1. Marlisa has been diagnosed
The principal goals of therapy for
with diabetes mellitus type 1. She
asks Nurse Errol what this means.
What is the best response by the
nurse? Select all that apply.
A. Your alpha cells should be able to
secrete insulin, but cannot.
B. The exocrine function of
your pancreas is to secrete insulin.
C. Without insulin, you will develop
ketoacidosis (DKA).
D. The endocrine function of
your pancreas is to secrete insulin.
E. It means your pancreas cannot
secrete insulin.
2. Dr. Shrunk orders intravenous (IV)
insulin for Rita, a client with a blood
sugar of 563. Nurse AJ administers
insulin lispro (Humalog)
intravenously (IV). What does the
best evaluation of the nurse reveal?
Select all that apply.
A. The nurse could have given the insulin
subcutaneously.
B. The nurse should have contacted the
physician.
C. The nurse should have used regular
insulin (Humulin R).
D. The nurse used the correct insulin.
3. Ben injects his insulin as
prescribed, but then gets busy and
forgets to eat. What will the best
assessment of the nurse reveal?
A. The client will be very thirsty.
B. The client will complain of nausea.
C. The client will need to urinate.
D. The client will have moist skin.
4. A clinical instructor teaches a class
for the public
about diabetes mellitus. Which
individual does the nurse assess as
being at highest risk for
developing diabetes?
A. The 50-year-old client who does not
get any physical exercise
B. The 56-year-old client who drinks
three glasses of wine each evening
C. The 42-year-old client who is 50
pounds overweight
D. The 38-year-old client who smokes
one pack of cigarettes per day
5. Steven John has type 1 diabetes
mellitus and receives insulin. Which
laboratory test will the nurse assess?
A. Potassium
B. AST (aspartate aminotransferase)
C. Serum amylase
D. Sodium
6. Jansen receives metformin
(Glucophage). What will the best
plan of the nurse include with regard
to patient education with this drug?
Select all that apply.
A. It stimulates the pancreas to produce
more insulin.
B. It must be taken with meals.
C. It decreases sugar production in
the liver.
D. It inhibits absorption of carbohydrates.
E. It reduces insulin resistance.
7. Serafica who has diabetes
mellitus type 1 is found unresponsive
in the clinical setting. Which nursing
action is a priority? arrange from 1 to
4.
1. Treat the client for hypoglycemia.
2. Call the physician STAT.
3. Assess the vital signs.
4. Call a code.
A. 1, 2, 3, 4
B. 1, 3, 2, 4
C. 3, 1, 2, 4
D. 4, 3, 2, 1
8. Serge who has diabetes mellitus is
taking oral agents, and is scheduled
for a diagnostic test that requires
him to be NPO. What is the best plan
of the nurse with regard to giving the
client his oral medications?
A. Administer the oral agents immediately
after the test.
B. Notify the the diagnostic department
and request orders.
C. Notify the physician and request
orders.
D. Administer the oral agents with a sip
of water before the test.
9. A client diagnosed with type
1 diabetes receives insulin. He asks
the nurse why he cant just take pills
instead. What is the best response by
the nurse?
A. Insulin must be injected because it
needs to work quickly.
B. Insulin cant be in a pill because it is
destroyed in stomach acid.
C. Have you talked to your doctor about
taking pills instead?
D. I know it is tough, but you will get
used to the shots soon.
10. Nurse Andy has finished teaching
a client with diabetes mellitus how to
administer insulin. He evaluates the
learning has occurred when the client
makes which statement?
A. I should check my blood sugar
immediately prior to the administration.
B. I should provide direct pressure over
the site following the injection.
C. I should use the abdominal area only
for insulin injections.
D. I should only use calibrated insulin
syringe for the injections.
11. Genevieve has diabetes type 1
and receives insulin for glycemic
control. She tells the nurse that she
likes to have a glass of wine with
dinner. What will the best plan of the
nurse for client education include?
A. The alcohol could cause pancreatic
disease.
B. The alcohol could cause
serious liver disease.
C. The alcohol could predispose you
to hypoglycemia.
D. The alcohol could predispose you
to hyperglycemia.
12. Dr. Wijangco orders insulin lispro
(Humalog) 10 units for Alicia, a client
with diabetes mellitus. When will the
nurse administer this medication?
A. When the client is eating
B. Thirty minutes before meals
C. fifteen minutes before meals
D. When the meal trays arrive on the
floor
13. Nurse Matt makes a home visit to
the client with diabetes mellitus.
During the visit, Nurse Matt notes the
clients additional insulin vials are
not refrigerated. What is the best
action by the nurse at this time?
A. Instruct the client to label each vial
with the date when opened.
B. Tell the client there is no need to keep
additional vials.
C. Have the client place the insulin vials
in the refrigerator.
D. Have the client discard the vials.
14. During the morning rounds,
Nurse AJ accompanied the physician
in every patients room. The
physician writes orders for the client
with diabetes mellitus. Which order
would the nurse validate with the
physician?
A. Use Humalog insulin for sliding scale
coverage.
B. Metformin (Glucophage) 1000 mg per
day in divided doses.
C. Administer regular insulin 30 minutes
prior to meals.
D. Lantus insulin 20U BID.
15. Gary has diabetes type 2. Nurse
Martha has taught him about the
illness and evaluates learning has
occurred when the client makes
which statement?
A. My cells have increased their
receptors, but there is enough insulin.
B. My peripheral cells have increased
sensitivity to insulin.
C. My beta cells cannot produce enough
insulin for my cells.
D. My cells cannot use the insulin
my pancreas makes.
16.
older patients who have poor
glycemic control are:
A. Enhancing quality of life.
B. Decreasing the chance of
complications.
C. Improving self-care through education.
D. All of the above.
17. Which of the following is accurate
pertaining to physical exercise and
type 1 diabetes mellitus?
A. Physical exercise can slow the
progression of diabetes mellitus.
B. Strenuous exercise is beneficial when
the blood glucose is high.
C. Patients who take insulin and engage
in strenuous physical exercise might
experience hyperglycemia.
D. Adjusting insulin regimen allows for
safe participation in all forms of exercise.
18. Harry is a diabetic patient who is
experiencing a reaction of alternating
periods of
nocturnal hypoglycemia and hypergly
cemia. The patient might be
manifesting which of the following?
A. Uncontrolled diabetes
B. Somogyi phenomenon
C. Brittle diabetes
D. Diabetes insipidus
19. Dr. Hugo has prescribed
sulfonylureas for Rebecca in the
management of diabetes
mellitus type 2. As a nurse, you know
that the primary purpose of
sulfonylureas, such as long-acting
glyburide (Micronase), is to:
A. Induce hypoglycemia by decreasing
insulin sensitivity.
B. Improve insulin sensitivity and
decrease hyperglycemia.
C. Stimulate the beta cells of the
pancreas to secrete insulin.
D. Decrease insulin sensitivity by
enhancing glucose uptake.
20. Rosemary has been taking
Glargine (Lantus) to treat her
condition. One of the benefits of
Glargine (Lantus) insulin is its ability
to:
A. Release insulin rapidly throughout the
day to help control basal glucose.
B. Release insulin evenly throughout the
day and control basal glucose levels.
C. Simplify the dosing and better control
blood glucose levels during the day.
D. Cause hypoglycemia with other
manifestation of other adverse reactions.
21. A 50-year-old widower is
admitted to the hospital with a
diagnosis of diabetes mellitus and
complaints of rapid-onset weight
loss, elevated blood glucose levels,
and polyphagia, the gerontology
nurse should anticipate which of the
following secondary medical
diagnoses?
A. Impaired glucose tolerance
B. Gestational diabetes mellitus
C. Pituitary tumor
D. Pancreatic tumor
22. An older woman with diabetes
mellitus visits the clinic concerning
her condition. Of which of the
following symptoms might an older
woman with diabetes
mellitus complain?
A. Anorexia
B. Pain intolerance
C. Weight loss
D. Perineal itching
23. Gregory is a 52-year-old man
identified as high-risk for diabetes
mellitus. Which laboratory test
should a nurse anticipate a physician
would order for him? (Select all that
apply.)
A. Fasting Plasma Glucose (FPG)
B. Two-hour Oral Glucose Tolerance Test
(OGTT)
C. Glycosylated hemoglobin (HbA1C)
D. Finger stick glucose three times daily
24. According to the
National Diabetes Statistics
Report, diabetes remains as one of
the leading causes of death in the
United States since 2010. Which of
the following factors are risks for the
development of diabetes mellitus?
(Select all that apply.)
A. Age over 45 years
B. Overweight with a waist/hip ratio >1
C. Having a consistent HDL level above
40 mg/dl
D. Maintaining a sedentary lifestyle
25. During a visit in the hospital, the
student nurses are asked which of
the following persons would most
likely be diagnosed with diabetes
mellitus. They are correct if they
answered a 44-year-old:
A. Caucasian woman.
B. Asian woman.
C. African-American woman.
D. Hispanic male.
26. An ailing 70-year-old woman with
a diagnosis of type 2 diabetes
mellitus has been ill with pneumonia.
The clients intake has been very
poor, and she is admitted to the
hospital for observation and
management as needed. What is the
most likely problem with this
patient?
A. Insulin resistance has developed.
B. Diabetic ketoacidosis is occurring.
C. Hypoglycemia unawareness is
developing.
D. Hyperglycemic hyperosmolar non-
ketotic coma.
27. Daniel is diagnosed of having
hyperthyroidism (Graves disease).
Which of the following is a drug of
choice for his condition?
A. Furosemide (Lasix)
B. Digoxin (Lanoxin)
C. Propranolol (Inderal)
D. Propylthiouracil (PTU)
28. Which of the following
medications are most likely to
cause hypothyroidism? (Select all
that apply.)
A. Acetylsalicylic acid (aspirin)
B. Furosemide (Lasix)
C. Docusate sodium (Colace)
D. Rifampin (Rifadin)
29. After visiting the physician,
Angela found out that she has a
thyroid problem. In line with her
condition, which of the following
diagnostic studies is done to
determine the size and composition
of the thyroid gland?
A. Thyroid scan with RAI 123I
B. Electrocardiography
C. Ultrasonography
D. Venous duplex Doppler study
30. Nurse Gil is caring for a patient
with a diagnosis of hypothyroidism.
Which nursing diagnosis should the
nurse most seriously consider when
analyzing the needs of the patient?
A. High risk for aspiration related to
severe vomiting
B. Diarrhea related to
increased peristalsis
C. Hypothermia related to slowed
metabolic rate
D. Oral mucous membrane, altered
related to disease process
Answers and Rationale
Here are the answers for this exam.
Gauge your performance by counter
checking your answers to those below. If
you have any disputes or clarifications,
please direct them to the comments
section.
1. Answer: C, D, E
One function of your pancreas is to
secrete insulin. The endocrine function of
the pancreas is to secrete insulin. The
endocrine, not the exocrine, function of
the pancreas is to secrete insulin. Insulin
is secreted by the beta, not the alpha,
cells of the pancreas. A consequence
of diabetes mellitus type 1 is that without
insulin, severe metabolic disturbances,
such as ketoacidosis (DKA) will result.
2. Answer: B, C
Regular insulin is the only insulin that can
be given intravenously (IV). The nurse
did not use correct insulin as it was not
regular insulin. Contact the provider to
clarify the order, regular insulin is the
only insulin that can be given
intravenously (IV). The nurse cannot give
the insulin subcutaneously when it is
ordered to be given intravenously (IV).
3. Answer: D. The client will have
moist skin.
Moist skin is the sign of hypoglycemia,
which the client would experience if he
injected himself with insulin and did not
eat. Thirst, nausea, and increased
urination are signs of hyperglycemia.
4. Answer: C. The 42-year-old client
who is 50 pounds overweight
Obesity increases the likelihood of
developing diabetes mellitus due to over
stimulation of the endocrine system.
Exercise is important, but lack of exercise
is not as big a risk factor as obesity.
Smoking is a serious health concern but
is not a specific risk factor for diabetes.
Consuming alcohol is associated
with liver disease but is not as high a risk
factor for diabetes as obesity.
5. Answer: A. Potassium
Insulin causes potassium to move into
the cell and may cause hypokalemia.
There is no need to monitor the sodium,
serum amylase, and AST levels.
6. Answer: B, C, E
Metformin (Glucophage) reduces insulin
resistance, decreases sugar production in
the liver, and should be taken with meals
for the best absorption and effect. It does
not stimulate the pancreas to produce
more insulin and does not inhibit the
absorption of carbohydrates.
7. Answer: A. 1, 2, 3, 4
When a patient with diabetes
mellitus type 1 is unresponsive, the nurse
should focus on and treat for
hypoglycemia, as this is more likely than
hyperglycemia. This is an emergency
situation where the nurse must act before
calling the physician. Vital signs should be
taken after the client is treated for
hypoglycemia. Assessment for ABCs
should precede calling a code; there is no
information that the client is not
breathing.
8. Answer: C. Notify the physician
and request orders.
It is best to notify the clients physician
and request orders. The client should not
receive the medication during NPO status
unless directed by the physician. The
medications should not be given upon
return unless the physician orders this;
the client may still need to be NPO. The
radiologist in the diagnostic department
might give orders, but it would be best to
check with the clients physician first.
9. Answer: B. Insulin cant be in a
pill because it is destroyed
in stomach acid.
Insulin must be injected because it is
destroyed in the stomach acid if taken
orally. Telling he will get used to shots
does not answer his question and is
condescending. Insulin must be injected
because it is destroyed in stomach acid if
taken orally; the onset of action is not the
issue here. The nurse should answer the
clients question, not refer him back to
the physician.
10. Answer: D. I should only use
calibrated insulin syringe for the
injections.
To ensure the correct insulin dose, a
calibrated insulin syringe must be used.
Insulin injections should be rotated to the
arm and thigh, not just the abdominal
area. There is no need to apply direct
pressure over the site following an insulin
injection. There is no need to check blood
glucose immediately prior to the
injection.
11. Answer: C. The alcohol could
predispose you to hypoglycemia.
Alcohol can potentiate hypoglycemic, not
hypoglycemic, effects in the client.
Alcohol can cause pancreatic disease, but
the clients pancreas is not producing any
insulin currently. Alcohol can
cause liver disease, but the more
immediate concern is hypoglycemia.
12. Answer: A. When the client is
eating
The onset action for the insulin lispro
(Humalog) is 10 to 15 minutes so it must
be given when the client is eating to
prevent hypoglycemia. It must be given
when the client is eating, not when the
meal trays arrive on the floor and not
thirty minutes before meals.
13. Answer: C. Have the client place
the insulin vials in the refrigerator.
Vials not in use should be refrigerated to
preserve drug potency. There is no need
to discard the vials. The client should
always have additional vials of insulin
available. Writing the date of opening on
the vial is good practice, but does not
address the need to refrigerate additional
vials.
14. Answer: D. Lantus insulin 20U
BID.
Lantus insulin is usually prescribed once-
a-day so an order for BID dosing should
be validated with the physician. Humalog
insulin can be prescribed for sliding scale
coverage. Regular insulin is administered
30 minutes before meals. Metformin
(Glucophage) is often prescribed in
divided doses of 1000 mg per day.
15. Answer: D. My cells cannot use
the insulin my pancreas makes.
With type 2 diabetes mellitus, the
pancreas produces insulin, but the cells
cannot use it. Peripheral cells have a
decreased, not an increased, sensitivity
to insulin. The beta cells continue to
produce insulin with type 2 diabetes.
There is a decrease, not an increase, in
receptor sites with type 2 diabetes.
16. Answer: D. All of the above.
The principal goals of therapy for older
persons with diabetes mellitus and poor
glycemic control are enhancing quality of
life, decreasing the chance of
complications, improving self-care
through education, and maintaining or
improving general health status.
17. Answer: A. Physical exercise can
slow the progression of diabetes
mellitus.
Physical exercise slows the progression
of diabetes mellitus because exercise has
beneficial effects on carbohydrate
metabolism and insulin sensitivity.
Strenuous exercise can cause retinal
damage and can cause hypoglycemia.
Insulin and foods both must be adjusted
to allow safe participation in exercise.
18. Answer: B. Somogyi phenomenon
Somogyi phenomenon manifests itself
with nocturnal hypoglycemia, followed by
a marked increase in glucose and
increase in ketones.
19. Answer: C. Stimulate the beta
cells of the pancreas to secrete
insulin.
Sulfonylureas such as glyburide are used
only with patients who have some
remaining pancreatic-beta cell function.
These drugs stimulate insulin secretion,
which reduces liver glucose output and
increases cell uptake of glucose,
enhancing the number of and sensitivity
of cell receptor sites for interaction with
insulin.
20. Answer: B. Release insulin evenly
throughout the day and control basal
glucose levels.
Glargine (Lantus) insulin is designed to
release insulin evenly throughout the day
and control basal glucose levels.
21. Answer: D. Pancreatic tumor
The onset of hyperglycemia in the older
adult can occur more slowly. When the
older adult reports rapid-onset weight
loss, elevated blood glucose levels, and
polyphagia, the healthcare provider
should consider pancreatic tumor.
22. Answer: D. Perineal itching
Older women might complain of perineal
itching due to vaginal candidiasis.
23. Answer: A, B
When an older person is identified as
high-risk for diabetes, appropriate testing
would include FPG and OGTT. An FPG
greater than 140 mg/dL usually
indicates diabetes. The OGTT is to
determine how the body responds to the
ingestion of carbohydrates in a meal.
HbA1C evaluates long-term glucose
control. A finger stick glucose three times
daily spot-checks blood glucose levels.
24. Answer: A, B, D
Aging results in reduced ability of beta
cells to respond with insulin effectively.
Overweight with waist/hip ratio increase
is part of the metabolic syndrome of DM
II. There is an increase in atherosclerosis
with DM due to the metabolic syndrome
and sedentary lifestyle.
25. Answer: C. African-American
woman.
Age-specific prevalence of
diagnosed diabetes mellitus (DM) is
higher for African-Americans and
Hispanics than for Caucasians. Among
those younger than 75, black women had
the highest incidence.
26. Answer: D. Hyperglycemic
hyperosmolar non-ketotic coma.
Illness, especially with the frail elderly
patient whose appetite is poor, can result
in dehydration and HHNC. Insulin
resistance usually is indicated by a daily
insulin requirement of 200 units or
more. Diabetic ketoacidosis, an acute
metabolic condition, usually is caused by
absent or markedly decreased amounts of
insulin.
27. Answer: D. Propylthiouracil (PTU)
Propylthiouracil (PTU) initially is given in
divided doses, and functions to block
thyroid hormone synthesis.
28. Answer: A, B, D
Acetylsalicylic acid
(aspirin), Furosemide (Lasix),
and Rifampin (Rifadin) are most likely to
cause hypothyroidism.
29. Answer: C. Ultrasonography
Although thyroid scans frequently are
done to evaluate the thyroid gland, I 123
is used to destroy overactive thyroid cells
such as are seen in thyroid cancer.
Ultrasonography can be used early in the
evaluation process to rule out Graves
disease, nodular goiter, or other thyroid
dysfunction.
30. Answer: C. Hypothermia related
to slowed metabolic rate
Thyroid hormone deficiency results in
reduction in the metabolic rate, resulting
in hypothermia, and does predispose the
older adult to a host of other health-
related issues. One-quarter of affected
elderly experience constipation.
1. Knowing that gluconeogenesis
helps to maintain blood levels, a
nurse should:
1. Document weight changes because of
fatty acid mobilization
2. Evaluate the patients sensitivity to low
room temperatures because of decreased
adipose tissue insulation
3. Protect the patient from sources
of infection because of decreased cellular
protein deposits
4. Do all of the above
2. Clinical manifestations associated
with a diagnosis of type 1 DM include
all of the following except:
1. Hypoglycemia
2. Hyponatremia
3. Ketonuria
4. Polyphagia
3. The lowest fasting plasma glucose
level suggestive of a diagnosis of DM
is:
1. 90mg/dl
2. 115mg/dl
3. 126mg/dl
4. 180mg/dl
4. Rotation sites for insulin injection
should be separated from one
another by 2.5 cm (1 inch) and
should be used only every:
1. Third day
2. Week
3. 2-3 weeks
4. 2-4 weeks
5. A clinical feature that
distinguishes a hypoglycemic
reaction from a ketoacidosis reaction
is:
1. Blurred vision
2. Diaphoresis
3. Nausea
4. Weakness
6. Clinical nursing assessment for a
patient with microangiopathy who
has manifested impaired peripheral
arterial circulation includes all of the
following except:
1. Integumentary inspection for the
presence of brown spots on the lower
extremities
2. Observation for paleness of the lower
extremities
3. Observation for blanching of the feet
after the legs are elevated for 60 seconds
4. Palpation for increased pulse volume in
the arteries of the lower extremities
7. The nurse expects that a type 1
diabetic may receive ____ of his or
her morning dose of insulin
preoperatively:
1. 10-20%
2. 25-40%
3. 50-60%
4. 85-90%
8. Albert, a 35-year-old insulin
dependent diabetic, is admitted to
the hospital with a diagnosis
of pneumonia. He has been febrile
since admission. His daily insulin
requirement is 24 units of NPH. Every
morning Albert is given NPH insulin
at 0730. Meals are served at 0830,
1230, and 1830. The nurse expects
that the NPH insulin will reach its
maximum effect (peak) between the
hours of:
1. 1130 and 1330
2. 1330 and 1930
3. 1530 and 2130
4. 1730 and 2330
9. A bedtime snack is provided for
Albert. This is based on the
knowledge that intermediate-acting
insulins are effective for an
approximate duration of:
1. 6-8 hours
2. 10-14 hours
3. 16-20 hours
4. 24-28 hours
10. Albert refuses his bedtime snack.
This should alert the nurse to assess
for:
1. Elevated serum bicarbonate and a
decreased blood pH.
2. Signs of hypoglycemia earlier than
expected.
3. Symptoms of hyperglycemia during the
peak time of NPH insulin.
4. Sugar in the urine
11. A client is taking NPH insulin
daily every morning. The nurse
instructs the client that the most
likely time for a hypoglycemic
reaction to occur is:
1. 2-4 hours after administration
2. 6-14 hours after administration
3. 16-18 hours after administration
4. 18-24 hours after administration
12. An external insulin pump is
prescribed for a client with DM. The
client asks the nurse about the
functioning of the pump. The nurse
bases the response on the
information that the pump:
1. Gives small continuous dose of regular
insulin subcutaneously, and the client can
self-administer a bolus with an additional
dosage from the pump before each meal.
2. Is timed to release programmed doses
of regular or NPH insulin into the
bloodstream at specific intervals.
3. Is surgically attached to
the pancreas and infuses regular insulin
into the pancreas, which in turn releases
the insulin into the bloodstream.
4. Continuously infuses small amounts of
NPH insulin into the bloodstream while
regularly monitoring blood glucose levels.
13. A client with a diagnosis
of diabetic ketoacidosis (DKA) is
being treated in the ER. Which
finding would a nurse expect to note
as confirming this diagnosis?
1. Elevated blood glucose level and a low
plasma bicarbonate
2. Decreased urine output
3. Increased respirations and an increase
in pH
4. Comatose state
14. A client with DM demonstrates
acute anxiety when first admitted for
the treatment of hyperglycemia. The
most appropriate intervention to
decrease the clients anxiety would
be to:
1. Administer a sedative
2. Make sure the client knows all the
correct medical terms to understand what
is happening.
3. Ignore the signs and symptoms
of anxiety so that they will soon
disappear
4. Convey empathy, trust, and respect
toward the client.
15. A nurse is preparing a plan of
care for a client with DM who
has hyperglycemia. The priority
nursing diagnosis would be:
1. High risk for deficient fluid volume
2. Deficient knowledge: disease process
and treatment
3. Imbalanced nutrition: less than body
requirements
4. Disabled family coping: compromised.
16. A nurse is caring for a client
admitted to the ER with DKA. In the
acute phase the priority nursing
action is to prepare to:
1. Administer regular insulin
intravenously
2. Administer 5% dextrose intravenously
3. Correct the acidosis
4. Apply an electrocardiogram monitor.
17. A nurse performs a physical
assessment on a client with type 2
DM. Findings include a fasting blood
glucose of 120mg/dl, temperature of
101, pulse of 88, respirations of 22,
and a bp of 140/84. Which finding
would be of most concern of the
nurse?
1. Pulse
2. BP
3. Respiration
4. Temperature
18. A client with type 1 DM calls the
nurse to report recurrent episodes
of hypoglycemia with exercise. Which
statement by the client indicated an
inadequate understanding of the
peak action of NPH insulin and
exercise?
1. The best time for me to exercise is
every afternoon.
2. The best time for me to exercise is
right after I eat.
3. The best time for me to exercise is
after breakfast.
4. The best time for me to exercise is
after my morning snack.
19. A client with diabetes
mellitus visits a health care clinic.
The clients diabetes previously had
been well controlled with glyburide
(Diabeta), 5 mg PO daily, but
recently the fasting blood glucose
has been running 180-200mg/dl.
Which medication, if added to the
clients regimen, may have
contributed to the hyperglycemia?
1. Prednisone (Deltasone)
2. Atenolol (Tenormin)
3. Phenelzine (Nardil)
4. Allopurinol (Zyloprim)
20. Glucose is an important molecule
in a cell because this molecule is
primarily used for:
1. Extraction of energy
2. Synthesis of protein
3. Building of genetic material
4. Formation of cell membranes.
21. When a client is first admitted
with hyperglycemic hyperosmolar
nonketotic syndrome (HHNS), the
nurses priority is to provide:
1. Oxygen
2. Carbohydrates
3. Fluid replacement
4. Dietary instruction
22. The nurse is admitting a client
with hypoglycemia. Identify the signs
and symptoms the nurse should
expect. Select all that apply.
1. Thirst
2. Palpitations
3. Diaphoresis
4. Slurred speech
5. Hyperventilation
23. When a client is in diabetic
ketoacidosis, the insulin that would
be administered is:
1. Human NPH insulin
2. Human regular insulin
3. Insulin lispro injection
4. Insulin glargine injection
24. The nurse recognizes that
additional teaching is necessary
when the client who is learning
alternative site testing (AST) for
glucose monitoring says:
1. I need to rub my forearm vigorously
until warm before testing at this site.
2. The fingertip is preferred for glucose
monitoring if hyperglycemia is
suspected.
3. I have to make sure that my current
glucose monitor can be used at an
alternate site.
4. Alternate site testing is unsafe if I am
experiencing a rapid change in glucose
levels.
25. Which adaptations should the
nurse caring for a client with diabetic
ketoacidosis expect the client to
exhibit? Select all that apply:
1. Sweating
2. Low PCO2
3. Retinopathy
4. Acetone breath
5. Elevated serum bicarbonate
26. A clients blood gases reflect
diabetic acidosis. The nurse should
expect:
1. Increased pH
2. Decreased PO2
3. Increased PCO2
4. Decreased HCO3
27. The nurse knows that glucagon
may be given in the treatment of
hypoglycemia because it:
1. Inhibits gluconeogenesis
2. Stimulates the release of insulin
3. Increases blood glucose levels
4. Provides more storage of glucose.
28. A client with type 1 DM has a
fingerstick glucose level of 258mg/dl
at bedtime. An order for sliding scale
insulin exists. The nurse should:
1. Call the physician
2. Encourage the intake of fluids
3. Administer the insulin as ordered
4. Give the client c. of orange juice
29. The physician orders 36 units of
NPH and 12 units of regular insulin.
The nurse plans to administer these
drugs in 1 syringe. Identify the steps
in this procedure by listing them in
priority order.
1. Inject air equal to NPH dose into NPH
vial
2. Invert regular insulin bottle and
withdraw regular insulin dose
3. Inject air equal to regular dose into
regular dose
4. Invert NPH vial and withdraw NPH
dose.
30. The insulin that has the most
rapid onset of action would be:
1. Lente
2. Lispro
3. Ultralente
4. Humulin N
31. A client with DM states, I cannot
eat big meals; I prefer to snack
throughout the day. The nurse
should carefully explain that the:
1. Regulated food intake is basic to
control
2. Salt and sugar restriction is the main
concern
3. Small, frequent meals are better for
digestion
4. Large meals can contribute to a weight
problem
32. A client with DM has an above-
knee amputation because of severe
peripheral vascular disease, Two
days following surgery, when
preparing the client for dinner, it is
the nurses primary responsibility to:
1. Check the clients serum glucose level
2. Assist the client out of bed to the chair
3. Place the client in a high-Fowlers
position
4. Ensure that the clients residual limb is
elevated.
33. Which of the following nursing
interventions should be taken for a
client who complains of nausea and
vomits one hour after taking his
glyburide (DiaBeta)?
1. Give glyburide again
2. Give subcutaneous insulin and monitor
blood glucose
3. Monitor blood glucose closely, and look
for signs of hypoglycemia.
4. Monitor blood glucose, and assess for
signs of hyperglycemia.
34. Which of the following chronic
complications is associated
with diabetes?
1. Dizziness, dyspnea on exertion,
and coronary artery disease.
2. Retinopathy, neuropathy, and coronary
artery disease
3. Leg ulcers, cerebral ischemic events,
and pulmonary infarcts
4. Fatigue, nausea, vomiting, muscle
weakness, and cardiac arrhythmias
35. Rotating injection sites when
administering insulin prevents which
of the following complications?
1. Insulin edema
2. Insulin lipodystrophy
3. Insulin resistance
4. Systemic allergic reactions
36. Which of the following methods
of insulin administration would be
used in the initial treatment of
hyperglycemia in a client with
diabetic ketoacidosis?
1. Subcutaneous
2. Intramuscular
3. IV bolus only
4. IV bolus, followed by continuous
infusion.
37. Insulin forces which of the
following electrolytes out of the
plasma and into the cells?
1. Calcium
2. Magnesium
3. Phosphorus
4. Potassium
38. Which of the following causes of
HHNS is most common?
1. Insulin overdose
2. Removal of the adrenal gland
3. Undiagnosed, untreated
hyperpituitarism
4. Undiagnosed,
untreated diabetes mellitus
39. A client is in DKA, secondary
to infection. As the condition
progresses, which of the following
symptoms might the nurse see?
1. Kussmauls respirations and a fruity
odor on the breath
2. Shallow respirations and severe
abdominal pain
3. Decreased respirations and
increased urine output.
4. Cheyne-stokes respirations and foul-
smelling urine
40. Clients with type 1 diabetes may
require which of the following
changes to their daily routine during
periods of infection?
1. No changes
2. Less insulin
3. More insulin
4. Oral antidiabetic agents
Answers and Rationale
1. Answer: 4. Do all of the above
2. Answer: 1. Hypoglycemia
3. Answer: 3. 126mg/dl
4. Answer: 3. 2-3 weeks
5. Answer: 2. Diaphoresis
6. Answer: 4. Palpation for increased
pulse volume in the arteries of the
lower extremities
7. Answer: 3. 50-60%
8. Answer: 2. 1330 and 1930
9. Answer: 3. 16-20 hours
10. Answer: 2. Signs of hypoglycemia
earlier than expected.
11. Answer: 2. 6-14 hours after
administration
NPH is intermediate acting insulin. The
onset of action is 1-2 hours, it peaks in 6-
14 hours, and its duration of action is 24
hours. Hypoglycemic reactions most likely
occur during peak time.
12. Answer: 1. Gives small
continuous dose of regular insulin
subcutaneously, and the client can
self-administer a bolus with an
additional dosage from the pump
before each meal.
An insulin pump provides a small
continuous dose of regular insulin
subcutaneously throughout the day and
night, and the client can self-administer a
bolus with additional dosage from the
pump before each meal as needed.
Regular insulin is used in an insulin
pump. An external pump is not attached
surgically to the pancreas.
13. Answer: 1. Elevated blood
glucose level and a low plasma
bicarbonate
In diabetic acidosis, the arterial pH is less
than 7.35. plasma bicarbonate is less
than 15mEq/L, and the blood glucose
level is higher than 250mg/dl and
ketones are present in the blood
and urine. The client would be
experiencing polyuria, and Kussmauls
respirations would be present. A
comatose state may occur if DKA is not
treated, but coma would not confirm the
diagnosis
14. Answer: 4. Convey empathy,
trust, and respect toward the client.
The most appropriate intervention is to
address the clients feelings related to
the anxiety. Administering a sedative is
not the most appropriate intervention.
The nurse should not ignore the clients
anxious feelings. A client will not relate to
medical terms, particularly
when anxiety exists.
15. Answer: 1. High risk for deficient
fluid volume
Increased blood glucose will cause the
kidneys to excrete the glucose on the
urine. This glucose is accompanied
by fluids and electrolytes, causing
osmotic diuresis leading to dehydration.
This fluid loss must be replaced when it
becomes severe. Options B, C, and D are
not related specifically to the issue of the
question.
16. Answer: 1. Administer regular
insulin intravenously
Lack (absolute or relative) of insulin is the
primary cause of DK1. Treatment consists
of insulin administration (regular insulin),
IV fluid administration (normal
saline initially),
and potassium replacement, followed by
correcting acidosis. Applying an
electrocardiogram monitor is not a
priority action.
17. Answer: 4. Temperature
An elevated temperature may indicate
infection. Infection is a leading cause
of hyperglycemic hyperosmolar
nonketotic syndrome or diabetic
ketoacidosis.
18. Answer: 1. The best time for me
to exercise is every afternoon.
A hypoglycemic reaction may occur in the
response to increased exercise. Clients
should avoid exercise during the peak
time of insulin. NPH insulin peaks at 6-14
hours; therefore afternoon exercise will
occur during the peak of the medication.
Options B, C, and D do not address peak
action times.
19. Answer: 1. Prednisone
(Deltasone)
Prednisone may decrease the effect of
oral hypoglycemics, insulin, diuretics,
and potassium supplements.
20. Answer: 1. Extraction of energy
Glucose catabolism is the main pathway
for cellular energy production.
21. Answer: 3. Fluid replacement
As a result of osmotic pressures created
by increased serum glucose, the cells
become dehydrated; the client must
receive fluid and then insulin.
22. Answer: 2, 3, 4.
Palpitations, an adrenergic symptom,
occur as the glucose levels fall; the
sympathetic nervous system is activated
and epinephrine and norepinephrine are
secreted causing this response.
Diaphoresis is a sympathetic nervous
system response that occurs as
epinephrine and norepinephrine are
released. Slurred speech is a
neuroglycopenic symptom; as the brain
receives insufficient glucose, the activity
of the CNS becomes depressed.
23. Answer: 2. Human regular insulin
Regular insulin (Humulin R) is a short-
acting insulin and is administered via
IV with an initial dose of 0.3 units/kg,
followed by 0.2 units/kg 1 hour later,
followed by 0.2 units/kg every 2 hours
until blood glucose becomes <13.9
mmol/L (<250 mg/dL). At this point,
insulin dose should be decreased by half,
to 0.1 units/kg every 2 hours, until the
resolution of DKA.
24. Answer: 2. The fingertip is
preferred for glucose monitoring if
hyperglycemia is suspected.
The fingertip is preferred for glucose
monitoring if hypoglycemia, not
hyperglycemia, is suspected.
25. Answer: 2, 3.
Metabolic acidosis initiates respiratory
compensation in the form of Kussmauls
respirations to counteract the effects of
ketone buildup, resulting in a lowered
PCO2. A fruity odor to the breath
(acetone breath) occurs when the ketone
level is elevated in ketoacidosis.
26. Answer: 4. Decreased HCO3
The bicarbonate-carbonic acid buffer
system helps maintain the pH of the body
fluids; in metabolic acidosis, there is a
decrease in bicarbonate because of an
increase of metabolic acids.
27. Answer: 3. Increases blood
glucose levels
Glucagon, an insulin antagonist produced
by the alpha cells in the islets of
Langerhans, leads to the conversion of
glycogen to glucose in the liver.
28. Answer: 3. Administer the insulin
as ordered
A value of 258mg/dl is above the
expected range of 70-105 mg/dl; the
nurse should administer the insulin as
ordered.
29. Answer: 1, 3, 2, 4.
30. Answer: 2. Lispro
Lispro has an immediate onset, a peak of
30-90 minutes, and duration of 2-4
hours.
31. Answer: 1. Regulated food intake
is basic to control
An understanding of the diet is imperative
for compliance. A balance of
carbohydrates, proteins, and fats usually
apportioned over three main meals and
two between meals snacks needs to be
tailored to the clients specific needs, with
due regard for activity, diet, and therapy.
32. Answer: 1. Check the clients
serum glucose level
Because the client has diabetes, it is
essential that the blood glucose level be
determined before meals to evaluate the
success of control of diabetes and the
possible need for insulin coverage.
33. Answer: 3. Monitor blood glucose
closely, and look for signs of
hypoglycemia.
When a client who has taken an oral
antidiabetic agent vomits, the nurse
would monitor glucose and assess him
frequently for signs of hypoglycemia.
Most of the medication has probably been
absorbed. Therefore, repeating the dose
would further lower glucose levels later in
the day. Giving insulin would also lower
the glucose levels, causing hypoglycemic.
The client wouldnt have hyperglycemia if
the glyburide was absorbed.
34. Answer: 2. Retinopathy,
neuropathy, and coronary
artery disease
These are all chronic complications
of diabetes. Dizziness, dyspnea on
exertion, and coronary artery disease are
symptoms of aortic
valve stenosis. Fatigue, nausea, vomiting,
muscle weakness, and cardiac
arrhythmias are symptoms of
hyperparathyroidism. Leg ulcers, cerebral
ischemic events, and pulmonary infarcts
are complications of sickle cell anemia.
35. Answer: 2. Insulin lipodystrophy
Insulin lipodystrophy produces fatty
masses at the injection sites, causing
unpredictable absorption of insulin
injected into these sites.
36. Answer: 4. IV bolus, followed by
continuous infusion.
An IV bolus of insulin is given initially to
control the hyperglycemia; followed by a
continuous infusion, titrated to control
blood glucose. After the client is
stabilized, subcutaneous insulin is given.
Insulin is never given intramuscularly.
37. Answer: 4. Potassium
Insulin forces potassium out of the
plasma, back into the cells,
causing hypokalemia. Potassium is
needed to help transport glucose and
insulin into the
cells. Calcium, magnesium, and
phosphorus arent affected by insulin.
38. Answer: 4. Undiagnosed,
untreated diabetes mellitus
Undiagnosed, untreated DM is one of the
most common causes of HHNS.
39. Answer: 1. Kussmauls
respirations and a fruity odor on the
breath
Coma and severe acidosis are ushered in
with Kussmauls respirations (very deep
but not labored respirations) and a fruity
odor on the breath (academia).
40. Answer: 3. More insulin
During periods of infection or illness,
diabetics may need even more insulin to
compensate for increased blood glucose
levels.
1. During lecture, the clinical
instructor tells the students that
50% to 60% of daily calories should
come from carbohydrates. What
should the nurse say about the types
of carbohydrates that can be eaten?
A. Try to limit simple sugars to between
10% and 20% of daily calories.
B. Simple carbohydrates are absorbed
more rapidly than complex
carbohydrates.
C. Simple sugars cause rapid spike in
glucose levels and should be avoided.
D. Simple sugars should never be
consumed by someone with diabetes.
2. At the time Cherrie Ann found out
that the symptoms of diabetes were
caused by high levels of blood
glucose, she decided to break the
habit of eating carbohydrates. With
this, the nurse would be aware that
the client might develop what
complication?
A. retinopathy
B. atherosclerosis
C. glycosuria
D. acidosis
3. Joko has recently been diagnosed
with Type I diabetes and asks Nurse
Jessica for help formulating a
nutrition plan. Which of the following
recommendations would the nurse
make to help the client increase
calorie consumption to offset
absorption problems?
A. Eat small meals with two or three
snacks throughout the day to keep blood
glucose levels steady
B. Increase consumption of simple
carbohydrates
C. Eating small meals with two or three
snacks may be more helpful in
maintaining blood glucose levels than
three large meals.
D. Skip meals to help lose weight
4. Billy is being asked concerning his
health in the emergency department.
When obtaining a health history from
a patient with acute pancreatitis, the
nurse asks the patient specifically
about a history of
A. alcohol use.
B. cigarette smoking.
C. diabetes mellitus.
D. high-protein diet.
5. Nurse Shey is educating a
pregnant client who has
gestational diabetes. Which of the
following statements should the
nurse make to the client? Select all
that apply.
A. Cakes, candies, cookies, and regular
soft drinks should be avoided.
B. Gestational diabetes increases the risk
that the mother will
develop diabetes later in life.
C. Gestational diabetes usually resolves
after the baby is born.
D. Insulin injections may be necessary.
E. The baby will likely be born
with diabetes
F. The mother should strive to gain no
more weight during the pregnancy.
6. The goal for pre-prandial blood
glucose for those with Type
1 diabetes mellitus is:
A. <80 mg/dl
B. <130 mg/dl
C. <180 mg/dl
D. <6%
7. The guidelines for Carbohydrate
Counting as medical nutrition therapy
for diabetes mellitus includes all of
the following EXCEPT:
A. Flexibility in types and amounts of
foods consumed
B. Unlimited intake of total fat, saturated
fat and cholesterol
C. Including adequate servings of fruits,
vegetables and the dairy group
D. Applicable to with either Type 1 or
Type 2 diabetes mellitus
8. The nurse working in the
physicians office is reviewing lab
results on the clients seen that day.
One of the clients who has classic
diabetic symptoms had an eight-hour
fasting plasma glucose (FPG) test
done. The nurse realizes that
diagnostic criteria developed by the
American Diabetes Association
for diabetes include classic diabetic
symptoms plus which of the
following fasting plasma glucose
levels?
A. Higher than 106 mg/dl
B. Higher than 126 mg/dl
C. Higher than 140 mg/dl
D. Higher than 160 mg/dl
9. When taking a health history, the
nurse screens for manifestations
suggestive of Diabetes Type I. Which
of the following manifestations are
considered the primary
manifestations of Diabetes Type I
and would be most suggestive and
require follow-up investigation?
A. Excessive intake of calories, rapid
weight gain, and difficulty losing weight
B. An increase in three areas: thirst,
intake of fluids, and hunger
C. Poor circulation, wound healing, and
leg ulcers,
D. Lack of energy, weight gain,
and depression
10. The nurse is working with an
overweight client who has a high-
stress job and smokes. This client
has just received a diagnosis of Type
II Diabetes and has just been started
on an oral hypoglycemic agent.
Which of the following goals for the
client which if met, would be most
likely to lead to an improvement in
insulin efficiency to the point the
client would no longer require oral
hypoglycemic agents?
A. Comply with medication regimen 100%
for 6 months
B. Quit the use of any tobacco products
by the end of three months
C. Lose a pound a week until weight is in
normal range for height and exercise 30
minutes daily
D. Practice relaxation techniques for at
least five minutes five times a day for at
least five months
11. During a visit in a community, the
nurse will recommend routine
screening for diabetes when the
person has one or more of seven risk
criteria. Which of the following
persons that the nurse comes in
contact with most needs to be
screened for diabetes based on the
seven risk criteria?
A. A client with an HDL cholesterol level
of 40 mg/dl and a triglyceride level of 300
mg/dl
B. A woman who is at 90% of standard
body weight after delivering an eight-
pound baby
C. A middle-aged Caucasian male
D. An older client who is hypotensive
12. During the admission of a client
with diabetic ketoacidosis, Nurse
Kendra will anticipate the physician
ordering which of the following types
of intravenous solution if the client
cannot take fluids orally?
A. Lactated Ringers solution
B. 0.9 normal saline solution
C. 5% dextrose in water (D5W)
D. 0.45% normal saline solution
13. You are doing some teaching with
a client who is starting on a
sulfonylurea antidiabetic agent. The
client mentions that he usually has a
couple of beers each night and takes
an aspirin each day to prevent heart
attack and/or strokes. Which of the
following responses would be best on
the part of the nurse?
A. As long as you only drink two beers
and take one aspirin, this should not be a
problem
B. The aspirin is alright but you need to
give up drinking any alcoholic beverages
C. Taking alcohol and/or aspirin with a
sulfonylurea drug can cause development
of hypoglycemia
D. Aspirin and alcohol will cause
the stomach to bleed more when on a
sulfonylurea drug
14. Which of the following if stated
by the nurse is correct
about Hyperglycemic Hyperosmolar
Nonketotic Syndrome (HHNS)?
A. This syndrome occurs mainly in people
with Type I Diabetes
B. It has a higher mortality rate
than Diabetic Ketoacidosis
C. The client with HHNS is in a state of
overhydration
D. This condition develops very rapidly
15. Nurse Robedee is teaching a thin
client about the proper
methods/techniques when giving
insulin. Which one of the following is
proper?
A. Pinch the skin up and use a 90 degree
angle
B. Use a 45 degree angle with the skin
pinched up
C. Massage the area of injection after
injecting the insulin
D. Warm the skin with a warmed towel or
washcloth prior to the injection
16. Nurse Pira is explaining to the
client about Type II Diabetes. Risk
factors of such condition include all
of the following except:
A. Advanced age
B. Physical inactivity
C. Obesity
D. Smoking
17. Blood sugar is well controlled
when Hemoglobin A1C is:
A. Below 5.7%
B. Between 12%-15%
C. Less than 180 mg/dL
D. Between 90 and 130 mg/dL
18. Which of the
following diabetes drugs acts by
decreasing the amount of glucose
produced by the liver?
A. Alpha-glucosidase inhibitors
B. Biguanides
C. Meglitinides
D. Sulfonylureas
19. A 39-year-old company driver
presents with shakiness,
sweating, anxiety, and palpitations
and tells the nurse he has Type
I Diabetes Mellitus. Which of the
follow actions should the nurse do
first?
A. Inject 1 mg of glucagon
subcutaneously.
B. Administer 50 mL of 50% glucose I.V.
C. Give 4 to 6 oz (118 to 177 mL) of
orange juice.
D. Give the client four to six glucose
tablets.
20. An external insulin pump is
prescribed for a client with diabetes
mellitus and the client asks the nurse
about the functioning of the pump.
The nurse bases the response on the
information that the pump:
A. is timed to release programmed doses
of regular or NPH insulin into the
bloodstream at specific intervals
B. gives a small continuously dose of
regular insulin subcutaneously, and the
client can self-administer a bolus with an
additional dose from the pump before
each meal
C. continuously infuses small amounts of
NPH insulin into the bloodstream while
regularly monitoring blood glucose levels
D. is surgically attached to
the pancreas and infuses regular insulin
into the pancreas, which in turn releases
the insulin into the bloodstream
21. Which of the following persons
would most likely be diagnosed
with Diabetes Mellitus? A 44-year-
old:
A. Caucasian woman.
B. Asian woman.
C. African-American woman.
D. Hispanic male.
22. Which of the following factors are
risks for the development of Diabetes
Mellitus? Select all that apply.
A. Age over 45 years
B. Overweight with a waist/hip ratio >1
C. Having a consistent HDL level above
40 mg/dl
D. Maintaining a sedentary lifestyle
23. Anton brought his grandfather to
the clinic to confirm his blood sugar
levels. Which laboratory test should a
nurse anticipate a physician would
order when an older person is
identified as high-risk for Diabetes
Mellitus? Select all that apply.
A. Fasting Plasma Glucose (FPG)
B. Two-hour Oral Glucose Tolerance Test
(OGTT)
C. Glycosylated hemoglobin (HbA1C)
D. Finger stick glucose three times daily
24. A patient received 6 units of
regular insulin 3 hours ago. The
nurse would be MOST concerned if
which of the following was observed?
A. kussmaul respirations and diaphoresis
B. anorexia and lethargy
C. diaphoresis and trembling
D. headache and polyuria
25. Mr. Wesley is newly diagnosed
with Type I DM and is being seen by
the home health nurse. The doctors
orders include: 1200 calorie ADA
diet, 15 units NPH insulin before
breakfast, and check blood sugar qid.
When the nurse visits the patient at 5
pm, the nurse observes the man
performing blood sugar analysis. The
result is 50 mg/dL. The nurse would
expect the patient to be
A. confused with cold, clammy skin and
pulse of 110
B. lethargic with hot dry skin and rapid
deep respirations
C. alert and cooperative with BP of
130/80 and respirations of 12
D. short of breath, with distended neck
veins and bounding pulse of 96.
Answers and Rationale
Here are the answers for this exam.
Gauge your performance by counter
checking your answers to those below. If
you have any disputes or clarifications,
please direct them to the comments
section.
1. Answer: A. Try to limit simple
sugars to between 10% and 20% of
daily calories.
It is recommended that carbohydrates
provide 50% to 60% of the daily calories.
Approximately 40% to 50% should be
from complex carbohydrates. The
remaining 10% to 20 % of carbohydrates
could be from simple sugars. Studies give
no evidence that carbohydrates from
simple sugars are digested and absorbed
more rapidly that are complex
carbohydrates, and they do not appear to
affect blood sugar control.
2. Answer: D. acidosis
When a clients carbohydrate
consumption is inadequate, ketones are
produced from the breakdown of fat.
These ketones lower the pH of the blood,
potentially causing acidosis that can lead
to a diabetic coma.
3. Answer: C. Eating small meals with
two or three snacks may be more
helpful in maintaining blood glucose
levels than three large meals.
Eating small meals with two or three
snacks may be more helpful in
maintaining blood glucose levels than
three large meals.
4. Answer: A. alcohol use.
Alcohol use is one of the most common
risk factors for pancreatitis in the United
States.
5. Answer: A, B, C, D
Gestational diabetes can occur between
the 16th and 28th week of pregnancy. If
not responsive to diet and exercise,
insulin injections may be necessary.
Concentrated sugars should be avoided.
Weight gain should continue, but not in
excessive amounts. Usually,
gestational diabetes disappears after the
infant is born. However, diabetes can
develop 5 to 10 years after the
pregnancy.
6. Answer: B. <130 mg/dl
The goal for pre-prandial blood glucose
for those with Type 1 diabetes
mellitus is <130 mg/dl.
7. Answer: B. Unlimited intake of
total fat, saturated fat and
cholesterol
The guidelines for Carbohydrate Counting
as medical nutrition therapy for diabetes
mellitus includes all of the following
EXCEPT option B, unlimited intake of total
fat, saturated fat and cholesterol.
8. Answer: B. Higher than 126 mg/dl
Diabetes is diagnosed at fasting blood
glucose of greater than or equal to 126
mg/dl.
9. Answer: B. An increase in three
areas: thirst, intake of fluids, and
hunger
The primary manifestations
of diabetes type I are polyuria
(increased urine output), polydipsia
(increased thirst), polyphagia (increased
hunger).
10. Answer: C. Lose a pound a week
until weight is in normal range for
height and exercise 30 minutes daily
When Type II diabetics lose weight
through diet and exercise they sometimes
have an improvement in insulin efficiency
sufficient to the degree they no longer
require oral hypoglycemic agents.
11. Answer: A. A client with an HDL
cholesterol level of 40 mg/dl and a
triglyceride level of 300 mg/dl
The seven risk criteria include: greater
than 120% of standard body weight,
Certain races but not including
Caucasian, delivery of a baby weighing
more than 9 pounds or a diagnosis of
gestational diabetes, hypertensive, HDL
greater than 35 mg/dl or triglyceride level
greater than 250 or a triglyceride level of
greater than 250 mg/dl, and, lastly,
impaired glucose tolerance or impaired
fasting glucose on prior testing.
12. Answer: D. 0.45% normal
saline solution
0.45% normal saline solution is
recommended.
13. Answer: C. Taking alcohol and/or
aspirin with a sulfonylurea drug can
cause development of hypoglycemia
Alcohol and/or aspirin taken with a
sulfonylurea can cause development
of hypoglycemia.
14. Answer: B. It has a higher
mortality rate than Diabetic
Ketoacidosis
HHNS occurs only in people with Type
II Diabetes. It is a medical emergency
and has a higher mortality rate than
Diabetic Ketoacidosis. This condition
develops very slowly over hours or days.
15. Answer: A. Pinch the skin up and
use a 90 degree angle
The best angle for a thin person is 90
degrees with the skin pinched up. The
area is not massaged and it is not
necessary to warm it.
16. Answer: D. Smoking
Additional risk factors for type
2 diabetes are a family history
of diabetes, impaired glucose
metabolism, history of
gestational diabetes, and race/ethnicity.
African-Americans, Hispanics/Latinos,
Asian Americans, Native Hawaiians,
Pacific Islanders, and Native Americans
are at greater risk of
developing diabetes than whites.
17. Answer: A. Below 5.7%
A1c measures the percentage of
hemoglobin that is glycated and
determines average blood glucose during
the 2 to 3 months prior to testing. Used
as a diagnostic tool, A1C levels of 6.5%
or higher on two tests indicate diabetes.
A1C of 6% to 6.5% is considered
prediabetes.
18. Answer: B. Biguanides
Biguanides, such as metformin, lower
blood glucose by reducing the amount of
glucose produced by the liver.
Sulfonylureas and Meglitinides stimulate
the beta cells of the pancreas to produce
more insulin. Alpha-glucosidase inhibitors
block the breakdown of starches and
some sugars, which helps to reduce blood
glucose levels
19. Answer: C. Give 4 to 6 oz (118 to
177 mL) of orange juice.
Because the client is awake and
complaining of symptoms, the nurse
should first give him 15 grams of
carbohydrate to treat hypoglycemia. This
could be 4 to 6 oz of fruit juice, five to six
hard candies such as Lifesavers, or 1
tablespoon of sugar. When a client has
worsening symptoms of hypoglycemia or
is unconscious, treatment includes 1 mg
of glucagon subcutaneously or
intramuscularly, or 50 mL of 50% glucose
I.V. The nurse may also give two to three
glucose tablets for a hypoglycemic
reaction.
20. Answer: B. gives a small
continuously dose of regular insulin
subcutaneously, and the client can
self-administer a bolus with an
additional dose from the pump before
each meal
An insulin pump provides a small
continuous dose of regular insulin
subcutaneously throughout the day and
night, and the client can self-administer a
bolus with an additional dose from the
pump before each meal as needed.
Regular insulin is used in an insulin
pump. An external pump is not attached
surgically to the pancreas.
21. Answer: C. African-American
woman.
Age-specific prevalence of
diagnosed diabetes mellitus (DM) is
higher for African-Americans and
Hispanics than for Caucasians. Among
those younger than 75, black women had
the highest incidence.
22. Answer: A, B, D
Aging results in reduced ability of beta
cells to respond with insulin effectively.
Overweight with waist/hip ratio increase
is part of the metabolic syndrome of DM
II. There is an increase in atherosclerosis
with DM due to the metabolic syndrome
and sedentary lifestyle.
23. Answer: A, B
When an older person is identified as
high-risk for diabetes, appropriate testing
would include FPG and OGTT. A FPG
greater than 126 mg/dL usually
indicates diabetes. The OGTT is to
determine how the body responds to the
ingestion of carbohydrates in a meal.
HbA1C evaluates long-term glucose
control. A finger stick glucose three times
daily spot-checks blood glucose levels.
24. Answer: C. diaphoresis and
trembling
Diaphoresis and trembling indicates
hypoglycemia.
25. Answer: A. confused with cold,
clammy skin and pulse of 110
Confused with cold, clammy skin and
pulse of 110 indicate hypoglycemia.