vSim - Sherman "Red" Yoder 1/2/3 All Questions and Answers with Rationales

vSim - Sherman "Red" Yoder 1/2/3 All Questions and Answers with Rationales Early diagnosis for diabetes mellitus in the older adult is more difficult due to the presentation of nonspecific manifestations of the diseas ...

vSim - Sherman "Red" Yoder 1/2/3 All Questions and Answers with Rationales Early diagnosis for diabetes mellitus in the older adult is more difficult due to the presentation of nonspecific manifestations of the disease. Therefore, how often should the nurse obtain fasting blood glucose levels to determine a diagnosis? a) Monthly for the adult older than age 65 years b) Yearly for the adult older than age 65 years c) Every 3 years for the adult older than age 65 years d) Every 3 years for the adult beginning at age 45 years ✔✔ d) Every 3 years for the adult beginning at age 45 years An early diagnosis of diabetes mellitus in the older adult is difficult due to the common presentation of nonspecific symptoms. Because the renal threshold for glucose increases with age, older adults can be hyperglycemic without the specific evidence of glycosuria. Therefore quarterly fasting blood sugar testing is preferred over urine testing in older adults to demonstrate elevated blood glucose levels when other symptoms may not have manifested. Monthly testing would be overly burdensome for the older adult, and only yearly or every 3years would give the condition time to develop and cause serious complications, which is what early diagnosis seeks to avoid. What criterion establishes the diagnosis of diabetes in the older adult? a) Blood glucose concentrations 2 hours after an oral glucose intake that is greater than or equal to 200 mg/dL during an oral glucose tolerance test. b) Blood glucose concentration 2 hours after an oral glucose intake that is greater than 125 mg/dL during an oral glucose tolerance test. c) Symptoms of disease and a random blood glucose concentration of greater than 350 mg/dL. d) Fasting blood glucose concentration greater than or equal to 225 mg/dL. ✔✔ a) Blood glucose concentrations 2 hours after an oral glucose intake that is greater than or equal to 200 mg/dL during an oral glucose tolerance test. Of the diagnostic tests for diabetes mellitus, the oral glucose tolerance test is the most effective. Diagnosis is usually established when the oral glucose intake is greater than or equal to 200 mg/dL during the oral glucose tolerance test. A blood glucose level greater than 125 mg/dL is insufficient to establish the diagnosis of diabetes; levels greater than or equal to 225 mg/dL and greater than 350 mg/dL are higher than the minimum necessary to establish the diagnosis. Educating the patient with diabetes about self-care concerns, including skin care, is critical. One of the major complications of diabetes mellitus is ulcer development on the feet. What teaching points should the nurse provide to the patient with diabetes? a) Trim the toenails with scissors whenever needed. b) Wear shoes and socks at all times; never walk barefooted. c) Lubricate the feet with petroleum jelly followed with a fresh powder scattered between the toes. d) Inspect the feet every month. ✔✔ b) Wear shoes and socks at all times; never walk barefooted. Poor circulation in the lower extremities of the patient with diabetes may occur, causing a lack of sensation with numbness and weak pulses. The patient may develop gangrene as a result. Therefore, wearing socks and shoes will help the patient with diabetes avoid cuts and scrapes that may become problematic. The nurse should notify the physician of any peripheral vascular disease; educating the patient with diabetes in proper foot care and in the early detection of problems may reduce the risk of these problems. Feet should be inspected daily (not monthly) for cuts, blisters, and red spots and swelling. Patients with diabetes are at great risk for developing fungal infections form normal foot perspiration. They must take great care when trimming toenails; it is best to use an emery board or nail file instead of scissors to groom the toenails. Feet should be softened with a thin coat of skin lotion over the tops and bottoms of the feet, but not between the toes. Powdering after using lotion can lead to areas with thickened coatings of powder and lotion, which may cause further damage. The older adult with diabetes mellitus may present manifestations of hypoglycemia that differ from the classic symptoms of tachycardia, restlessness, and anxiety. What symptom might indicate hypoglycemia in the older adult? a) Confusion b) Signs of ketoacidosis c) Cardiac arrhythmias d) Diaphoresis ✔✔ a) Confusion