# Situation: A 50-year-old woman with beta-thalassemia trait comes to the clinic because of fatigue and frequent urination. She has hypertension and a body mass index (BMI) of 31 kg/m². She has no signs of acute illness. She is diagnosed with type 2 diabetes mellitus, and the nurse drafts her monitoring plan. Which items should be included? 1. The first eye examination 5 years after diagnosis 2. A urine albumin-to-creatinine ratio each year 3. Urine glucose tests in place of blood glucose checks 4. A comprehensive foot examination at least yearly 5. A dilated eye examination now, at the time of diagnosis

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630496  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 50-year-old woman with beta-thalassemia trait comes to the clinic because of fatigue and frequent urination. She has hypertension and a body mass index (BMI) of 31 kg/m². She has no signs of acute illness.

She is diagnosed with type 2 diabetes mellitus, and the nurse drafts her monitoring plan. Which items should be included?
1. The first eye examination 5 years after diagnosis
2. A urine albumin-to-creatinine ratio each year
3. Urine glucose tests in place of blood glucose checks
4. A comprehensive foot examination at least yearly
5. A dilated eye examination now, at the time of diagnosis

## 보기

1. 1, 2 and 4
2. 2, 4 and 5 **✔ 정답**
3. 3, 4 and 5
4. 1, 3 and 5

**정답: 2**

## 해설

In type 2 diabetes a dilated eye examination is done at diagnosis, because retinopathy may already be present after years of unrecognized hyperglycemia; the 5-year delay applies to type 1. The urine albumin-to-creatinine ratio detects early kidney disease, and a comprehensive foot examination is done at least yearly. Urine glucose does not reflect current blood glucose and is not a substitute for blood glucose monitoring.

## 심화 해설

The three items that belong in her plan
Monitoring in type 2 diabetes aims to detect complications early, when treatment can slow them. Item 2, a yearly urine albumin-to-creatinine ratio, screens for early diabetic kidney disease, which can be present before the eGFR falls. Item 4, a comprehensive foot examination at least yearly, detects neuropathy, poor circulation, deformity, and skin breakdown before ulcers develop. Item 5, a dilated eye examination at diagnosis, is needed because retinopathy may already be present. In type 2 diabetes, screening for eye, kidney, and foot complications begins at the time of diagnosis.

Why the eye examination is done now
Type 2 diabetes often develops silently, and many clients have had raised glucose for years before diagnosis. During that time, microvascular damage to the retina may already have occurred. That is why the first dilated eye examination is done at diagnosis in type 2 diabetes. In type 1 diabetes, onset is usually abrupt and recognized quickly, so the first eye examination is generally done within 5 years of diagnosis. Item 1 applies the type 1 schedule to a type 2 client and is therefore wrong.

| Item | Include? | Reason |
| --- | --- | --- |
| 1. First eye examination 5 years after diagnosis | No | Type 1 schedule; type 2 needs it at diagnosis |
| 2. Urine albumin-to-creatinine ratio yearly | Yes | Detects early kidney disease |
| 3. Urine glucose instead of blood glucose | No | Outdated; does not reflect current glucose |
| 4. Comprehensive foot examination yearly | Yes | Detects neuropathy and vascular disease |
| 5. Dilated eye examination now | Yes | Retinopathy may already be present |

Why urine glucose testing is outdated
Glucose appears in the urine only when blood glucose exceeds the renal threshold, roughly 180 mg/dL, so a negative urine test cannot distinguish normal glucose from hypoglycemia or moderate hyperglycemia. Urine glucose also lags behind blood glucose and is affected by hydration. Current practice uses blood glucose monitoring and HbA1c where valid. In her case, because her beta-thalassemia trait makes HbA1c unreliable, blood glucose results are even more important. Watch out! Item 3 looks practical and low-cost, but it is no longer an accepted substitute.

Exam takeaway
Other parts of her plan include blood pressure control, lipid assessment, and education on foot care, diet, and activity. Key point! For type 2 diabetes: dilated eye examination at diagnosis, then regularly; yearly albumin-to-creatinine ratio; and at least yearly comprehensive foot examination.

## 임상 시나리오

Type 2 Diabetes Monitoring PlanScreening for complications from diagnosis
Dilated eye examination at diagnosis: retinopathy may already be present after years of unrecognized hyperglycemia. The 5-year delay applies to type 1 diabetes.

Yearly urine albumin-to-creatinine ratio detects early diabetic kidney disease; a comprehensive foot examination at least yearly detects neuropathy and vascular disease.

Blood glucose monitoring, not urine glucose, guides care; her thalassemia trait makes HbA1c less reliable.

CautionUrine glucose testing cannot detect hypoglycemia or reflect current blood glucose and is not a substitute for blood glucose checks.

## 핵심 개념

- **Urine albumin-to-creatinine ratio** — A spot urine test that detects small amounts of albumin as an early sign of kidney damage.
- **Diabetic retinopathy** — Damage to retinal blood vessels from chronic hyperglycemia that can lead to vision loss.
- **Comprehensive foot examination** — Assessment of skin, deformity, sensation, and circulation to identify feet at risk of ulcers.
- **Renal threshold for glucose** — The blood glucose level, about 180 mg/dL, above which glucose spills into the urine.

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