The nurse assists an older man who has type 2 diabetes mellitus to improve his glucose control. ...

Answer to #1

C
Diabetes mellitus is controlled by balancing exercise, calories, and hypoglycemic medication; if one element of therapy is altered, then one or both of the remaining elements must be adjusted. When the patient's activity is going to metabolize more calories, the medication has to be re-duced or the calories have to increase. For a patient with type 2 diabetes mellitus, adjusting the medication can be difficult; therefore the nurse instructs this older adult to supplement his caloric intake, which can be accomplished by eating snacks during the walk or by increasing the gly-cemic load before walking. The patient ensures glucose control during these activities by testing his blood sugar levels. The nurse cannot tell the patient to omit medication because doing so is not within a nurse's scope of practice. The nurse instructs the older adult to wear closed, well-fitting leather shoes to protect the feet from trauma. Although many individuals with type 2 diabetes mellitus periodically take insulin, insulin is administered to induce hypoglycemia. Be-cause the individual plans to walk more than usual, more calories are needed to prevent hypog-lycemia.

Answer to #2

B, C, F

a. Incorrect. Shaking is an early clinical indicator of hypoglycemia and likely to be masked by the action of a beta-adrenergic blocker such as metoprolol, because beta-blockers oppose the surge of epinephrine in early hypoglycemia.
b. Correct. Dizziness is a clinical indicator of moderate hypoglycemia. It is unlikely to be masked by the affects of metoprolol, a beta-adrenergic blocker, because beta-blockers mask the early signs of hypoglycemia effectively.
c. Correct. Weakness is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the affects of metoprolol.
d. Incorrect. Diaphoresis is an early clinical indicator of hypoglycemia, and it is likely to be masked by the action of a beta-adrenergic blocker such as metoprolol.
e. Incorrect. Increased heart rate is an early clinical indicator of hypoglycemia and is likely to be masked by the action of a beta-adrenergic blocker such as metoprolol.
f. Correct. Impaired vision is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol.

Answer to #3

A
Hyperlipidemia, a condition commonly associated with type 2 diabetes mellitus, accelerates the development of microvascular complications of diabetes mellitus because high serum, low-density lipoproteins contribute to the formation of atherosclerotic plaque. The plaque first accumulates in the smallest arteries, causing complications of diabetes mellitus including peri-pheral arterial disease, retinopathy, and nephropathy. Hypothyroidism, venous insufficiency, and chronic constipation are not associated with type 2 diabetes mellitus.

Answer to #4

D
The nurse should respect the resident's beliefs and practices and accommodate them when they are not harmful. Receiving the Sacrament can potentially relieve much of the patient's anxiety. Arranging an appointment with an Episcopal priest for the resident is not an appropriate inter-vention; the two belief systems are not the same, and the resident is unlikely to experience the minister's efforts as satisfactory. Reporting the resident's change in behavior to the attending physician is also inappropriate; the resident's wish can be understood entirely within the resi-dent's belief system and need not reflect a medical problem, particularly if a visit by a priest re-lieves the resident's anxiety. Referring the resident to the staff psychologist to address the un-derlying cause of the patient's anxiety is an approach that attempts to change the resident's belief system.

Answer to #5

A

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A Correct. Diabetes is much more prevalent among older Americans.
B Incorrect. This man's blood pressure is normal.
C Incorrect. Palpable peripheral pulses are a normal finding.
D Incorrect. A total cholesterol level below 200 mg/dl is normal and highly desir-able for a man at risk for diabetes.

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