vSim - Sherman "Red" Yoder 1/2/3 All Questions and Answers with complete solution
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vSim - Sherman "Red" Yoder 1/2/3 All Questions and Answers with complete solution
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 le...
vSim - Sherman "Red" Yoder 1/2/3 All Questions and
Answers with complete solution
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
The older adult patient with diabetes may not present with the classic manifestations of
hypoglycemia (i.e., tachycardia, restlessness, perspiration, and anxiety). Instead, the
first indication of hypoglycemia in the older adult may be somnolence, convulsions, or
mental status changes that include confusion, disorientation, poor sleep patterns,
nocturnal headaches, slurred speech, or unconsciousness. Diaphoresis, cardiac
disturbances, and ketoacidosis are other classic symptoms of hypoglycemia, but these
may be totally absent in the older adult.
Why are first-generation antihistamines (e.g., diphenhydramine [Benadryl])
considered inappropriate for the older adult?
a) These drugs have anticholinergic effects and should not be administered to the
older adult.
b) These drugs cause the older person to wander during the nighttime hours.
c) These drugs cause euphoria in the older adult.
d) These drugs have a strong sleep effect for older adults who have trouble
awakening.
, a) These drugs have anticholinergic effects and should not be administered to the older
adult.
First-generation antihistamines should be avoided in the older adult because they have
anticholinergic effects and may cause blurred vision, urinary retention, confusion,
hallucinations, dry mouth, constipation, and delirium. Trouble waking, euphoria, and
nocturnal wandering have not been documented as side effects of older adult
anticholinergic use.
A nurse is talking with an older adult patient who unexpectedly mention having
trouble sleeping. What tool besides the Pittsburgh Sleep Quality Index (PSQI) can
the nurse use to assess for sleep disorders?
a) Geriatric Depression Scale
b) Elder Mistreatment Assessment
c) Mini-Cog Assessment Tool
d) SPICES: An Overall Assessment Tool for Older Adults
d) SPICES: An Overall Assessment Tool for Older Adults
Approximately half of adults complain of sleep disorders, especially insomnia. Although
the SPICES tool is an overall assessment tool, it also provides insight into potential
sleep disorders. The other tools assess for depression, abuse, and cognitive decline,
respectively.
Glucose intolerance is common in the older adult, which causes a higher
incidence of diabetes in that population. What is the most significant factor
leading to glucose intolerance among older adults?
a) Malnourishment and dehydration in an older adult lead to glucose intolerance.
b) All older adults develop glucose intolerance with age.
c) Obesity and inactivity in an older adult lead to glucose intolerance.
d) Older adults develop glucose intolerance because they tend to have higher
stress levels.
c) Obesity and inactivity in an older adult lead to glucose intolerance.
Several theories have been proposed regarding the development of glucose intolerance
in the older adult, such as it being related to the aging process. However, the increased
amount of fatty tissue present in the obese, inactive older adult--similar to that in the
general population is not considered significant to the development of diabetes mellitus.
The older adult endocrine system undergoes age-related changes, one of which
is prolonged hyperglycemic levels. What statement best describes why this
occurs?
a) In the older adult, the alpha cells of the pancreas produce increased insulin.
b) In the older adult, the pituitary gland releases decreased amounts of
adrencorticotropic hormone.
c) The older adult has increased tissue sensitivity to insulin.
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