The nurse prepares to teach four clients about diabetes mellitus. Which client has the greatest need for instructions?

Reference Range:

Glycosylated hemoglobin A1C (HbA1C) [good glycemic control: less than 10%]

Random blood glucose [less than or equal to 200 mg/dL (less than 11.1 mmol/L]

Postprandial glucose (1-hour gestational diabetes) [less than 140 mg/dL (less than 7.8 mmol/L)]

Fasting blood glucose [70 to 110 mg/dL (less than 6.1 mmol/L)]

A child with asthma, who takes prednisone and has a fasting serum glucose of 180 mg/dL (10 mmol/L).

An adolescent male who has type 1 diabetes and a random glucose at 120 mg/dL (6.7 mmol/L).

A female who has gestational diabetes and has a 1-hour postprandial glucose at 140 mg/dL (7.8 mmol/L).

An adult who has type 2 diabetes and has a glycosylated hemoglobin (Hb A1C) at 10%.

Answer and Explanation

The Correct Answer is A

A. A child with asthma, who takes prednisone and has a fasting serum glucose of 180 mg/dL (10 mmol/L): This client’s fasting glucose is well above the normal range. Prednisone can increase blood glucose levels, placing the child at risk for hyperglycemia. This indicates a need for urgent education on blood glucose management while on steroids.

B. An adolescent male who has type 1 diabetes and a random glucose at 120 mg/dL (6.7 mmol/L): This blood glucose level is within normal limits for random testing. No immediate need for change in diabetic teaching is evident based on this value.

C. A female who has gestational diabetes and has a 1-hour postprandial glucose at 140 mg/dL (7.8 mmol/L): Her result meets the upper limit range for gestational diabetes. While she requires ongoing monitoring, her values do not indicate a need for urgent intervention.

D. An adult who has type 2 diabetes and has a glycosylated hemoglobin (Hb A1C) at 10%: Although this indicates poor long-term control, it reflects a chronic issue. The child with an acutely elevated fasting glucose and corticosteroid use is at greater immediate risk and thus has higher priority for education.

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Correct Answer is B

Explanation

A. The woman is timid and speaks softly when asked about the accident: Timid behavior may suggest fear or anxiety, but it's nonspecific and may be due to trauma or emotional distress, not necessarily abuse.

B. Spiral fracture on the woman's arm and wrist: Spiral fractures occur from twisting injuries and are often associated with non-accidental trauma, especially when the injury doesn't match the reported mechanism.

C. The woman is hyperventilating and appears to be in pain: Hyperventilation and visible pain may indicate anxiety or physical injury, but they are expected after trauma and not unique to domestic violence.

D. Fresh bruises on the woman's shoulder and chest: Bruising is a possible sign of abuse, but bruises alone can result from a car accident. The type and location must be assessed in context.

A. Prior to exercising. B. Before going to bed. C. Immediately after meals. D. During acute illness.

Correct Answer is D

Explanation

A. Prior to exercising: Testing before exercise is important, especially for clients on insulin, but may not be necessary for all clients depending on their diabetes management and regimen.

B. Before going to bed: This is often recommended for insulin-dependent diabetics to avoid nocturnal hypoglycemia, but it's not universally required for all clients.

C. Immediately after meals: Postprandial glucose testing is useful, especially for gestational diabetes or insulin adjustments, but it is not routinely required for all diabetics.

D. During acute illness: All clients with diabetes should monitor blood glucose more frequently during illness, as stress hormones can cause hyperglycemia or unexpected hypoglycemia.

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Naxlex Comprehensive Predictor Exams

A woman and her live-in significant other come in the emergency department following a motor vehicle collision. Which finding should alert the nurse to assess for the possibility of domestic violence?

Correct Answer is B

Explanation

The nurse is planning a class about blood glucose monitoring for a group of clients with diabetes mellitus. Which timing of glucose testing would apply for any client regardless of the client's age or type of diabetes?

Correct Answer is D

Explanation

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