vSim - Sherman "Red" Yoder 1/2/3 Q& A Plus
Elaboration updated (2023-2024)
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 - answ- 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. - answ- 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. - answ- 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 - answ- 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. - answ- 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 - answ- d) SPICES: An Overall Assessment Tool for
Older Adults
Elaboration updated (2023-2024)
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 - answ- 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. - answ- 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. - answ- 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 - answ- 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. - answ- 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 - answ- d) SPICES: An Overall Assessment Tool for
Older Adults
