# A 52-year-old client is at her first outpatient visit 2 weeks after being diagnosed with type 2 diabetes. The nurse reviews the electronic health record. Which teaching topic should the nurse address first at this visit? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617288&lang=en > language: en > subject: Self-Care > category: HPM ## Question A 52-year-old client is at her first outpatient visit 2 weeks after being diagnosed with type 2 diabetes. The nurse reviews the electronic health record. Which teaching topic should the nurse address first at this visit? History Vitals Labs Orders Notes Type 2 diabetes diagnosed 2 weeks ago. Obesity, hypertension, hyperlipidemia. Works as a school bus driver on a split shift (0600-0900 and 1400-1700). Callus on the left heel, no open areas; monofilament sensation intact. BP 136/84 mm Hg, HR 78/min, RR 16/min, temperature 36.8 C, BMI 33 kg/m2, SpO2 98% on room air. HbA1c 8.9% (at diagnosis). Fasting glucose today 168 mg/dL. Creatinine 0.8 mg/dL, eGFR above 90 mL/min/1.73 m2. LDL 142 mg/dL. Urine albumin-to-creatinine ratio 22 mg/g. Metformin 500 mg PO twice daily with meals. Glipizide 5 mg PO every morning before breakfast. Atorvastatin 20 mg PO daily. Self-monitoring of blood glucose before breakfast and when symptomatic. Diabetes self-management education referral. Client reports 3 loose stools daily since starting metformin, now improving. Reports two episodes this week of shakiness, sweating, and a pounding heart around 1100 on days she skipped breakfast to lose weight; symptoms eased after drinking juice. Does not yet know what these episodes were. Has a glucose meter but has not used it. Walks 10 minutes twice a week. 1 Taking metformin with meals to lessen loose stools ✕ 2 Building up to 150 minutes of weekly moderate activity ✕ 3 Daily foot inspection and care of the heel callus ✕ 4 Recognizing and treating low blood glucose ✕ ## Explanation The notes describe likely hypoglycemia (shakiness, sweating, pounding heart, relieved by juice) on days she skips breakfast after taking glipizide, and she drives a school bus, so recognizing and treating low glucose is the immediate safety priority. Loose stools are improving and expected with metformin, activity and foot care are important long-term topics, and her callus has intact sensation with no open area. ## In-depth explanation Quick answer Option 4: recognizing and treating low blood glucose. Why this is correct Glipizide, a sulfonylurea, stimulates insulin release regardless of food intake, so skipping breakfast after the morning dose causes hypoglycemia. The notes describe adrenergic symptoms relieved by juice, and the client does not know what they were. Because she drives a bus for her job, an unrecognized low glucose could harm her and others. Teaching her to check glucose when symptomatic, treat with 15 g of fast carbohydrate, recheck in 15 minutes, and not skip meals after glipizide addresses the most urgent risk. Easy analogy or mental picture It makes sense to teach someone how to use the brakes before teaching them fuel efficiency: long-term goals matter, but the immediate danger comes first. Memory hook Sulfonylurea + skipped meal = low. Low + driving = teach it today. NCLEX decision rule When several teaching needs exist, choose the one that prevents immediate harm suggested by the chart (symptoms, medication risk, and occupation) before long-term risk reduction. Why the other choices are wrong Metformin with meals (option 1): tempting because the notes mention GI effects, but the loose stools are expected, improving, and not dangerous. Activity goal (option 2): tempting because she is obese and walks little, and exercise is central to type 2 diabetes care, but it is a long-term goal and more activity without meals can worsen glipizide-related lows. Foot care (option 3): tempting because a callus is documented, but sensation is intact and there is no open area, so this is routine prevention rather than an urgent need. References 1ADA Standards of Care in Diabetes-2025Sulfonylurea hypoglycemia risk, hypoglycemia education, and diabetes self-management education 2American Diabetes Association: Hypoglycemia (Low Blood Glucose)Recognition and 15-15 treatment of hypoglycemia ## Clinical scenario Scenario A newly diagnosed client with type 2 diabetes taking glipizide and metformin reports episodes of shakiness and sweating on days she skips breakfast; she drives a school bus. ## Key concepts - **Sulfonylurea** — An oral diabetes drug class, such as glipizide, that stimulates insulin release and can cause hypoglycemia. - **15-15 rule** — Treat glucose below 70 mg/dL with 15 g of fast-acting carbohydrate and recheck in 15 minutes. - **Adrenergic hypoglycemia symptoms** — Shakiness, sweating, palpitations, and anxiety from the stress response to low blood glucose. ## Related questions - [A client has taken daily prednisone for three months and is preparing for home self-manage…](https://mymerci.kr/pages/nclex_q.php?qn_id=396141&lang=en) - [Review the postpartum symptom timeline and determine how the nurse should respond to the c…](https://mymerci.kr/pages/nclex_q.php?qn_id=546511&lang=en) - [A client with heart failure is being discharged with a 2,000-mg daily sodium limit. 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