Deck 47: Caring for the Patient With Diabetes

Question 1

The nurse is preparing patients newly diagnosed with diabetes mellitus (DM) for discharge from an acute care facility. What should the nurse include in patient teaching regarding medications to treat DM?

A) Patients with type 1 diabetes may achieve normal blood glucose levels with oral medications.
B) Type 1 diabetes may progress to type 2 if blood glucose levels are not well controlled.
C) Patients with type 1 diabetes will always need an exogenous source of insulin.
D) Patients with type 2 diabetes generally need a combination of oral medications and insulin to achieve normal blood glucose levels.

Answer 1

Patients with type 1 diabetes will always need an exogenous source of insulin.

Question 2

A patient recently diagnosed with diabetes states, "A friend whose mother was diabetic told me that it is more economical to use urine dipsticks than to monitor blood levels with a glucometer." Which response by the nurse is most appropriate?

A) "Urinary glucose is no longer used to routinely monitor glucose control."
B) "You will be monitoring your urine glucose as well as your blood glucose."
C) "Yes, urine dipsticks are cheaper than glucose test strips."
D) "Would you like to switch to this method of monitoring?"

Answer 2

"Urinary glucose is no longer used to routinely monitor glucose control."

Question 3

The nurse is caring for a patient who has a diagnosis of diabetes mellitus type 1. Which finding would best indicate that the patient is at risk for developing diabetic ketoacidosis?

A) Reports of anxiety
B) Tremors
C) Nausea and vomiting
D) Extreme hunger

Answer 3

Nausea and vomiting

Question 4

The nurse is caring for a healthy patient who has a serum glucose level of 60 mg/dL. The nurse anticipates that which counterregulatory serum hormonal changes are likely to occur in this patient?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Increased epinephrine levels
B) Increased growth hormone levels
C) Increased insulin levels
D) Decreased glucagon levels
E) Decreased cortisol levels

Question 5

A patient who has diabetes mellitus says to the nurse, "I've had difficulty swallowing and have felt nauseous for months. I have been taking milk of magnesia every day for constipation, too." The nurse should recognize these statements as likely being indicative of which condition?

A) The aging process
B) Autonomic neuropathy
C) Retinopathy
D) Nephropathy

Question 6

The nurse is caring for a patient with no history of diabetes who has a new laboratory finding of a glycosylated hemoglobin (A1C) level of

A) Deficient Knowledge regarding disease process
B) Risk for Deficient Fluid Volume
C) Risk for Impaired Skin Integrity
D) Ineffective Tissue Perfusion
E)0%. Which nursing diagnoses should receive priority for this patient?

Question 7

A nurse manager is observing a staff nurse providing teaching to a 5-year-old patient who has a diagnosis of type 1 diabetes mellitus. The manager evaluates that instruction is appropriate when the nurse makes which analogy to explain the action of insulin?

A) "Insulin is like a building block that helps make protein into strong muscles."
B) "Insulin is like a wagon that carries sugar into the cells of the body."
C) "Insulin is like a mud pie that makes the blood vessels thick and sticky."
D) "Insulin is like salty potato chips that make people feel very thirsty."

Question 8

The nurse is evaluating the effectiveness of teaching in a patient with a diagnosis of diabetes mellitus type 2 who is learning to self-monitor blood glucose. The nurse knows teaching has been effective when the patient identifies which factors that may adversely affect glucose meter performance?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The age of the monitor strip
B) Failure to follow manufacturer's recommendations regarding cleaning of meter
C) The lot number of the strips
D) Use of soap and water to cleanse the finger before puncture
E) Insufficient amount of blood on the meter strip

Question 9

The nurse is identifying patient demographic groups that are at increased risk for needing insulin to control blood sugar. Which patient groups would the nurse identify?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Patients who are fasting or malnourished
B) Patients with type 2 diabetes who are diagnosed with an infection
C) Patients with type 2 diabetes who are undergoing surgical procedures
D) Patients with gestational diabetes
E) Patients receiving total parenteral nutrition

Question 10

Genetic testing indicates that a child has DR3 and DR4 antigens on chromosome 6 of the human leukocyte antigen system. Which statement by the parents would indicate the nurse should reinforce teaching about these test results?

A) "Our son has a genetic immunity disorder."
B) "These results mean our son has diabetes."
C) "These markers are present in 95% of people with type 1 diabetes."
D) "These results are associated with increased susceptibility to diabetes."

Question 11

A patient who has a diagnosis of diabetes mellitus says, "I am worried because my feet are swollen. You don't think my diabetes is getting worse, do you?" The nurse identifies that the patient is hypertensive and has albuminuria. These findings would help substantiate which priority nursing diagnosis?

A) Excess Fluid Volume related to compromised regulatory mechanisms
B) Anxiety related to illness
C) Risk for Infection related to chronic disease process
D) Ineffective Denial related to minimization of symptoms

Question 12

A newly admitted patient has a fasting serum blood glucose level of 125 mg/dL. How should the nurse interpret this value?

A) This is a critical value that should be reported immediately.
B) The patient has type 1 diabetes.
C) The patient has normal glucose metabolism.
D) The patient may be prediabetic.

Question 13

Which teaching, included in the plan of care for a patient who has type 1 diabetes mellitus, would be most effective in reducing the development of complications?

A) Self-monitoring of blood glucose levels
B) Effective foot care
C) Importance of early eye exam
D) Avoidance of simple carbohydrates in the diet

Question 14

Which of these statements by a patient who has a new diagnosis of diabetes mellitus requires immediate nursing intervention?

A) "I am allergic to eggs."
B) "I will take my lispro insulin 15 minutes before I eat breakfast."
C) "I will adjust the amounts of my premixed insulin according to my food intake."
D) "I will not use detemir insulin in my insulin pump."

Question 15

The nurse is assessing a patient who has a family history of type 2 diabetes. Which finding would require follow-up by the nurse?

A) The patient reports having a new prescription for a thiazide diuretic for blood pressure control.
B) Measurements indicate the patient has decreased the waist-to-hip ratio through dietary changes.
C) The patient delivered a baby that weighed 8 pounds and 12 ounces.
D) The patient's fasting blood glucose level is 95 mg/dL.

Question 16

A patient has been recently diagnosed with type 1 diabetes mellitus. The patient states, "I am thin and eat all the time. How can I have diabetes?" Which response by the nurse is most appropriate?

A) "Thin people can be diabetic, too."
B) "Your condition makes it impossible for you to gain weight."
C) "People with type 1 diabetes are usually thin or of normal weight at diagnosis."
D) "Your lab tests indicate the presence of diabetes."

Question 17

The nurse is caring for a patient with a diagnosis of diabetes. The nurse notes the patient's toenails are thick and ingrown. Which instruction should the nurse provide?

A) Soak feet in Epsom salts daily.
B) Use a clean, sharp razor blade to trim the toenails.
C) Make an appointment with a foot care specialist.
D) Trim nails to follow the curve of the toe.

Question 18

A patient diagnosed with type 2 diabetes is prescribed the second-generation sulfonylurea glipizide. What medication information should the nurse provide?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "It is best to take this medication at bedtime."
B) "Give us a call if you begin to gain weight."
C) "If you drink alcohol while taking this medication, you will probably feel very sick."
D) "Because you are taking this medication, dietary control of your disease is not as important."
E) "Be watchful for any swelling in your ankles."

Question 19

The nurse recognizes that which factor in a patient's history increases the risk for type 2 diabetes mellitus (DM)?

A) Body mass index of 23
B) Blood pressure of 130/80
C) Physical inactivity
D) Low waist-to-hip ratio

Question 20

A diabetic patient complains of frequent corns and asks for information about managing the condition. What is the nurse's best response?

A) "Make sure you select shoes that fit correctly."
B) "You can use corn pads to gradually remove the growths."
C) "Corns are best treated by shaving them off."
D) "Apply a generous amount of emollient lotion on and between the toes twice daily."

Question 21

The nurse is planning a presentation to a community group on diabetes mellitus. The nurse should include information about which possible etiology for type 1 diabetes?

A) Inflammatory disorder
B) Infectious disorder
C) Autoimmune disorder
D) Drug-induced disorder

Question 22

The nurse is teaching a patient with newly diagnosed type 1 diabetes about the required diet for managing the disorder. Which information should the nurse include?

A) "Do not consume alcoholic beverages."
B) "Restrict the carbohydrates in your diet."
C) "Eat whenever you feel hungry."
D) "Select carbohydrates such as whole grains or legumes."

Question 23

A patient has been prescribed metformin for treatment of type 2 diabetes. Which teaching would the nurse provide?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "You are likely to have one or two episodes of hypoglycemia while your body adjusts to this medication."
B) "If you need any diagnostic testing that requires radiocontrast dye, be certain to report that you are taking metformin."
C) "You may have mild stomach upset at first when taking this medication."
D) "Take this medication just before you begin to eat."
E) "You may develop a persistent cough while taking metformin."

Question 24

Which nursing diagnosis is of the highest priority for the patient presenting with hyperosmolar hyperglycemic syndrome (HHS)?

A) Altered Nutrition: More than Body Requirement
B) Deficient Fluid Volume
C) Noncompliance related to self-management
D) Knowledge Deficit related to diabetic diet

Question 25

An obese patient diagnosed with type 2 diabetes would like to achieve a healthy weight. The patient says, "My girlfriend lost a lot of weight on a high-protein diet." Which nursing responses are indicated?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "You might try the diet for a few weeks and see how your weight and blood glucose respond."
B) "You should keep your protein intake to about 15% to 20% of your diet."
C) "You would probably be more successful if you restricted your carbohydrate intake to less than 130 grams a day."
D) "If you make healthy food choices and increase your exercise, you should experience weight loss."
E) "You should avoid starchy foods, all sweets, and follow the American Diabetes Association exchange program."

Question 26

The nurse is addressing a group of patients with prediabetes. What should the nurse include in a teaching plan for this group?

A) The person with prediabetes needs insulin to maintain normal blood glucose levels.
B) Patients with prediabetes are at increased risk for macular degeneration.
C) Individuals with prediabetes should limit fluid intake.
D) The person with prediabetes has an increased risk of heart disease.

Question 27

The nurse is providing instruction to a group of patients who are planning to participate in an athletic triathlon. Each member of the group has been diagnosed with either diabetes mellitus type 1 or type 2. A member of the group asks, "If we each follow our usual daily diabetic control routine, which diabetic complication is most likely to occur during this event?" What is the nurse's best answer?

A) Diabetic ketoacidosis
B) Hypoglycemia
C) Hyperosmolar hyperglycemic state
D) Impaired glucose tolerance

Question 28

The nurse is providing dietary instruction to a patient diagnosed with type 2 diabetes. The nurse includes information on how to reduce dietary intake of cholesterol to no more than _______ mg per day.

Question 29

At a community health screening for blood glucose testing, the nurse would expect which person to have the highest risk for having type 2 diabetes?

A) A 30-year-old Caucasian patient who recently had a baby
B) A patient who lives in a nearby rural farming town
C) A patient following a high-protein diet
D) A 40-year-old with weight centered in the abdomen

Question 30

Which information should the nurse include when teaching a patient about fasting blood glucose level testing?

A) "Your test is scheduled for 6:00 a.m., so do not eat or drink anything after midnight."
B) "After the sample is drawn you will be asked to drink a sweet liquid."
C) "This test will indicate your average blood sugar over the last 2 months."
D) "The fasting glucose must be 100 or under to be normal."

Question 31

The nurse is assessing a patient who has a diagnosis of diabetes mellitus. Which questions would be most important to help determine the patient's risk for amputation of a lower extremity?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "Do you use insulin or oral hypoglycemic agents?"
B) "What were your glycosylated hemoglobin values over the past year?"
C) "Do you have any problems with your eyes related to diabetes?"
D) "Do you have any problems with your kidneys related to diabetes?"
E) "When were you first diagnosed with diabetes mellitus?"

Question 32

A patient has been admitted for treatment of diabetic ketoacidosis (DKA). The nurse should include which intervention in the patient's plan of care?

A) Place the patient on strict bed rest.
B) Monitor intravenous fluid administration.
C) Review the diabetic diet with the patient.
D) Administer oral hypoglycemics on schedule.