Diabetes NCLEX questions

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1.

"1. A patient with newly diagnosed type 2

diabetes mellitus asks the nurse what ""type
2"" means in relation to diabetes. The nurse
explains to the patient that type 2 diabetes
differs from type 1 diabetes primarily in that
with type 2 diabetes
a. the pt is totally dependent on an outside
source of insulin
b. there is a decreased insulin secretion and
cellular resistance to insulin that is produced
c. the immune system destroys the pancreatic
insulin-producing cells
d. the insulin precurosr that is secreted by the
pancreas is not activated by the liver

Answer B - Rationale: In type 2 diabetes, the pancreas produces insulin, but the
insulin is insufficient for the body's needs or the cells do not respond to the insulin
appropriately. The other information describes the physiology of type 1 diabetes

2.

18. The benefits of using an insulin pump

include all of the following except: "a. By
continuously providing insulin they eliminate
the need for injections of insulin
b. They simplify management of blood sugar
and often improve A1C
c. They enable exercise without compensatory
carbohydrate consumption
d. They help with weight loss

D: Using an insulin pump has many advantages, including fewer dramatic swings in
blood glucose levels, increased flexibility about diet, and improved accuracy of insulin
doses and delivery; however, the use of an insulin pump has been associated with
weight gain.

3.

A 54-year-old patient admitted with type 2

diabetes, asks the nurse what "type 2" means.
Which of the following is the most appropriate
response by the nurse?
"1. ""With type 2 diabetes, the body of the
pancreas becomes inflamed."
2. "With type 2 diabetes, insulin secretion is
decreased and insulin resistance is
increased."
3. "With type 2 diabetes, the patient is totally
dependent on an outside source of insulin."
4. "With type 2 diabetes, the body produces
autoantibodies that destroy b-cells in the
pancreas.""

"Right Answer: 2
Rationale: In type 2 diabetes mellitus, the secretion of insulin by the pancreas is
reduced and/or the cells of the body become resistant to insulin"

4.

"A client is admitted to the hospital with signs

and symptoms of diabetes mellitus. Which
findings is the nurse most likely to observe in
this client? Select all that apply:
"1. Excessive thirst
2. Weight gain
3. Constipation
4. Excessive hunger
5. Urine retention
6. Frequent, high-volume urination

1, 4, 6 Rationale: Classic signs of diabetes mellitus include polydipsia (excessive

thirst), polyphagia (excessive hunger), and polyuria (excessive urination). Because
the body is starving from the lack of glucose the cells are using for energy, the client
has weight loss, not weight gain. Clients with diabetes mellitus usually don't present
with constipation. Urine retention is only a problem is the patient has another renalrelated condition.

5.

"A client is taking Humulin NPH insulin daily

every morning. The nurse instructs the client
that the mostlikely time for a hypoglycemic
reaction to occur is:
A) 2-4 hours after administration
B) 4-12 hours after administration
C) 16-18 hours after administration
D) 18-24 hours after administration

B: Rationale: Humulin is an intermediate acting insulin. The onset of action is 1.5

hours, it peaks in 4-12 hours, and its duration is 24 hours. Hypoglycemic reactions to
insulin are most likely to occur during the peak time.

"A client who is started on

metformin and glyburide
would have initially presented
with which symptoms?
"a. Polydispisa, polyuria, and
weight loss
b. weight gain, tiredness, &
bradycardia
c. irritability, diaphoresis,
and tachycardia
d. diarrhea, abdominal pain,
and weight loss

"a. Polydispisa, polyuria, and weight loss"Symptoms of hyperglycemia include polydipsia, polyuria, and
weight loss. Metformin and sulfonylureas are commonly ordered medications.

7.

"A diabetic patient has a

serum glucose level of 824
mg/dL (45.7 mmol/L) and is
unresponsive. Following
assessment of the patient, the
nurse suspects diabetic
ketoacidosis rather than
hyperosmolar hyperglycemic
syndrome based on the
finding of
"a. polyuria
b. severe dehydration
c. rapid, deep respirations )
d. decreased serum
potassium"

C is correct, Signs and symptoms of DKA include manifestations of dehydration such as poor skin
turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include
lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose,
and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be
accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated
with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess
carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a
blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level
less than 15 mEq/L, and moderate to large ketone levels in the urine or blood ketones.

8.

"A frail elderly patient with a

diagnosis of type 2 diabetes
mellitus has been ill with
pneumonia. The cliet's intake
has been very poor, and she
is admitted to the hospital for
observation and management
as needed. What is the most
likely problem with this
patient?
"A. Insulin resistance has
developed.
B. Diabetic ketoacidosis is
occuring.
C. Hypoglycemia
unawareness is developing.
D. Hyperglycemic
hyperosmolar non-ketotic
coma.

D.Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and
HHNC. Insulin resisitance is inidcated by a daily insulin requirement of 200 units or more. Diabetic
ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly decreased
amounts of insulin.

6.

Weight gain, tiredness, and bradycardia are symptoms of hypothyroidism.

Irritability, diaphoresis, and tachycardia are symptoms of hypoglycemia.
Symptoms of Crohn's disease include diarrhea, abdominal pain, and weight loss."

9.

"An 18-year-old female client, 5'4'' tall, weighing 113 kg,

comes to the
clinic for a non-healing wound on her lower leg, which she
has had for two weeks. Which disease process should the
nurse suspect the client is developing?

"A: Type 1 diabetes usually occurs in young clients who are underweight.
In this disease, there is no production of insulin from the beta cells
in the pancreas. People with type 1 diabetes are insulin dependent with a
rapid onset of symptoms, including polyuria, polydipsia, and
polyphagia.

"A. Type 1 diabetes

B. Type 2 diabetes
C. Gestational diabetes
D. Acanthosis nigricans"

CORRECT -->B. Type 2 diabetes is a disorder usually occurring

around the age of 40, but it is now being detected in children and young
adults as a result of obesity and sedentary lifestyles. Non-healing
wounds are a hallmark sign of type 2 diabetes. This client weights 248.6
lbs and is short.
C. Gestational diabetes occurs during pregnancy. There is no mention of
this.
D.
Acanthosis nigricans (AN), dark pigmentation and skin creases in the
neck, is a sign of hyperinsulinemia. The pancreas is secreting excess
amounts of insulin as a result of excessive caloric intake. It is
identified in young children and is a precursor to the development of
type 2 diabetes."

10.

"An adolescent client with type I diabetes mellitus is

admitted to the emergency department for treatment of
diabetic ketoacidosis. Which assessment findings
should the nurse expect to note? "a) sweating and tremors
b) hunger and hypertension
c) cold, clammy skin
and irritability
d) fruity breath and decreasing
level of consciousness

d) fruity breath and decreasing

level of consciousness"Hyperglycemia occurs with diabetic ketoacidosis.
Signs
of hyperglycemia include fruity breath and a decreasing
level of consciousness. Hunger can be a sign of
hypoglycemia or hyperglycemia, but hypertension is not
a sign of diabetic ketoacidosis. Instead, hypotension
occurs because of a decrease in blood volume related to the dehydrated
state
that occurs during diabetic ketoacidosis. Cold, clammy
skin, irritability, sweating, and tremors are all signs of
hypoglycemia."

11.

Analyze the following diagnostic findings for your patient

with type 2 diabetes. Which result will need further
assessment?
A) BP 126/80 B) A1C 9% C)FBG 130mg/dL D) LDL
cholesterol 100mg/dL

"B) A1C 9%
Rationale: Lowering hemoglobin A1C (to average of 7%) reduces
microvascular and neuropathic complications. Tighter glycemic
control(normal A1C < 6%) may further reduce complications but
increases hypoglycemia risk."

12.

"A nurse is caring for a client admitted to the emergency

department with diabetic ketoacidosis (DKA). In the acute
phase, the priority nursing action is to prepare to:
"A. Correct the acidosis
B. Administer 5% dextrose intravenously
C. Administer regular insulin inraVenously
D. Apply a monitor for an electrocardiogram."

C. Administer regular insulin inraVenously Lack (absolute or relative) of

insulin is the primary cause of DKA. Treatment consists of insulin
administration (regular insulin), intravenous fluid administration (normal
saline initially), and potassium replacement, followed by correcting
acidosis. Applying an electrocardiogram monitor is not a priority action.

13.

"A nurse performs a physical assessment on a client with

type 2 diabetes mellitus. Findings include a fasting blood
glucose of 120 mg/dL, temp of 101 F, pulse of 88 bpm,
respirations of 22, and blood pressure of 100/72. Which
finding would be of most concern to the nurse?
"1. Pulse
2. Respiration
3. Temperature
4. Blood pressure"

3) temp. An elevated temperature may indicate infection. Infection is a

leading cause of hyperglycemic hyperosmolar nonketotic syndrome or
diabetic ketoacidosis. The other findings noted in the question are within
normal limits.

14.

15.

"A nurse shoud recognize which symptom as a

cardinal sign of diabetes mellitus?
"a. Nausea
b. Seizure
c. Hyperactivity
d. Frequent urination

"D. Frequent Urination

"A patient with type 1 diabetes has received diet

instruction as part of the treatment plan. The nurse
determines a need for additional instruction when the
patient says,
"a. ""I may have an occasional alcoholic drink if I
include it in my meal plan.""

"D. ""I may eat whatever I want, as long as I use enough insulin to cover the
calories.""

b. ""I will need a bedtime snack because I take an

evening dose of NPH insulin.""

Polyphagia, polyuria, polydipsia, and weight loss are cardinal signs of DM.
Other signs include irritability, shortened attention span, lowered frustration
tolerance, fatigue, dry skin, blurred vision, sores that are slow to heal, and
flushed skin."

Rationale: Most patients with type 1 diabetes need to plan diet choices very
carefully. Patients who are using intensified insulin therapy have considerable
flexibility in diet choices but still should restrict dietary intake of items such
as fat, protein, and alcohol. The other patient statements are correct and
indicate good understanding of the diet instruction."

c. ""I will eat meals as scheduled, even if I am not

hungry, to prevent hypoglycemia.""
d. ""I may eat whatever I want, as long as I use
enough insulin to cover the calories.
Blood sugar is well controlled when Hemoglobin A1C
is...
"a. Below 7%
b. Between 12%-15%
c. Less than 180 mg/dL
d. Between 90 and 130 mg/dL"

"a. Below 7%

17.

The client diagnosed with Type I diabetes is found

lying unconscious on the floor of the bathroom. Which
interventions should the nurse implement first? A.
Administer 50% dextrose IVP. B. Notify the healthcare provider. C. Move the client to ICD. D. Check the
serum glucose level.

A) admin 50% dextrose IVPThe nurse should assume the client is

hypoglycemic and administer IVP dextrose, which will rouse the client
immediately. If the collapse is the result of hyperglycemia, this additional
dextrose will not further injure the client.

18.

A client is brought to the emergency department in an

unresponsive state, and a diagnosis of hyperglycemic
hyperosmolar nonketotic syndrome is made. The
nurse would immediately prepare to initiate which of
the following anticipated physician's prescriptions? 1.
Endotracheal intubation 2. 100 units of NPH insulin 3.
Intravenous infusion of normal saline 4. Intravenous
infusion of sodium bicarbonate

CORRECT ANSWER: 3. Intravenous infusion of normal saline Rationale: The

primary goal of treatment is hyperglycemic hyperosmolar nonketotic syndrome
(HHNS) is to rehydrate the client to restore the fluid volume and to correct
electrolyte deficiency. Intravenous fluid replacement is similar to that
administered in diabetic keto acidosis (DKA) and begins with IV infusion of
normal saline. Regular insulin, not NPH insulin, would be administered. The
use of sodium bicarbonate to correct acidosis is avoided because it can
precipitate a further drop in serum potassium levels. Intubation and
mechanical ventilation are not required to treat HHNS.

19.

A client with diabetes mellitus demonstratees acute

anxiety when first admitted for the treatment of
hyperglycemia. The most appropriate intervention to
decrease the client's anxiety would be to 1.
administer a sedative 2. make sure the client knows
all the correct medical terms to understand what is
happening 3. ignore the signs and symptoms of
anxiety so that they will soon disappear 4. convey
empathy, trust, and respect toward the client

4. The most appropriate intervention is to address the client's feelings related

to the anxiety

20.

A client with diabetes melllitus has a blood glucose of

644mg/dl. The nurse intreprets that this client is most
at risk of developing which type of acid base
imbalance? "A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis"

"Correct Answer: A, Metabolic Acidosis

Rationale: DM can lead to metabolic acidosis. When the body does not have
sufficient circulating insulin, the blood glucose level rises. At the same time,
the cells of the body use all available glucose. The body then breaks down
glycogen and fat for fuel. The by-products of fat metabolism are acidotic and
can lead to the condition known as diabetic ketoacidosis."

16.

A1c measures the percentage of hemoglobin that is glycated and determines

average blood glucose during the 2 to 3 months prior to testing. Used as a
diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes.
A1C of 6% to 6.5% is considered prediabetes."

21.

A client with DKA is being treated in the ED. What would

the nurse suspect? 1. Comatose state 2. Decreased Urine
Output 3. Increased respirations and an increase in pH. 4.
Elevated blood glucose level and low plasma bicarbonate
level.

Correct Answer: 4 Rationale: In DKA the arteriole pH is lower than 7.35,

plasma bicarbonate is lower than 15 mEq/L, the blood glucose is higher
than 250, and ketones are present in the blood and urine. The client
would be experiencing polyuria and Kussmauls respirations would be
present. A comatose state may occur if DKA is not treated.

22.

A client with type I diabetes is placed on an insulin pump.

The most appropriate short-term goal when teaching this
client to control the diabetes is: "1) adhere to the medical
regimen
2) remain normoglycemic for 3 weeks
3) demonstrate the correct use of the administration
equipment.
4) list 3 self care activities that are necessary to control
the diabetes"

3.) is correct
"1) this is not a short-term goal
2) this is measurable, but it's a long-term goal
3) this is a short-term goal, client oriented, necessary for the client to
control the diabetes, and measurable when the client performs a return
demonstration for the nurse
4) although this is measurable and a short-term goal, it is not the one
with the greatest priority when a client has an insulin pump that must be
mastered before discharge"

23.

During a diabetes screening program, a patient tells the

nurse, "My mother died of complications of type 2
diabetes. Can I inherit diabetes?" The nurse explains that
"a.) as long as the patient maintains normal weight and
exercises, type 2 diabetes can be prevented.
b.) the patient is at a higher than normal risk for type 2
diabetes and should have periodic blood glucose level
testing.
c.) there is a greater risk for children developing type 2
diabetes when the father has type 2 diabetes.
d.) although there is a tendency for children of people with
type 2 diabetes to develop diabetes, the risk is higher for
those with type 1 diabetes."

"B
Rationale: Offspring of people with type 2 diabetes are at higher risk for
developing type 2 diabetes. The risk can be decreased, but not
prevented, by maintenance of normal weight and exercising. The risk for
children of a person with type 1 diabetes to develop diabetes is higher
when it is the father who has the disease. Offspring of people with type
2 diabetes are more likely to develop diabetes than offspring of those
with type 1 diabetes."

24.

"Excessive thirst and volume of very dilute urine may be

symptoms of:
"A. Urinary tract infection
B. Diabetes insipidus
C. Viral gastroenteritis
D.Hypoglycemia"

"Correct answer: B
Diabetes insipidus is a condition in which the kidneys are unable to
conserve water, often because there is insufficient antidiuretic hormone
(ADH) or the kidneys are unable to respond to ADH. Although diabetes
mellitus may present with similar symptoms, the disorders are different.
Diabetes insipidus does not involve hyperglycemia."

25.

An external insulin pump is prescribed for a client with

DM. The client asks the nurse about the functioning of the
pump. The nurse bases the response on the information
that the pump: "a. Gives small continuous dose of regular
insulin subcutaneously, and the client can self-administer
a bolus with an additional dosage from the pump before
each meal.
b. Is timed to release programmed doses of regular or
NPH insulin into the bloodstream at specific intervals.
c. Is surgically attached to the pancreas and infuses
regular insulin into the pancreas, which in turn releases
the insulin into the bloodstream.
d. Continuously infuses small amounts of NPH insulin into
the bloodstream while regularly monitoring blood glucose
levels"

ANSWER A. An insulin pump provides a small continuous dose of regular

insulin subcutaneously throughout the day and night, and the client can
self-administer a bolus with additional dosage from the pump before each
meal as needed. Regular insulin is used in an insulin pump. An external
pump is not attached surgically to the pancreas.

26.

A home health nurse is at the home of a client with

diabetes and arthritis. The client has difficulty drawing up
insulin. It would be most appropriate for the nurse to refer
the client to:
"A) A social worker from the local hospital
B) An occupational therapist from the community center
C) A physical therapist from the rehabilitation agency
D) Another client with diabetes mellitus and takes insulin"

B) An occupational therapist can assist a client to improve the fine motor

skills needed to prepare an insulin injection.

27.

In educating a client with diabetes, what response

would reveal need for further education? "A. I
should avoid tights
B. I should take good care of my toe nails
C. I should not go more than 3 days without washing
my feet
D. I should avoid going barefoot and should wear
clean socks

C)I should not go more than 3 days w/o washing my feet"The recommended
self-care routine is to wash feet on a daily basis without
soaking and carefully cleaning."

28.

The nurse assisting in the admission of a client

with diabetic ketoacidosis will anticipate the
physician ordering which of the following types of
intravenous solution if the client cannot take any
fluids orally? "
a. 0.45% normal saline solution
b. Lactated Ringer's solution
c. 0.9 normal saline solution
d. 5% dextrose in water (D5W)"

a. 0.45% normal saline solution Helps to hydrate patient and keep electrolyte
levels balanced

29.

A nurse is caring for a cient with type 1 diabetes

mellitus. which client complaint would alert the
nurse to the presence of a possible hypoglycemic
reaction?
"1. Tremors
2. Anorexia
3. Hot, dry skin
4. Muscle cramps

1) tremorsdecreased blood glucose levels produce autonomic nervous system

symptoms, which are manifested classically as nervousness, irritability, and
tremors. option 3 is more likely for hyperglycemia, and options 2 and 4 are
unrelated to the signs of hypoglycemia.

30.

The nurse is caring for a client who has normal

glucose levels at bedtime, hypoglycemia at 2am
and hyperglycemia in the morning. What is this
client likely experiencing?
"A. Dawn phenomenon
B. Somogyi effect
C. An insulin spike
D. Excessive corticosteroids"

"1. B
The Somogyi effect is when blood sugar drops too low in the morning causing
rebound hyperglycemia in the morning. The hypoglycemia at 2am is highly
indicative. The Dawn phenomenon is similar but would not have the
hypoglycemia at 2am."

31.

The nurse is caring for a client with long-term Type

2 diabetes and is assessing the feet. Which
assessment data would warrant immediate
intervention by the nurse?
"1)The client has crumbling toenails
2)The client has athlete's feet
3)The client has a necrotic big toe
4)The client has thickened toenails."

3) Nectrotic big toe"1)Crumbling toenails indicate tinea unguium, which is a

fungus infection of the toenail.
2)Athlete's foot is a fungal infection that is not life threatening.
3)A necrotic big toe indicates "dead" tissue. The client does not feel pain in the
lower extremity and does not realize there has been an injury and therefore
does not seek treatment. Increased blood glucose levels decrease oxygen
supply that is needed to heal the wound and increase the risk for developing an
infection.
4)Big, thick toenails are fungal infections and would not require immediate
intervention by the nurse; 50% of the adult population has this."

32.

A nurse is caring for a client with type 1 diabetes

mellitus. Which client complaint would alert the
nurse to the presence of a possible hypoglycemic
reaction ?
A. Tremors B. Anorexia C. Hot, Dry skin D. Muscle
cramps

Correct Answer A Decreased blood glucose levels produce autonomic nervous

system symptoms, which are manifested classsically as nervousness,
irritability, and tremors. Option C is more likely to occur with hyperglycemia.
Options B and D are unrealted to the signs of hyperglycemia

The nurse is educating a pregnant client who has gestational

diabetes. Which of the following statements should the nurse make
to the client? Select all that apply.
"a. Cakes, candies, cookies, and regular soft drinks should be
avoided.
b. Gestational diabetes increases the risk that the mother will
develop diabetes later in life.
c. Gestational diabetes usually resolves after the baby is born.
d. Insulin injections may be necessary.
e. The baby will likely be born with diabetes
f. The mother should strive to gain no more weight during the
pregnancy.

"ANS: A, B, C, D

34.

a nurse is interviewing a client with type 2 diabetes mellitus.

which statement by the client indicated an understanding of the
treatment for this disorder? "1. ""i take oral insulin instead of
shots""
2. ""by taking these medications I am able to eat more""
3. ""when I become ill, I need to increase the number of pills I
take""
4. ""the medications I'm taking help release the insulin I already
make""

4.)Clients with type 2 diabetes mellitus have decreased or

imparied insulin secretion. Oral hypoglycemic agents are given
to these clients to facilitate glucose uptake. Insulin injections
may be given during times of stress-induced hyperglycemia.
Oral insulin is not available because of the breakdown of the
insulin by digestion. Options 1, 2 and 3 are incorrect

35.

A nurse is preparing a plan of care for a client with diabetes

mellitus who has hyerglycemia. The priority nursing diagnosis
would be: 1. Deficient knowledge 2. Deficient fluid volume 3.
Compromised family coping 4. Imbalanced nutrition less than body
requirements

2) deficient fluid volumeAn increased blood glucose level will

cause the kidneys to excrete the glucose in the urine. This
glucose is accompanied by fluids and electrolytes, causing an
osmotic diuresis leading to dehydration. This fluid loss must be
replaced when it becomes severe.

36.

A nurse is preparing a teaching plan for a client with diabetes

Mellitus regarding proper foot care. Which instruction is included
in the plan? 1. Soak feet in hot water 2. apply a moisturizing lotion
to dry feet but not between the toes 3. Always have a podiatrist cut
your toenails, never cut them yourself 4. avoid using mild soap on
the feet

2. The client is instructed to use a moisturizing lotion on the

feet and to avoid applying the lotion between the toes.

37.

Of which of the following symptoms might an older woman with

diabetes mellitus complain? wps.prenhall.com 1) anorexia 2)pain
intolerance 3) weight loss 4) perineal itching

4) perineal itchingRationale: Older women might complain of

perineal itching due to vaginal candidiasis.

38.

One of the benefits of Glargine (Lantus) insulin is its ability to:

"a.Release insulin rapidly throughout the day to help control basal
glucose.b. Release insulin evenly throughout the day and control
basal glucose levels.c. Simplify the dosing and better control
blood glucose levels during the day.d. Cause hypoglycemia with
other manifestation of other adverse reactions.

B)Release insulin evenly throughout the day and control basal

glucose levels"Glargine (Lantus) insulin is designed to release
insulin evenly throughout the
day and control basal glucose levels.

39.

A patient is admitted with diabetes mellitus, has a glucose level of

380 mg/dl, and a moderate level of ketones in the urine. As the
nurse assesses for signs of ketoacidosis, which of the following
respiratory patterns would the nurse expect to find?"A-Central
apnea
B-Hypoventilation
C-Kussmaul respirations
D- Cheyne-Stokes respirations"

C-Kussmaul respirationsIn diabetic ketoacidosis, the lungs try

to compensate for the acidosis by blowing off volatile acids and
carbon dioxide. This leads to a pattern of Kussmaul
respirations, which are deep and nonlabored.

40.

Patients with type 1 diabetes mellitus may require which of the

following changes to their daily routine during times of infection?
"a. no change
b. less insulin
c. more insulin
d. oral diabetic agents"

answer C: during times of infection and illness diabetic patients

may need even more insulin to compensate for increased blood
glucose levels.

33.

Gestational diabetes can occur between the 16th and 28th week
of pregnancy.
If not responsive to diet and exercise, insulin injections may be
necessary.
Concentrated sugars should be avoided.
Weight gain should continue, but not in excessive amounts.
Usually, gestational diabetes disappears after the infant is born.
However, diabetes can develop 5 to 10 years after the
pregnancy"

41.

Polydipsia and poly uria related to diabetes mellitus are

primarily due to: "a.The release of ketones from cells
during fat metabolism
b. Fluid shifts resulting from exposure to high levels of
hyperglycemia
c. Damage to the kidneys from exposure to high levels of
glucose
d. changes in RBCs resulting from attachemnt of
excessibe glucose to hemoglobin"

"Coorect answer: d.
Rationale: The osmotic effect of glucose produces the manifesatiaions of
polydispsia and poly uria."

42.

"Polydipsia and polyuria related to diabetes mellitus are

primarily due to:
"a. The release of ketones from cells during fat
metabolism
b. Fluid shifts resulting from the osmotic effect of
hyperglycemia
c. Damage to the kidneys from exposure to high levels of
glucose
d. Changes in RBCs resulting from attachment of
excessive glucose to hemoglobin

b. Fluid shifts resulting from the osmotic effect of hyperglycemia

Rationale: The osmotic effect of glucose produces the manifestations of
polydipsia and polyuria.

43.

"Polydipsia and polyuria related to diabetes mellitus are

primarily due to:
"a. The release of ketones from cells during fat
metabolism
b. Fluid shifts resulting from the osmotic effect of
hyperglycemia
c. Damage to the kidneys from exposure to high levels of
glucose
d. Changes in RBCs resulting from attachment of
excessive glucose to hemoglobin"

b. Fluid shifts resulting from the osmotic effect of hyperglycemia

Rationale: The osmotic effect of glucose produces the manifestations of
polydipsia and polyuria.

44.

"Prediabetes is associated with all of the following

except:
" a. Increased risk of developing type 2 diabetes
b. Impaired glucose tolerance
c. Increased risk of heart disease and stroke
d. Increased risk of developing type 1 diabetes"

"ANSWER: D
Persons with elevated glucose levels that do not yet meet the criteria for
diabetes are considered to have prediabetes and are at increased risk of
developing type 2 diabetes. Weight loss and increasing physical activity
can help people with prediabetes prevent or postpone the onset of type 2
diabetes."

45.

Risk factors for type 2 diabetes include all of the

following except: "a. Advanced age
b. Obesity
c. Smoking
d. Physical inactivity"

Smoking
"Additional risk factors for type 2 diabetes are a family history of
diabetes,
impaired glucose metabolism, history of gestational diabetes, and
race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans,
Native Hawaiians, Pacific Islanders, and Native Americans are at greater
risk of developing diabetes than whites."

46.

"The client, an 18-year-old female, 5'4'' tall, weighing 113

kg, comes to the clinic for a wound on her lower leg that
has not healed for the last two (2) weeks. Which
diseaseprocess would the nurse suspect that the client
has developed?
"1.Type 1 diabetes.
2.Type 2 diabetes.
3.Gestational diabetes.
4.Acanthosis nigricans"

"Correct Answer: 2
Type 2 diabetes is a disorder that usually occurs around the age of 40,
but it is now being detected in children and young adultsas a result of
obesity and sedentary life-styles. Wounds that do not heal are a hall-mark
sign of Type 2 diabetes. This client weighs 248.6 pounds and is short"

47.

"The client diagnosed with Type 1 diabetes has a glycosylated

hemoglobin (A1
c) of 8.1%. Which interpretation should the nurse make based on this
result? 1.This result is below normal levels.2.This result is within
acceptable levels. 3.This result is above recommended levels 4.This
result is dangerously high.

"1.The acceptable level for an A1c for a client with diabetes

is between 6% and 7%, which corresponds to a 120-140
mg/dL average blood glucose level. 2.This result is not
within acceptable levelsfor the client with diabetes, which is
6% to7%.
3.(CORRECT) This result parallels a serum blood
glucoselevel of approximately 180 to 200 mg/dL. An A1
c is a blood test that reects average blood glucose levels
over a period of 2-3months; clients with elevated blood
glucose levels are at risk for developing long-term
complications.
4.An A1c of 13% is dangerously high; it reects a 300mg/dL average blood glucose level overthe past 3 months."

48.

"The client diagnosed with type 1 diabetse is receiving Humalog, a

rapid-acting insulin, by sliding scale. The order reads blood glucose
level: <150, zero (0) units; 151 to 200, three (3) units; 201 to 250, six
(6 units); >251, contact health-care provider. The unlicensed assistive
personnel (UAP) reports to thenurse the client's glucometer reading is
189. How much insulin should the nurse administer to the client?

3 unitsThe client's result is 189, which is between 151 and

200, so the nurse should administer 3 units of Humalog
insulin subcutaneously.

49.

"The guidelines for Carbohydrate

Counting as medical nutrition therapy for diabetes mellitus includes
all
of the following EXCEPT:
a. Flexibility in types and amounts of foods consumed
b. Unlimited intake of total fat, saturated fat and cholesterol
c. Including adequate servings of fruits, vegetables and the dairy
group
d. Applicable to with either Type 1 or Type 2 diabetes mellitusb.
Unlimited intake of total fat, saturated fat and cholesterol"

B. You want to be careful of how much you eat in any food

group.

50.

"The nurse administered 28 units of Humulin N, an intermediate-acting

insulin, to a client diagnosed with Type 1 diabetes at 1600. Which
action should the nurse implement?
"1. Ensure the client eats the bedtime snack.
2. Determine how much food the client ate at lunch.
3. Perform a glucometer reading at 0700.
4. Offer the client protein after administering insulin.

1: ensure the client eats the bedtime snack"1. Humulin N

peaks in 6-8 hours, making the client at risk for
hypoglycemia around midnight, which is why the client
should receive a bedtime snack. This snack will prevent
nighttime hypoglycemia. (Correct)
2. The food intake at lunch will not affect the client's blood
glucose level at midnight.
3. The client's glucometer reading should be done around
2100 to assess the effectiveness of insulin at 1600.
4. Humulin N is an intermediate-acting insulin that has an
onset in 2-4 hours but does not peak until 6-8 hours."

51.

"The nurse caring for a 54-year-old patient hospitalized with diabetes

mellitus would look for which of the following laboratory test results
to obtain information on the patient's past glucose control?
a. prealbumin level
b. urine ketone level
c. fasting glucose level
d. glycosylated hemoglobin level

Answer d: A glycosylated hemoglobin level detects the

amount of glucose that is bound to red blood cells (RBCs).
When circulating glucose levels are high, glucose attaches
to the RBCs and remains there for the life of the blood cell,
which is approximately 120 days. Thus the test can give an
indication of glycemic control over approximately 2 to 3
months.

52.

"The nurse is caring for a patient whose blood glucose level is

55mg/dL. What is the likely nursing response?
"A. Administer a glucagon injection
B. Give a small meal
C. Administer 10-15 g of a carbohydrate
D. Give a small snack of high protein food"

"C
The client has low hypoglycemia. This is generally treated
with a small snack."

53.

"The nurse is caring for a woman at 37 weeks gestation. The client was
diagnosed with insulin-dependent diabetes mellitis (IDDM) at age 7. The client
states, ""I am so thrilled that I will be breastfeeding my baby."" Which of the
following responses by the nurse is best?
"1. You will probably need less insulin while you are breastfeeding.
2. You will need to initially increase your insulin after the baby is born.
3. You will be able to take an oral hypoglycemic instead of insulin after the
baby is born.
4. You will probably require the same dose of insulin that you are now
taking."

"1. breastfeeding has an antidiabetogenic effect, less

insulin is needed. (correct)
2. insulin needs will decrease due to antidiabetogenic
effect of breastfeeding and physiological changes
during immediate postpartum period.
3. client has IDDM, insulin required.
4. during third trimester insulin requirements increase
due to increased insulin resistance"

54.

"The nurse is discharging a client diagnosed with diabetes insipidus. Which

statementmade by the client warrants further intervention?
"1."I will keep a list of my medications in my wallet and wear a Medi
bracelet."
2."I should take my medication in the morning and leave it refrigerated at
home."
3."I should weigh myself every morning and record any weight gain."
4."If I develop a tightness in my chest, I will call my health-care provider."

2."I should take my medication in the morning and

leave it refrigerated at home.""1.The client should
keep a list of medication being taken and wear a
Medic Alert bracelet.
2. Medication taken for DI is usually every 8-12
hours, depending on the client. Theclient should keep
the medication close at hand.
3.The client is at risk for uid shifts. Weighing every
morning allows the client to follow theuid shifts.
Weight gain could indicate too much medication.
4.Tightness in the chest could be an indicator that
the medication is not being tolerated; if this occurs
the client should call the health-care provider"

55.

"The nurse is discussing the importance of exercising to a client diagnosed

with Type 2diabetes whose diabetes is well controlled with diet and exercise.
Which informationshould the nurse include in the teaching about diabetes?
"1.Eat a simple carbohydrate snack before exercising.
2.Carry peanut butter crackers when exercising.
3.Encourage the client to walk 20 minutes three (3) times a week.
4.Perform warmup and cooldown exercises

4.Perform warmup and cooldown exercises "The client

diagnosed with Type 2 diabetes whois not taking
insulin or oral agents does notneed extra food before
exercise.2.The client with diabetes who is at risk
forhypoglycemia when exercising should carry
asimple carbohydrate, but this client is not atrisk for
hypoglycemia.3.Clients with diabetes that is
controlled by dietand exercise must exercise daily at
the sametime and in the same amount to control
theglucose level.
4. [correct] All clients who exercise should perform
warmup and cooldown exercises to helpprevent
muscle strain and injury"

56.

"The nurse is teaching a class on atherosclerosis. Which statement

describes the scien-tic rationale as to why diabetes is a risk factor for
developing atherosclerosis? (1.Glucose combines with carbon monoxide,
instead of with oxygen, and this leads tooxygen deprivation of
tissues.2.Diabetes stimulates the sympathetic nervous system, resulting in
peripheralconstriction that increases the development of
atherosclerosis.3.Diabetes speeds the atherosclerotic process by thickening
the basement membraneof both large and small vessels.4.The increased
glucose combines with the hemoglobin, which causes deposits of plaque in
the lining of the vessels.

3.Diabetes speeds the atherosclerotic process by

thickening the basement membraneof both large and
small vessels."1.Glucose does not combine with
carbonmonoxide.2.Vasoconstriction is not a risk
factor for devel-oping atherosclerosis.
3.This is the scientic rationale why diabetesmellitus
is a modiable risk factor for atherosclerosis.
4.When glucose combines with the hemoglobinin a
laboratory test called glycosylated hemo-globin, the
result can determine the client'saverage glucose level
over the past three (3)months"

57.

"The nurse is teaching a community class to peole with Type 2 diabetes

mellitus. Which explanation would explain the development of Type 2
diabetes?
1. The islet cells in the pancreas stop producing insulin.
2. The client eats too many foods that are high in sugar.
3 The pituitary gland does not produce vasopression.
4. The cells become resistant to the circulating insulin.

"1. This is the cause of Type 1 diabetes mellitus.

2. This may be a reason for obesity, which may lead
to Type 2 diabetes, but eating too much sugar does
not cause diabetes.
3. This is the explanation for diabetes insipidus,
which should not be confused with diabetes mellitus.
4. (CORRECT) Normally insulin binds to special
receptor sites on the cells and initiates a series of
reactions involved in metabolism. In Type 2 diabetes
these reactions are diminished primarily as a result of
obesity and aging."

58.

"The nurse is working with an overweight client who has a high-stress job
and smokes. This client has just received a diagnosis of Type II Diabetes and
has just been started on an oral hypoglycemic agent. Which of the following
goals for the client which if met, would be most likely to lead to an
improvement in insulin efficiency to the point the client would no longer
require oral hypoglycemic agents?
"a. Comply with medication regimen 100% for 6 months
b. Quit the use of any tobacco products by the end of three months
c. Lose a pound a week until weight is in normal range for height and
exercise 30 minutes daily
d. Practice relaxation techniques for at least five minutes five times a day
for at least five months"

c. Lose a pound a week until weight is in normal

range for height and exercise 30 minutes daily When
type II diabetics lose weight through diet and
exercise they sometimes have an improvement in
insulin efficiency sufficient to the degree they no
longer require oral hypoglycemic agents.

59.

"The principal goals of therapy for older patients who have poor glycemic
control are:
"A. Enhancing quality of life.
B. Decreasing the chance of complications.
C. Improving self-care through education.
D. All of the above."

"D. All of the above.

60.

"The risk factors for type 1 diabetes include all of the following except:
"a. Diet
b. Genetic
c. Autoimmune
d. Environmental"

A: Type 1 diabetes is a primary failure of pancreatic

beta cells to produce insulin. It primarily affects
children and young adults and is unrelated to diet.

61.

"What insulin type can be given by IV? Select all that apply:
"A. Glipizide (Glucotrol)
B. Lispro (Humalog)
C. NPH insulin
D. Glargine (Lantus)
E. Regular insulin

E) Regular insulinThe only insulin that can be given

by IV is regular insulin.

62.

"What will the nurse teach the client with diabetes regarding exercise in his
or
her treatment program?
1. During exercise the body will use carbohydrates for energy production,
which
in turn will decrease the need for insulin. 2. With an increase in activity, the
body will use more carbohydrates; therefore
more insulin will be required. 3. The increase in activity results in an
increase in the use of insulin;
therefore the client should decrease his or her carbohydrate intake. 4.
Exercise will improve pancreatic circulation and stimulate the islets of
Langerhans to increase the production of intrinsic insulin.

1. During exercise the body will use carbohydrates for

energy production, which in turn will decrease the
need for insuli"Rationale: As carbohydrates are used
for energy, insulin needs decrease.
Therefore during exercise, carbohydrate intake should
be increased to cover the
increased energy requirements. The beneficial effects
of regular exercise may
result in a decreased need for diabetic medications in
order to reach target
blood glucose levels. Furthermore, it may help to
reduce triglycerides, LDL
cholesterol levels, increase HDLs, reduce blood
pressure, and improve
circulation."

63.

"When an older adult is admitted to the hospital with a diagnosis of diabetes

mellitus and complaints of rapid-onset weight loss, elevated blood glucose
levels, and polyphagia, the gerontology nurse should anticipate which of the
following secondary medical diagnoses?
"1.Impaired glucose tolerance
2.Gestational diabetes mellitus
3.Pituitary tumor
4. Pancreatic tumor

"Pancreatic tumor
Rationale: The onset of hyperglycemia in the older
adult can occur more slowly. When the older adult
reports rapid-onset weight loss, elevated blood
glucose levels, and polyphagia, the healthcare
provider should consider pancreatic tumor."

Rationale: The principal goals of therapy for older

persons with diabetes mellitus and poor glycemic
control are enhancing quality of life, decreasing the
chance of complications, improving self-care through
education, and maintaining or improving general
health status."

64.

"When assessing the patient experiencing the onset of

symptoms of type 1 diabetes, which question should the nurse
ask?
a. ""Have you lost any weight lately?""
b. ""Do you crave fluids containing sugar?""
c. ""How long have you felt anorexic?""
d. ""Is your urine unusually dark-colored?""

A) lost any weight?"a. Weight loss occurs because the body is no

longer able to absorb glucose and starts to break down protein and
fat for energy.
b. The patient is thirsty but does not necessarily crave sugarcontaining fluids.
c. Increased appetite is a classic symptom of type 1 diabetes.
d. With the classic symptom of polyuria, urine will be very dilute."

65.

When taking a health history, the nurse screens for

manifestations suggestive of diabetes type I. Which of the
following manifestations are considered the primary
manifestations of diabetes type I and would be most suggestive
of diabetes type I and require follow-up investigation? "a.
Excessive intake of calories, rapid weight gain, and difficulty
losing weight
b. Poor circulation, wound healing, and leg ulcers,
c. Lack of energy, weight gain, and depression
d. An increase in three areas: thirst, intake of fluids, and
hunger

d. An increase in three areas: thirst, intake of fluids, and hunger

"The primary manifestations of diabetes type I are polyuria
(increased urine output), polydipsia (increased thirst), polyphagia
(increased hunger).
Excessive calorie intake, weight gain, and difficulty losing weight
are common risk factors for type 2 diabetes.
Poor circulation, wound healing and leg ulcers are signs of chronic
diabetes.
Lack of energy, weight gain and depression are not necessarily
indicative of any type of diabetes."

66.

which are symptoms of hypoglycemia? A. irritability, B.

drowsiness c. Abdominal pain D. nausea and vomiting

A. Irritability: signs of hypoglycemia include irritability, shaky

feeling, hunger, headache, dizziness. Other symptoms are
hyperglycemia.

67.

Which electrolyte replacement should the nurse anticipate

being ordered by thehealth-care provider in the client diagnosed
with DKA who has just been admitted tothe ICD? 1.Glucose.
2.)Potassium.
3.Calcium.
4.Sodium

Potassium"1.Glucose is elevated in DKA; therefore, theHCP would

not be replacing glucose.
2.(CORRECT)-->The client in DKA loses potassium from increased
urinary output, acidosis, cata-bolic state, and vomiting.
Replacement isessential for preventing cardiac dysrhyth-mias
secondary to hypokalemia.
3.Calcium is not affected in the client with DKA.4.The IV that is
prescribed 0.9% normal salinehas sodium, but it is not specically
orderedfor sodium replacement. This is an isotonicsolution.
TEST-TAKING HINT:
Option "1" should be elim-inated because the problem with DKA
iselevated glucose so the HCP would not bereplacing it. The test
taker should use physiol-ogy knowledge and realize potassium is in
thecell."

68.

"Which of the following factors are risks for the development of

diabetes mellitus? (Select all that apply.)
"a) Age over 45 years
b) Overweight with a waist/hip ratio >1
c) Having a consistent HDL level above 40 mg/dl
d) Maintaining a sedentary lifestyle

Correct: a,b,d"Rationale: Aging results in reduced ability of beta

cells to respond with insulin effectively. Overweight with waist/hip
ratio increase is part of the metabolic syndrome of DM II. There is
an increase in atherosclerosis with DM due to the metabolic
syndrome and sedentary lifestyle.

69.

"Which of the following is accurate pertaining to physical

exercise and type 1 diabetes mellitus?
"1. Physical exercise can slow the progression of diabetes
mellitus.
2. Strenuous exercise is beneficial when the blood glucose is
high.
3. Patients who take insulin and engage in strenuous physical
exercise might experience hyperglycemia.
4. Adjusting insulin regimen allows for safe participation in all
forms of exercise."

1) physical exercise can slow the progression of diabetes

mellitusRationale: Physical exercise slows the progression of
diabetes mellitus, because exercise has beneficial effects on
carbohydrate metabolism and insulin sensitivity. Strenuous
exercise can cause retinal damage, and can cause hypoglycemia.
Insulin and foods both must be adjusted to allow safe participation
in exercise.

70.

"Which of the following persons would most likely be diagnosed

with diabetes mellitus? A 44-year-old..
"A. Caucasian Woman
B. Asian Woman
C. African-American woman
D. Hispanic Male

"Correct answer: African-American woman

Rationale: Age-specific prevalence of diagnosed diabetes mellitus
(DM) is higher for African-Americans and Hispanics than for
Caucasians. Among those younger than 75, black women had the
highest incidence."

71.

Which statement by the patient with type 2 diabetes is accurate. "a. ""I am
supposed to have a meal or snak if I drink alcohol""
b. ""I am not allowed to eat any sweets because of my diabetes.""
c. I do not need to watch what I eat because my diabetes is not the bad kind.""
d. The amunt of fat in my diet is not important; it is just the carbohydrates that
raise my blood sugar."""

"Correct Answer: A
Alcohol should be consumed with food to reduce
the risk of hypoglycemia."