A nurse is providing teaching about a weight reduction plan to a client who is obese and has type 2 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?
I should reduce my caloric intake by 200 calories a day to lose 1 pound a week.
I need to lose 5 percent of my body weight to improve my glycemic control.
I must exercise for 30 minutes three times a week to lose 1 pound per week.
If my blood glucose level drops during exercise, I should drink 16 ounces of apple juice.
The Correct Answer is B
Choice A reason: Reducing caloric intake by 200 calories a day may not be enough to achieve significant weight loss for a client who is obese. The recommended daily calorie deficit for weight loss is 500 to 750 calories, which can result in a loss of 1 to 1.5 pounds per week¹.
Choice B reason: Losing 5 percent of body weight can improve glycemic control and reduce the need for glucose-lowering medications for a client who has type 2 diabetes. Studies have shown that weight loss of 5 to 10 percent can lower HbA1c levels by 0.5 to 1.0 percentage points².
Choice C reason: Exercising for 30 minutes three times a week may not be sufficient to lose 1 pound per week. The recommended amount of physical activity for weight loss is at least 150 minutes of moderate-intensity aerobic exercise per week, plus resistance training at least twice a week³.
Choice D reason: Drinking 16 ounces of apple juice is not advisable if the blood glucose level drops during exercise, as it can cause hyperglycemia. Apple juice contains about 48 grams of carbohydrates, which is equivalent to four servings of glucose tablets⁴. The recommended treatment for hypoglycemia is to consume 15 to 20 grams of fast-acting carbohydrates, such as glucose tablets, gel, or juice, and recheck the blood glucose level after 15 minutes⁵.
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Correct Answer is D
Explanation
Choice D reason: A calorie reduction of 500 fewer calories per day can result in a weight loss of about 0.45 kg (1 lb) per week, which is a safe and realistic goal for most clients. A pound of fat contains about 3,500 calories, so reducing the daily intake by 500 calories can create a deficit of 3,500 calories per week.
Choice A reason: A weight loss of 0.45 kg (1 lb) per day is too rapid and unhealthy, as it can cause dehydration, electrolyte imbalance, muscle loss, and metabolic slowdown. It can also be unsustainable and lead to weight regain. A calorie reduction of 500 fewer calories per day cannot achieve such a drastic weight loss.
Choice B reason: A weight loss of 0.23 kg (0.5 lb) per day is also too rapid and unhealthy, for the same reasons as choice A. A calorie reduction of 500 fewer calories per day cannot achieve such a drastic weight loss.
Choice C reason: A weight loss of 0.23 kg (0.5 lb) per week is too slow and unlikely, as it would require a calorie reduction of only 250 fewer calories per day. This is not enough to create a significant deficit and stimulate weight loss. A calorie reduction of 500 fewer calories per day can result in a faster weight loss.
Correct Answer is D
Explanation
Choice A reason: Fever is not an indication of an allergic reaction, as it is a sign of infection or inflammation. The nurse should assess the infant for other causes of fever, such as ear infection, urinary tract infection, or viral illness.
Choice B reason: Jaundice is not an indication of an allergic reaction, as it is a sign of liver dysfunction or hemolysis. The nurse should evaluate the infant for other causes of jaundice, such as hepatitis, biliary atresia, or hemolytic anemia.
Choice C reason: Bruising is not an indication of an allergic reaction, as it is a sign of trauma or bleeding disorder. The nurse should examine the infant for other causes of bruising, such as injury, coagulopathy, or leukemia.
Choice D reason: Diarrhea is an indication of an allergic reaction, as it is a sign of gastrointestinal hypersensitivity or intolerance. The nurse should ask the parents about the infant's food intake, history of allergies, and symptoms of anaphylaxis, such as hives, swelling, or difficulty breathing.
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