Deck 52: Nursing Management: Diabetes Mellitus

Question 1

What should the nurse emphasize when teaching a patient with type 1 diabetes about the Somogyi effect and dawn phenomenon?

A) The Somogyi effect occurs early at night,and the dawn phenomenon occurs on arising.
B) The Somogyi effect is characterized by hyperglycemia and the dawn phenomenon by hypoglycemia.
C) The Somogyi effect occurs when the patient is asleep,and the dawn phenomenon occurs after the patient awakens.
D) In the Somogyi effect,hyperglycemia results from too much insulin,and the dawn phenomenon results from too little insulin.

Answer 1

In the Somogyi effect,hyperglycemia results from too much insulin,and the dawn phenomenon results from too little insulin.

Question 2

A patient receives a daily injection of 70/30 NPH/regular insulin premix at 0700 hours.The nurse expects that a hypoglycemic reaction is most likely to occur between which of the following times?

A) 0800 and 1000 hours
B) 1600 and 1800 hours
C) 1900 and 2100 hours
D) 2200 and 2400 hours

Answer 2

1600 and 1800 hours

Question 3

During a clinic visit 3 months following a diagnosis of type 2 diabetes,the patient reports that she has been following her reduced-calorie diet,but she has not lost any weight,and she has neglected to bring her record of glucose monitoring results.What does the nurse recognize as the best indicator of the patient's control of her diabetes since her initial diagnosis and instruction?

A) A fasting glucose level
B) Analysis for microalbuminuria
C) A glycosylated hemoglobin (HbA_1C)level
D) The patient's verbal report of her symptoms

Answer 3

A glycosylated hemoglobin (HbA_1C)level

Question 4

A 20-year-old university student who has type 1 diabetes normally walks each evening as part of her exercise regimen.She now plans to enroll in a swimming class to meet her physical education requirement.What should the nurse teach the patient that adjustments to her treatment plan should include?

A) Delaying the normal meal before the swimming class until the session is over
B) Adding 10 units of regular insulin to her usual morning dose on the days she plans to swim
C) Timing her morning insulin injection so that the peak action will occur during her swimming class
D) Monitoring her glucose level before,during,and after swimming to determine the need for alterations in food or insulin

Question 5

When teaching a patient with type 2 diabetes about taking an oral antihyperglycemic medication,the nurse determines that additional teaching about the medication is needed when the patient gives which of the following responses?

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

Question 6

During a diabetes screening program,a young woman tells the nurse that her mother died of complications of diabetes and asks whether she will inherit the disease.After determining that the woman's mother most likely had type 2 diabetes,what should the nurse explain?

A) Her 60% chance of developing type 2 diabetes can be prevented by maintaining a normal weight and a low-carbohydrate diet.
B) The patient has a higher familial risk for developing type 2 diabetes than for type 1 diabetes,and she should have her glucose level tested periodically.
C) She would have a higher risk for developing diabetes if her father,rather than her mother,had diabetes,but she should still be tested periodically.
D) Although there is a familial tendency for children or siblings of individuals with type 2 diabetes to develop diabetes,the inherited risk is not as high as it is for type 1 diabetes.

Question 7

A patient with newly diagnosed type 2 diabetes asks the nurse what "type 2" means in relation to diabetes.Which of the following statements best explains to the patient how type 2 diabetes primarily differs from type 1 diabetes?

A) "With type 2 diabetes,the patient is totally dependent on an outside source of insulin."
B) "With type 2 diabetes,decreased insulin secretion,cellular resistance to insulin,or both are produced."
C) "With type 2 diabetes,islet cell antibodies and insulin autoantibodies destroy beta cells in the pancreas."
D) "With type 2 diabetes,the C-peptide chain of proinsulin secreted by the pancreas cannot be removed by the liver,resulting in a lack of active insulin."

Question 8

A patient screened for diabetes at a clinic has a fasting plasma glucose of 6.7 mmol/L (120 mg/dL).What will the nurse 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 9

A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes.The patient tells the nurse that she hates to exercise and asks whether just following her diet would control her diabetes.What primary reason should the nurse stress to the patient for planning a pleasant,regular exercise routine?

A) It will give her increased energy and a sense of well-being.
B) It will facilitate weight loss,which will decrease peripheral insulin resistance.
C) It will improve cardiovascular and respiratory fitness,which is important for all individuals.
D) It will set a pattern for the other routines of dietary changes and meal scheduling necessary for diabetes control.

Question 10

A patient is diagnosed with type 2 diabetes at the clinic.A nursing assessment of the patient reveals vital signs of blood pressure 158/96 mm Hg,heart rate 88 beats/min,respiration 18 breaths/min,temperature 37.1°C,height 160 cm,and weight 82 kg.The physician prescribes a 1200-calorie diet with a daily exercise program as initial therapy for the patient.The nurse refers the patient to the dietitian for initial diet planning and teaching with the knowledge that which of the following is the primary goal of nutritional therapy for the patient?

A) Control of dietary intake to achieve ideal body weight
B) Elimination of simple sugars in exchange for complex carbohydrate in the diet
C) Reduction in dietary calories and fat to normalize glucose,lipid,and blood pressure levels
D) Maintenance of equal distribution of carbohydrate throughout the day with strict adherence to consistency in daily intake

Question 11

When intensive insulin therapy is used for control of diabetes,the nurse recognizes that which of the following types of insulin is preferred for mealtime coverage?

A) NPH insulin
B) Lispro insulin
C) Lente insulin
D) Insulin glargine

Question 12

When assessing the patient experiencing the onset 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-coloured?"

Question 13

A patient with type 1 diabetes has been using self-capillary blood glucose monitoring (CBGM)as part of his diabetes management.During evaluation of his technique of CBGM,the nurse identifies a need for additional teaching when the patient does which of the following actions?

A) Chooses a puncture site in the centre of the finger pad
B) Washes his hands with soap and water to cleanse the puncture site
C) Tells the nurse that the result of 130 mg indicates good control of his diabetes
D) Hangs his arm down before a second puncture site attempt for an adequate drop of blood

Question 14

A hospitalized patient with diabetes receives 12 units of regular insulin mixed with 34 units of NPH insulin at 0700 hours.The patient is away from the nursing unit for diagnostic testing at noon,when lunch trays are distributed.What is the most appropriate nursing action?

A) Save the lunch tray to be provided on the patient's return to the unit.
B) Call the diagnostic testing area,and ask the physician to start an intravenous (IV)line of 5% dextrose solution.
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 15

A program of weight loss and exercise is recommended for a patient with insulin resistance syndrome.When the patient asks why these measures are necessary when she really does not have diabetes,what should the nurse explain?

A) The high insulin levels associated with this syndrome damage the lining of blood vessels and cause osmotic diuresis.
B) Although her fasting plasma glucose levels do not indicate diabetes,she has impaired glucose tolerance,which is characteristic of the syndrome.
C) The liver is inappropriately producing glucose,which will eventually exhaust the ability of the pancreas to produce insulin,and exercise will normalize glucose production.
D) She has a variety of abnormalities associated with diabetes,which indicate a very high risk for cardiovascular disease,and the onset of diabetes can be delayed or prevented by weight loss and exercise.

Question 16

The nurse has been teaching the patient to administer a dose of 10 units regular insulin and 28 units Lente insulin.Which of the following statements by the patient indicates a need for additional instruction?

A) "I should rotate injection sites among my arms,legs,and abdomen each day."
B) "I may reuse my insulin syringes for more injections if I recap them after use."
C) "I should draw up the regular insulin first after injecting air into the Lente bottle."
D) "I do not have to pull back on the plunger to check for blood before I inject the insulin."

Question 17

Glyburide (Diabeta)is prescribed for a patient when her type 2 diabetes has not been controlled with diet and exercise.When teaching the patient about glyburide,what should the nurse explain?

A) Glyburide is thought to stimulate insulin production and release from the pancreas.
B) Glyburide is a substitute for insulin and acts by directly stimulating glucose uptake into the cell.
C) Glyburide,like all oral antidiabetes agents,does not cause the hypoglycemic reactions that may occur with insulin use.
D) Glyburide and other sulphonylureas lower blood sugar by decreasing the rate of hepatic glucose production,preventing gluconeogenesis.

Question 18

A patient with type 1 diabetes has received diet instruction as part of his treatment plan.The nurse determines a need for additional instruction when the patient makes which one of the following comments?

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 may eat whatever I want as long as I cover the calories with sufficient insulin."
D) "I should eat meals as scheduled,even if I am not hungry,to prevent hypoglycemia."

Question 19

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

A) Administration of insulin while taking prednisone
B) Development of acute hypoglycemia during the rheumatoid arthritis exacerbation
C) Evidence of rashes caused by metformin-prednisone interactions
D) Requirement of a diet higher in calories while receiving prednisone

Question 20

A patient using a split mixed-dose insulin regimen tells the nurse that he is interested in using intensive insulin therapy because he has read that it promotes fewer and less severe complications of diabetes.In response to the patient's comment,what should the nurse explain?

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 patients who have recently received a diagnosis of type 1 diabetes and 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) The use of an insulin pump does not require as much attention as intensive insulin therapy and offers the same protection against long-term complications.

Question 21

Which of the following is true of type 2 diabetes?

A) Diet modifications and insulin are required for glucose control.
B) Uniform timing of meals is crucial.
C) Reduction in caloric intake is desirable to control weight.
D) Intermeal and bedtime snacks are frequently necessary.

Question 22

Which of the following is a characteristic of type 1 diabetes?

A) Incidence in young people is increasing
B) Insidious onset
C) Absent islet-cell antibodies
D) Patient prone to ketosis at onset

Question 23

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 HbA_1C result was 6%.
B) The patient takes metformin every morning.
C) The patient uses captopril (Capoten)for hypertension.
D) The patient's admission blood glucose is 7.1 mmol/L (128 mg/dL).

Question 24

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.What will the nurse teach the patient?

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 callus remover may be used to remove calluses and prevent pressure.

Question 25

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 26

A patient with type 1 diabetes is found unresponsive in the morning by his wife and is admitted to the emergency department.On admission,the patient is unresponsive to stimuli and has fruity,sweet breath with Kussmaul's respirations.Laboratory results include arterial blood gases of pH 7.32,PCO₂ 34 mm Hg,and HCO₃^- 11 mmol/L,and a plasma glucose of 28.8 mmol/L (518 mg/dL).Which of the following interventions does the nurse anticipate will be prescribed initially for the patient?

A) IV fluid and electrolyte replacement therapy
B) Administration of an IV bolus of regular insulin
C) Low-dose insulin infusion in a normal saline solution
D) IV administration of sodium bicarbonate to replace bicarbonate and reverse the acidosis

Question 27

The nurse is preparing a mixed insulin dose for administration.After injecting air into both vials,what would be the immediate next step?

A) Gently rotate the NPH insulin bottle.
B) Invert and draw up regular insulin.
C) Swab the tops of both vials with alcohol sponge or swab.
D) Invert and draw up NPH insulin.

Question 28

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

A) Fasting blood glucose of 6.5 mmol/L
B) Noon blood glucose of 2.6 mmol/L
C) HbA_1C of 6.9%
D) HbA_1C of 5.8%

Question 29

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis.The nurse recognizes that this measure is important to identify which of the following complications?

A) Electrocardiogram (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 excess glucose on cardiac muscle

Question 30

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,what should the nurse do?

A) Obtain a glucose reading using a finger stick.
B) Administer 1 mg glucagon subcutaneously.
C) Have the patient eat a chocolate bar.
D) Have the patient drink 113 g of orange juice.

Question 31

Amitriptyline (Elavil)is prescribed for a patient with diabetes 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 correct some of the blood vessel changes that cause pain.

Question 32

A patient recovering from diabetic ketoacidosis asks the nurse how acidosis occurs.What is the best response?

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

Question 33

A patient newly diagnosed with type 1 diabetes likes to run 5 km 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 34

Which of the following is an example of a short-acting insulin?

A) Lispro (Humalog)
B) Glulisine (Apidra)
C) Regular (Novolin)
D) Detemir (Levemir)

Question 35

A patient with diabetes is admitted with ketoacidosis,and the physician writes all of the following orders.Which order should the nurse implement first?

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

Question 36

A patient with type 1 diabetes develops a sore throat,cough,and fever.He calls the clinic when he finds his blood glucose level to be 11.67 mmol/L (210 mg/dL)with his monitor.What should the nurse advise the patient to do?

A) Hold all food and insulin until his fever is relieved.
B) Measure his urinary output,and test his urine for ketones.
C) Reduce his carbohydrate intake until his glucose level is about 8.33 mmol/L (150 mg/dL).
D) Monitor his blood glucose every 4 hours,and notify the clinic if it continues to rise.

Question 37

A patient with diabetes was admitted to the emergency department when he was found unresponsive at his desk at work.A capillary blood glucose level was 2.2 mmol/L (38 mg/dL),and he was treated for hypoglycemia.When he recovers,he tells the nurse that he had no warning of the hypoglycemia.Which of the following questions 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 38

Which of the following is a common side effect of metformin?

A) Nausea and diarrhea
B) Edema and weight gain
C) Upper respiratory tract infections
D) Hypoglycemia