Chapter 64: Care of Patients with Diabetes Mellitus Ignatavicius: MedicalSurgical Nursing, 8th Edition

Chapter 64: Care of Patients with Diabetes Mellitus Ignatavicius: Medical- Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1.A nurse is teaching a client with diabetes mellitus who asks, “Why is it necessary to maintain my blood glu- cose levels no lower than about 60 mg/dL?” How should the nurse respond?

• “Glucose is the only fuel used by the body to produce the energy that it needs.”

• “Your brain needs a constant supply of glucose because it cannot store it.”

• “Without a minimum level of glucose, your body does not make red blood cells.”

• “Glucose in the blood prevents the formation of lactic acid and prevents acidosis.”

ANS: B

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 would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.

DIF:Remembering/KnowledgeREF:1301

KEY: Diabetes mellitus| hypoglycemia MSC: Integrated Process: Teaching/Learning

NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2.A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client’s polyuria?

a. Serum sodium: 163 mEq/L

b. Serum creatinine: 1.6 mg/dL

• Presence of urine ketone bodies

d. Serum osmolarity: 375 mOsm/kg

ANS: D

Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis.The client’s serum osmolarity is high. The client’s sodium would be expected to be high owing to dehydration.Serum creatinine and urine ketone bodies are not related to the polyuria.

DIF:Applying/ApplicationREF:1302

KEY:Diabetes mellitus| hyperglycemia

MSC:Integrated Process: Nursing Process: Analysis

NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3.After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?

• “At my age, I should continue seeing the ophthalmologist as I usually do.”

• “I will see the eye doctor when I have a vision problem and yearly after age 40.”

• “My vision will change quickly. I should see the ophthalmologist twice a year.”

• “Diabetes can cause blindness, so I should see the ophthalmologist yearly.”

ANS: D

Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of

age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.

DIF:Applying/ApplicationREF:1303

KEY: Diabetes mellitus| health screening MSC: Integrated Process: Teaching/Learning

NOT:Client Needs Category: Health Promotion

4.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?

• Document the finding in the client’s chart.

• Assess tactile sensation in the client’s hands.

• Examine the client’s feet for signs of injury.

• Notify the health care provider.

ANS: C

Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common loca- tions for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the client’s chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed.

DIF:Applying/ApplicationREF:1321

KEY:Diabetes mellitus| neuropathy

MSC:Integrated Process: Nursing Process: Analysis

NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential