H. CH 46 Diabetes

Question 1

1. A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurses most plausible conclusion based on this assessment finding?
   A) The patient should withhold his next scheduled dose of insulin.
   B) The patient should promptly eat some protein and carbohydrates.
   C) The patients insulin levels are inadequate.
   D) The patient would benefit from a dose of metformin (Glucophage).

Answer 1

C) The patients insulin levels are inadequate.

Question 2

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes?
A) Fasting plasma glucose greater than or equal to 126 mg/dL
B) Random plasma glucose greater than 150 mg/dL
C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions
D) Random plasma glucose greater than 126 mg/dL

Answer 2

A) Fasting plasma glucose greater than or equal to 126 mg/dL

Question 3

3. A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients at this class?
   A) Low fat generally indicates low sugar.
   B) Protein should constitute 30% to 40% of caloric intake.
   C) Most calories should be derived from carbohydrates.
   d) Animal fats should be eliminated from the diet.

Answer 3

C) Most calories should be derived from carbohydrates.

Question 4

A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the bodys need for insulin?

Adequate sleep
Low stimulation
Exercise
Low-fat diet

Answer 4

Exercise

Question 5

A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration record includes the administration of regular insulin three times daily. Knowing that the patients lunch tray will arrive at 11:45, when should the nurse administer the patients insulin?
A)10:45 
B) 11:15 
C) 11:45
D) 11:50

Answer 5

B) 11:15

Question 6

A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?
A) A sulfonylurea
B) A biguanide
C) A thiazolidinedione
D) An alpha glucosidase inhibitor

Answer 6

B) A biguanide

Question 7

A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient?
A) Do not eliminate insulin when nauseated and vomiting.
B) Report elevated glucose levels greater than 150 mg/dL.
C) Eat three substantial meals a day, if possible.
D) Reduce food intake and insulin doses in times of illness.

Answer 7

A) Do not eliminate insulin when nauseated and vomiting.

Question 8

The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address
what
topic during this dialogue?

A. The need for frequent eye examinations for patients with diabetes
B. The fact that patients with diabetes have an elevated risk of myocardial infarction
C. The relationship between kidney function and blood glucose levels
D. The need to monitor urine for the presence of albumin

Answer 8

B. The fact that patients with diabetes have an elevated risk of myocardial infarction

Question 9

A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individuals risk for developing diabetes?
A) Have blood glucose levels checked annually.
B) Stop using tobacco in any form.
C) Undergo eye examinations regularly.
D) Lose weight, if obese.

Answer 9

D) Lose weight, if obese.

Question 10

10. A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the childs pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes?
A) Type 1 diabetes
B) Type 2 diabetes
C) Noninsulin-dependent diabetes
D) Prediabetes

Answer 10

A) Type 1 diabetes

Question 11

11. A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?
    A) The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase.
    B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it.
    C) The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin.
    D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.

Answer 11

D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.

Question 12

12. An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes?
    A) Ive always been a fan of sweet foods, but lately Im turned off by them.
    B) Lately, I drink and drink and cant seem to quench my thirst.
    C) No matter how much sleep I get, it seems to take me hours to wake up.
    D) When I went to the washroom the last few days, my urine smelled odd.

Answer 12

B) Lately, I drink and drink and cant seem to quench my thirst.

Question 13

A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what?
A) I read that a pancreas transplant will provide a cure for my diabetes.
B) I will take my oral antidiabetic agents when my morning blood sugar is high.
C) I will make sure to follow the weight loss plan designed by the dietitian.
D) I will make sure I call the diabetes educator when I have questions about my insulin.

Answer 13

C) I will make sure to follow the weight loss plan designed by the dietitian.

Question 14

14. A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADAs recommendations include?
    A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein
    B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein
    C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein
    D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

Answer 14

D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

Question 15

15. An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?
    A) Administration of antihypertensive medications
    B) Administering sodium bicarbonate intravenously
    C) Reversing acidosis by administering insulin
    D) Fluid and electrolyte replacement

Answer 15

D) Fluid and electrolyte replacement

Question 16

16. A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the patients ability to prepare and self-administer insulin?
    A) Ask the patient to describe the process in detail.
    B) Observe the patient drawing up and administering the insulin.
    C) Provide a health education session reviewing the main points of insulin delivery.
    D) Review the patients first hemoglobin A1C result after discharge.

Answer 16

B) Observe the patient drawing up and administering the insulin.

Nurses should assess the patients ability to perform diabetes related self-care as soon as possible during the hospitalization or office visit to determine whether the patient requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the patient about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.

Question 17

17. An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient?
    A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.
    B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living.
    C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.
    D) Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.

Answer 17

B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living.

Question 18

A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what?
A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.
B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day.
C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea.
D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.

Answer 18

A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.

Question 19

Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control?

A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
B) A patient who never deviates from her prescribed dose of insulin
C) A patient who adheres closely to a meal plan and meal schedule
D) A patient who eliminates carbohydrates from his daily intake

Answer 19

C) A patient who adheres closely to a meal plan and meal schedule

Question 20

A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor?

A) Increased caloric intake during the first trimester
B) Changes in osmolality and fluid balance
C) The effects of hormonal changes during pregnancy
D) Overconsumption of carbohydrates during the first two trimesters

Answer 20

C) The effects of hormonal changes during pregnancy

Question 21

A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur?

A) Patients who are obese and who have no known history of diabetes
B) Patients with type 1 diabetes and poor dietary control
C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics
D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes

Answer 21

D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes

Question 21

A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient about self-administration of insulin in the home setting. The nurse should teach the patient to do which of the following?

A) Avoid using the same injection site more than once in 2 to 3 weeks.
B) Avoid mixing more than one type of insulin in a syringe.
C) Cleanse the injection site thoroughly with alcohol prior to injecting.
D) Inject at a 45 angle.

Answer 21

A) Avoid using the same injection site more than once in 2 to 3 weeks.

Question 22

23. A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment?

A) Alterations in bile metabolism and release have likely caused hyperglycemia.
B) Stress has likely caused an increase in the patients blood sugar levels.
C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures.
D) The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

Answer 22

B) Stress has likely caused an increase in the patients blood sugar levels.

Question 23

24. A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best response?
    A) Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years.
    B) The cause is not known for sure but it is thought to have something to do with ketoacidosis.
    C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years.
    D) Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels.

Answer 23

C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years.

Question 24

25. A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should prioritize which of the following assessments? A) Monitoring the patients neutrophil levels B) Assessing the patient for signs of impaired liver function C) Monitoring the patients level of consciousness and behavior D) Reviewing the patients creatinine and BUN levels

Answer 24

D) Reviewing the patients creatinine and BUN levels

Question 25

``` 26. A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A) Infection B) Acute pain C) Acute confusion D) Impaired urinary elimination ```

Answer 25

A) Infection

Question 26

27. A patient has been brought to the emergency department by paramedics after being found unconscious. The patients Medic Alert bracelet indicates that the patient has type 1 diabetes and the patients blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? A) IV administration of 50% dextrose in water B) Subcutaneous administration of 10 units of Humalog C) Subcutaneous administration of 12 to 15 units of regular insulin D) IV bolus of 5% dextrose in 0.45% NaCl

Answer 26

A) IV administration of 50% dextrose in water

Question 27

28. A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A) Always carry a form of fast-acting sugar. B) Perform exercise prior to eating whenever possible. C) Eat a meal or snack every 8 hours. D) Check blood sugar at least every 24 hours.

Answer 27

A) Always carry a form of fast-acting sugar.

Question 28

9. A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address? A) Signs and symptoms of diabetic nephropathy B) Management of diabetic ketoacidosis C) Effects of surgery and pregnancy on blood sugar levels D) Recognition of hypoglycemia and hyperglycemia

Answer 28

D) Recognition of hypoglycemia and hyperglycemia

Question 29

A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of insulin can be stored at room temperature before it goes bad. What would be the nurses best answer? A) If you are going to use up the vial within 1 month it can be kept at room temperature. B) If a vial of insulin will be used up within 21 days, it may be kept at room temperature. C) If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature. D) If a vial of insulin will be used up within 1 week, it may be kept at room temperature.

Answer 29

A) If you are going to use up the vial within 1 month it can be kept at room temperature.

Question 30

A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the patient and will implement a program of health education. What is the nurses priority action? A) Ensure that the patient understands the basic pathophysiology of diabetes. B) Identify the patients body mass index. C) Teach the patient survival skills for diabetes. D) Assess the patients readiness to learn.

Answer 30

D) Assess the patients readiness to learn.

Question 31

A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A) A combination of protein and carbohydrates, such as a small cup of yogurt B) Two teaspoons of sugar dissolved in a cup of apple juice C) Half of a cup of juice, followed by cheese and crackers D) Half a sandwich with a protein-based filling

Answer 31

C) Half of a cup of juice, followed by cheese and crackers

Question 32

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase of treatment? A) Monitoring the patient for dysrhythmias B) Maintaining and monitoring the patients fluid balance C) Assessing the patients level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism

Answer 32

B) Maintaining and monitoring the patients fluid balance

Question 33

A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is likely to have minimal contact with the health care system. In order to ensure that the patient maintains adequate blood sugar control over the long term, the nurse should recommend which of the following? A) Participation in a support group for persons with diabetes B) Regular consultation of websites that address diabetes management C) Weekly telephone check-ins with an endocrinologist D) Participation in clinical trials relating to antihyperglycemics

Answer 33

A) Participation in a support group for persons with diabetes

Question 34

A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient? A) Examine feet weekly for redness, blisters, and abrasions. B) Avoid the use of moisturizing lotions. C) Avoid hot-water bottles and heating pads. D) Dry feet vigorously after each bath.

Answer 34

C) Avoid hot-water bottles and heating pads.

Question 35

A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes? A) Ask the patient to describe an optimally healthy meal. B) Ask the patient to keep a food diary and review it with the nurse. C) Ask the patients family what he typically eats. D) Ask the patient to describe a typical days food intake.

Answer 35

B) Ask the patient to keep a food diary and review it with the nurse.

Question 36

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurses most appropriate action? A) Teach the patient about actions to slow the progression of nephropathy. B) Ensure that the patient receives a comprehensive assessment of liver function. C) Determine whether the patient has been using expired insulin. D) Administer a fluid challenge and have the test repeated.

Answer 36

A) Teach the patient about actions to slow the progression of nephropathy.

Question 37

A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse should question the patient about what sign or symptom that would suggest the possible development of peripheral neuropathy? A) Persistently cold feet B) Pain that does not respond to analgesia C) Acute pain, unrelieved by rest D) The presence of a tingling sensation

Answer 37

D) The presence of a tingling sensation

Question 38

A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient? A) Make sure to stick to your normal diet. B) Try to eat small amounts of carbs, if possible. C) Ensure that you check your blood glucose every hour. D) For now, check your urine for ketones every 8 hours.

Answer 38

B) Try to eat small amounts of carbs, if possible.

Question 39

``` A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply. A) Leukocytosis B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia ```

Answer 39

B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia