MED SURG 170 Exam 3 Evolve NCLEX Review- Galen College of Nursing

CHAPTER 64 1. 1.ID: 8 Which explanation best assists a client in differentiating type 1 diabetes from type 2 diabetes? A. Most clients with type 1 diabetes are born with it. B. People with type 1 diabetes are often obese. C. Those with type 2 diabetes make insulin, but in inadequate amounts. Correct D. People with type 2 diabetes do not develop typical diabetic complications. People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for complications, especially cardiovascular complications. 2. 2.ID: 8 The nurse receives report on a 52-year-old client with type 2 diabetes: Physical Assessment Diagnostic Findings Provider Prescriptions Lungs clear Glucose 179 mg/dL Regular insulin 8 units if blood glucose 250 to 275 mg/dL and cold to touch Right great toe mottled Hemoglobin A1c 6.9% Regular insulin 10 units if glucose 275 to 300 mg/dL Client states wears eyeglasses to read Which complication of diabetes does the nurse report to the provider? A. Poor glucose control B. Visual changes C. Respiratory distress D. Decreased peripheral perfusion Correct A cold, mottled toe may indicate arterial occlusion secondary to arterial occlusive disease or embolization; this must be reported to avoid potential gangrene and amputation. Although one glucose reading is elevated, the hemoglobin A1c indicates successful glucose control over the past 3 months. After the age of 40, reading glasses may be needed due to difficulty in accommodating to close objects. Lungs are clear and no evidence of distress is noted. 3. 3.ID: 6 A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client should be monitored for hypoglycemia at which time? A. 7:30 a.m. B. 11:00 a.m. Correct C. 2:00 p.m. D. 7:30 p.m. Onset of regular insulin is ½ to 1 hour; peak is 2 to 4 hours. Therefore, 11:00 a.m. is the anticipated peak time for regular insulin received at 7:00 a.m. For regular insulin received at 7:00 a.m., 7:30 a.m., 2:00 p.m., and 7:30 p.m. are not the anticipated peak times. 4. 4.ID: 0 A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client’s family? A. Causes and treatment of hyperglycemia B. Causes and treatment of hypoglycemia Correct C. Dietary control D. Insulin administration The causes and treatment of hypoglycemia must be understood by the client and family to manage the client’s diabetes effectively. The causes and treatment of hyperglycemia is a topic for secondary teaching and is not the priority for the client with diabetes. Dietary control and insulin administration are important, but are not the priority in this situation. 5. 5.ID: 2 The nurse is providing discharge teaching to a client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching? A. “I can break in my shoes by wearing them all day.” Correct B. “I need to monitor my feet daily for blisters or skin breaks.” C. “I should never go barefoot.” D. “I should quit smoking.” Shoes should be properly fitted and worn for a few hours a day to break them in, with frequent inspection for irritation or blistering. People with diabetes have decreased peripheral circulation, so even small injuries to the feet must be managed early. Going barefoot is contraindicated. Tobacco use further decreases peripheral circulation in a client with diabetes.