When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:

"It's easier to get foot infections if you have diabetes."

"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

"The physician wants to be sure your shoes fit properly so you won't develop pressure sores."

"The circulation in your feet can help us determine how severe your diabetes is."

Answer and Explanation

The Correct Answer is B

Diabetes mellitus leads to peripheral neuropathy, a condition resulting from microvascular damage to the vasa nervorum. This leads to a progressive loss of protective sensation, meaning patients cannot feel pressure, heat, or sharp objects. Chronic hyperglycemia also impairs leukocyte function, significantly delaying the inflammatory response and wound healing process in the lower extremities.

A. "It's easier to get foot infections if you have diabetes.": While statistically true due to compromised immune responses, this statement is less comprehensive than explaining the sensory deficit. High glucose levels provide a medium for bacterial growth, increasing the risk of gangrene. However, it does not explain how the patient can prevent injury through sensory awareness and visual inspection.

B. "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it.": This is the most helpful response as it identifies the loss of nociception caused by nerve fiber degradation. It educates the client on the risk of silent trauma, which is the leading cause of diabetic foot ulcers. Understanding this mechanism encourages the client to perform daily visual inspections to catch injuries early.

C. "The physician wants to be sure your shoes fit properly so you won't develop pressure sores.": Shoe fit is an important intervention, but it is a secondary action rather than the primary physiological reason for a podiatry referral. Pressure sores develop precisely because the patient cannot feel the friction or tightness of the footwear. This response focuses on the solution without explaining the underlying pathophysiological vulnerability.

D. "The circulation in your feet can help us determine how severe your diabetes is.": Circulation assessment through pedal pulse checks is important, but it is not a diagnostic tool for the overall severity of the disease. While peripheral vascular disease is a common complication, the primary concern for a new diabetic is preventing neuropathic ulcers. This statement is technically inaccurate as a measure of disease staging.

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Free Nursing Study Resources

Correct Answer is A,B,C,D

Explanation

Mixing insulin requires a precise sequence to maintain the chemical stability of the vials. By injecting air into the cloudy NPH vial first, the nurse avoids touching the intermediate-acting suspension with a needle that might already contain regular insulin. The "clear before cloudy" withdrawal sequence ensures that the rapid-acting regular insulin remains free of protamine contamination.

Step 1. Inject 20 units of air into the NPH insulin vial: This step creates the necessary positive pressure inside the cloudy vial without the needle touching the solution. It must be done first so that the syringe remains empty when moving to the next vial. Proper air displacement prevents the formation of a vacuum during later withdrawal steps.

Step 2. Inject 10 units of air into the regular insulin vial: The nurse then adds air to the clear insulin vial, which is the medication that will be withdrawn first. This maintains the vial pressure while ensuring the needle is ready to aspirate the clear liquid immediately. Keeping the regular vial uncontaminated is the primary safety goal of this entire procedure.

Step 3. Withdraw 10 units of insulin from the regular insulin vial: Withdrawing the clear insulin first is critical because accidental transfer of regular insulin into an NPH vial does not significantly alter the NPH's action. However, the reverse would contaminate the fast-acting supply. This ensures the dose for immediate glycemic correction remains pure and predictable.

Step 4. Withdraw 20 units of insulin from the NPH insulin vial: The final step is to add the cloudy insulin to the syringe already containing the regular insulin. The nurse must be careful to pull back to the total volume of 30 units exactly. Once NPH is in the syringe, the dose cannot be adjusted by pushing fluid back, as this would mix the two types within the vials.

A. Polyuria, polydipsia, hypotension, and hypernatremia B. Kussmaul's respirations, dry skin, hypotension, and bradycardia C. Coma, anxiety, confusion, headache, and cool, moist skin D. Polyuria, polydipsia, polyphagia, and weight loss

Correct Answer is C

Explanation

Hypoglycemia, defined as a blood glucose below 70 mg/dL, triggers an immediate sympathoadrenal response to stimulate glucose release. As levels drop further, the central nervous system suffers from a lack of fuel, leading to altered mentation and cognitive decline. If untreated, the brain's metabolic requirements cannot be met, resulting in loss of consciousness, permanent brain injury, or death.

A. Polyuria, polydipsia, hypotension, and hypernatremia: These signs are characteristic of severe hyperglycemia and dehydration, often seen in Hyperosmolar Hyperglycemic State (HHS). High glucose causes osmotic diuresis, leading to massive fluid loss and elevated sodium concentrations. These symptoms are the physiologic opposite of the clinical picture presented by a low glucose level of 45 mg/dL.

B. Kussmaul's respirations, dry skin, hypotension, and bradycardia: Kussmaul's breathing is a compensatory mechanism for metabolic acidosis, specifically seen in diabetic ketoacidosis (DKA) due to high blood sugar. Dry skin reflects dehydration caused by prolonged hyperglycemia, whereas hypoglycemia typically presents with diaphoresis. These findings indicate acidotic states rather than an acute drop in plasma glucose.

C. Coma, anxiety, confusion, headache, and cool, moist skin: These symptoms reflect the dual impact of neuroglycopenia and epinephrine release. Cool, clammy skin is a classic adrenergic sign as the body attempts to raise glucose levels through sympathetic activation. Confusion and headache are early indicators of cerebral glucose deprivation, which can quickly progress to a comatose state.

D. Polyuria, polydipsia, polyphagia, and weight loss: This triad of symptoms, known as the "3 Ps," defines the clinical presentation of undiagnosed or poorly controlled hyperglycemia. In the absence of insulin, glucose cannot enter cells, leading to cellular starvation and weight loss despite increased intake. These symptoms develop over days or weeks, not as a result of acute hypoglycemia.

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When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A,B,C,D

Explanation

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?

Correct Answer is C

Explanation

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin?

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