A nurse is caring for a client at the endocrinologist's office.

Exhibits

The client sees the diabetic nurse educator. Click to highlight the findings that indicate an understanding of the diabetic foot care education the client received. To deselect a finding, click on the finding again.

"I understand that I need to inspect my feet daily. I will dry my feet thoroughly when I get out of the shower. It is important to apply lotion to my feet and especially my toes to keep my skin in good health. That will prevent any sores on my feet. I will be very careful when I cut my toenails and will be sure to cut them straight across and then file the edges with an emery board. I will wear closed toed shoes. I am glad I can still go barefoot in the house because I never wear shoes at home. If I have any foot sores or corns come up, I will see my doctor or go to a podiatrist instead of treating it myself."

I understand that I need to inspect my feet daily.

I will dry my feet thoroughly when I get out of the shower.

I will be very careful when I cut my toenails and will be sure to cut them straight across and then file the edges with an emery board.

I will wear closed toed shoes.

If I have any foot sores or corns come up, I will see my doctor or go to a podiatrist instead of treating it myself.

Answer and Explanation

The Correct Answer is ["A","B","C","D","E"]

Rationale:

A.   "I understand that I need to inspect my feet daily."Daily foot inspection is essential for individuals with diabetes to identify any cuts, blisters, or signs of infection early. Reduced sensation due to peripheral neuropathy can lead to unnoticed injuries that progress to serious complications if untreated.
B.   "I will dry my feet thoroughly when I get out of the shower." Keeping the feet dry, especially between the toes, helps prevent fungal infections and skin breakdown. Moist environments encourage fungal growth, which can worsen foot health in diabetic clients.
C.   "It is important to apply lotion to my feet and especially my toes to keep my skin in good health." While moisturizing helps prevent dry, cracked skin, lotion should not be applied between the toes. Moisture trapped between the toes increases the risk of fungal infections and skin maceration in diabetic clients.
D.   "I will be very careful when I cut my toenails and will be sure to cut them straight across and then file the edges with an emery board." Cutting toenails straight across and filing the edges helps prevent ingrown toenails and reduces the risk of accidental skin injury. Diabetic clients are advised to be cautious during nail care due to impaired healing and infection risk.
E.   "I will wear closed toed shoes." Wearing closed-toed shoes protects the feet from injury and trauma. Open-toed shoes or sandals may expose the feet to injury, and diabetic clients may not feel injuries due to neuropathy.
F.   "I am glad I can still go barefoot in the house because I never wear shoes at home."Going barefoot, even indoors, increases the risk of stepping on sharp objects and sustaining unnoticed injuries. Clients with diabetes should always wear well-fitting shoes or protective footwear, even at home.
G.   "If I have any foot sores or corns come up, I will see my doctor or go to a podiatrist instead of treating it myself." Diabetic clients should avoid self-treating foot problems like sores or corns. Prompt evaluation by a healthcare provider prevents complications like infections or ulcers, which can escalate quickly in this population.

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Correct Answer is C

Explanation

Rationale:
A. Hypernatremia: While mild hypernatremia can occur in severe dehydration, it is not a defining or consistent feature of type 1 diabetes. Electrolyte imbalances may vary depending on hydration and glucose levels.

B. Decreased serum osmolality: In type 1 diabetes, serum osmolality is typically increased due to hyperglycemia and the osmotic effect of glucose in the bloodstream, which draws water out of cells and into the vascular space. A decrease would be inconsistent with the expected metabolic state.

C. Ketones in the urine: Ketones in the urine are a hallmark of type 1 diabetes, especially when insulin is deficient. Without insulin, the body breaks down fat for energy, producing ketones as a byproduct, which can be detected in the urine during diabetic ketoacidosis.

D. Hypoglycemia: Hypoglycemia is a complication of diabetes management, often resulting from too much insulin or missed meals. It is not a presenting manifestation of newly diagnosed type 1 diabetes, which typically presents with hyperglycemia and related symptoms.

A. A pearly, waxy nodule B. An irregular border on a variegated-colored lesion C. A firm, nodular, crusty, or ulcerated lesion D. A weeping vesicle

Correct Answer is A

Explanation

Rationale:
A. A pearly, waxy nodule: This is the classic presentation of basal cell carcinoma. These lesions often appear as small, shiny, flesh-colored or pink nodules with a translucent or pearly surface and may have visible blood vessels. They are slow-growing and rarely metastasize.

B. An irregular border on a variegated-colored lesion: This description is more indicative of malignant melanoma, which often appears as an asymmetric lesion with uneven borders and multiple colors, including black, brown, red, or white.

C. A firm, nodular, crusty, or ulcerated lesion: These characteristics are more commonly associated with squamous cell carcinoma, which tends to be more aggressive and can metastasize if untreated.

D. A weeping vesicle: This finding is consistent with inflammatory skin conditions such as contact dermatitis or eczema, not basal cell carcinoma. These vesicles are usually associated with allergic or irritant reactions.

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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