ch53.doc

[Osborn] chapter 53

Learning Outcomes [Number and Title] Learning Outcome 1 Discuss the epidemiology of diabetes and pre-diabetes

(impaired glucose tolerance and impaired fasting glucose).Learning Outcome 2 Differentiate between the classifications of pre-diabetes and

diabetes as they relate to clinical manifestations and health care management.

Learning Outcome 3 Compare and contrast the pathophysiology of pre-diabetes and diabetes.

Learning Outcome 4 Identify the major acute and chronic complications associated with diabetes.

Learning Outcome 5 Identify risk factors for adults associated with the development of pre-diabetes and diabetes.

Learning Outcome 6 Discuss the pharmacologic and nutritional management of diabetes as contrasted between diabetes type 1 and type 2.

Learning Outcome 7 Discuss the role of physical activity and exercise in the prevention and treatment of diabetes.

Learning Outcome 8 Describe the clinical signs and symptoms, diagnosis, medical therapy, nursing assessment, and management of diabetes.

Learning Outcome 9 Compare and contrast the clinical signs and symptoms, diagnosis, treatment, nursing assessment, and management of diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, and hypoglycemia.

Learning Outcome 10 Describe the prevention, progression, clinical signs and symptoms, nursing assessment, and management of lower extremity disease as it relates to diabetes.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice Copyright 2010 by Pearson Education, Inc.

1. The nurse is assessing a group of patients with pre-diabetes. Which of the following should the nurse include in the teaching plan regarding pre-diabetes?

1. The person with pre-diabetes has an increased risk of heart disease.2. Individuals with pre-diabetes should limit fluid intake.3. Patients with pre-diabetes are at increased risk for macular degeneration.4. The person with pre-diabetes needs insulin to maintain normal blood glucose

levels.

Correct Answer: The person with pre-diabetes has an increased risk of heart disease.

Rationale: The individual with pre-diabetes is at risk for cardiovascular disease. Fluids are not restricted in pre-diabetes. While individuals with poorly managed diabetes are at risk for retinopathy, the pre-diabetic is not at risk for diabetes, but does not have or necessarily develop macular degeneration. A client with pre-diabetes may not always develop diabetes, and not all diabetics require insulin.

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2. The nurse teaches a group of patients that type 1 diabetes involves which of the following etiologies?

1. Autoimmune disorder2. Infectious disorder3. Inflammatory disorder4. Drug induced disorder

Correct Answer: Autoimmune disorder Rationale: Type 1 diabetes, formerly called insulin-dependent or juvenile diabetes, is caused by an autoimmune process. There is no indication that this type of diabetes is directly caused by infections, inflammation, or drugs.

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3. The nurse is teaching a client about fasting blood glucose levels and an oral glucose tolerance test. Which of the following should be included in the teaching?

“You must fast before each of the tests for 8 to 10 hours.” “You must fast 8 hours before the fasting blood glucose test, and then eat a

large meal, after which your blood glucose is measured.” “The fasting glucose must be 123 or under to be normal.” “The 2-hour glucose tolerance test must be over 140 to be considered

normal.”

Correct Answer: “You must fast before each of the tests for 8 to 10 hours.”

Rationale: A fasting blood glucose level requires the client to fast for 8 to 12 hours prior to the test. A glucose tolerance test involves both a fasting blood glucose level and ingesting a known quantity of glucose with measurement of the blood glucose at ½, 1, and 2 hours. Fasting for 8 hours and then eating a large meal describes a postprandial blood glucose test. The normal value for fasting glucose is 60 to 100 mg/dL. The normal result of a 2-hour glucose tolerance test should be a value of <140 mg/dL.

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4. Which of the following individuals is most at risk for type 2 diabetes?

1. A 40-year-old with weight centered in the abdomen 2. A patient following a high-protein diet3. A 30-year-old Caucasian patient who recently had a baby4. A patient living in rural America

Correct Answer: A 40-year-old with weight centered in the abdomen

Rationale: The risk factors for type 2 diabetes include obesity (especially the “apple” shape or abdominal obesity), high caloric intake (especially carbohydrates), physical inactivity, living in an urban setting, and a lower level of education. Consuming a high-protein diet and postpartum status do not appear to be risk factors for type 2 diabetes. Individuals living in urban areas, perhaps due to more sedentary lifestyles, may be at higher risk for type 2 diabetes.

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5. When caring for a client with new-onset diabetes, which of the following diagnostic tests supports this diagnosis?

1. Hemoglobin A1C of 8.42. Fasting glucose level of 74 mg/dL3. Proteinuria4. Hypokalemia

Correct Answer: Hemoglobin A1C of 8.4

Rationale: Glycemic control over the last 3 months is best reflected in the HbA1C test. When hyperglycemia is present, glucose permanently enters the red blood cell and remains for the life span of the cell. A fasting blood glucose level of 74 mg/dL is normal. Proteinuria is present in processes that damage the glomerulus. Hypokalemia may be caused by many factors, including diuretics, medications such as corticosteroids, and vomiting; it is not specific to diabetes.



6. When teaching the client with diabetes about long-term management, the nurse emphasizes which of the following?

Select all that apply.

1. Have an eye examination yearly.2. Have the urine checked for microalbuminuria.3. Consult the provider to plan an exercise program.4. Check your urine for ketones daily.5. Measure your blood pressure daily.

Correct Answer:1. Have an eye examination yearly.2. Have the urine checked for microalbuminuria.3. Consult the provider to plan an exercise program.

Rationale: Have an eye examination yearly. The client with diabetes should have a yearly dilated eye examination to check for retinopathy. Have the urine checked for microalbuminuria. Microalbuminuria may warn of early diabetic nephropathy. Consult the provider to plan an exercise program. Exercise will help maintain lower glucose levels. Check your urine for ketones daily. There is no need to check the urine for ketones when well; fingerstick glucose levels are done before meals. Measure your blood pressure daily. There is no indication of instability and need to measure the blood pressure daily.

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7. The nurse is teaching a group of students about pre-diabetes and diabetes. Which of the following is correct about the pathophysiology of pre-diabetes as compared to diabetes?

1. The patient with pre-diabetes has a fasting glucose level between 101 and 125 on at least two occasions.

2. The patient with diabetes presents with a random glucose level of 75 mg/dl at any time of day.

3. The patient with pre-diabetes will complain of polydypsia, polyuria, and polyphagia.

4. The patient with pre-diabetes experiences weight loss and dehydration.

Correct Answer: The patient with prediabetes has a fasting glucose level between 101 and 125 on at least two occasions.

Rationale: Diagnostic criteria for pre-diabetes includes fasting glucose level between 101 and 125 on at least two occasions. A blood glucose level of 75 mg/dL is normal and therefore not associated with diabetes. The symptoms of polydypsia, polyuria, and polyphasia are present in diabetics with hyperglycemia, not pre-diabetics. Weight loss and dehydration are associated with hyperglycemia and/or DKA, and therefore are not part of the pre-diabetes syndrome.

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8. The nurse is screening a group of patients for metabolic syndrome. Which of the following findings are present in metabolic syndrome?


1. Fasting glucose of 187 mg/dL2. Triglyceride levels 325 mg/dL3. Blood pressure 166/844. Abdominal obesity5. Swelling of thighs and lower extremities

Correct Answer:1. Fasting glucose of 187 mg/dL2. Triglyceride levels 325 mg/dL3. Blood pressure 166/844. Abdominal obesity

Rationale: Fasting glucose of 187 mg/dL. Metabolic syndrome is present when three or more of the following are present: blood pressure >135/85, triglycerides > 150 mg/dL, low HDL, abdominal obesity or fasting glucose >100 mg/dL. Triglyceride levels 325 mg/dL. Metabolic syndrome is present when three or more of the following are present: blood pressure >135/85, triglycerides > 150 mg/dL, low HDL, abdominal obesity or fasting glucose >100 mg/dL. Blood pressure 166/84. Metabolic syndrome is present when three or more of the following are present: blood pressure >135/85, triglycerides > 150 mg/dL, low HDL, abdominal obesity or fasting glucose >100 mg/dL. Abdominal obesity. Metabolic syndrome is present when three or more of the following are present: blood pressure >135/85, triglycerides > 150 mg/dL, low HDL, abdominal obesity or fasting glucose >100 mg/dL. Swelling of thighs and lower extremities. Swelling of lower extremities may be associated with poor venous return, CHF, hypoalbuminemia, or other disorders.

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9. The nurse is teaching a client about prevention and complications of pre-diabetes. Which of the following should be included in the plan of care?


1. Develop an exercise plan with your health care provider. 2. Consume a diet high in fruits and vegetables.3. Try to attain a target body weight 10% lower than your suggested weight.4. Increase your calories and decrease your intake of saturated fats.5. Follow a low-residue diet.

Correct Answer:1. Develop an exercise plan with your health care provider. 2. Consume a diet high in fruits and vegetables.

Rationale: Develop an exercise plan with your health care provider. Exercise will help avoid obesity and attain/maintain normal weight, a risk factor for type 2 diabetes. Consume a diet high in fruits and vegetables. A Mediterranean diet high in monounsaturated fat, fresh vegetables, and fruit, as well as exercise, is indicated. Try to attain a target body weight 10% lower than your suggested weight. Moderate weight loss is indicated, not radical weight loss. Increase your calories and decrease your intake of saturated fats. Because obesity is a risk factor, caloric intake is usually decreased, not increased. Follow a low-residue diet. A low-residue diet is contraindicated; a diet high in fiber moderates blood glucose levels.



10. When caring for a male client with diabetes, the nurse assesses for which of the following chronic complications of diabetes?

1. Erectile dysfunction2. Hypoglycemia3. Icteric sclera4. Diabetic ketoacidosis

Correct Answer: Erectile dysfunction

Rationale: Atherosclerotic diseases and poor blood flow are long-term complications of diabetes; this may include erectile dysfunction, PAD, or coronary heart disease. Icteric sclera are associated with hepato-biliary disorders, not diabetes. Hypoglycemia and diabetic ketoacidosis are acute complications of diabetes.

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11. When caring for the patient with diabetes, which of the following acute complications requires immediate intervention?

1. The patient presents with vomiting, abdominal pain, and flushing.2. The patient complains of burning in the feet and lower extremities.3. The patient states his vision has decreased over the last several years.4. The patient’s creatinine is 1.1 mg/dl.

Correct Answer: The patient presents with vomiting, abdominal pain, and flushing.

Rationale: Vomiting, flushed and dry skin, abdominal pain, and acetone odor to the breath are symptoms of diabetic ketoacidosis (DKA), which, if untreated, leads to severe dehydration and acidosis. Burning in the lower extremities may indicate diabetic neuropathy, a chronic complication of diabetes that can be treated, but not necessarily immediately. Decreased visual acuity is a chronic complication of diabetes due to retinopathy, macular degeneration, or cataracts. A creatinine of 1.1 mg/dL is normal and does not represent a complication of diabetes.



12. The nurse teaches the client that he has been placed on an ACE inhibitor to prevent which of the following complications of diabetes?

1. Kidney damage2. Hypotensive crisis3. Neurogenic bladder4. Infections

Correct Answer: Kidney damage

Rationale: ACE inhibitors and ARBs prevent the progression of diabetic nephropathy. A hypotensive crisis is not a component of diabetes; hypertension is more common. A neurogenic bladder may occur, but an ACE inhibitor will not prevent this. ACE inhibitors are antihypertensive medications and will not prevent infection.

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13. Hypoglycemia is manifested by: 1. Blood glucose level less than 60 mg/dL.2. Polydipsia.3. Blood glucose level of 60-75 mg/dL4. Polyuria.

Correct Answer: Blood glucose level less than 60 mg/dL.

Rationale: The manifestations of hypoglycemia result from a compensatory autonomic nervous system (ANS) response and from impaired cerebral function due to a decrease in glucose available for use by the brain. The manifestations vary, particularly in older adults. The onset is sudden, and blood glucose is usually less than 45 to 60 mg/dL. Severe hypoglycemia may cause death.

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14. For which of the following clients would the nurse develop a plan of care to discuss risk factors for developing pre-diabetes and diabetes?

1. Client is a secretary and watches 5 hours of television daily2. Male who is 5 feet 9 inches tall and weighs 150 pounds3. 22-year-old female whose hobby is hiking4. Client prefers to eat chicken rather than pork

Correct Answer: Client is a secretary and watches 5 hours of television daily

Rationale: A sedentary lifestyle of physical inactivity is associated with the development of pre-diabetes and type 2 diabetes. The male who is 5 feet 9 inches tall and weighs 150 pounds is at an appropriate weight. Hiking or physical activity can reduce the risk for diabetes. Eating chicken rather than pork does not identify the client as at risk for high caloric intake.



15. The community health nurse is performing diabetes screening. Which of the following groups of individuals is at highest risk for the development of type 2 diabetes?

1. Native Americans 2. Children and adolescents3. Caucasian Americans4. Asians living in the Far East

Correct Answer: Native Americans

Rationale: Groups at higher risk for diabetes include Native Americans, Hispanics, non-Hispanic blacks, and certain Hawaiians. While children and adolescent diabetes is increasing, evidence shows these children belong to the same population as the adult group. Caucasians are not in the highest risk groups.

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16. The nurse is providing health education for a group of clients with type 2 diabetes. Which of the following risk factors should be included in the teaching plan?

1. Overweight2. Family history3. Sedentary lifestyle4. Picky eater5. Large hip-to-abdomen ratio

Correct Answer:1. Overweight2. Family history3. Sedentary lifestyle

Rationale: Overweight. The typical risks for developing type 2 diabetes include being overweight. Family history. The typical risks for developing type 2 diabetes include family members with diabetes. Sedentary lifestyle. The typical risks for developing type 2 diabetes include a sedentary lifestyle. Picky eater. There is no indication that being a picky eater is related to diabetes. Large hip-to-abdomen ratio. The diabetic is typically apple shaped, with a larger abdomen-to-hip ratio.

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17. The public health nurse plans a teaching program for senior citizens on modifying risk factors in their lifestyle to decrease risk of developing type 2 diabetes mellitus. Which of the following would the nurse not include in the teaching plan?

1. Genetic predisposition2. Hypertension3. Physical inactivity4. Obesity

Correct Answer: Genetic predisposition

Rationale: Genetic predisposition, or a history of diabetes in parents or siblings, increases risk for type 2 diabetes mellitus, but this is not a modifiable factor. Modifiable risk factors that increase cellular resistance to the effect of insulin include hypertension, physical inactivity, and obesity.

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18. When caring for the patient with type 1 diabetes, the nurse includes which of the following in the plan of care?

1. Administer insulin lispro or aspart immediately prior to the meal. 2. Administer oral hypoglycemic medications ½ hour prior to meals.3. Observe for hypoglycemia approximately ½ to 1 hour after injecting NPH

insulin.4. Avoid insulin if the patient reports an allergy to sulfa drugs.

Correct Answer: Administer insulin lispro or aspart immediately prior to the meal.

Rationale: Insulin lispro and aspart are rapid-acting insulins; the meal should be prepared prior to injecting the insulin. Oral hypoglycemics are not used in the care of type 1 diabetics. The peak action of NPH, an intermediate-acting insulin, is 4 to 10 hours; the peak action of insulin is when hypoglycemia is most likely to occur. Sulfonylurea oral agents may cause cross sensitivity and hypersensitivity in people with sulfa allergy.

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19. The nurse should include which of the following in the teaching plan related to diet for the patient with diabetes?

1. “Select carbohydrates such as whole grains or legumes.”2. “Eat whenever you feel hungry.”3. “Do not consume alcoholic beverages.”4. “Restrict the carbohydrates in your diet.”

Correct Answer: “Select carbohydrates such as whole grains or legumes.”

Rationale: Complex carbohydrates such as whole grains, legumes, fruits, and those with low glycemic indices will limit spikes in the blood glucose values. Maintaining a normal weight is important to the management of diabetes; eating whenever hungry is not consistent with the diabetic food prescription. Moderate alcohol consumption is permitted, within the dietary prescription. Restricting carbohydrates to less than 130 grams per day is not recommended.

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20. The nurse is responding to a client with diabetes about incorporating an occasional alcoholic beverage into the meal plan with the provider’s permission. Which of the following indicates the client understands the teaching?

1. “If I drink alcohol, I should have only one alcohol-containing beverage daily.”2. “Alcoholic beverages will raise my blood glucose and I will need more

insulin.”3. “If I have a mixed drink, my blood glucose may drop.”4. “I should take a vitamin supplement on the days I consume alcohol.”

Rationale: One alcohol-containing beverage for women or two for men is considered a moderate and acceptable intake of alcohol. Blood glucose is not acutely affected with alcohol consumption; mixed with carbohydrates such as in a mixed drink, blood glucose levels may rise. Vitamin supplements do not provide additional medical benefits to diabetics whether they consume alcohol or not.

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21. The nurse teaches the patient with diabetes or pre-diabetes that exercise is especially important for which of the following reasons?


1. Obesity is linked to type 2 diabetes and pre-diabetes.2. Exercise helps increase insulin receptors and sensitivity to insulin.3. Exercise enhances the ability of glucose to enter the cells.4. Individuals with their weight centered in their hips and thighs are at increased

risk for glucose intolerance.5. Regular exercise will prevent destruction of the beta cells.

Correct Answer:1. Obesity is linked to type 2 diabetes and pre-diabetes.2. Exercise helps increase insulin receptors and sensitivity to insulin.3. Exercise enhances the ability of glucose to enter the cells.

Rationale: Obesity is linked to type 2 diabetes and pre-diabetes. Obesity is a risk factor for glucose intolerance and diabetes. Exercise helps increase insulin receptors and sensitivity to insulin. Exercise increases sensitivity of receptors to insulin and promotes glucose entry into the cells, improving glycemic control. Exercise enhances the ability of glucose to enter the cells. Exercise increases sensitivity of receptors to insulin and promotes glucose entry into the cells, improving glycemic control. Individuals with their weight centered in their hips and thighs are at increased risk for glucose intolerance. Abdominal obesity, not the “pear” shape, is a risk factor for metabolic syndrome, which includes impaired glucose tolerance. Regular exercise will prevent destruction of the beta cells. Regular exercise will not prevent destruction of the beta cells.

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22. When developing a plan of care regarding exercise for clients with diabetes, the nurse emphasizes which of the following?

1. Plan to carry a carbohydrate-containing snack.2. Do not exercise if your glucose level is elevated.3. Avoid aerobic exercises.4. Exercise must be done every day to be effective.

Correct Answer: Plan to carry a carbohydrate-containing snack.

Rationale: Exercise promotes entry of glucose into the cell and may precipitate hypoglycemia; the client should carry a snack when exercising to promptly treat hypoglycemia. There is no indication that exercise is dangerous with blood glucose values <250 mg/dL. Diabetics may participate in aerobic exercise once cleared by their health care provider and when good metabolic control is achieved. All exercise is beneficial; the goal is to exercise three to five times weekly.



23. Which of the following outcomes for a type 2 diabetic indicates the client’s exercise program has been effective?

1. Hemoglobin A1C goes from 8 to 72. Patient’s weight remains the same3. Fingerstick glucose levels range from 52 to 2094. Client states she feels less hungry

Correct Answer: Hemoglobin A1C goes from 8 to 7

Rationale: Hemoglobin A1C is a reflection of the average daily glucose level over the last 3 months; exercise sensitizes the receptor to insulin, lowering glucose levels. While weight gain is undesirable, weight loss is the typical goal. Pre-prandial glucose levels should range from 70 mg to 110 mg/dL.

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24. When assessing the patient with diabetes for complications, it is especially important for the nurse to pay attention to:

1. Creatinine. 2. Albumin.3. Potassium.4. Sclera.

Correct Answer: Creatinine.

Rationale: Nephropathy is a long-term complication of diabetes, reflected by an increase in the serum creatinine. Albumin, potassium, and the sclera are not specifically related to assessment of diabetic complications. Assessment of the retina for evidence of microvascular complications is part of the assessment of complications in the diabetic.

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25. When developing the plan of care for a patient who has been newly diagnosed with diabetes, which of the following points is of highest priority?

1. Hunger and irritability may indicate low blood glucose.2. Cut toenails straight across.3. Avoid alcohol in the diet.4. Do not eat any sweets or desserts.

Correct Answer: Hunger and irritability may indicate low blood glucose.

Rationale: Untreated hypoglycemia may lead to brain damage, and therefore is the highest priority for teaching. Cutting the toenails straight across and proper foot care is taught, but is not the priority. Alcohol and sweets may be incorporated into the diabetic diet prescription in moderation.



26. When teaching a client about the signs and symptoms of diabetes, which response indicates more teaching is necessary?

1. “Developing coarse, thinning hair is a symptom of diabetes.”2. “Intense thirst is a symptom of diabetes.”3. “Extreme hunger occurs with diabetes.”4. “Some people with diabetes get frequent urinary infections.”

Rationale: Coarse hair is not a typical symptom of diabetes. Signs and symptoms of diabetes include polydypsia, polyuria, polyphagia, fatigue, and more frequent infections, including UTIs.

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27. When caring for the client with diabetic ketoacidosis (DKA), it is essential to include which of the following interventions in the plan of care?

1. Administer fluids intravenously.2. Place the patient on bed rest.3. Review the diabetic exchange diet with the patient.4. Administer oral hypoglycemics on schedule.

Correct Answer: Administer fluids intravenously.

Rationale: Hyperglycemia creates an osmotic diuresis and leads to dehydration. Insulin and fluids are the priorities in the care of the patient with DKA. Bed rest may be used to protect the patient from falling, but will not be a priority. The diabetic exchange diet will be reviewed, but due to osmotic diuresis, the client may have confusion; prior to resolving diabetic ketoacidosis, teaching is not appropriate. Patients with DKA will require insulin; this is a complication of type 1 diabetes.

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28. Which of the following nursing diagnoses is of highest priority for the client presenting with hyperosmolar hyperglycemic syndrome (HHS)?

Deficient Fluid Volume Altered Nutrition: more than body requirement Knowledge Deficit related to diabetic diet Noncompliance related to self-management

Correct Answer: Deficient Fluid Volume

Rationale: The client with HHS typically has blood glucose levels >600 mg/dL, which leads to profound osmotic diuresis and dehydration. This syndrome may develop more frequently in type 2 diabetics who are ill and have unreplaced fluid losses. While proper diet is important in diabetes management, dietary indiscretion is not the main cause of HHS. Noncompliance with self-management is too broad a category to address in a critically ill client.

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29. When caring for the client with diabetic ketoacidosis (DKA), the nurse monitors the blood urea nitrogen (BUN) level for which of the following reasons?

1. Polyuria leads to dehydration and renal impairment.2. Clients with DKA frequently develop chronic renal failure.3. The BUN is frequently lower in clients with DKA than clients with HHNS.4. Acidosis causes the BUN to elevate.

Correct Answer: Polyuria leads to dehydration and renal impairment.

Rationale: The client with DKA experiences polyuria secondary to osmotic diuresis, causing fluid-volume deficit and decreased renal perfusion that will be reflected in an elevated BUN. Chronic renal failure is a long-term complication of diabetes, not acute. The BUN will not be lower in DKA than HHNS; both cause fluid deficit and will result in decreased renal perfusion. Acidosis does not directly affect the BUN; rather, it develops from lack of insulin to move glucose into the cell and break down fat for energy.

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30. The nurse teaches the patient with diabetes that he is particularly prone to injury that may lead to amputation of the lower extremities due to which of the following?


1. Loss of protective sensation may lead to ulceration and infection. 2. The patient with diabetes is at risk for impaired tissue perfusion secondary to

peripheral arterial disease.3. Taking insulin increases the likelihood of developing atherosclerotic disease.4. Patients with hemoglobin A1C greater than 4 are at risk for gangrene.5. Individuals with diabetes are particularly prone to arthritis.

Correct Answer:1. Loss of protective sensation may lead to ulceration and infection. 2. The patient with diabetes is at risk for impaired tissue perfusion secondary to

peripheral arterial disease.

Rationale: Loss of protective sensation may lead to ulceration and infection. Poor blood flow (PAD) may cause gangrene and decreased sensation may allow an injury to go unobserved and infection such as osteomyelitis may develop, requiring amputation. The patient with diabetes is at risk for impaired tissue perfusion secondary to peripheral arterial disease. Clients with diabetes are prone to atherosclerotic disease and peripheral neuropathy; these process decrease blood flow to the lower extremities and cause lack of sensation. Taking insulin increases the likelihood of developing atherosclerotic disease. Taking insulin promotes glycemic control and decreases risk of vascular complications. Patients with hemoglobin A1C greater than 4 are at risk for gangrene. The target for hemoglobin A1C should be below 7. Individuals with diabetes are particularly prone to arthritis. Arthritis is not a risk factor for injury and PAD leading to amputation.

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31. When assessing a 65-year-old patient with diabetes, which of the following assessment findings requires notification of the health care provider?

1. Cool, mottled discoloration of right great toe2. Blood glucose value of 70 mg/dL prior to patient eating breakfast3. Patient states he cannot read teaching materials without eyeglasses4. Brown discoloration over medial malleous

Correct Answer: Cool, mottled discoloration of right great toe

Rationale: Cool, mottled skin indicates poor blood flow and indicates underlying atherosclerotic disease. Blood glucose of 70 mg/dL is normal. A 65-year-old patient is expected to have presbyopia with lack of accommodation and needs reading glasses. Brown discoloration is symptomatic of venous, not arterial, insufficiency.

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32. When caring for a group of clients with diabetes, the nurse recognizes that which of the following is at highest risk for peripheral arterial disease?

1. A client whose hemoglobin A1C is 6.92. A client diagnosed with pre-diabetes 3. A client who has had a myocardial infarction*4. A client who states her glucose levels vary from 70 to 125 mg/dL daily

Correct Answer: A client whose hemoglobin A1C is 6.9

Rationale: The client who has had a myocardial infarction has evidence of atherosclerotic disease, which strikes the large arteries of the body. A client with pre-diabetes is at higher risk for developing diabetes. The client with glucose levels of 70 to 125 mg/dL is fairly well controlled and would not have the same risk as a client with evidence of atherosclerotic disease.

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ch53.doc

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