A nursing student is reinforcing teaching for a client with Type 2 Diabetes about the purpose of diabetes education. Which client statement indicates understanding?

Rationale:

A. Monitor for signs of hypoglycemia is incorrect because prednisone, a corticosteroid, typically causes hyperglycemia, not hypoglycemia. Corticosteroids increase blood glucose levels by stimulating gluconeogenesis, reducing peripheral glucose uptake, and promoting insulin resistance. Therefore, the client is at increased risk of high blood sugar, not low blood sugar.

B. Prednisone commonly causes significant hyperglycemia, especially in clients with type 2 diabetes mellitus. Because this client is already insulin-dependent, the priority intervention is to anticipate the need for increased insulin dosing and adjust the regimen accordingly. This prevents severe hyperglycemia, diabetic ketoacidosis (DKA), or hyperosmolar hyperglycemic state (HHS). Close monitoring of blood glucose levels and titration of insulin is essential.

C. The dose of prednisone is determined by the provider for asthma management. Increasing the dose without provider direction is unsafe and would worsen hyperglycemia and potential steroid-related complications.

D. Although corticosteroids can cause fluid retention, fluid restriction is not appropriate or safe unless the client has another condition requiring restriction (e.g., heart failure). Managing glucose levels is a much higher priority, and fluid restriction does not prevent steroid-induced hyperglycemia.

Rationale:

A. Secondary progressive MS initially begins as relapsing-remitting, with periods of symptom flare-ups followed by partial recovery. Over time, the disease may transition into a phase of steady progression, but this is after an initial relapsing course, not from disease onset.

B. Progressive-relapsing MS is characterized by steady neurological decline from onset, with occasional superimposed relapses. However, it is a rare subtype. Although it has continuous worsening, the hallmark is the presence of distinct relapses, unlike primary progressive MS, which is purely progressive without relapses.

C. Relapsing-remitting MS is the most common form and is characterized by episodes of new or worsening neurological symptoms (relapses) followed by partial or complete recovery (remissions). Neurological function does not worsen continuously, making this inconsistent with the scenario.

D. Primary progressive MS involves gradual, continuous neurological deterioration from the onset of symptoms, without distinct relapses or remissions. Patients experience steady accumulation of disability, often involving spinal cord symptoms such as weakness and spasticity. This subtype represents 10–15% of MS cases and typically does not respond as well to disease-modifying therapies compared with relapsing forms.