Lewis Chapter 52: Diabetes Mellitus

Question 1

The nurse would anticipate abnormal assessment findings related to which affected organ when caring for a patient with type 1 diabetes who inadvertently administered a dose of insulin that was too high in the morning and now has a serum glucose level of 60 mg/dL?

A. Heart

B. Lungs

C. Kidneys

D. Brain

Answer 1

D. Brain

The brain relies heavily on glucose for energy and, unlike other organs, it cannot utilize secondary sources for fuel. Thus, an early manifestation of hypoglycemia may be a change in level of consciousness.

Question 2

Which risk factor is the most powerful for developing type 2 diabetes mellitus (DM)?

A. Schizophrenia

B. Dyslipidemia

C. Hypertension

D. Obesity

Answer 2

D. Obesity

The most powerful risk factor for developing type 2 DM is believed to be obesity, specifically abdominal and visceral adiposity.

Question 3

Which variable best differentiates between type 1 and type 2 diabetes?

A. Diagnostic tests

B. Level of endogenous insulin

C. Nutritional status

D. Age at onset of the disease

Answer 3

B. Level of endogenous insulin

In type 1 diabetes, there may be very little or no endogenous insulin present; in type 2 diabetes, there is not enough endogenous insulin to meet the body’s needs.

Question 4

Which value for glycated hemoglobin (A1C) level is a diagnostic test for diabetes mellitus (DM)?

A. ≥5.0%

B. ≥5.5%

C. ≥6.0%

D. ≥6.5%

Answer 4

D. ≥6.5%

One of the diagnostic tests for DM is an A1C ≥6.5%.

Question 5

Which information would the nurse include when teaching about secondary diabetes?

A. Can be resolved when the underlying condition is treated

B. Goes on to become classified as primary type 2 if it last longer than the condition that induced it

C. Occurs in neonates who acquire diabetes from a mother with gestational diabetes

D. Limited to only those with type 1 diabetes

Answer 5

A. Can be resolved when the underlying condition is treated

Secondary diabetes can be resolved when the underlying condition is treated or the medication is discontinued.

Question 6

Which substance requires a second nurse to validate the dosing prior to administration of the medication? Select all that apply. One, some, or all responses may be correct.

A. Oral antihyperglycemic agents (OHAs)

B. Synthetic, rapid-acting insulins

C. Long- or intermediate-acting (basal) insulin

D. Low-glycemic snacks/foods

E. Short- or rapid-acting insulin mixed with an intermediate-acting insulin

Answer 6

B, C, E.
When synthetic, rapid-acting insulins are given in the hospital, the standard is a two-nurse check before administration. Insulin is one of the top five medications implicated in medication incidents associated with death in Canada.
When long- or intermediate-acting insulin is given in the hospital, the standard is a two-nurse check before administration. Insulin is one of the top five medications implicated in medication incidents associated with death in Canada.
When short- or rapid-acting insulin mixed with an intermediate-acting insulin is given in the hospital, the standard is a two-nurse check before administration. Insulin is one of the top five medications implicated in medication incidents associated with death in Canada.

Question 7

Which route of administration of insulin is not used?

A. Intravenous

B. Subcutaneous

C. Continuous subcutaneous infusion (pump)

D. Oral

Answer 7

D. Oral

Insulin is inactivated by gastric juices; therefore, it cannot be taken orally.

Question 8

Which benefit of insulin pumps make them desirable to most patients with type 2 diabetes mellitus (DM)?

A. They reduce hypoglycemic episodes.

B. They eliminate hyperglycemic events.

C. They are available at reduced costs to patients with DM.

D. The insertion site needs to be changed only once a week.

Answer 8

A. They reduce hypoglycemic episodes.

A major advantage of the insulin pump is the reduction of hypoglycemia episodes.

Question 9

Which benefit do oral antihyperglycemic agents (OHAs) provide for type 2 diabetes mellitus (DM) treatment?

A. Improve how insulin and glucose are produced and used by the body

B. Increase insulin production

C. Eliminate hypoglycemic episodes

D. Are meant to be a replacement for insulin

Answer 9

A. Improve how insulin and glucose are produced and used by the body

OHAs and noninsulin injectables improve how insulin and glucose are produced and used by the body.

Question 10

Which action of metformin makes it a first-line medication for use in patients with type 2 diabetes mellitus (DM)?

A. It reduces glucose production by the liver.

B. It reduces the import of glucose into cells.

C. Serum creatinine is maintained at normal levels.

D. It reduces insulin sensitivity at the tissue level.

Answer 10

A. It reduces glucose production by the liver.

The primary action of metformin is to reduce glucose production of the liver.

Question 11

Which medication would the nurse withhold when caring for a patient with diabetes who underwent magnetic resonance imaging (MRI) with and without intravenous (IV) contrast dye yesterday?

A. Glipizide

B. Exenatide

C. Metformin

D. Regular insulin

Answer 11

C. Metformin

Metformin should be withheld on the day of the test and for 48 hours after the test when a patient has received IV contrast dye because the combination of metformin and the dye can lead to acute kidney injury.

Question 12

A patient diagnosed with type 2 diabetes mellitus (DM) would most likely present with which initial complaint?

A. Excessive thirst

B. Abdominal pain

C. Prolonged wound healing

D. Significant weight loss

Answer 12

C. Prolonged wound healing
Chronic hyperglycemia in type 2 DM can cause long-term complications that are manifested late in the disease. One such complication is microvascular disease, which can cause delayed wound healing.

Question 13

Which preventive strategy significantly lowers the incidence of type 2 diabetes mellitus (DM)?

A. Exercising regularly

B. Limiting use of tobacco products

C. Avoiding all red meats

D. Taking medications as ordered

Answer 13

A. Exercising regularly
Regular exercise is one of several strategies that can reduce the development of type 2 DM by 60%.

Question 14

When caring for a patient newly diagnosed with type 2 diabetes mellitus (DM) who wants to learn about the condition, the nurse would initiate teaching by identifying which body function as being impaired?

A. Insulin production

B. Insulin metabolism

C. Glucose production

D. Glucose metabolism

Answer 14

D. Glucose metabolism
The key feature of all types of DM is the problem with glucose metabolism. Most body cells rely on insulin to take glucose from the blood for energy. In type 1 DM, the body develops antibodies against insulin and/or the pancreatic β cells that produce insulin. Type 2 DM is characterized by a combination of inadequate insulin production and insulin resistance.

Question 15

Which benefit does rapid-acting insulins provide to patients?

A. Decreased hypoglycemic episodes

B. Administered once daily

C. Does not have to be used with another insulin

D. Can be injected 5 minutes before a meal

Answer 15

A. Decreased hypoglycemic episodes
Decreased hypoglycemic episodes makes rapid-acting insulin desirable to patients.

Question 16

Which situation would the nurse suspect when a 16-year-old patient with diabetes reports morning blood glucose levels have been averaging around 200 mg/dL but are within acceptable range the rest of the day?

A. Consuming large late-night snacks

B. Experiencing the dawn phenomenon

C. Has not been taking insulin as prescribed

D. Not following dietary recommendations

Answer 16

B. Experiencing the dawn phenomenon
Increased blood glucose levels in the morning and normal blood levels during the day indicate the patient is experiencing the dawn phenomenon.

Question 17

Which information would the nurse provide to a patient with newly diagnosed type 1 diabetes mellitus (DM) who states the desire to go camping but is now afraid to go because of insulin needs?

A. Insulin can be stored at room temperature.

B. Insulin can withstand temperatures between 0°C and 32°C.

C. The patient should not go camping until the disease is stabilized.

D. The patient should have a cooler with ice available at all times to store the insulin.

Answer 17

A. Insulin can be stored at room temperature.
Insulin does not need to be refrigerated and can be stored at room temperature. The patient can go on camping trips if able to obtain a storage method that can keep the insulin at room temperature while camping outdoors.

Question 18

When caring for a patient with diabetes mellitus (DM) who is scheduled for a fasting blood glucose (FBG) level at 0800 hours the next day, the nurse instructs the patient to only drink water after which time?

A. 1800 hours

B. 0400 hours

C. 0000 hours

D. 0700 hours

Answer 18

C. 0000 hours
Typically, a patient is ordered to be NPO for 8 hours before an FBG level. For this reason, the patient who has a laboratory draw at 0800 hours should not have any food or beverages containing any calories after 0000 hours.

Question 19

Which contraindication exists for the use of metformin?

A. Hyperglycemia

B. Elevated estimated glomerular filtration rate (eGFR)

C. Hyperlipidemia

D. Stage 1 or 2 kidney disease

Answer 19

B. Elevated estimated glomerular filtration rate (eGFR)
Do not use metformin in patients with stage 4 or 5 kidney disease or with an eGFR <30 mL/min, liver disease, or unstable heart failure. Lactic acidosis is a rare complication of metformin accumulation.

Question 20

Which information would the nurse include when providing education about how sodium-glucose cotransporter 2 (SGLT2) inhibitors work?

A. They decrease glucose excretion.

B. They increase reabsorption of glucose by the kidney.

C. They decrease blood glucose levels.

D. They increase insulin production.

Answer 20

C. They decrease blood glucose levels.
SGLT2 inhibitors work by lowering blood glucose levels, blocking the reabsorption of glucose by the kidney, and increasing glucose excretion.