BIOLOGY102Medical-Surgical Nursing Critical Thinking in Client Care, CHAPTER 20

Medical-Surgical Nursing Critical Thinking in Client Care, 4th Edition Priscilla LeMon

CHAPTER 20

1. The client with diabetes mellitus reports having difficulty cutting his toenails. The nurse assesses the toenails and notes the nails are thick and ingrown. Which of the following recommendations should be provided to the client?

a. Cut the nails straight across with a clipper after the bath.

b. Make an appointment with a nail shop for a pedicure.

c. Make an appointment with a podiatrist.

d. Offer to file the tops of the nails to reduce thickness after cutting.

Hint: Foot Care Teaching Session

Strategy: Employ knowledge of the complications associated with diabetes mellitus and the process of elimination to make the correct selection.

Objective: Provide accurate information to clients with diabetes mellitus to facilitate self-management of medications, diet planning, exercise, and self-assessment, including foot care.

2. The diabetic client reports the presence of corns, and asks for information about preventing the condition. What is the best response by the nurse to the client’s inquiry?

a. “You will need to make sure that you select shoes that are appropriately fitted.”

b. “You can use corn pads to gradually remove the growths.”

c. “Corns are best treated by shaving them off.”

d. “You can use a mild abrasive soap to scrub the area to remove them.”

Hint: Food Care Teaching Session

Strategy: Use the nursing process and the process of elimination to make the correct selection.

Objective: Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 diabetes mellitus.

3. A client at risk for the development of type 2 diabetes mellitus asks why weight loss will reduce risk of the condition. Which of the following responses by the nurse is most correct?

a. “The amount of foods taken in require more insulin to adequately metabolize them, resulting in diabetes.”

b. “Excess body weight impairs the body’s release of insulin.”

c. “Thin people are less likely to become diabetic.”

d. “The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin.”

Hint: Risk Factors

Strategy: Utilize knowledge of diabetes and therapeutic communication to make the correct selection.

Objective: Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 diabetes mellitus.

4. A client has been recently diagnosed with type 1 diabetes mellitus. The client is making statements that signal denial of the problem. The client states, “I am thin and eat all of the time, how can this mean I have diabetes?” Which of the following responses by the nurse is most appropriate?

a. “Thin people are diabetic too.”

b. “Your condition makes it impossible for you to gain weight.”

c. “You are eating large quantities because your condition makes it difficult for your body to obtain energy from the foods taken in.”

d. “Your lab tests indicate the presence of diabetes.”

Hint: Manifestations

Strategy: Utilize the principles of therapeutic communication and knowledge of diabetes to make the correct selection.

Objective: Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 diabetes mellitus.

5. The nurse notes the laboratory testing performed on a 78-year-old client reveal a serum glucose level of 130 mg/dL. The nurse performs an assessment on the client and notes the absence of polyuria, polydipsia, or polyphagia. Which of the following impressions by the nurse is most correct?

a. The client might have eaten a meal with high sugar content prior to the testing.

b. The laboratory results might be erroneous.

c. The client has type 1 diabetes mellitus.

d. The client will need to be assessed for other manifestations.

Hint: Diabetes in the Older Adult

Strategy: Utilize knowledge of elder care and diabetes to make the correct selection.

Objective: Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 diabetes mellitus.

6. A nurse is acting as a preceptor for a new graduate nurse. One of the patients assigned to their care is a 41-year-old client whose laboratory test results reveal a fasting serum blood glucose level of 125 mg/dL. The graduate nurse asks the nurse what this means. Which of the following statements by the nurse is most correct?

a. “These results must be called to the physician.”

b. “This client has diabetes.”

c. “These results are normal.”

d. “The results are consistent with prediabetes.”

Hint: Interdisciplinary Care

Strategy: Utilize knowledge of laboratory testing and diabetes to make the correct selection.

Objective: Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 diabetes mellitus.

7. A client recently diagnosed with diabetes reports hearing it is more economical to use urine dipsticks instead of monitoring blood levels with a glucometer. Which response by the nurse is most correct?

a. “Urine dipstick testing is best when combined with serum testing.”

b. “Urine dipstick testing is not reliable.”

c. “You are right.”

d. “Would you like to switch to this method of monitoring?”

Hint: Monitoring Blood Glucose

Strategy: Employ knowledge of diagnostic testing and diabetes to select the correct answer.

Objective: Identify the diagnostic tests used for screening, diagnosis, and monitoring of diabetes mellitus.

8. The nurse is caring for a client with type 1 diabetes mellitus. The client reports feeling “flu-like”. The client reports he does believe he should take the scheduled morning insulin in light of these feelings. What action by the nurse is best at this time?

a. Contact the physician.

b. Encourage the client to take the insulin.

c. Document the refusal and continue on with the planned care.

d. Do nothing.

Hint: Insulin

Strategy: Utilize knowledge of diabetes and make the correct answer selection.

Objective: Discuss the nursing implications for insulin and oral hypoglycemic agents used to treat clients with diabetes mellitus.

COGNITIVE LEVEL: Application

9. A client recently diagnosed with diabetes has been hospitalized for insulin regulation. The client states he has begun to notice blurred vision, and is concerned about losing his sight as a result of his disease. What response by the nurse is most appropriate?

a. “I will make an appointment for you to see an ophthalmologist.”

b. “I will call the physician.”

c. “It is nothing.”

d. “This is a common reaction when insulin therapy is initiated.”

Hint: Insulin

Strategy: Utilize knowledge of insulin therapy and the process of elimination to make the correct selection.

Objective: Compare and contrast the manifestations and interdisciplinary care of hypoglycemia, diabetic ketoacidosis, and hyperosmolar hyperglycemic state.

10. The client reports feeling nervous and shaky. Upon assessment, the nurse notes the client is diaphoretic and the heart rate is 112 beats/minute. Which of the following actions by the nurse should be taken first?

a. Provide the client with a snack of milk and crackers.

b. Administer insulin utilizing the sliding scale dosages.

c. Contact the laboratory and order a serum glucose level.

d. Use the glucometer and obtain a glucose level reading.

Hint: Insulin

Strategy: Utilize knowledge of diabetes and the process of elimination to make the correct selection.

Objective: Identify the diagnostic tests used for screening, diagnosis, and monitoring of diabetes mellitus.

11. The nurse is preparing to administer pork insulin to an underweight client. Which of the following techniques should be observed when planning this therapy? Select all that apply.

a. Inject insulin that is at room temperature.

b. Make sure no air bubbles are present in the syringe.

c. Massage the site of insertion.

d. Rotation within sites

e. Insert the needle at a 90-degree angle.

Hint: Preparing the Injection

Strategy: Utilize knowledge of insulin administration practices and the process of elimination to make the correct selection.

Objective: Discuss the nursing implications for insulin and oral hypoglycemic agents used to treat clients with diabetes mellitus.