Diabetes MellitusDiabetes Mellitus

Practice QuestionsPractice Questions

The client, an 18-year old female, The client, an 18-year old female, comes to the clinic with a wound on comes to the clinic with a wound on her left lower leg that has not healed her left lower leg that has not healed for 2 weeks. Which disease process for 2 weeks. Which disease process would the nurse suspect that the would the nurse suspect that the client developed?client developed?

A.A. Type 1 DMType 1 DMB.B. Type 2 DMType 2 DMC.C. Gestational DMGestational DMD.D. Secondary DMSecondary DM

The client diagnosed with Type 1 The client diagnosed with Type 1 DM has a glycosylated Hgb (A1C) DM has a glycosylated Hgb (A1C) of 8.1%. Which interpretation of 8.1%. Which interpretation should the nurse make based on should the nurse make based on this result?this result?

A.A. This result is below normal levelsThis result is below normal levels

B.B. This result is within acceptable rangeThis result is within acceptable range

C.C. This result is above recommended This result is above recommended levelslevels

D.D. This result is dangerously highThis result is dangerously high

The nurse administered 28 units of The nurse administered 28 units of Humulin N, an intermediate acting Humulin N, an intermediate acting insulin, to a client diagnosed with insulin, to a client diagnosed with Type 1 DM at 1700. Which action Type 1 DM at 1700. Which action should the nurse implement?should the nurse implement?

A.A. Determine how much food the client Determine how much food the client ate at lunchate at lunch

B.B. Perform a glucometer reading at 0700Perform a glucometer reading at 0700C.C. Ensure the client eats a bedtime snackEnsure the client eats a bedtime snackD.D. Offer the client protein after Offer the client protein after

administering insulinadministering insulin

The client diagnosed with Type 1 DM The client diagnosed with Type 1 DM is receiving Humalog, a rapid-acting is receiving Humalog, a rapid-acting insulin, by sliding scale. The order insulin, by sliding scale. The order reads blood glucose level: <150, give reads blood glucose level: <150, give 0 units; 151-200, give 3 units; 201-0 units; 151-200, give 3 units; 201-250, give 6 units; >251, contact MD. 250, give 6 units; >251, contact MD. The client’s BS is 189 mg/dL. The client’s BS is 189 mg/dL. – How much insulin should you How much insulin should you

administer?_________administer?_________– What is the most important follow-up What is the most important follow-up

assessment for this patient and when? assessment for this patient and when? ________________________________________

The nurse is completing an admission The nurse is completing an admission assessment for a 76 year old client assessment for a 76 year old client with Type 2 DM that must be controlled with Type 2 DM that must be controlled with 70/30 combination insulin. Which with 70/30 combination insulin. Which intervention should be included in the intervention should be included in the plan of care?plan of care?

A.A. Assess the client’s ability to read small Assess the client’s ability to read small printprint

B.B. Monitor the client’s coagulation studiesMonitor the client’s coagulation studies

C.C. Teach the client how to perform a HgbA1C Teach the client how to perform a HgbA1C test dailytest daily

D.D. Instruct the client to check the feet weekly.Instruct the client to check the feet weekly.

The client with Type 2 DM controlled with The client with Type 2 DM controlled with biguanide oral diabetic medication is biguanide oral diabetic medication is scheduled for a computed tomography scheduled for a computed tomography with contrast of the abdomen to evaluate with contrast of the abdomen to evaluate pancreatic function. Which intervention pancreatic function. Which intervention should the nurse implement?should the nurse implement?

A.A. Provide a high fat diet 24 hours prior to testProvide a high fat diet 24 hours prior to test

B.B. Hold the biguanide medication for 48 hours Hold the biguanide medication for 48 hours to testto test

C.C. Obtain an informed consent for the testObtain an informed consent for the test

D.D. Administer pancreatic enzymes prior to testAdminister pancreatic enzymes prior to test

The diabetic educator is teaching a class on The diabetic educator is teaching a class on diabetes Type 1 and is discussing sick-day rules. diabetes Type 1 and is discussing sick-day rules. Which interventions should the educator include Which interventions should the educator include in the discussion?in the discussion?

A.A. Take diabetic medication even if unable to eat Take diabetic medication even if unable to eat the client’s normal diabetic dietthe client’s normal diabetic diet

B.B. If unable to eat, drink liquids equal to client’s If unable to eat, drink liquids equal to client’s normal caloric intakenormal caloric intake

C.C. It is not necessary to notify health care It is not necessary to notify health care provider if ketones are present in urineprovider if ketones are present in urine

D.D. Test blood glucose levels frequently and test Test blood glucose levels frequently and test urine for ketones once a day and keep a recordurine for ketones once a day and keep a record

The client received 10 units of Humulin R, The client received 10 units of Humulin R, a fast acting insulin, at 0700. At 1030, the a fast acting insulin, at 0700. At 1030, the unlicensed nursing assistant tells the unlicensed nursing assistant tells the nurse the client has a headache and is nurse the client has a headache and is asking for his lunch tray early because he asking for his lunch tray early because he is feeling very hungry. Which action is feeling very hungry. Which action should the nurse implement first?should the nurse implement first?

A.A. Order the client’s lunch tray from the kitchen Order the client’s lunch tray from the kitchen and give it to him earlyand give it to him early

B.B. Have the client drink 8 ounces of orange juiceHave the client drink 8 ounces of orange juiceC.C. Go to the client’s room and assess the client Go to the client’s room and assess the client

for hypoglycemiafor hypoglycemiaD.D. Prepare to administer 1 amp of 50% Dextrose Prepare to administer 1 amp of 50% Dextrose

intravenouslyintravenouslyE.E. Instruct the nursing assistant to obtain a Instruct the nursing assistant to obtain a

blood glucose levelblood glucose level

The client diagnosed with Type 1 DM The client diagnosed with Type 1 DM is found lying unconscious on the is found lying unconscious on the floor of the bathroom. Which floor of the bathroom. Which intervention should the nurse intervention should the nurse implement first?implement first?

A.A. Notify the physicianNotify the physician

B.B. Check the serum glucose levelCheck the serum glucose level

C.C. Administer 50% dextrose IVPAdminister 50% dextrose IVP

D.D. Move the client to the ICUMove the client to the ICU

The nurse is discussing ways to The nurse is discussing ways to prevent DKA with the client prevent DKA with the client diagnosed with Type 1 DM. Which diagnosed with Type 1 DM. Which instruction would be most important instruction would be most important to discuss with the client?to discuss with the client?

A.A. Refer the client to American Diabetes Refer the client to American Diabetes AssociationAssociation

B.B. Do not take any over the counter Do not take any over the counter medicationsmedications

C.C. Take the prescribed insulin even when Take the prescribed insulin even when unable to eat because of illnessunable to eat because of illness

D.D. Be sure to get you annual flu and Be sure to get you annual flu and pneumonia vaccinespneumonia vaccines

The goal of treatment with hypoglycemic agents is The goal of treatment with hypoglycemic agents is the maintenance of stable blood glucose levels to the maintenance of stable blood glucose levels to prevent the acute complications of hypoglycemia prevent the acute complications of hypoglycemia and hyperglycemia, and the long-term and hyperglycemia, and the long-term complications associated with hyperglycemia. Your complications associated with hyperglycemia. Your patient will initially be taking Humulin N/Humulin R patient will initially be taking Humulin N/Humulin R 70/30 insulin subcutaneously q a.m., a sliding-scale 70/30 insulin subcutaneously q a.m., a sliding-scale dose of regular insulin subcutaneously before lunch dose of regular insulin subcutaneously before lunch and dinner, and Humulin N insulin at bedtime.and dinner, and Humulin N insulin at bedtime.

Which statement made by a client indicates that Which statement made by a client indicates that she correctly understands self-administration of she correctly understands self-administration of insulin?insulin?

A) "My daily dose of 70/30 insulin is based on how A) "My daily dose of 70/30 insulin is based on how much I ate the day before."much I ate the day before."B) "The amount of short-acting insulin I take every B) "The amount of short-acting insulin I take every day is based on my blood sugar readings."day is based on my blood sugar readings."C) "I should store my insulin in the refrigerator and C) "I should store my insulin in the refrigerator and remove it thirty minutes before I need it."remove it thirty minutes before I need it."D) "I will alternate my injection sites from leg to D) "I will alternate my injection sites from leg to abdomen each day to avoid overuse."abdomen each day to avoid overuse."   11.

An hour before the next dose of sliding-An hour before the next dose of sliding-scale insulin is scheduled, the client tells scale insulin is scheduled, the client tells the nurse, "I guess I’m really nervous the nurse, "I guess I’m really nervous about giving myself insulin injections. Look about giving myself insulin injections. Look how shaky and sweaty I am.“how shaky and sweaty I am.“

    What is the priority nursing action?What is the priority nursing action?

A) Obtain Lara’s vital signs.A) Obtain Lara’s vital signs.B) Check Lara’s blood glucose.B) Check Lara’s blood glucose.C) Assure Lara that she will be able to give C) Assure Lara that she will be able to give

herself the injections.herself the injections.D) Offer to bring Lara an orange so she can D) Offer to bring Lara an orange so she can

practice giving injections.practice giving injections.

13

After discharge, Lara is scheduled for a follow-up After discharge, Lara is scheduled for a follow-up evaluation at the outpatient clinic. A glycosylated Hgb evaluation at the outpatient clinic. A glycosylated Hgb level is drawn, and the results were 11%.level is drawn, and the results were 11%.

Which statement by Lara reflects understanding of Which statement by Lara reflects understanding of glycosylated Hgb?glycosylated Hgb?A) "The results of the test are probably high, because I A) "The results of the test are probably high, because I

was not fasting before my blood was drawn this was not fasting before my blood was drawn this morning."morning."

B) "The results of my test are probably high, because I B) "The results of my test are probably high, because I went to a party last night and did not follow my went to a party last night and did not follow my

diet."diet."C) "I know that I need to check my glycosolated Hgb C) "I know that I need to check my glycosolated Hgb before each meal and at bedtime, but I don’t always before each meal and at bedtime, but I don’t always have time."have time."D) "At least I won't have this done again for 3 months. D) "At least I won't have this done again for 3 months. I I will really work at following my diet between will really work at following my diet between now now

and then."and then."

21.

Lara tells the nurse that her 15-year-old sister had Lara tells the nurse that her 15-year-old sister had a fasting blood glucose test last week, because a fasting blood glucose test last week, because she felt that she had some of the same symptoms she felt that she had some of the same symptoms that Lara had before being diagnosed with that Lara had before being diagnosed with diabetes. Lara states her sister's results were 135 diabetes. Lara states her sister's results were 135 mg/dl.mg/dl.

How should the nurse respond?How should the nurse respond?

A) "She needs a second test performed before a A) "She needs a second test performed before a diagnosis diagnosis is made."is made."B) "Since her value is high, it sounds like both of B) "Since her value is high, it sounds like both of you you have have diabetes."diabetes."C) "Her value is low and indicates that she does C) "Her value is low and indicates that she does not have not have diabetes."diabetes."D) "She is too young to develop Type 1 diabetes. D) "She is too young to develop Type 1 diabetes. She She may have may have Type 2."Type 2."

•22.

Lara talks to the nurse about what to do if she Lara talks to the nurse about what to do if she gets sick. She states, "It just doesn’t make sense gets sick. She states, "It just doesn’t make sense to take my insulin when I feel sick, knowing I to take my insulin when I feel sick, knowing I won’t want to eat anything."won’t want to eat anything."

How should the nurse respond?How should the nurse respond?A) "You are right. You should not take your insulin A) "You are right. You should not take your insulin if you if you are feeling sick."are feeling sick."B) "Take only sliding-scale insulin, not your B) "Take only sliding-scale insulin, not your regular dose, regular dose, if you are feeling sick."if you are feeling sick."C) "Being sick increases your blood sugar. Taking C) "Being sick increases your blood sugar. Taking your your usual insulin dose is important."usual insulin dose is important."D) "When you are sick, you should test your urine D) "When you are sick, you should test your urine and and only take insulin if ketones are present."only take insulin if ketones are present."

23.

Which finding indicates that Lara is Which finding indicates that Lara is experiencing a complication of experiencing a complication of diabetes?diabetes?

A) Burning sensation in her toes.A) Burning sensation in her toes.B) Visual acuity of 60/20.B) Visual acuity of 60/20.C) Lack of protein in her urine.C) Lack of protein in her urine.D) Blood pressure of 110/60.D) Blood pressure of 110/60.