After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?

The lower abdomen is the best location because it is closest to the pancreas.

I can reach my thigh the best, so I will use the different areas of my thighs.

By rotating the sites in one area, my chance of having a reaction is decreased.

Changing injection sites from the thigh to the arm will change absorption rates.

Answer and Explanation

The Correct Answer is A

Choice A rationale: This statement is incorrect. While the abdomen is a preferred injection site due to its large subcutaneous fat layer and consistent absorption, the proximity to the pancreas is not the reason. The pancreas's location is irrelevant to where insulin is absorbed and distributed systemically. The statement shows a misunderstanding of anatomy and pharmacology.
Choice B rationale: This is a correct statement. Using different areas within the same site, such as the thigh, is a good practice for rotating injection spots. It helps prevent lipodystrophy (fat hypertrophy or atrophy) and ensures consistent insulin absorption. The thigh is an appropriate injection site.
Choice C rationale: This is a correct statement. Rotating injection sites within one area, such as the abdomen, minimizes the risk of tissue damage and the formation of scar tissue or lumps (lipohypertrophy). These reactions can alter insulin absorption, making blood glucose management unpredictable.
Choice D rationale: This is a correct statement. Insulin absorption rates vary between different injection sites. The abdomen generally has the fastest absorption, followed by the arm, thigh, and buttocks. This is due to differences in blood flow and subcutaneous tissue composition. Changing sites can thus change absorption rates.

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Correct Answer is A

Explanation

Choice A rationale: Diabetic ketoacidosis (DKA) is a severe complication characterized by hyperglycemia, metabolic acidosis, and ketosis. Elevated glucose levels (typically >250 mg/dL) result from insufficient insulin. The body then breaks down fat for energy, producing ketones which lower the blood pH, resulting in metabolic acidosis. The expected finding is a low plasma bicarbonate level (normal range 22-29 mEq/L) reflecting the metabolic acidosis.
Choice B rationale: Decreased urine output is an incorrect finding. In DKA, hyperglycemia leads to osmotic diuresis, where excess glucose pulls water out of the body, leading to polyuria (increased urine output) and dehydration. The kidneys attempt to excrete the excess glucose and ketones, resulting in frequent and copious urination.
Choice C rationale: Increased respirations (Kussmaul respirations) are a compensatory mechanism for metabolic acidosis, but they lead to a decrease in pH, not an increase. The deep, rapid breathing attempts to blow off carbon dioxide, a form of carbonic acid, to raise the pH back to the normal range of 7.35-7.45.
Choice D rationale: While coma can be a late and severe complication of DKA, it is not a confirming diagnostic finding. DKA is confirmed by the specific biochemical triad of hyperglycemia, ketonemia/ketonuria, and metabolic acidosis. Patients are often awake and responsive in the early stages, experiencing symptoms like nausea, abdominal pain, and lethargy.

A. Once your pancreas recovers, you may be able to discontinue the injections. B. You will need insulin injections for the rest of your life. C. If you follow your diet closely, your blood sugar may be controlled by just taking insulin pills. D. You may be able to stop the injections if you exercise regularly and adhere to the prescribed diet.

Correct Answer is B

Explanation

Choice A rationale: Type 1 diabetes is an autoimmune disease where the body's immune system destroys the insulin-producing beta cells in the pancreas. This process is irreversible, leading to a permanent inability to produce insulin. The pancreas will not recover its function, and the client will always require exogenous insulin.
Choice B rationale: Type 1 diabetes is characterized by the absolute lack of insulin production due to the autoimmune destruction of the pancreatic beta cells. Without insulin, the body cannot utilize glucose for energy, a condition that is incompatible with life. Consequently, clients with type 1 diabetes will require lifelong insulin replacement therapy to survive.
Choice C rationale: Insulin is a peptide hormone that is destroyed by digestive enzymes in the gastrointestinal tract. Therefore, it cannot be taken orally in a pill form. Insulin must be administered via injection to be effective. Oral medications are typically used for type 2 diabetes, which involves insulin resistance or insufficient insulin production, not an absolute lack.
Choice D rationale: While exercise and diet are essential for managing blood glucose levels in all types of diabetes, they cannot replace the absolute lack of insulin in type 1 diabetes. These lifestyle modifications help improve insulin sensitivity and glucose utilization but do not stimulate the pancreas to produce the missing hormone.

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After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?

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