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(Answered) vSim - Sherman "Red" Yoder 1/2/3 pre/post quizzes Explained deeply - 2022.
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vSim - Sherman "Red" Yoder 1/2/3Pre/Post Quizzes (2022)
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
(Ans) - 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.
(Ans) - 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.(Ans)
- 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(Ans)
- 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.
(Ans) - 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
(Ans) - 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.
(Ans) - c) Obesity and inactivity in an older adult lead to glucose intolerance.
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