Download The Client with Diabetes Mellitus

The Client with Diabetes Mellitus
19. The nurse is teaching a diabetic client using
an empowerment approach. The nurse should initiate
teaching by asking which of the following?
■ 1. “How much does your family need to be
involved in learning about your condition?”
■ 2. “What is required for your family to manage
your symptoms?”
■ 3. “What activities are most important for you to
be able to maintain control of your diabetes?”
■ 4. “What do you know about your medications
and condition?”
20. A nurse is participating in a diabetes screening
program. Who of the following is (are) at risk for
developing type 2 diabetes? Select all that apply.
■ 1. A 32-year-old female who delivered a 9½-lb
infant.
■ 2. A 44-year-old Native American Indian who
has a body mass index (BMI) of 32.
■ 3. An 18-year-old Hispanic who jogs four times
a week.
■ 4. A 55-year-old Asian American who has hypertension
and two siblings with type 2 diabetes.
■ 5. A 12-year-old who is overweight.
21. A 57-year-old with diabetes insipidus is hospitalized
for care. Which fi nding should the nurse
report to the physician?
■ 1. Urine output of 350 mL in 8 hours.
■ 2. Urine specifi c gravity of 1.001.
■ 3. Potassium of 4.0 mEq.
■ 4. Weight gain.
22. The nurse is checking the laboratory results
on a 52-year-old client with type 1 diabetes (see
chart). What laboratory result indicates a problem
that should be managed?
■ 1. Blood glucose.
■ 2. Total cholesterol.
■ 3. Hemoglobin.
■ 4. Low-density lipoprotein (LDL) cholesterol.
Laboratory Results
Test Result
Blood glucose 192 mg/dL
Total cholesterol 250 mg/dL
Hemoglobin 12.3 mg/dL
Low-density lipoprotein cholesterol 125 mg/dL
23. A client with type 1 diabetes mellitus has
diabetic ketoacidosis. Which of the following fi ndings
has the greatest effect on fl uid loss?
■ 1. Hypotension.
■ 2. Decreased serum potassium level.
■ 3. Rapid, deep respirations.
■ 4. Warm, dry skin.
24. A client is to receive glargine (Lantus) insulin
in addition to a dose of aspart (NovoLog). When the
nurse checks the blood glucose level at the bedside,
it is greater than 200 mg/dL. How should the nurse
administer the insulins?
■ 1. Put air into the glargine insulin vial, and then
air into the aspart insulin vial, and draw up
the correct dose of aspart insulin fi rst.
■ 2. Roll the glargine insulin vial, then roll the
aspart insulin vial. Draw up the longer-acting
glargine insulin fi rst.
■ 3. Shake both vials of insulin before drawing up
each dose in separate insulin syringes.
■ 4. Put air into the glargine insulin vial, and
draw up the correct dose in an insulin
syringe; then, with a different insulin syringe,
put air into the aspart vial and draw up the
correct dose.
25. An adult client with type 2 diabetes is taking
metformin (Glucophage) 1,000 mg two times every
day. After the nurse provides instructions regarding
the interaction of alcohol and metformin, the nurse
evaluates that the client understands the instructions
when the client says:
■ 1. “If I know I’ll be having alcohol, I must
not take metformin; I could develop lactic
acidosis.”
■ 2. “If my physician approves, I may drink alcohol
with my metformin.”
■ 3. “Adverse effects I should watch for are feeling
excessively energetic, unusual muscle stiffness,
low back pain, and a rapid heartbeat.”
■ 4. “If I feel bloated, I should call my physician.”
26. A client has recently been diagnosed with
type 2 diabetes mellitus and is to take tolbutamide
(Orinase). When teaching the client about the drug,
the nurse explains that tolbutamide is believed to
lower the blood glucose level by which of the following
actions?
■ 1. Potentiating the action of insulin.
■ 2. Lowering the renal threshold of glucose.
■ 3. Stimulating insulin release from functioning
beta cells in the pancreas.
■ 4. Combining with glucose to render it inert.
27. Which information should the nurse include
when developing a teaching plan for a client newly
diagnosed with type 2 diabetes mellitus. Select all
that apply.
■ 1. A major risk factor for complications is obesity
and central abdominal obesity.
■ 2. Supplemental insulin is mandatory for controlling
the disease.
■ 3. Exercise increases insulin resistance.
■ 4. The primary nutritional source requiring
monitoring in the diet is carbohydrates.
■ 5. Annual eye and foot examinations are recommended
by the American Diabetes Association
(ADA).
28. When teaching the diabetic client about
foot care, the nurse should instruct the client to do
which of the following?
■ 1. Avoid going barefoot.
■ 2. Buy shoes a half size larger.
■ 3. Cut toenails at angles.
■ 4. Use heating pads for sore feet.
29. A client with diabetes mellitus asks the nurse
to recommend something to remove corns from his
toes. The nurse should advise the client to:
■ 1. Apply a high-quality corn plaster to the area.
■ 2. Consult a physician or podiatrist about
removing the corns.
■ 3. Apply iodine to the corns before peeling them
off.
■ 4. Soak the feet in borax solution to peel off the
corns.
30. A client with diabetes mellitus comes to the
clinic for a regular 3-month follow-up appointment.
The nurse notes several small bandages covering
cuts on the client’s hands. The client says, “I’m so
clumsy. I’m always cutting my fi nger cooking or
burning myself on the iron.” Which of the following
responses by the nurse would be most appropriate?
■ 1. “Wash all wounds in isopropyl alcohol.”
■ 2. “Keep all cuts clean and covered.”
■ 3. “Why don’t you have your children do the
cooking and ironing?”
■ 4. “You really should be fi ne as long as you take
your daily medication.”
31. The client with diabetes mellitus says, “If I
could just avoid what you call carbohydrates in my
diet, I guess I would be okay.” The nurse should
base the response to this comment on the knowledge
that diabetes affects metabolism of which of
the following?
■ 1. Carbohydrates only.
■ 2. Fats and carbohydrates only.
■ 3. Protein and carbohydrates only.
■ 4. Proteins, fats, and carbohydrates.
32. A client with type 1 diabetes mellitus is
admitted to the emergency department. Which of
the following respiratory patterns requires immediate
action?
■ 1. Deep, rapid respirations with long
expirations.
■ 2. Shallow respirations alternating with long
expirations.
■ 3. Regular depth of respirations with frequent
pauses.
■ 4. Short expirations and inspirations.
33. Which of the following fi ndings should the
nurse report to the client’s physcian for a client with
unstable type 1 diabetes mellitus? Select all that
apply.
■ 1. Systolic blood pressure, 145 mm Hg.
■ 2. Diastolic blood pressure, 87 mm Hg.
■ 3. High-density lipoprotein (HDL), 30 mg/dL.
■ 4. Glycosylated hemoglobin (HbA1c), 10.2%.
■ 5. Triglycerides, 425 mg/dL.
■ 6. Urine ketones, negative.
34. The nurse should caution the client with
diabetes mellitus who is taking a sulfonylurea that
alcoholic beverages should be avoided while taking
these drugs because they can cause which of the
following?
■ 1. Hypokalemia.
■ 2. Hyperkalemia.
■ 3. Hypocalcemia.
■ 4. Disulfi ram (Antabuse)–like symptoms.
35. Which of the following conditions is the
most signifi cant risk factor for the development of
type 2 diabetes mellitus?
■ 1. Cigarette smoking.
■ 2. High-cholesterol diet.
■ 3. Obesity.
■ 4. Hypertension.
36. Which of the following indicates a potential
complication of diabetes mellitus?
■ 1. Infl amed, painful joints.
■ 2. Blood pressure of 160/100 mm Hg.
■ 3. Stooped appearance.
■ 4. Hemoglobin of 9 g/dL.
37. The nurse is teaching the client about home
blood glucose monitoring. Which of the following
blood glucose measurements indicates hypoglycemia?
■ 1. 59 mg/dL.
■ 2. 75 mg/dL.
■ 3. 108 mg/dL.
■ 4. 119 mg/dL.
38. Assessment of the diabetic client for common
complications should include examination of the:
■ 1. Abdomen.
■ 2. Lymph glands.
■ 3. Pharynx.
■ 4. Eyes.
39. The client with type 1 diabetes mellitus is
taught to take isophane insulin suspension NPH
(Humulin N) at 5 p.m. each day. The client should
be instructed that the greatest risk of hypoglycemia
will occur at about what time?
■ 1. 11 a.m., shortly before lunch.
■ 2. 1 p.m., shortly after lunch.
■ 3. 6 p.m., shortly after dinner.
■ 4. 1 a.m., while sleeping.
40. A nurse is teaching a client with type 1
diabetes mellitus who jogs daily about the preferred
sites for insulin absorption. What is the most appropriate
site for a client who jogs?
■ 1. Arms.
■ 2. Legs.
■ 3. Abdomen.
■ 4. Iliac crest.
41. A client with diabetes is taking insulin lispro
(Humalog) injections. The nurse should advise the
client to eat:
■ 1. Within 10 to 15 minutes after the injection.
■ 2. 1 hour after the injection.
■ 3. At any time, because timing of meals with
lispro injections is unnecessary.
■ 4. 2 hours before the injection.
42. The best indicator that the client has learned
how to give an insulin self-injection correctly is
when the client can:
■ 1. Perform the procedure safely and correctly.
■ 2. Critique the nurse’s performance of the
p rocedure.
■ 3. Explain all steps of the procedure correctly.
■ 4. Correctly answer a posttest about the procedure.
43. The nurse is instructing the client on insulin
administration. The client is performing a return
demonstration for preparing the insulin. The client’s
morning dose of insulin is 10 units of regular and
22 units of NPH. The nurse checks the dose accuracy
with the client. The nurse determines that
the client has prepared the correct dose when the
syringe reads how many units?
________________________ units.
44. Angiotensin-converting enzyme (ACE) inhibitors
may be prescribed for the client with diabetes
mellitus to reduce vascular changes and possibly
prevent or delay development of:
■
■
■
■
1. Chronic obstructive pulmonary disease.
2. Pancreatic cancer.
3. Renal failure.
4. Cerebrovascular accident.
45. The nurse should teach the diabetic client
that which of the following is the most common
symptom of hypoglycemia?
■ 1. Nervousness.
■ 2. Anorexia.
■ 3. Kussmaul’s respirations.
■ 4. Bradycardia.
46. The nurse is assessing the client’s use of
medications. Which of the following medications
may cause a complication with the treatment plan of
a client with diabetes?
■ 1. Aspirin.
■ 2. Steroids.
■ 3. Sulfonylureas.
■ 4. Angiotensin-converting enzyme (ACE) inhibitors.
47. A client with type 1 diabetes mellitus has
infl uenza. The nurse should instruct the client to:
■ 1. Increase the frequency of self-monitoring
(blood glucose testing).
■ 2. Reduce food intake to diminish nausea.
■ 3. Discontinue that dose of insulin if unable
to eat.
■ 4. Take half of the normal dose of insulin.
48. Which of the following is a priority nursing
diagnosis for the diabetic client who is taking insulin
and has nausea and vomiting from a viral illness
or infl uenza?
■ 1. Imbalanced nutrition: Less than body requirements.
■ 2. Ineffective health maintenance related to
ineffective coping skills.
■ 3. Acute pain.
■ 4. Activity intolerance.
49. During a home visit, a diabetic client begins
to cry and says, “I just cannot stand the thought of
having to give myself a shot every day.” Which of
the following would be the best response by the
nurse?
■ 1. “If you do not give yourself your insulin
shots, you will die.”
■ 2. “We can teach your daughter to give the shots
so you will not have to do it.”
■ 3. “I can arrange to have a home care nurse give
you the shots every day.”
■ 4. “What is it about giving yourself the insulin
shots that bothers you?”
**************************************************************
Choose the single best answer for each question.
Questions 1 and 2 refer to the following case study.
A 54-year-old man who is new to the area presents
for a routine medical evaluation. He reports a history of
hypertension for which he takes long-acting diltiazem.
He also reports mild fatigue and notes that he has experienced
nocturnal voiding approximately twice per
week for the past 18 months. He denies drinking alcohol
but has a 30 pack-year history of smoking. He has a
48-year-old brother with type 2 diabetes, and his father
died of a myocardial infarction at age 53 years. On physical
examination, the patient is obese and his blood
pressure is 140/90 mm Hg and pulse is 60 bpm. Other
results of physical examination are normal. A fasting
plasma glucose level is 138 mg/dL.
1. What is the most appropriate management of the
patient’s glucose level?
A) Repeat the fasting blood glucose measurement
on another day
B) Order a glycosylated hemoglobin level
C) Perform an oral glucose tolerance test
D) Follow up with a fasting blood glucose measurement
in 1 year
2. A second fasting glucose measurement for this patient
is 157 mg/dL. All of the following studies
would be helpful at this time EXCEPT:
A) Electrocardiography
B) Fasting lipid panel
C) 24-Hour urine cortisol level
D) Glycosylated hemoglobin level
Questions 3 and 4 refer to the following laboratory
studies.
The patient’s total cholesterol level is 290 mg/dL,
and his low-density lipoprotein and triglyceride levels
are increased. His high-density lipoprotein level is
31 mg/dL. Based on his laboratory results, the patient
is diagnosed with type 2 diabetes. He receives diabetes education and dietary counseling. At this time, his
ophthalmoscopic
examination and urinalysis are normal,
and no microalbuminuria is present. Results from an
exercise stress test are normal.
The patient returns for follow-up testing 4 months
later. He continues to smoke but claims he has been
compliant with his diet; however, his weight is unchanged.
His glycosylated hemoglobin level has increased
from 7.2 mg/dL at baseline to 7.5 mg/dL.
He returns again for follow-up 7 months later. His
blood pressure is now 150/80 mmHg. Repeated laboratory
testing reveals a fasting blood glucose level of
210 mg/dL. His glycosylated hemoglobin level has
increased to 8.2 mg/dL.
3. Which therapeutic measure would be most appropriate
at this time?
A) Begin therapy with insulin
B) Begin therapy with metformin
C) Begin therapy with acarbose
D) Try 6 more months of behavior modification
4. Which of the following statements is TRUE?
A) A standardized diet is essential for all patients
with diabetes
B) Poorly controlled diabetic patients should be
encouraged to exercise vigorously to improve
glucose control
C) Meticulous glucose control with multiple insulin
injections per day based on the Diabetes
Control and Complications Trial results should
be universally prescribed
D) None of the above
MULTIPLE CHOICE
1. The nurse explains that type 1 diabetes mellitus is a disease in which the body does not
produce enough insulin so my blood glucose is elevated because of:
1. prolonged elevation of stress hormone levels (cortisol, epinephrine, glucagon,
growth hormone).
2. malfunction of the glycogen-storing capabilities of the liver.
3. destruction of the beta cells in the pancreas.
4. insulin resistance of the receptor cells of the muscle tissue.
ANS: 3
Type 1 diabetes mellitus is a disease in which the pancreas does not produce adequate
insulin because of the destruction of beta cells.
PTS:
1
OBJ: 6
DIF:
Cognitive Level: Comprehension
REF: 1002
TOP: Type 1 Diabetes
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
2. When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to
take a pill instead of insulin, you reply that in type 2 diabetes, the body makes insulin but:
1. overweight and underactive people simply cannot use the insulin produced.
2. metabolism is slowed in some people so they have to take a pill to speed up their
metabolism.
3. sometimes the autoimmune system works against the action of the insulin.
4. the cells become resistant to the action of insulin. Pills are given to increase the
sensitivity.
ANS: 4
Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of
insulin and the blood glucose level rises. Oral hyperglycemic agents make the cells more
sensitive.
PTS:
1
OBJ: 6
DIF:
Cognitive Level: Application
REF: 1002
TOP: Type 2 Diabetes
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
3. A patient tells the nurse that she eats “huge” amounts of food but stays hungry most of
the time. The nurse explains that hunger experienced by persons with type 1 diabetes is
caused by the:
1. excess amount of glucose
2. need for additional calories to correct the increased metabolism.
3. fact that the cells cannot use the blood glucose.
4. need for exercise to stimulate insulin secretion.
ANS: 3
The cells cannot use the glucose without insulin, so the diabetic client still feels hungry
although there is abundant glucose circulating in the blood.
PTS:
1
OBJ: 1
DIF:
Cognitive Level: Comprehension
REF: 1002
TOP: Hunger in the Diabetic
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
4. The nurse stresses that the type 1 diabetic is at risk for cardiovascular disorders because
lack of insulin causes:
1. high glucose levels that irritate and shrink the vessels.
2. inadequate metabolism of proteins, which causes ketosis.
3. increased fatty acid levels.
4. increased metabolism of ketones, which causes hypertension.
ANS: 3
The increase in fatty acid levels causes an increase in triglyceride and an attendant rise in
low-density lipoprotein (LDL) levels.
PTS:
1
OBJ: 10
DIF:
Cognitive Level: Application
REF: 1002
TOP: Diabetes—Complications
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
5. The goal of diabetic self-care is to keep the patient’s blood sugar level normal.
Hyperglycemia occurs when:
1. blood glucose levels rise, stimulating production of insulin.
2. insulin conversion of glycogen to glucose is inhibited.
3. the body responds to glucose-starved tissues by changing stored glycogen into
glucose.
4. glycogen is unable to be stored in the liver and muscles.
ANS: 3
The hypothalamus is receiving a message that the cells need glucose, so it responds by
adding more glucose to the already overburdened blood.
PTS:
1
OBJ: 1
DIF:
Cognitive Level: Application
REF: 1002
TOP: Hyperglycemia
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
6. The young patient complains that diabetes is causing her to “have no life at all . . . . It’s
too hard.” The most helpful response is:
1. “Yes, you must make some sacrifices.”
2. “It’s hard, but with significant alterations in your lifestyle, you can live a long
life.”
3. “What’s hard about exercise, diet, and medicine?”
4. “Let’s talk about what makes it so hard.”
ANS: 4
Involving the patient in decisions about how she will cope with diabetes will make the
goal more realistic and personal, which will give it a greater chance of success.
PTS:
1
OBJ: 10
DIF:
Cognitive Level: Analysis
REF: 1028
TOP: Diabetes Lifestyle
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity
7. When the type 2 diabetic patient says, “Why in the world are they looking at my
hemoglobin? I thought my problem was with my blood sugar.” The nurse responds that
the level of hemoglobin A1c:
1. shows how a high glucose level can cause a significant drop in the hemoglobin
level.
2. shows what the glucose level has done for the last 3 months.
3. indicates a true picture of the patient’s nutritional state.
4. reflects the effect of high glucose levels on the ability to produce red blood cells.
ANS: 2
By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose
can be evaluated for the last 3 months, because the glucose stays bound to the
hemoglobin for the life of the red blood cell (RBC).
PTS:
1
OBJ: 9
DIF:
Cognitive Level: Application
REF: 1017
TOP: Hemoglobin A1c-Glycosylated Hemoglobin Level
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
8. The patient with type 2 diabetes shows a blood sugar reading of 72 at 6 AM. Based on the
reading of 72, the nurse should:
1. notify the charge nurse of the reading.
2. give regular insulin per sliding scale.
3. give him
cup of milk.
4. administer the oral hyperglycemic tablet.
ANS: 3
The patient is hypoglycemic and needs an immediate source of glucose, such as milk or
orange juice. The oral hyperglycemic agent will not work quickly enough. Notifying the
charge nurse can be done later. Giving insulin per sliding scale would lower the blood
sugar level.
PTS:
1
OBJ: 5
DIF:
Cognitive Level: Analysis
TOP: Hypoglycemic Reaction
REF: 1007
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
9. The nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that
this is a life-threatening condition that results in:
1. the inability of carbohydrates, fats, and proteins to be metabolized.
2. the storage of glycogen, so that there is a severe shortage of glucose in the
bloodstream.
3. dangerously elevated pH and bicarbonate levels in the blood.
4. severe hypoglycemia, which can result in coma and convulsions.
ANS: 1
DKE is mainly related to the use of fat as an energy source because of the inability to use
glucose. The metabolism of fat produces ketones.
PTS:
1
OBJ: 7
DIF:
Cognitive Level: Knowledge
REF: 1007
TOP: Diabetic Ketoacidosis
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
10. The patient has been admitted to the hospital with the diagnosis of diabetic ketoacidosis.
The nurse anticipates that the patient will exhibit vital signs of:
1. T, 99; P, 62; R, 16 and shallow.
2. T, 98.6; P, 76; R, 16 and deep.
3. T, 98; P, 84; R, 18 and shallow.
4. T, 97.4; P, 100; R, 20 and deep.
ANS: 4
DKA is caused by the attempt of the body to metabolize fat for energy, which results in
an acidotic state. The classic signs of DKA are hypothermia, tachycardia, and
Kussmaul’s respirations (rapid and deep) to blow off the acid ions via respirations. The
respirations will have a fruity odor.
PTS:
1
OBJ: 8
DIF:
Cognitive Level: Analysis
REF: 1007
TOP: Diabetic Ketoacidosis
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
11. The home health nurse is assessing a type 1 diabetic patient who has been controlled for 6
months. The nurse is surprised and concerned about a blood glucose reading of 52. This
episode of hypoglycemia is probably caused by the patient’s having:
1. taken a new form of birth control pill this morning.
2. used large amounts of sugar substitute in her tea this morning.
3. had a 2-hour long exercise class at the spa this morning.
4. underdosed herself with insulin this morning.
ANS: 3
Excessive exercise used up the glucose that was made available by the insulin taken by
the patient. The patient now has too much insulin for the available glucose and has
become hypoglycemic.
PTS:
1
OBJ: 5
DIF:
Cognitive Level: Analysis
REF: 1011
TOP: Diabetes—Treatment
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
12. As part of the teaching plan in preparation for discharge, the patient with type 1 diabetes
needs guidelines for exercise. Be sure to include which of the following?
1. Plan your exercise so that it coincides with the peak action of insulin.
2. Insulin should be injected into the lower extremity before exercise because that site
provides the greatest absorption.
3. Exercise should be done daily at the same time of day and at the same intensity.
4. Keep exercise at a minimum to conserve your energy.
ANS: 3
If the body is using more glucose than available, the body will draw on fatty acids, which
will give off ketones.
PTS:
1
OBJ: 5
Implementation
DIF:
Cognitive Level: Analysis
TOP: Exercise
REF: 1010
KEY: Nursing Process Step:
MSC: NCLEX: Physiological Integrity
13. The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor
has ordered two types of insulin, 10 U of regular insulin and 35 U of NPH insulin. The
proper procedure is to:
1. draw up the insulins in two separate syringes so that there can be no confusion.
2. draw up the regular insulin before drawing up the NPH insulin.
3. inject air into the NPH insulin, draw it up to 35 U, then inject air into the clear
regular insulin and withdraw to 45 U.
4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin,
withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.
ANS: 4
When drawing up two insulins, the vials are injected with air and the regular insulin is
drawn first. This slow and time-consuming activity has been greatly reduced with the
advent of premixed insulins.
PTS:
1
OBJ: 5
DIF:
Cognitive Level: Application
REF: 1014
TOP: Insulin Administration
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
14. A patient has come into the emergency room with her friend. Her friend states that she
had been acting very strangely and confused. The friend states that the patient has
diabetes and takes insulin. The nurse knows that signs and symptoms of hypoglycemia
include:
1. slow pulse rate and low blood pressure.
2. irritability, anxiety, confusion, and dizziness.
3. flushing, anger, and forgetfulness.
4. sleepiness, edema, and sluggishness.
ANS: 2
When blood sugar levels fall, hormones are activated to increase serum glucose. One of
the hormones is epinephrine, which causes these symptoms.
PTS:
1
OBJ: 2
DIF:
Cognitive Level: Application
REF: 1023
TOP: Hypoglycemia
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
15. A patient has come to the doctor’s office after finding out that her blood glucose level
was 135 mg/dL. She states that she had not eaten before the test and was told to come and
see her doctor. She asks you if she has diabetes. The nurse responds:
1. “Having a fasting serum glucose that high certainly indicates diabetes.”
2. “That test indicates that we need to do more tests that are specific for diabetes.”
3. “How do you feel? Do you have any other signs of diabetes?”
4. “Do you have a family history of diabetes, stroke, or heart disease? We need to
know before making a diagnosis.”
ANS: 2
The nurse needs to answer the patient’s question in a way that gives information and is
not misleading. Although 135 is high, there may be a nonpathologic explanation. More
tests should be done to evaluate the patient.
PTS:
1
OBJ: 4
DIF:
Cognitive Level: Comprehension
REF: 1009
TOP: Laboratory Tests for Diabetes
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
16. The teaching plan for a 22-year-old woman on Avandia (rosiglitazone) would include a
caution relative to:
1. decreased effectiveness of her birth control pills.
2. excessive exposure to the sun.
3. sudden drop in blood pressure with dizziness.
4. possible severe diarrhea.
ANS: 1
Avandia causes some birth control pills to be less effective.
PTS:
1
DIF:
Cognitive Level: Analysis
REF: 1016, Drug Therapy table
OBJ: 4
TOP: Side Effects of Avandia
Implementation
KEY: Nursing Process Step:
MSC: NCLEX: Health Promotion and Maintenance
17. The type 1 diabetic patient has an insulin order for NPH insulin, 35 U, to be given at 7
AM. The patient is also NPO for laboratory work that will not be drawn until 10 AM. The
nurse should:
1. give the insulin as ordered.
2. give the insulin with a small snack.
3. inform the charge nurse.
4. hold the insulin until after the blood draw.
ANS: 4
Holding the insulin for the NPO order is appropriate. The patient will not be getting food
until after the blood draw, so will not need the insulin until then. Giving the insulin as
ordered will create a possibility of hypoglycemia before the blood is drawn. Giving a
snack to a patient who is NPO is inappropriate.
PTS:
1
OBJ: 10
DIF:
Cognitive Level: Analysis
REF: 1014
TOP: Insulin with NPO Order
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
18. The patient comes to the diabetes clinic and confides to the nurse that she does not follow
the diet exchange program that she was given. You respond:
1. “The exchange program is a carefully developed and very important program that
allows you to take control of your disease.”
2. “A lot of people have trouble with that program. You aren’t the first one to go off
your diet.”
3. “We had better go ahead and check your blood work to see what you’ve done to
yourself.”
4. “Okay. Let’s talk about what you do eat and drink and how you manage your
diabetes.”
ANS: 4
In order to evaluate effectiveness of treatment, you must find out how the patient
perceives the importance of diet, drugs, and exercise.
PTS:
1
OBJ: 10
DIF:
Cognitive Level: Analysis
TOP: Nutrition
REF: 1020
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity
19. When the Type 1 diabetic patient asks why his 7 AM insulin has been changed from NPH
insulin to 70/30 premixed insulin, the nurse explains that 70/30 insulin:
1. is absorbed more rapidly into the bloodstream.
2. has no peak action time and lasts all day.
3. makes insulin administration easier and safer.
4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.
ANS: 4
70/30 insulin is 30% rapid-acting and 70% intermediate-acting insulin. The rapid action
of the 7 AM premixed insulin prevents hyperglycemia after the morning meal.
PTS:
1
OBJ: 10
DIF:
Cognitive Level: Analysis
REF: 1012
TOP: Use of 70/30 Insulin
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Physiological Integrity
20. In drawing up a patient diabetes teaching plan, the nurse needs to include the following:
1. Develop an exercise plan, because regular exercise helps control your blood
glucose level.
2. Monitor your blood sugar only if you are not feeling well so that you don’t prick
your fingertips too much.
3. If you are experiencing nervousness, palpitations, or hunger, take a small dose (1
to 2 U) of regular insulin and call the doctor.
4. Use over-the-counter measures for any foot blisters, calluses, or wounds before
you seek medical help.
ANS: 1
Exercise is an integral part of the patient taking charge of his or her diabetes and needs to
be included in the teaching plan.
PTS:
1
DIF:
Cognitive Level: Application
REF: 1023, Diagnostic Tests and Procedures table
TOP: Diabetes Teaching Plan
Implementation
OBJ: 8
KEY: Nursing Process Step:
MSC: NCLEX: Physiological Integrity
21. A patient who has been diagnosed with endogenous hypoglycemia most likely has:
1. taken an overdose of hypoglycemic drugs.
2. been following a very restricted fasting diet or is malnourished.
3. excessive secretion of insulin or an increase in glucose metabolism.
4. exercised unwittingly without replenishing needed fluid and nutrients.
ANS: 3
Endogenous refers to within; in this case, it refers to internal factors, such as an increase
of insulin or of glucose metabolism. Both these conditions would lead to hypoglycemia.
PTS:
46-1
1
OBJ: 2
DIF:
Cognitive Level: Application
TOP: Hypoglycemia
REF: 1027, Table
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity
22. The nurse giving Humulin R 20 U at 7 AM is aware that this drug will peak in:
1. 15 minutes.
2. 30 minutes.
3. 1 hour.
4. 2 hours.
ANS: 1
Humulin R has its onset in about 15 minutes, but its peak is in 2 hours.
PTS:
1
DIF:
Cognitive Level: Knowledge
REF: 1013, Drug Therapy table
OBJ: 10
TOP: Humulin R Insulin Peak
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity
23. It is recognized that people with diabetes are at greater risk for complications than
nondiabetic patients because of:
1. high blood pressure, which can lead to a stroke.
2. genetic susceptibility, which leads to a generalized weakening of the immune
system.
3. thickening of the basement membrane of the capillaries.
4. chronic pain, which leads to activity intolerance.
ANS: 3
Thickening of the basement membrane of the capillaries is responsible for damage to the
eyes, kidneys, and nerve fibers, as well as the peripheral circulation.
PTS:
1
OBJ: 9
DIF:
Cognitive Level: Comprehension
REF: 1004
TOP: Complications of Diabetes
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
24. The nurse suspects that the patient with type 1 diabetes may be experiencing the Somogyi
phenomenon when the patient exhibits:
1. headache on awakening and enuresis.
2. 6 AM blood sugar of 58 and nausea.
3. abdominal pain and blood pressure elevation.
4. drowsiness and disorientation after eating.
ANS: 1
The Somogyi phenomenon occurs because of a rebound hyperglycemia after a period of
hypoglycemia during the early morning. The patient wakes with a headache, enuresis,
nausea and vomiting, nightmares, and a high blood sugar level.
PTS:
1
OBJ: 10
DIF:
Cognitive Level: Application
REF: 1017
TOP: Somogyi Phenomenon
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
25. The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome
(HHNKS). Her blood glucose level is very high (880 mg/dL on admission). The
physician believes that her condition is to the result of large amounts of glucose solutions
administered intravenously during kidney dialysis. The nurse would anticipate that the
patient would exhibit:
1. a fruity breath and high level of ketones in her urine.
2. severe dehydration and hypernatremia caused by the hyperglycemia.
3. exactly the same symptoms and signs as diabetic ketoacidosis.
4. Kussmaul’s respirations, nausea, and vomiting.
ANS: 2
IV solutions containing glucose will bypass the digestive system, so there is no trigger for
the pancreas to release insulin, but there is just enough insulin to prevent the breakdown
of fatty acids and the formation of ketones.
PTS:
1
OBJ: 9
DIF:
Cognitive Level: Application
REF: 1008
TOP: Hyperglycemic Hyperosmolar Nonketotic Syndrome
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
MULTIPLE RESPONSE
1. The nurse tells a patient that the functional causes of hypoglycemia include (select all that
apply):
1. dumping syndrome.
2. overdose of insulin.
3. Addison’s disease.
4. spontaneous hypoglycemia.
5. chronic alcoholism.
ANS: 1, 3, 4
Dumping syndrome, Addison’s disease and spontaneous hypoglycemia are functional
causes of hypoglycemia; overdose of insulin and chronic alcoholism are exogenous
causes.
PTS:
46-1
1
OBJ: 2
DIF:
Cognitive Level: Analysis
TOP: Functional Causes of Hypoglycemia
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
REF: 1027, Table
2. The teaching plan for a diabetic patient for foot care would include that the patient should
(select all that apply):
1. wash and carefully dry the feet every day.
2. apply lotion between the toes.
3. protect the feet from extreme temperatures.
4. walk barefoot only indoors.
5. buy shoes that are comfortable and supportive.
ANS: 1, 3, 5
Washing, inspecting, and drying the feet, especially between the toes, is essential.
Protecting the feet from heat and cold and wearing supportive shoes is important to good
foot health. Lotion can be applied to the soles and tops of the feet, but not between the
toes. Walking barefoot is contraindicated for a diabetic.
PTS:
1
DIF:
Cognitive Level: Application
REF: 1006, Patient Teaching Plan
OBJ: 9
TOP: Foot Care
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance
3. The teaching plan for a diabetic is focused on smoking cessation and control of
hypertension for the avoidance of microvascular complications, such as (select all that
apply):
1. macular degeneration.
2. end-stage renal disease (ESRD).
3. coronary artery disease (CAD).
4. peripheral vascular disease (PVD).
5. cerebrovascular accident (CVA).
ANS: 1, 2
Macular degeneration and ESRD are both microvascular complications. CAD, PVD, and
CVA are all macrovascular complications.
PTS:
1
OBJ: 9
DIF:
Cognitive Level: Analysis
REF: 1004-1005
TOP: Microvascular Complications
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance
OTHER
1. The nurse instructs a patient about how insulin affects blood glucose. Arrange the events
in sequence.
1. Beta cells are stimulated to release insulin.
2. Glucose enters the bloodstream.
3. Glycogen is converted to glucose by alpha cells (glycogenesis).
4. Glycogen is stored in the liver.
5. Insulin transports glucose to muscle cells.
ANS:
2, 1, 5, 4, 3
Insulin transports the glucose to muscle cells or converts it to glycogen, which is stored in
the liver to be accessed when hypoglycemia occurs.
PTS:
1
OBJ: 1
DIF:
Cognitive Level: Analysis
TOP: Insulin's Effect on Glucose
KEY: Nursing Process Step: Implementation
REF: 1002
MSC: NCLEX: Health Promotion and Maintenance