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An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient?
- A. An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.
- B. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living.
- C. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.
- D. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.
Correct Answer: B
Rationale: The nurse recognizes that providing information on the long-term complications especially foot and eye problems associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs administered for diabetes.
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A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what?
- A. I read that a pancreas transplant will provide a cure for my diabetes.
- B. I will take my oral antidiabetic agents when my morning blood sugar is high.
- C. I will make sure to follow the weight loss plan designed by the dietitian.
- D. I will make sure I call the diabetes educator when I have questions about my insulin.
Correct Answer: C
Rationale: Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.
A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur?
- A. Patients who are obese and who have no known history of diabetes
- B. Patients with type 1 diabetes and poor dietary control
- C. Adolescents with type 2 diabetes and sporadic use of antihyperglycemics
- D. Middle-aged or older people with either type 2 diabetes or no known history of diabetes
Correct Answer: D
Rationale: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes.
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 patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients at this class?
- A. Low fat generally indicates low sugar.
- B. Protein should constitute 30% to 40% of caloric intake.
- C. Most calories should be derived from carbohydrates.
- D. Animal fats should be eliminated from the diet.
Correct Answer: C
Rationale: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.
A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient?
- A. Do not eliminate insulin when nauseated and vomiting.
- B. Report elevated glucose levels greater than 150 mg/dL.
- C. Eat three substantial meals a day, if possible.
- D. Reduce food intake and insulin doses in times of illness.
Correct Answer: A
Rationale: The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.