# Situation: A 67-year-old woman who has had type 2 diabetes mellitus for 15 years attends the medical clinic. She takes metformin, glipizide, and acarbose for diabetes and metoprolol for hypertension. Monofilament testing shows loss of protective sensation in both feet. Which instruction should the nurse include in her foot care teaching?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630400  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 67-year-old woman who has had type 2 diabetes mellitus for 15 years attends the medical clinic. She takes metformin, glipizide, and acarbose for diabetes and metoprolol for hypertension. Monofilament testing shows loss of protective sensation in both feet.

Which instruction should the nurse include in her foot care teaching?

## 보기

1. Soak the feet in warm water for 20 minutes daily
2. Trim the toenails in a curve that follows the toe
3. Rub lotion between the toes to prevent cracking
4. Test the bath water with the elbow first **✔ 정답**

**정답: 4**

## 해설

With loss of protective sensation she cannot feel a burn, so bath water is tested with the elbow or a thermometer and should be lukewarm. Feet are washed and dried well between the toes, nails are cut straight across, and the feet are inspected daily with a mirror.

## 심화 해설

The correct foot care instruction
Monofilament testing shows loss of protective sensation in both feet. Because she cannot feel heat, bath water is tested with the elbow or a thermometer before her feet go in, and the water should be lukewarm. A burn from water that feels comfortable to the hands or that she simply cannot feel with her feet is a common way that foot ulcers begin in diabetic neuropathy.

Why neuropathy changes foot care
Long-standing diabetes damages peripheral nerves, beginning in the feet. Without protective sensation, a client does not notice burns, blisters, small cuts, or pressure from tight shoes. Poor circulation and impaired healing then allow minor injuries to become ulcers and infections, which can lead to amputation. Foot care teaching therefore replaces the missing sensation with deliberate checks: test water temperature, inspect the feet every day (using a mirror for the soles), and wear properly fitted footwear.

| Practice | Correct method | Reason |
| --- | --- | --- |
| Bath water | Test with elbow or thermometer; lukewarm | She cannot feel a burn |
| Washing | Brief wash; dry well between toes | Prolonged soaks macerate skin |
| Nails | Cut straight across | Curved cuts promote ingrown nails |
| Lotion | On dry skin, not between toes | Moisture between toes promotes fungal infection |
| Inspection | Daily, with a mirror | Detects injuries she cannot feel |

Why the other instructions are wrong
Soaking the feet for 20 minutes softens and macerates the skin, and warm water she cannot feel may burn; feet are washed briefly in lukewarm water. Trimming nails in a curve encourages ingrown toenails and infection; nails are cut straight across. Rubbing lotion between the toes keeps the area moist and promotes fungal infection and skin breakdown; lotion is applied to dry skin elsewhere on the foot.

Nursing application
The nurse teaches daily inspection, careful washing and drying, appropriate nail care, avoidance of walking barefoot, and wearing well-fitted shoes with clean socks. The client should report any cut, blister, redness, or color change promptly and should not self-treat corns or calluses.

Exam takeaway
Key point With loss of protective sensation, the right answer replaces the lost sensation: test water temperature with the elbow or a thermometer and inspect the feet daily.

## 임상 시나리오

Foot Care With Diabetic NeuropathyProtecting feet that cannot feel
Loss of protective sensation means she cannot feel burns, blisters, or cuts. Bath water is tested with the elbow or a thermometer and should be lukewarm.

Feet are washed briefly and dried well between the toes, nails are cut straight across, lotion is kept off the spaces between the toes, and the feet are inspected daily with a mirror.

CautionAvoid long foot soaks, walking barefoot, and self-treatment of corns or calluses. Report any cut, blister, or color change promptly.

## 핵심 개념

- **Loss of protective sensation** — Reduced ability to feel pressure or injury in the feet, detected by monofilament testing.
- **Monofilament test** — A screening test using a nylon filament pressed on the foot to assess protective sensation.
- **Diabetic neuropathy** — Nerve damage caused by long-standing high blood glucose, often starting in the feet.
- **Maceration** — Softening and breakdown of skin caused by prolonged exposure to moisture.

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