right afterward.
Correct Answer: A
Rationale: Insulin glargine cannot be mixed with other insulins. Administering glargine first, followed by regular insulin as separate injections, is correct to avoid mixing and ensure proper action.
A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take?
- A. Apply ice to the site to reduce inflammation.
- B. Consult the provider for a new administration route.
- C. Assess the client for other signs of cellulitis.
- D. Instruct the client to rotate sites for insulin injection.
Correct Answer: D
Rationale: The spongy, swollen area suggests lipohypertrophy from repeated injections at the same site. Rotating injection sites prevents this complication. Ice, a new route, or assessing for cellulitis are not appropriate for lipohypertrophy.