LACHARITY 13 Diabetes Mellitus

Question 1

The nurse is caring for an older patient with type 1 diabetes and diabetic
retinopathy. What is the nurse’s priority concern for assessing this patient?
1. Assess ability to measure and inject insulin and to monitor blood glucose
levels.
2. Assess for damage to motor fibers, which can result in muscle weakness.
3. Assess which modifiable risk factors can be reduced.
4. Assess for albuminuria, which may indicate kidney disease.

Answer 1

Ans: 1 The older patient with diabetic retinopathy also has general age-
related vision changes, and the ability to perform self-care may be seriously
affected. He or she may have blurred vision, distorted central vision,
fluctuating vision, loss of color perception, and mobility problems resulting
from loss of depth perception. When a patient has visual changes, it is
especially important to assess his or her ability to measure and inject insulin
and to monitor blood glucose levels to determine if adaptive devices are
needed to assist in self-management. The other options are important but are
not specific to diabetic retinopathy. Focus: Prioritization.

Question 2

An older patient with type 2 diabetes has cardiovascular autonomic
neuropathy (CAN). Which instruction would the nurse provide for the
unlicensed assistive personnel (UAP) assisting the patient with morning care?
1. Provide a complete bed bath for this patient.
2. Sit the patient up slowly on the side of the bed before standing.
3. Only let the patient wash his or her face and brush his or her teeth.
4. Be sure to provide rest periods between activities.

Answer 2

Ans: 2 CAN affects sympathetic and parasympathetic nerves of the heart and
blood vessels. It may lead to orthostatic (postural) hypotension and syncope
(brief loss of consciousness on standing) caused by failure of the heart and
arteries to respond to position changes by increasing heart rate and vascular
tone. The nurse should be sure to instruct the UAP to have the patient change
positions slowly when moving from lying to sitting and standing. Focus:
Supervision, Delegation.

Question 3

The nurse is preparing to review a teaching plan for a patient with type 2
diabetes mellitus. To determine the patient’s level of compliance with his
prescribed diabetic regimen, which value would the nurse be sure to review?
1. Fasting glucose level
2. Oral glucose tolerance test results
3. Glycosylated hemoglobin (HgbA 1c ) level
4. Fingerstick glucose findings for 24 hours

Answer 3

Ans: 3 The higher the blood glucose level is over time, the more glycosylated
the hemoglobin becomes. The HgbA 1c level is a good indicator of the average
blood glucose level over the previous 120 days. Fasting glucose and oral
glucose tolerance tests are important diagnostic tools. Fingerstick blood
glucose monitoring provides information that allows adjustment of the
patient’s therapeutic regimen. Focus: Prioritization.

Question 4

A patient has newly-diagnosed type 2 diabetes. Which task should the RN
delegate to an experienced unlicensed assistive personnel (UAP)?
1. Arranging a consult with the dietitian
2. Assessing the patient’s insulin injection technique
3. Teaching the patient to use a glucometer to monitor glucose at home
4. Checking the patient’s glucose level before each meal

Answer 4

Ans: 4 The experienced UAP would have been taught to perform tasks such
as checking pulse oximetry and glucose checks, and these actions would be
part of his or her scope of practice. Arranging for a consult with the dietitian
is appropriate for the unit clerk. Teaching and assessing require additional
education and should be carried out by licensed nurses. Focus: Delegation,
Supervision, Assignment.

Question 5

A patient with newly diagnosed diabetes has peripheral neuropathy. Which
key points should the nurse include in the teaching plan for this patient?
Select all that apply.
1. “Clean and inspect your feet every day.”
2. “Be sure that your shoes fit properly.”
3. “Nylon socks are best to prevent friction on your toes from shoes.”
4. “Only a podiatrist should trim your toenails.”
5. “Report any nonhealing skin breaks to your health care provider (HCP).”
6. “Use a thermometer to check the temperature of water before taking a
255bath.”

Answer 5

Ans: 1, 2, 5, 6 Sensory alterations are the major cause of foot complications in
patient with diabetes, and patients should be taught to examine their feet on a
daily basis. Properly fitted shoes protect the patient from foot complications.
Broken skin increases the risk of infection. Cotton socks are recommended to
absorb moisture. Using a bath thermometer can prevent burn injuries.
Patients, family, or HCPs may trim toenails. Focus: Prioritization; Test
Taking Tip: When caring for patients with diabetes, the nurse must be
knowledgeable about safety issues with the potential for injuries to these
patients. A key nursing role is patient teaching regarding these concerns so
patients can perform protective interventions in the home to prevent injuries.

Question 6

An LPN/LVN is assigned to perform assessments on two patients with
diabetes. Assessments reveals all of these findings. Which finding would the
RN instruct the LPN/LVN to report immediately?
1. Fingerstick glucose reading of 185 mg/dL (10.3 mmol/L)
2. Numbness and tingling in both feet
3. Profuse perspiration
4. Bunion on the left great toe

Answer 6

Ans: 3 Profuse perspiration is a symptom of hypoglycemia, a complication of
diabetes that requires urgent treatment. A glucose level of 185 mg/dL
264(10.3 mmol/L) will need coverage with sliding-scale insulin, but this is not
urgent. Numbness and tingling, as well as bunions, are related to the chronic
nature of diabetes and are not urgent problems. Focus: Prioritization.

Question 7

The plan of care for a patient with diabetes includes all of these interventions.
Which intervention should the nurse delegate to unlicensed assistive
personnel (UAP)?
1. Reminding the patient to put on well-fitting shoes before ambulating
2. Discussing community resources for diabetic outpatient care
3. Teaching the patient to perform daily foot inspection
4. Assessing the patient’s technique for drawing insulin into a syringe

Answer 7

Ans: 1 Reminding the patient to put on well-fitting shoes (after the nurse has
taught the patient about the importance of this action) is part of assisting with
activities of daily living and is within the education and scope of practice of
the UAP. It is a safety measure that can prevent injury. Discussing
community resources, teaching, and assessing require a higher level of
education and are appropriate to the scope of practice of licensed nurses.
Focus: Delegation.

Question 8

A 58-year-old patient with type 2 diabetes was admitted to the acute care unit
with a diagnosis of chronic obstructive pulmonary disease (COPD)
exacerbation. When the RN prepares a care plan for this patient, what would
he or she be sure to include? Select all that apply.
1. Fingerstick blood glucose checks before meals and at bedtime
2. Sliding-scale insulin dosing as prescribed
3. Bed rest until the COPD exacerbation is resolved
4. Teaching about the Atkins diet for weight loss
5. Demonstration of the components of foot care
6. Discussing the relationship between illness and glucose levels

Answer 8

Ans: 1, 2, 5, 6 When a patient with diabetes is ill, glucose levels become
elevated, and administration of insulin may be necessary. Administration of
sliding-scale insulin is guided by fingerstick blood glucose checks. Teaching
or reviewing the components of proper foot care is always a good idea with a
patient with diabetes. Bed rest is not necessary, and glucose levels may be
better controlled when a patient is more active. The Atkins diet recommends
decreasing the consumption of carbohydrates and is not a good diet for
patient with diabetes. Focus: Prioritization.

Question 9

An unlicensed assistive personnel (UAP) tells the nurse that while assisting
with the morning care of a postoperative patient with type 2 diabetes who
has been given insulin, the patient asked if she will always need to take
insulin now. What is the RN’s priority for teaching the patient?
1. Explain to the patient that she is now considered to have type 1 diabetes.
2. Tell the patient to monitor fingerstick glucose level every 4 hours after
discharge.
3. Teach the patient that a person with type 2 diabetes does not always need
insulin.
4. Discuss the relationship between illness and increased glucose levels.

Answer 9

Ans: 4 When a patient with diabetes is ill or has surgery, glucose levels
become elevated, and administration of insulin may be necessary. This is a
temporary change that usually resolves with recovery from the illness or
surgery. Option 3 is correct but does not explain why the patient may
currently need insulin. The patient does not have type 1 diabetes, and
fingerstick glucose checks are usually prescribed for before meals and at
bedtime. Focus: Prioritization.

Question 10

An LPN/LVN is assigned to administer rapid-acting insulin, lispro, to a
patient with type 1 diabetes. What essential information would the RN be
sure to tell the LPN/LVN?
1. Give this insulin when the food tray has been delivered and the patient is
ready to eat.
2562. Only give this insulin for fingerstick glucose reading is above 200 mg/dL
(11.1 mmol/L).
3. This insulin mimics the basal glucose control of the pancreas.
4. Rapid-acting insulin is the only insulin that can be given subcutaneously or
IV.

Answer 10

Ans: 1 The onset of action for rapid-acting insulin is within minutes, so it
should be given only when the patient has food and is ready to eat. Because
of this, rapid-acting insulin is sometimes called “see food” insulin. Options 2,
3, and 4 are incorrect with regard to rapid-acting insulin. Option 2 is incorrect
with regard to all forms of insulin. Long-acting insulins mimic the action of
the pancreas. Regular insulin is the only insulin that can be given IV. Focus:
Assignment, Supervision.

Question 11

In the care of a patient with type 2 diabetes, which actions should the nurse
delegate to an unlicensed assistive personnel (UAP)? Select all that apply.
1. Providing the patient with extra packets of artificial sweetener for coffee
2. Assessing how well the patient’s shoes fit
3. Recording the liquid intake from the patient’s breakfast tray
4. Teaching the patient what to do if dizziness or lightheadedness occurs
5. Checking and recording the patient’s blood pressure
6. Assisting the patient to ambulate to the bathroom

Answer 11

Ans: 1, 3, 5, 6 Giving the patient extra sweetener, recording oral intake,
assisting with ambulation, and checking blood pressure are all within the
scope of practice of the UAP. Assessing shoe fit and patient teaching are
within the professional nurse’s scope of practice. Focus: Assignment.

Question 12

In the emergency department, during initial assessment of a newly admitted
patient with diabetes, the nurse discovers all of these findings. Which finding
should be reported to the health care provider immediately?
1. Hammer toe of the left second metatarsophalangeal joint
2. Rapid respiratory rate with deep inspirations
3. Numbness and tingling bilaterally in the feet and hands
4. Decreased sensitivity and swelling of the abdomen

Answer 12

Ans: 2 Rapid, deep respirations (Kussmaul respirations) are symptomatic of
diabetic ketoacidosis. Hammer toe, as well as numbness and tingling, are
chronic complications associated with diabetes. Decreased sensitivity and
swelling (lipohypertrophy) occur at a site of repeated insulin injections, and
treatment involves teaching the patient to rotate injection sites within one
anatomic site. Focus: Prioritization.

Question 13

The nurse is caring for a patient with diabetes who is developing diabetic
ketoacidosis (DKA). Which task delegation or assignment is most
appropriate?
1. Ask the unit clerk to page the health care provider to come to the unit.
2. Ask the LPN/LVN to administer IV push insulin according to a sliding
scale.
3. Ask the unlicensed assistive personnel (UAP) to hang a new bag of normal
saline.
4. Ask the UAP to get the patient a cup (236 mL) of orange juice.

Answer 13

Ans: 1 The nurse should not leave the patient. The scope of the unit clerk’s
265job includes calling and paging physicians. LPNs/LVNs generally do not
administer IV push medication, although in some states with additional
training, this may be done. (Be sure to check the Scope of Practice in your
specific state.) IV fluid administration is not within the scope of practice of
UAPs. Patients with DKA already have a high glucose level and do not need
orange juice. Focus: Delegation, Supervision.

Question 14

The RN is serving as preceptor to a new graduate nurse who has recently
passed the RN licensure (NCLEX®) examination. The new nurse has only
been on the unit for 2 days. Which patient should be assigned to the new
graduate nurse?
1. A 68-year-old patient with diabetes who is showing signs of hyperglycemia
2. A 58-year-old patient with diabetes who has cellulitis of the left ankle
3. A 49-year-old patient with diabetes just returned from the postanesthesia
care unit after a below-knee amputation
4. A 72-year-old patient with diabetes with diabetic ketoacidosis who is
receiving IV insulin

Answer 14

Ans: 2 The new nurse is very early in orientation to the unit. Appropriate
patient assignments at this time include patients whose conditions are stable
and not complex. Patients 1, 3, and 4 are more complex and will benefit from
care by a nurse experienced in care of patients with diabetes. Focus:
Assignment; Test Taking Tip: For nurses new to a unit, always assign
patients who are most stable and least complex.

Question 15

A patient with diabetes has hot, dry skin; rapid and deep respirations; and a
257fruity odor to his breath. The charge nurse observes a newly graduated RN
performing all the following patient tasks. Which action requires that the
charge nurse intervene immediately?
1. Checking the patient’s fingerstick glucose level
2. Encouraging the patient to drink orange juice
3. Checking the patient’s order for sliding-scale insulin dosing
4. Assessing the patient’s vital signs every 15 minutes

Answer 15

Ans: 2 The signs and symptoms the patient is exhibiting are consistent with
hyperglycemia. The RN should not give the patient additional glucose. All of
the other interventions are appropriate for this patient. The RN should also
notify the health care provider at this time. Focus: Prioritization.

Question 16

A patient has newly diagnosed type 2 diabetes. Which action should the RN
assign to an LPN/LVN rather than an experienced unlicensed assistive
personnel (UAP)?
1. Measuring the patient’s vital signs every shift
2. Checking the patient’s glucose level before each meal
3. Administering subcutaneous insulin on a sliding scale as needed
4. Assisting the patient with morning care

Answer 16

Ans: 3 The UAP’s scope of practice includes checking vital signs and
assisting with morning care. Experienced UAPs with special training can
check the patient’s glucose level before meals and at bedtime. It is generally
not within the UAP’s scope of practice to administer medications, but this is
within the scope of practice of the LPN/LVN. Focus: Assignment.

Question 17

A patient with type 1 diabetes reports feeling dizzy. What should the nurse
do first?
1. Check the patient’s blood pressure.
2. Give the patient some orange juice.
3. Give the patient’s morning dose of insulin.
4. Use a glucometer to check the patient’s glucose level.

Answer 17

Ans: 4 Before orange juice or insulin is given, the patient’s blood glucose
level should be checked. Checking blood pressure is a good idea but is not
the first action the nurse should take. Focus: Prioritization.

Question 18

The nurse is responsible for the care of a patient with diabetes who is unable
to swallow, is unconscious and seizing, and has a blood glucose of less than
20 mg/dL (1.1 mmol/L). Which actions are most appropriate responses for
this patient at this time? Select all that apply.
1. Check the chart for the patient’s most recent A 1c level.
2. Give glucagon 1 mg subcutaneously or intramuscularly (IM).
3. Repeat the dose of glucagon in 10 minutes if the patient remains
unconscious.
4. Apply aspiration precautions because glucagon can cause vomiting.
5. Give the patient an oral simple sugar or snack.
6. Notify the health care provider (HCP) immediately.

Answer 18

Ans: 2, 3, 4, 6 This patient’s manifestations suggest severe hypoglycemia.
Essential actions at this time include notifying the HCP immediately and
giving glucagon 1 mg subcutaneously or IM. Glucagon is the main
counterregulatory hormone to insulin and is used as first-line therapy for
severe hypoglycemia in patients with diabetes. The dose or glucagon is
repeated after 10 minutes if the patient remains unconscious. Aspiration
precautions are important because this drug can cause vomiting. Checking
the patient’s A 1c level is not important at this time. Offering oral glucose or a
snack when a patient is unable to swallow or unconscious is inappropriate.
Focus: Prioritization.

Question 19

While working in the diabetes clinic, the RN obtains the following
information about an 8-year-old patient with type 1 diabetes. Which finding
is most important to address when planning child and parent education?
1. Most recent hemoglobin A 1c level of 7.8%
2. Many questions about diet choices from the parents
3. Child’s participation in soccer practice after school 2 days a week
4. Morning preprandial glucose range of 55 to 70 mg/dL (3.1 to 3.9 mmol/L)

Answer 19

Ans: 4 The low morning fasting blood glucose level indicates possible
nocturnal hypoglycemia. Research indicates that it is important to avoid
hypoglycemic episodes in pediatric patients because of the risk for permanent
neurologic damage and adverse developmental outcomes. Although a lower
hemoglobin A 1c might be desirable, the upper limit for hemoglobin A 1c levels
ranges from 7.5% to 8.5% in pediatric patients. The parents’ questions about
diet and the child’s activity level should also be addressed, but the most
urgent consideration is education about the need to avoid hypoglycemia.
Focus: Prioritization.

Question 20

Which actions can the school nurse delegate to an experienced unlicensed
258assistive personnel (UAP) who is working with a 7-year-old child with type 1
diabetes in an elementary school? Select all that apply.
1. Obtaining information about the child’s usual insulin use from the parents
2. Administering oral glucose tablets when blood glucose level falls below
60 mg/dL (3.3 mmol/L)
3. Teaching the child about what foods have high carbohydrate levels
4. Obtaining blood glucose readings using the child’s blood glucose monitor
5. Reminding the child to have a snack after the physical education class
6. Assessing the child’s knowledge level about his or her type 1 diabetes

Answer 20

Ans: 2, 4, 5 National guidelines published by the American Diabetes
Association (ADA) indicate that administration of emergency treatment for
hypoglycemia (e.g., glucose tablets), obtaining blood glucose readings, and
reminding children about content they have already been taught by licensed
caregivers are appropriate tasks for non–health care professional personnel
such as teachers, paraprofessionals, and UAP. Assessments and education
require more specialized education and scope of practice and should be done
by the school nurse. Focus: Delegation.

Question 21

While the RN is performing an admission assessment on a patient with type
2 diabetes, the patient states that he routinely drinks 3 beers a day. What is
the nurse’s priority follow-up question at this time?
1. “Do you have any days when you do not drink?”
2. “When during the day do you drink your beers?”
3. “Do you drink any other forms of alcohol?”
4. “Have you ever had a lipid profile completed?”

Answer 21

Ans: 2 Alcohol has the potential for causing alcohol-induced hypoglycemia.
It is important to know when the patient drinks alcohol and to teach the
patient to ingest it shortly after meals to prevent this complication. The other
questions are important but not urgent. The lipid profile question is
important because alcohol can raise plasma triglycerides but is not as urgent
as the potential for hypoglycemia. Focus: Prioritization.

Question 22

The unlicensed assistive personnel reports to the RN that a patient with type
1 diabetes has a question about exercise. What important points would the
RN be sure to teach this patient? Select all that apply.
1. Exercise guidelines are based on blood glucose and urine ketone levels.
2. Be sure to test your blood glucose only after exercising.
3. You can exercise vigorously if your blood glucose is between 100 and
250 mg/dL (5.6 and 13.9 mmol/L).
4. Exercise will help resolve the presence of ketones in your urine.
5. A 5- to 10-minute warm-up and cool-down period should be included in
your exercise.
6. For unplanned exercise, increased intake of carbohydrates is usually
needed.

Answer 22

Ans: 1, 3, 5, 6 Guidelines for exercise are based on blood glucose and urine
ketone levels. Patients should test blood glucose before, during, and after
exercise to be sure that it is safe to exercise. When ketones are present in
urine, the patient should not exercise because ketones indicate that current
insulin levels are not adequate. Vigorous exercise is permitted in patients
with type 1 diabetes if glucose levels are between 100 and 250 mg/dL (5.6 and
13.9 mmol/L). Warm-up and cool-down should be included in exercise to
gradually increase and decrease the heart rate. For planned exercise,
reduction in insulin dosage is used for hypoglycemia prevention. For
unplanned exercise, intake of additional carbohydrate is usually needed.
Focus: Prioritization.

Question 23

The experienced unlicensed assistive personnel (UAP) has been delegated to
take vital signs and check fingerstick glucose on a postoperative patient with
diabetes. Which vital sign change would the RN instruct the UAP to report
immediately?
1. Blood pressure increase from 132/80 to 138/84 mm Hg
2. Temperature increase from 98.4°F to 99°F (36.9°C to 37.2°C)
3. Respiratory rate increase from 18 to 22 breaths/min
4. Glucose increase from 190 to 236 mg/dL (10.6 to 13.1 mmol/L)

Answer 23

Ans: 4 An unexpected rise in blood glucose is associated with increased
mortality and morbidity after surgical procedures. American Diabetes
Association guidelines recommend insulin protocols to maintain blood
glucose levels between 140 and 180 mg/dL (7.8 and 10 mmol/L). Also,
unexpected rises in blood glucose values may indicate wound infection.
Focus: Delegation, Supervision, Prioritization.

Question 24

The RN is the preceptor for a senior nursing student who will teach a patient
with diabetes about self-care during sick days. For which statement by the
student must the RN intervene?
1. “When you are sick, be sure to monitor your blood glucose at least every 4
259hours.”
2. “Test your urine for ketones whenever your blood glucose level is less than
240 mg/dL (13.3 mmol/L).”
3. “To prevent dehydration, drink 8 ounces (236 mL) of sugar-free liquid
every hour while you are awake.”
4. “Continue to eat your meals and snacks at the usual times.”

Answer 24

Ans: 2 Urine ketone testing should be done whenever the patient’s blood
glucose is greater than 240 mg/dL (13.3 mmol/L). All of the other teaching
points are appropriate “sick day rules.” For dehydration, teaching should
also include that if the patient’s blood glucose is lower than her target range,
she should drink fluids containing sugar. Focus: Supervision, Delegation

Question 25

The nurse is caring for an 81-year-old adult with type 2 diabetes,
hypertension, and peripheral vascular disease. Which admission assessment
findings increase the patient’s risk for development of hyperglycemic-
hyperosmolar syndrome (HHS)? Select all that apply.
1. Hydrochlorothiazide (HCTZ) prescribed to control her blood pressure
2. Weight gain of 6 lb (2.7 kg) over the past month
3. Avoids consuming liquids in the evening
4. Blood pressure of 168/94 mm Hg
5. Urine output of 50 to 75 mL/hr
6. Glucose greater than 600 mg/dL (33.3 mmol/L)

Answer 25

Ans: 1, 3, 6 HHS often occurs in older adults with type 2 diabetes. Risk
factors include taking diuretics and inadequate fluid intake. Serum glucose is
greater than 600 mg/dL (33.3 mmol/L). Weight loss (not weight gain) would
be a symptom. Although the patient’s blood pressure is high, this is not a risk
factor. A urine output of 50 to 75 mL/hr is adequate. Focus: Prioritization.

Question 26

The RN is orienting a new graduate nurse who is providing diabetes
education for a patient about insulin injection. For which teaching statement
by the new nurse must the RN intervene?
1. “To prevent lipohypertrophy, be sure to rotate injection sites from the
abdomen to the thighs.”
2. “To correctly inject the insulin, lightly grasp a fold of skin and inject at a 90-
degree angle.”
3. “Always draw your regular insulin into the syringe first before your NPH
(neutral protamine Hagedorn) insulin.”
4. “Avoid injecting the insulin into scarred sites because those areas slow the
absorption rate of insulin.”

Answer 26

Ans: 1 Although it is important to rotate injection sites for insulin, it is
preferred that the injection sites be rotated within one anatomic site (e.g., the
267abdomen) to prevent day-to-day changes in the absorption rate of the insulin.
All of the other teaching points are appropriate. Focus: Supervision,
Prioritization.

Question 27

The patient with type 2 diabetes has a health care provider prescription for
NPO status for a cardiac catheterization. An LPN/LVN who is assigned to
administer medications to this patient asks the supervising RN whether the
patient should receive his ordered repaglinide. What is the RN’s best
response?
1. “Yes, because this drug will increase the patient’s insulin secretion and
prevent hyperglycemia.”
2. “No, because this drug may cause the patient to experience gastrointestinal
symptoms such as nausea.”
3. “No, because this drug should be given 1 to 30 minutes before meals and
the patient is NPO.”
4. “Yes, because this drug should be taken three times a day whether the
patient eats or not.”

Answer 27

Ans: 3 Repaglinide is a meglitinide analog drug. These drugs are short-
acting agents used to prevent postmeal blood glucose elevation. They should
be given within 1 to 30 minutes before meals and cause hypoglycemia shortly
after dosing when a meal is delayed or omitted. Focus: Supervision,
Assignment, Prioritization.

Question 28

The RN is caring for a patient with diabetes admitted with hypoglycemia
260that occurred at home. Which teaching points for treatment of hypoglycemia
at home would the nurse include in a teaching plan for the patient and family
before discharge? Select all that apply.
1. Signs and symptoms of hypoglycemia include hunger, irritability,
weakness, headache, and blood glucose less than 60 mg/dL (3.3 mmol/L).
2. Treat hypoglycemia with 4 to 8 g of carbohydrate such as glucose tablets or
1⁄4 cup (60 mL) of fruit juice.
3. Retest blood glucose in 30 minutes.
4. Repeat the carbohydrate treatment if the symptoms do not resolve.
5. Eat a small snack of carbohydrate and protein if the next meal is more than
an hour away.
6. If the patient has severe hypoglycemia, does not respond to treatment, and
is unconscious, transport to the emergency department (ED).

Answer 28

Ans: 1, 4, 5, 6 The manifestations listed in option 1 are correct. The
symptoms should be treated with carbohydrate, but 10 to 15 g (not 4 to 8 g).
Glucose should be retested at 15 minutes; 30 minutes is too long to wait.
Options 4 and 5 are correct. When a patient has severe hypoglycemia, does
not respond to administration of glucagon, and remains unconscious, he or
she should be transported to the ED and the health care provider notified.
Focus: Prioritization.

Question 29

The nurse is evaluating a patient with diabetes for foot risk category. The
patient lacks protective sensation and shows evidence of peripheral vascular
disease. According to the American Diabetes Association (ADA), which foot
risk category best fits this patient?
1. Risk category 0
2. Risk category 1
3. Risk category 2
4. Risk category 3

Answer 29

Ans: 3 The ADA’s foot risk categories are category 0 (has protective
sensation, has no evidence of peripheral vascular disease, has no evidence of
foot deformity), category 1 (does not have protective sensation; may have
evidence of foot deformity), category 2 (does not have protective sensation;
has evidence of peripheral vascular disease), and category 3 (has history of
ulcer or amputation). Focus: Prioritization.

Question 30

The nurse is preparing a teaching plan for a patient with type 2 diabetes who
has been prescribed albiglutide. Which key points would the nurse include?
Select all that apply.
1. The drug works in the intestine in response to food intake and acts with
insulin for glucose regulation.
2. This drug increases cellular utilization of glucose, which lowers blood
glucose levels.
3. This drug is used with diet and exercise to improve glycemic control in
adults with type 2 diabetes.
4. The drug is an oral insulin that should be given only when the patient has
something to eat immediately available.
5. Albiglutide is administered by the subcutaneous route once a week.
6. Albiglutide should be given with caution for a patient with a history of
pancreatic problems.

Answer 30

Ans: 1, 3, 5 Albiglutide is an incretin mimetic. These drugs work like the
natural “gut” hormones, glucagon-like peptide-1 (GLP-1) and glucose-
dependent insulinotropic polypeptide (GIP), that are released by the intestine
in response to food intake and act with insulin for glucose regulation. They
are used in addition to diet and exercise to improve glycemic control in
adults with type 2 diabetes. Albiglutide is administered subcutaneously once
a week. Focus: Prioritization.

Question 31

The nurse is assessing a newly admitted older adult with diabetes.
Assessment reveals abnormal appearance of the feet (see figure). The nurse
recognizes this as which deformity?
1. Claw toe deformity
2. Hammer toe deformity
3. Charcot foot deformity
4. Hypertrophic ungula labium deformity

Answer 31

Ans: 3 Charcot foot is a diabetic foot deformity. The foot is warm, swollen,
and painful. Walking collapses the arch, shortens the foot, and gives the sole
of the foot a “rocker bottom” shape. Focus: Prioritization.