Deck 49: Nursing Management: Diabetes Mellitus

Question 1

A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG) as part of diabetes management. During evaluation of the patient's technique of SMBG, the nurse identifies a need for additional teaching when the patient

A) chooses a puncture site in the center of the finger pad.
B) washes the puncture site using soap and water.
C) says the result of 130 mg indicates good blood sugar control.
D) hangs the arm down for a minute before puncturing the site.

Answer 1

chooses a puncture site in the center of the finger pad.

Question 2

During a clinic visit 3 months following a diagnosis of type 2 diabetes, the patient reports following a reduced-calorie diet. The patient has not lost any weight and did not bring the glucose-monitoring record. The nurse will plan to obtain a(n)

A) fasting blood glucose level.
B) urine dipstick for glucose.
C) glycosylated hemoglobin level.
D) oral glucose tolerance test.

Answer 2

glycosylated hemoglobin level.

Question 3

A diabetic patient is started on intensive insulin therapy. The nurse will plan to teach the patient about mealtime coverage using _____ insulin.

A) NPH
B) lispro
C) detemir
D) glargine

Answer 3

lispro

Question 4

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."
B) "I will need a bedtime snack because I take an evening dose of NPH insulin."
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."

Question 5

When teaching a patient with type 2 diabetes about taking glipizide (Glucotrol), the nurse determines that additional teaching about the medication is needed when the patient says,

A) "Since I can take oral drugs rather than insulin, my diabetes is not serious and won't cause many complications."
B) "If I overeat at a meal, I will still take just the usual dose of medication."
C) "If I become ill, I may have to take insulin to control my blood sugar."
D) "I should check with my doctor before taking any other medications because there are many that will affect glucose levels."

Question 6

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?"

Question 7

A patient with type 1 diabetes has an unusually high morning glucose measurement, and the health care provider wants the patient evaluated for possible Somogyi effect. The nurse will plan to

A) administer an increased dose of NPH insulin in the evening.
B) obtain the patient's blood glucose at 3:00 in the morning.
C) withhold the nighttime snack and check the glucose at 6:00 AM.
D) check the patient for symptoms of hypoglycemia at 2:00 to 4:00 AM.

Question 8

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 patient is totally dependent on an outside source of insulin.
B) there is decreased insulin secretion and cellular resistance to insulin that is produced.
C) the immune system destroys the pancreatic insulin-producing cells.
D) the insulin precursor that is secreted by the pancreas is not activated by the liver.

Question 9

A program of weight loss and exercise is recommended for a patient with impaired fasting glucose (IFG). When teaching the patient about the reason for these lifestyle changes, the nurse will tell the patient that

A) the high insulin levels associated with this syndrome damage the lining of blood vessels, leading to vascular disease.
B) although the fasting plasma glucose levels do not currently indicate diabetes, the glycosylated hemoglobin will be elevated.
C) the liver is producing excessive glucose, which will eventually exhaust the ability of the pancreas to produce insulin, and exercise will normalize glucose production.
D) the onset of diabetes and the associated cardiovascular risks can be delayed or prevented by weight loss and exercise.

Question 10

A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a swimming class every day at 1:00 PM. The clinic nurse teaches the patient to

A) delay eating the noon meal until after the swimming class.
B) increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the swimming class.
C) time the morning insulin injection so that the peak occurs while swimming.
D) check glucose level before, during, and after swimming.

Question 11

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.

Question 12

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about

A) use of low doses of regular insulin.
B) self-monitoring of blood glucose.
C) oral hypoglycemic medications.
D) maintenance of a healthy weight.

Question 13

A patient receives a daily injection of 70/30 NPH/regular insulin premix at 7:00 AM. The nurse expects that a hypoglycemic reaction is most likely to occur between

A) 8:00 and 10:00 AM.
B) 4:00 and 6:00 PM.
C) 7:00 and 9:00 PM.
D) 10:00 PM and 12:00 AM.

Question 14

A patient using a split mixed-dose insulin regimen asks the nurse about the use of intensive insulin therapy to achieve tighter glucose control. The nurse should teach the patient that

A) intensive insulin therapy requires three or more injections a day in addition to an injection of a basal long-acting insulin.
B) intensive insulin therapy is indicated only for newly diagnosed type 1 diabetics who have never experienced ketoacidosis.
C) studies have shown that intensive insulin therapy is most effective in preventing the macrovascular complications characteristic of type 2 diabetes.
D) an insulin pump provides the best glucose control and requires about the same amount of attention as intensive insulin therapy.

Question 15

Glyburide (Micronase, DiaBeta, Glynase) is prescribed for a patient whose type 2 diabetes has not been controlled with diet and exercise. When teaching the patient about glyburide, the nurse explains that

A) glyburide stimulates insulin production and release from the pancreas.
B) the patient should not take glyburide for 48 hours after receiving IV contrast media.
C) glyburide should be taken even when the blood glucose level is low in the morning.
D) glyburide decreases glucagon secretion.

Question 16

A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The patient tells the nurse, "I hate to exercise! Can't I just follow the diet to keep my glucose under control?" The nurse teaches the patient that the major purpose of exercise for diabetics is to

A) increase energy and sense of well-being, which will help with body image.
B) facilitate weight loss, which will decrease peripheral insulin resistance.
C) improve cardiovascular endurance, which is important for diabetics.
D) set a successful pattern, which will help in making other needed changes.

Question 17

A hospitalized diabetic patient receives 12 U of regular insulin mixed with 34 U of NPH insulin at 7:00 AM. The patient is away from the nursing unit for diagnostic testing at noon, when lunch trays are distributed. The most appropriate action by the nurse is to

A) save the lunch tray to be provided upon the patient's return to the unit.
B) call the diagnostic testing area and ask that a 5% dextrose IV be started.
C) ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic testing area.
D) request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.

Question 18

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may

A) require administration of insulin while taking prednisone.
B) develop acute hypoglycemia during the RA exacerbation.
C) have rashes caused by metformin-prednisone interactions.
D) need a diet higher in calories while receiving prednisone.

Question 19

A patient who has just been diagnosed with type 2 diabetes is 5 ft 4 in (160 cm) tall and weighs 182 pounds (82 kg). A nursing diagnosis of imbalanced nutrition: more than body requirements is developed. Which patient outcome is most important for this patient?

A) The patient will have a diet and exercise plan that results in weight loss.
B) The patient will state the reasons for eliminating simple sugars in the diet.
C) The patient will have a glycosylated hemoglobin level of less than 7%.
D) The patient will choose a diet that distributes calories throughout the day.

Question 20

The nurse has been teaching the patient to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the patient that indicates a need for additional instruction is,

A) "I need to rotate injection sites among my arms, legs, and abdomen each day."
B) "I will buy the 0.5-ml syringes because the line markings will be easier to see."
C) "I should draw up the regular insulin first after injecting air into the NPH bottle."
D) "I do not need to aspirate the plunger to check for blood before I inject the insulin."

Question 21

After the home health nurse has taught a patient and family about how to use glargine and regular insulin safely, which action by the patient indicates that the teaching has been successful?

A) The patient disposes of the open insulin vials after 4 weeks.
B) The patient draws up the regular insulin in the syringe and then draws up the glargine.
C) The patient stores extra vials of both types of insulin in the freezer until needed.
D) The patient's family prefills the syringes weekly and stores them in the refrigerator.

Question 22

A patient recovering from DKA asks the nurse how acidosis occurs. The best response by the nurse is that

A) insufficient insulin leads to cellular starvation, and as cells rupture they release organic acids into the blood.
B) when an insulin deficit causes hyperglycemia, then proteins are deaminated by the liver, causing acidic by-products.
C) excess glucose in the blood is metabolized by the liver into acetone, which is acidic.
D) an insulin deficit promotes metabolism of fat stores, which produces large amounts of acidic ketones.

Question 23

A 63-year-old patient is newly diagnosed with type 2 diabetes. When developing an education plan, the nurse's first action should be to

A) assess the patient's perception of what it means to have type 2 diabetes.
B) demonstrate how to check glucose using capillary blood glucose monitoring.
C) ask the patient's family to participate in the diabetes education program.
D) discuss the need for the patient to actively participate in diabetes management.

Question 24

A patient with type 2 diabetes is scheduled for an outpatient coronary arteriogram. Which information obtained by the nurse when admitting the patient indicates a need for a change in the patient's regimen?

A) The patient's most recent hemoglobin A1C was 6%.
B) The patient takes metformin (Glucophage) every morning.
C) The patient uses captopril (Capoten) for hypertension.
D) The patient's admission blood glucose is 128 mg/dl.

Question 25

A newly diagnosed type 1 diabetic patient likes to run 3 miles several mornings a week. Which teaching will the nurse implement about exercise for this patient?

A) "You should not take the morning NPH insulin before you run."
B) "Plan to eat breakfast about an hour before your run."
C) "Afternoon running is less likely to cause hypoglycemia."
D) "You may want to run a little farther if your glucose is very high."

Question 26

A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin develops a sore throat, cough, and fever. When the patient calls the clinic to report the symptoms and a blood glucose level of 210 mg/dl, the nurse advises the patient to

A) use only the lispro insulin until the symptoms of infection are resolved.
B) monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
C) decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
D) limit intake to non-calorie-containing liquids until the glucose is within the usual range.

Question 27

A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral vascular disease evidenced by decreased peripheral pulses and dependent rubor. The nurse teaches the patient that

A) the feet should be soaked in warm water on a daily basis.
B) flat-soled leather shoes are the best choice to protect the feet from injury.
C) heating pads should always be set at a very low temperature.
D) over-the-counter (OTC) callus remover may be used to remove callus and prevent pressure.

Question 28

While hospitalized and recovering from an episode of diabetic ketoacidosis, the patient calls the nurse and reports feeling anxious, nervous, and sweaty. Based on the patient's report, the nurse should

A) obtain a glucose reading using a finger stick.
B) administer 1 mg glucagon subcutaneously.
C) have the patient eat a candy bar.
D) have the patient drink 4 ounces of orange juice.

Question 29

A diabetic patient has a new order for inhaled insulin (Exubera). Which information about the patient indicates that the nurse should contact the patient before administering the Exubera?

A) The patient has a history of a recent myocardial infarction.
B) The patient's blood glucose is 224 mg/dl.
C) The patient uses a bronchodilator to treat emphysema.
D) The patient's temperature is 101.4° F.

Question 30

The nurse teaches the diabetic patient who rides a bicycle to work every day to administer morning insulin into the

A) thigh.
B) buttock.
C) arm.
D) abdomen.

Question 31

Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness?

A) Give the patient a snack of cheese and crackers.
B) Have the patient drink a glass of orange juice or nonfat milk.
C) Administer a continuous infusion of 5% dextrose for 24 hours.
D) Assess the patient for symptoms of hyperglycemia.

Question 32

The health care provider orders oral glucose tolerance testing for a patient seen in the clinic. Which information from the patient's health history is most important for the nurse to communicate to the health care provider?

A) The patient had a viral illness 2 months ago.
B) The patient uses oral contraceptives.
C) The patient runs several days a week.
D) The patient has a family history of diabetes.

Question 33

A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse will anticipate the need to

A) administer glargine (Lantus) insulin.
B) initiate oxygen by nasal cannula.
C) insert a large-bore IV catheter.
D) give 50% dextrose as a bolus.

Question 34

Amitriptyline (Elavil) is prescribed for a diabetic patient with peripheral neuropathy who has burning foot pain occurring mostly at night. Which information should the nurse include when teaching the patient about the new medication?

A) Amitriptyline will help prevent the transmission of pain impulses to the brain.
B) Amitriptyline will improve sleep and make you less aware of nighttime pain.
C) Amitriptyline will decrease the depression caused by the pain.
D) Amitriptyline will

Question 35

A type 1 diabetic patient who was admitted with severe hypoglycemia and treated tells the nurse, "I did not have any of the usual symptoms of hypoglycemia." Which question by the nurse will help identify a possible reason for the patient's hypoglycemic unawareness?

A) "Do you use any calcium-channel blocking drugs for blood pressure?"
B) "Have you observed any recent skin changes?"
C) "Do you notice any bloating feeling after eating?"
D) "Have you noticed any painful new ulcerations or sores on your feet?"

Question 36

A diabetic patient is admitted with ketoacidosis and the health care provider writes all of the following orders. Which order should the nurse implement first?

A) Start an infusion of regular insulin at 50 U/hr.
B) Give sodium bicarbonate 50 mEq IV push.
C) Infuse 1 liter of normal saline per hour.
D) Administer regular IV insulin 30 U.

Question 37

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis (DKA). The nurse recognizes that this measure is important to identify

A) electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia.
B) fluid overload resulting from aggressive fluid replacement.
C) the presence of hypovolemic shock related to osmotic diuresis.
D) cardiovascular collapse resulting from the effects of hyperglycemia.

Question 38

Which of these laboratory values noted by the nurse when reviewing the chart of a diabetic patient indicates the need for further assessment of the patient?

A) Fasting blood glucose of 130 mg/dl
B) Noon blood glucose of 52 mg/dl
C) Glycosylated hemoglobin of 6.9%
D) Hemoglobin A1C of 5.8%