, 1. A client who has recently been admitted with new-onset type 2 diabetes is
preparing for discharge and will be provided with a blood glucose meter for
self-monitoring of blood glucose (SMBG) levels. The client has limited
experience using the device and needs to learn how to obtain an accurate
blood glucose reading independently. When is the best time for the nurse to
explain and demonstrate the proper use of the glucose monitor?
Correct answer: While performing the test in the hospital
Rationale: Teaching the client while performing the actual test allows the nurse to
provide hands-on instruction in a real clinical situation. The nurse can demonstrate
each step, observe the client's technique, and immediately correct errors that could
affect the accuracy of future readings. This approach also allows the client to practice
using the equipment before discharge and ask questions about the procedure.
2. An intensive care client with diabetic ketoacidosis (DKA) is receiving an
intravenous insulin infusion to reduce the blood glucose level and correct the
metabolic abnormalities associated with DKA. During continuous cardiac
monitoring, the nurse observes ventricular ectopy, which may indicate an
electrolyte disturbance affecting cardiac conduction. Which laboratory
assessment is most important for the nurse to obtain immediately?
Correct answer: Potassium level
Rationale: Insulin drives potassium from the extracellular space into the cells,
which can cause or worsen hypokalemia during treatment of DKA. Low potassium
levels can produce ventricular dysrhythmias and may explain the ventricular ectopy
observed on the cardiac monitor. The nurse should therefore assess the serum
potassium level promptly and anticipate appropriate potassium replacement or
adjustment of therapy based on the result.
3. A client with type 2 diabetes who is taking metformin (Glucophage) is seen in
the diabetic clinic for follow-up. The client's fasting blood glucose is 108
mg/dL (6.0 mmol/L), which is within the expected target range, but the
, glycosylated hemoglobin (HbA1C) is elevated at 8.2%, indicating inadequate
overall glycemic control. Which action should the nurse take next to
determine possible reasons for the elevated HbA1C?
Correct answer: Ask the client about current dietary intake and medication
use.
Rationale: HbA1C reflects the client's average blood glucose control over
approximately the previous 2 to 3 months, so a single normal fasting glucose does
not necessarily indicate adequate long-term control. The nurse should assess the
client's dietary habits and medication-taking patterns to identify possible causes of
persistent hyperglycemia. This assessment may reveal missed doses, inappropriate
food choices, inconsistent meal patterns, or other factors contributing to the
elevated HbA1C.
4. The nurse is providing discharge teaching to a client with type 2 diabetes and
peripheral neuropathy. Because decreased sensation in the feet increases
the risk for unnoticed burns, pressure injuries, and other wounds, the nurse
emphasizes proper footwear and gradual adjustment to new shoes. Which
statement by the client indicates a need for further teaching about
preventing foot injuries?
Correct answer: "I can break in my shoes by wearing them all day."
Rationale: A client with peripheral neuropathy should not wear new shoes for an
entire day because pressure or friction may cause an injury that the client cannot
feel. New shoes should be worn for short periods initially, with the feet inspected
frequently for redness, blisters, or other areas of irritation. Gradually increasing the
wearing time helps reduce the risk of pressure-related skin breakdown and diabetic
foot complications.
5. A client with type 1 diabetes arrives in the emergency department reporting
difficulty breathing and stating, "I can't catch my breath." The client's
temperature is 98.4°F (36.9°C), pulse is 112 beats/min, respirations are 38
, breaths/min, blood pressure is 91/54 mm Hg, and oxygen saturation is 99%
on room air. The client is tachypneic and hypotensive, raising concern for a
serious metabolic complication of diabetes. Which assessment should the
nurse perform first?
Correct answer: Check the blood glucose.
Rationale: The client's type 1 diabetes, deep and rapid respirations, tachycardia,
and hypotension are concerning for diabetic ketoacidosis (DKA). Checking the blood
glucose is an immediate assessment that can rapidly identify significant
hyperglycemia and support recognition of the underlying metabolic emergency.
Although the oxygen saturation is normal, the abnormal respiratory pattern may
represent compensatory Kussmaul respirations rather than primary oxygenation
failure.
6. The clinic nurse is teaching a client who has recently been diagnosed with
diabetes about the importance of wearing a MedicAlert bracelet. The nurse
explains that the bracelet provides critical information to emergency
personnel if the client becomes unable to communicate or requires urgent
treatment. Which statement by the client demonstrates correct
understanding of why the bracelet is important?
Correct answer: "If I become hypoglycemic, I could become unconscious."
Rationale: Severe hypoglycemia can cause confusion, seizures, loss of
consciousness, and potentially life-threatening complications. A MedicAlert bracelet
can alert emergency personnel that the client has diabetes when the client is unable
to provide a medical history. This information can help healthcare providers
recognize hypoglycemia as a possible cause of altered consciousness and initiate
appropriate treatment promptly.
7. The nurse in an endocrine clinic is reviewing the differences between type 1
and type 2 diabetes with a group of nursing students. The nurse asks the
students to explain how insulin production differs between the two major
preparing for discharge and will be provided with a blood glucose meter for
self-monitoring of blood glucose (SMBG) levels. The client has limited
experience using the device and needs to learn how to obtain an accurate
blood glucose reading independently. When is the best time for the nurse to
explain and demonstrate the proper use of the glucose monitor?
Correct answer: While performing the test in the hospital
Rationale: Teaching the client while performing the actual test allows the nurse to
provide hands-on instruction in a real clinical situation. The nurse can demonstrate
each step, observe the client's technique, and immediately correct errors that could
affect the accuracy of future readings. This approach also allows the client to practice
using the equipment before discharge and ask questions about the procedure.
2. An intensive care client with diabetic ketoacidosis (DKA) is receiving an
intravenous insulin infusion to reduce the blood glucose level and correct the
metabolic abnormalities associated with DKA. During continuous cardiac
monitoring, the nurse observes ventricular ectopy, which may indicate an
electrolyte disturbance affecting cardiac conduction. Which laboratory
assessment is most important for the nurse to obtain immediately?
Correct answer: Potassium level
Rationale: Insulin drives potassium from the extracellular space into the cells,
which can cause or worsen hypokalemia during treatment of DKA. Low potassium
levels can produce ventricular dysrhythmias and may explain the ventricular ectopy
observed on the cardiac monitor. The nurse should therefore assess the serum
potassium level promptly and anticipate appropriate potassium replacement or
adjustment of therapy based on the result.
3. A client with type 2 diabetes who is taking metformin (Glucophage) is seen in
the diabetic clinic for follow-up. The client's fasting blood glucose is 108
mg/dL (6.0 mmol/L), which is within the expected target range, but the
, glycosylated hemoglobin (HbA1C) is elevated at 8.2%, indicating inadequate
overall glycemic control. Which action should the nurse take next to
determine possible reasons for the elevated HbA1C?
Correct answer: Ask the client about current dietary intake and medication
use.
Rationale: HbA1C reflects the client's average blood glucose control over
approximately the previous 2 to 3 months, so a single normal fasting glucose does
not necessarily indicate adequate long-term control. The nurse should assess the
client's dietary habits and medication-taking patterns to identify possible causes of
persistent hyperglycemia. This assessment may reveal missed doses, inappropriate
food choices, inconsistent meal patterns, or other factors contributing to the
elevated HbA1C.
4. The nurse is providing discharge teaching to a client with type 2 diabetes and
peripheral neuropathy. Because decreased sensation in the feet increases
the risk for unnoticed burns, pressure injuries, and other wounds, the nurse
emphasizes proper footwear and gradual adjustment to new shoes. Which
statement by the client indicates a need for further teaching about
preventing foot injuries?
Correct answer: "I can break in my shoes by wearing them all day."
Rationale: A client with peripheral neuropathy should not wear new shoes for an
entire day because pressure or friction may cause an injury that the client cannot
feel. New shoes should be worn for short periods initially, with the feet inspected
frequently for redness, blisters, or other areas of irritation. Gradually increasing the
wearing time helps reduce the risk of pressure-related skin breakdown and diabetic
foot complications.
5. A client with type 1 diabetes arrives in the emergency department reporting
difficulty breathing and stating, "I can't catch my breath." The client's
temperature is 98.4°F (36.9°C), pulse is 112 beats/min, respirations are 38
, breaths/min, blood pressure is 91/54 mm Hg, and oxygen saturation is 99%
on room air. The client is tachypneic and hypotensive, raising concern for a
serious metabolic complication of diabetes. Which assessment should the
nurse perform first?
Correct answer: Check the blood glucose.
Rationale: The client's type 1 diabetes, deep and rapid respirations, tachycardia,
and hypotension are concerning for diabetic ketoacidosis (DKA). Checking the blood
glucose is an immediate assessment that can rapidly identify significant
hyperglycemia and support recognition of the underlying metabolic emergency.
Although the oxygen saturation is normal, the abnormal respiratory pattern may
represent compensatory Kussmaul respirations rather than primary oxygenation
failure.
6. The clinic nurse is teaching a client who has recently been diagnosed with
diabetes about the importance of wearing a MedicAlert bracelet. The nurse
explains that the bracelet provides critical information to emergency
personnel if the client becomes unable to communicate or requires urgent
treatment. Which statement by the client demonstrates correct
understanding of why the bracelet is important?
Correct answer: "If I become hypoglycemic, I could become unconscious."
Rationale: Severe hypoglycemia can cause confusion, seizures, loss of
consciousness, and potentially life-threatening complications. A MedicAlert bracelet
can alert emergency personnel that the client has diabetes when the client is unable
to provide a medical history. This information can help healthcare providers
recognize hypoglycemia as a possible cause of altered consciousness and initiate
appropriate treatment promptly.
7. The nurse in an endocrine clinic is reviewing the differences between type 1
and type 2 diabetes with a group of nursing students. The nurse asks the
students to explain how insulin production differs between the two major
