DIABETES

41. A 30-yr-old patient has a new diagnosis of type 2 diabetes. The nurse will discuss
the need to schedule a dilated eye examination

a. every 2 years.

b. as soon as possible.

c. when the patient is 39 years old.

d. within the first year after diagnosis.

ANS: B

Because many patients have some diabetic retinopathy when they are first diagnosed
with type 2 diabetes, a dilated eye examination is recommended at the time of diagnosis
and annually thereafter. Patients with type 1 diabetes should have dilated eye
examinations starting 5 years after they are diagnosed and then annually.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Planning
REF: 1149
MSC: NCLEX: Physiological Integrity
1. Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is
correct?
a. Insulin is not used to control blood glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
d. Type 2 diabetes is usually diagnosed when the patient is admitted with a
hyperglycemic coma.
ANS: C
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve
blood glucose control. Insulin is frequently used for type 2 diabetes, complications are
equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with
routine laboratory testing or after a patient develops complications such as frequent
yeast infections.

DIF: Cognitive Level: Understand (comprehension) REF: 1134

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
00:0200:53

4. The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of

type 1 diabetes. To which question would the nurse anticipate a positive response?
a. "Are you anorexic?"
b. "Is your urine dark colored?"
c. "Have you lost weight lately?"
d. "Do you crave sugary drinks?"
ANS: C
Weight loss occurs because the body is no longer able to absorb glucose and starts to
break down protein and fat for energy. The patient is thirsty but does not necessarily
crave sugar-containing fluids. Increased appetite is a classic symptom of type 1
diabetes. With the classic symptom of polyuria, urine will be very dilute.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Assessment

REF: 1121
MSC: NCLEX: Physiological Integrity
5. A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several
months from now. Which test will the nurse schedule to evaluate the effectiveness of
treatment for the patient?
a. Fasting blood glucose
b. Oral glucose tolerance
c Glycosylated hemoglobin
d. Urine dipstick for glucose
_ANS: C
The glycosylated hemoglobin (A1C) test shows the overall control of glucose over 90 to
120 days. A fasting blood level indicates only the glucose level at one time. Urine
glucose testing is not an accurate reflection of blood glucose level and does not reflect
the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose
diabetes but is not used for monitoring glucose control after diabetes has been
diagnosed.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Planning

REF: 1124
MSC: NCLEX: Physiological Integrity
6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a
body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for
this patient?
a. The patient will reach a glycosylated hemoglobin level of less than 7%.
b. The patient will follow a diet and exercise plan that results in weight loss.
c. The patient will choose a diet that distributes calories throughout the day.
d. The patient will state the reasons for eliminating simple sugars in the diet.
ANS: A
The complications of diabetes are related to elevated blood glucose and the most
important patient outcome is the reduction of glucose to near-normal levels. A BMI of
30?9?kg/m2 or above is considered obese, so the other outcomes are appropriate but
are not as high in priority.

DIF: Cognitive Level: Analyze (analysis) REF: 1124

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
7. A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM.
The clinic nurse will plan to teach the patient to

a. check glucose level before, during, and after swimming.

b. delay eating the noon meal until after the swimming class.
c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
d. time the morning insulin injection so that the peak occurs while swimming.
ANS: A
The change in exercise will affect blood glucose, and the patient will need to monitor
glucose carefully to determine the need for changes in diet and insulin administration.
Because exercise tends to decrease blood glucose, patients are advised to eat before
exercising. Increasing the morning NPH or timing the insulin to peak during exercise
may lead to hypoglycemia, especially with the increased exercise.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Planning

REF: 1132
MSC: NCLEX: Physiological Integrity
8. The nurse determines a need for additional instruction when the patient with newly
diagnosed type 1 diabetes says which of the following?

a. "I will need a bedtime snack because I take an evening dose of NPH insulin."
b. "I can choose any foods, as long as I use enough insulin to cover the calories."
c. "I can have an occasional beverage with alcohol if I include it in my meal plan."
d. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."
ANS: B
Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who
are using intensified insulin therapy have considerable flexibility in diet choices but still
should restrict dietary intake of items such as fat, protein, and alcohol. The other patient
statements are correct and indicate good understanding of the diet instruction.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Evaluation
REF: 1132
MSC: NCLEX: Physiological Integrity
10. Which statement by the patient indicates a need for additional instruction in
administering insulin?

a. "I need to rotate injection sites among my arms, legs, and abdomen each day."

b. "I can buy the 0.5-mL syringes because the line markings will be easier to see."

c. "I do not need to aspirate the plunger to check for blood before injecting insulin."
d. "I should draw up the regular insulin first, after injecting air into the NPH bottle."
ANS: A
Rotating sites is no longer recommended because there is more consistent insulin
absorption when the same site is used consistently. The other patient statements are
accurate and indicate that no additional instruction is needed.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Evaluation

REF: 1128
MSC: NCLEX: Health Promotion and Maintenance
11. Which patient action indicates good understanding of the nurse's teaching about
administration of aspart (NovoLog) insulin?
a. The patient avoids injecting the insulin into the upper abdominal area.
b. The patient cleans the skin with soap and water before insulin administration.
c. The patient stores the insulin in the freezer after administering the prescribed dose.
d. The patient pushes the plunger down while removing the syringe from the injection
site.
ANS: B
Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The
patient should leave the syringe in place for about 5 seconds after injection to be sure
that all the insulin has been injected. The upper abdominal area is one of the preferred
areas for insulin injection.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Evaluation

REF: 1128
MSC: NCLEX: Physiological Integrity
12. A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the
nurse anticipate the highest risk for hypoglycemia?
a. 10:00 AM c. 2:00 PM
b. 12:00 AM d. 4:0 PM
ANS: A
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for
hypoglycemia at the other listed times, although hypoglycemia may occur.
DIF: Cognitive Level: Understand (comprehension) REF: 1132
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
13. Which patient action indicates a good understanding of the nurse's teaching about
the use of an insulin pump?

a. The patient programs the pump for an insulin bolus after eating.
b. The patient changes the location of the insertion site every week.
c. The patient takes the pump off at bedtime and starts it again each morning.
d. The patient plans a diet with more calories than usual when using the pump.
ANS: A

In addition to the basal rate of insulin infusion, the patient will adjust the pump to
administer a bolus after each meal, with the dosage depending on the oral intake. The
insertion site should be changed every 2 or 3 days. There is more flexibility in diet and
exercise when an insulin pump is used, but it does not provide for consuming a higher
calorie diet. The pump will deliver a basal insulin rate 24 hours a day.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Evaluation

REF: 1129
MSC: NCLEX: Health Promotion and Maintenance
14. A patient with diabetes is starting on intensive insulin therapy. Which type of insulin
will the nurse discuss using for mealtime coverage?

a. Lispro (Humalog)
b. Glargine (Lantus)
c. Detemir (Levemir)
d. NPH (Humulin N)
ANS: A
Rapid- or short- acting insulin is used for mealtime coverage for patients receiving
intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Planning

REF: 1125
MSC: NCLEX: Physiological Integrity
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15. Which information will the nurse include when teaching a patient who has type 2
diabetes about glyburide ?

a. Glyburide decreases glucagon secretion from the pancreas.

b. Glyburide stimulates insulin production and release from the pancreas.
c. Glyburide should be taken even if the morning blood glucose level is low.
d. Glyburide should not be used for 48 hours after receiving IV contrast media.
ANS: B
The sulfonylureas stimulate the production and release of insulin from the pancreas. If
the glucose level is low, the patient should contact the health care provider before
taking glyburide because hypoglycemia can occur with this class of medication.
Metformin should be held for 48 hours after administration of IV contrast media, but this
is not necessary for glyburide. Glucagon secretion is not affected by glyburide.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Implementation
REF: 1130
MSC: NCLEX: Physiological Integrity
16. The nurse has been teaching a patient with type 2 diabetes about managing blood
glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need
for additional teaching?
a. "If I overeat at a meal, I will still take the usual dose of med.."
b. "Other med. besides the Glucotrol may affect my blood sugar."
c. "When I am ill, I may have to take insulin to control my blood sugar."
d. "My diabetes won't cause complications because I don't need insulin."
ANS: D
The patient should understand that type 2 diabetes places the patient at risk for many
complications and that good glucose control is as important when taking oral agents as
when using insulin. The other statements are accurate and indicate good understanding
of the use of glipizide.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Evaluation

REF: 1130
MSC: NCLEX: Physiological Integrity
17. When a patient who takes metformin (Glucophage) to manage type 2 diabetes
develops an allergic rash from an unknown cause, the health care provider prescribes
prednisone. The nurse will anticipate that the patient may

a. need a diet higher in calories while receiving prednisone.

b. develop acute hypoglycemia while taking the prednisone.
c. require administration of insulin while taking prednisone.
d. have rashes caused by metformin-prednisone interactions.
ANS: C
Glucose levels increase when patients are taking corticosteroids, and insulin may be
required to control blood glucose. Hypoglycemia is not a side effect of prednisone.
Rashes are not an adverse effect caused by taking metformin and prednisone
simultaneously. The patient may have an increased appetite when taking prednisone
but will not need a diet that is higher in calories.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Planning

REF: 1124
MSC: NCLEX: Physiological Integrity
18. A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM,
the patient has been away from the nursing unit for 2 hours, missing the lunch delivery
while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to
a. save the lunch tray for the patient's later return to the unit.
b. ask that diagnostic testing area staff to start a 5% dextrose IV.
c. send a glass of milk or orange juice to the patient in the diagnostic testing area.
d. request that if testing is further delayed, the patient be returned to the unit to eat.
ANS: D
Consistency for mealtimes assists with regulation of blood glucose, so the best option is
for the patient to have lunch at the usual time. Waiting to eat until after the procedure is
likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive
for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic
but will cause a rapid rise in blood glucose because of the rapid absorption of the simple
carbohydrate in these items.

DIF: Cognitive Level: Analyze (analysis)

TOP: Nursing Process: Implementation
MSC:
REF: 1127
NCLEX: Physiological Integrity
20. The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2
diabetes about home management of the disease. Which action should the nurse take
first?

a. Ask the patient's family to participate in the diabetes education program.

b. Assess the patient's perception of what it means to have diabetes mellitus.
c. Demonstrate how to check glucose using capillary blood glucose monitoring.
d. Discuss the need for the patient to actively participate in diabetes management.
ANS: B
Before planning teaching, the nurse should assess the patient's interest in and ability to
self-manage the diabetes. After assessing the patient, the other nursing actions may be
appropriate, but planning needs to be individualized to each patient.

DIF: Cognitive Level: Analyze (analysis) REF: 1139

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
21. An unresponsive patient with type 2 diabetes is brought to the emergency
department and
diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate
the need to
a. give 50% dextrose.

b. insert an IV catheter.
c. initiate O2 by nasal cannula.

d. administer glargine (Lantus) insulin.

ANS: B
HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular
insulin is administered, not a long-acting insulin. There is no indication that the patient
requires O2. Dextrose solutions will increase the patient's blood glucose and would be
contraindicated.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Planning

REF: 1145
MSC: NCLEX: Physiological Integrity
19. The nurse identifies a need for additional teaching when the patient who is self-
monitoring blood glucose
a. washes the puncture site using warm water and soap.
b. chooses a puncture site in the center of the finger pad.
c. hangs the arm down for a minute before puncturing the site.
d. says the result of 120 mg indicates good blood sugar control.
ANS: B
The patient is taught to choose a puncture site at the side of the finger pad because
there are fewer nerve endings along the side of the finger pad. The other patient actions
indicate that teaching has been effective.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Evaluation
REF: 1136
MSC: NCLEX: Health Promotion and Maintenance
22. A 26-yr-old female with type 1 diabetes develops a sore throat and runny nose after
caring for her sick toddler. The patient calls the clinic for advice about her symptoms
and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and
lispro (Humalog) insulin. The nurse advises the patient to

a. use only the lispro insulin until the symptoms are resolved.
b. limit intake of calories until the glucose is less than 120 mg/dL.
c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
ANS: C
Infection and other stressors increase blood glucose levels and the patient will need to
test blood glucose frequently, treat elevations appropriately with lispro insulin, and call
the health care provider if glucose levels continue to be elevated. Discontinuing the
glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA).
Decreasing carbohydrate or caloric intake is not appropriate because the patient will
need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate
short-term alterations in blood glucose.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Implementation

REF: 1139
MSC: NCLEX: Physiological Integrity
42. After the nurse has finished teaching a patient who has a new prescription for
exenatide (Byetta), which patient statement indicates that the teaching has been
effective?

a. "I may feel hungrier than usual when I take this medicine."
b. "I will not need to worry about hypoglycemia with the Byetta."
c. "I should take my daily aspirin at least an hour before the Byetta."
d. "I will take the pill at the same time I eat breakfast in the morning."
ANS: C
Because exenatide slows gastric emptying, oral medications should be taken at least 1
hour before the exenatide to avoid slowing absorption. Exenatide is injected and
increases feelings of satiety. Hypoglycemia can occur with this medication.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Evaluation
REF: 1132
MSC: NCLEX: Physiological Integrity
43. A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has
been placed on metformin (Glucophage) therapy and taught about appropriate diet and
exercise, the home health nurse makes a visit. Which finding should the nurse promptly
discuss with the health care provider?

a. Hemoglobin A1C level is 7.9%.

b. Last eye examination was 18 months ago.
c. Glomerular filtration rate is decreased.
d. Patient has questions about the prescribed diet.
ANS: C
The decrease in renal function may indicate a need to adjust the dose of metformin or
change to a different medication. In older patients, the goal for A1C may be higher in
order to avoid complications associated with hypoglycemia. The nurse will plan on
scheduling the patient for an eye examination and addressing the questions about diet,
but the area for prompt intervention is the patient's decreased renal function.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Assessment
REF: 1130
MSC: NCLEX: Physiological Integrity
25. Which question during the assessment of a patient who has diabetes will help the
nurse identify autonomic neuropathy?

a. "Do you feel bloated after eating?"

b. "Have you seen any skin changes?"
c. "Do you need to increase your insulin dosage when you are stressed?"
d. "Have you noticed any painful new ulcerations or sores on your feet?"
ANS: A
Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated
feeling for the patient. The other questions are also appropriate to ask but would not
help in identifying autonomic neuropathy.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Assessment
REF: 1150
MSC: NCLEX: Physiological Integrity
44. The nurse has administered 4 oz of orange juice to an alert patient whose blood
glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which
action should the nurse take next?

a. Give the patient 4 to 6 oz more orange juice.

b. Administer the PRN glucagon (Glucagon) 1 mg IM.
c. Have the patient eat some peanut butter with crackers.
d. Notify the health care provider about the hypoglycemia.
ANS: A

The "rule of 15" indicates that administration of quickly acting carbohydrates should be
done two or three times for a conscious patient whose glucose remains less than 70
mg/dL before notifying the health care provider. More complex carbohydrates and fats
may be used after the glucose has stabilized. Glucagon should be used if the patient's
level of consciousness decreases so that oral carbohydrates can no longer be given.

DIF: Cognitive Level: Analyze (analysis)

OBJ: Special Questions: Prioritization
TOP:
REF: 1146
Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
26. Which information will the nurse include in teaching a female patient who has
peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and
legs?

a. Choose flat-soled leather shoes.

b. Set heating pads on a low temperature.
c. Use callus remover for corns or calluses.
d. Soak feet in warm water for an hour each day.
ANS: A
The patient is taught to avoid high heels and that leather shoes are preferred. The feet
should be washed, but not soaked, in warm water daily. Heating pad use should be
avoided. Commercial callus and corn removers should be avoided. The patient should
see a specialist to treat these problems.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Implementation
REF: 1151
MSC: NCLEX: Physiological Integrity
45. Which nursing action can the nurse delegate to experienced unlicensed assistive
personnel (UAP) who are working in the diabetic clinic?

a. Measure the ankle-brachial index.

b. Check for changes in skin pigmentation.
c. Assess for unilateral or bilateral foot drop.
d. Ask the patient about symptoms of depression.
ANS: A
Checking systolic pressure at the ankle and brachial areas and calculating the ankle-
brachial index is a procedure that can be done by UAP who have been trained in the
procedure. The other assessments require more education and critical thinking and
should be done by the registered nurse (RN).

DIF: Cognitive Level: Apply (application) REF: 1152

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
27. Which finding indicates a need to contact the health care provider before the nurse
administers metformin (Glucophage)?

a. The patient's blood glucose level is 174 mg/dL.

b. The patient is scheduled for a chest x-ray in an hour.
c. The patient has gained 2 lb (0.9 kg) in the past 24 hours.
d. The patient's blood urea nitrogen (BUN) level is 52 mg/dL.
ANS: A
The patient is taught to avoid high heels and that leather shoes are preferred. The feet
should be washed, but not soaked, in warm water daily. Heating pad use should be
avoided. Commercial callus and corn removers should be avoided. The patient should
see a specialist to treat these problems.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Implementation
REF: 1151
MSC: NCLEX: Physiological Integrity
46. After change-of-shift report, which patient will the nurse assess first?

a. A 19-yr-old patient with type 1 diabetes who was admitted with possible dawn
phenomenon
b. A 35-yr-old patient with type 1 diabetes whose most recent blood glucose reading
was 230 mg/dL
c. A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin
turgor and dry oral mucosa
d. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and
complains of burning foot pain
ANS: C
The patient's diagnosis of HHS and signs of dehydration indicate that the nurse should
rapidly assess for signs of shock and determine whether increased fluid infusion is
needed. The other patients also need assessment and intervention but do not have life-
threatening complications.

DIF: Cognitive Level: Analyze (analysis) REF: 1146

OBJ: Special Questions: Multiple Patients | Special Questions: Prioritization
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
28. A patient who has diabetes and reported burning foot pain at night receives a new
prescription. Which information should the nurse teach the patient about amitriptyline ?

a. Amitriptyline decreases the depression caused by your foot pain.

b. Amitriptyline helps prevent transmission of pain impulses to the brain.
c. Amitriptyline corrects some of the blood vessel changes that cause pain.
d. Amitriptyline improves sleep and makes you less aware of nighttime pain.
ANS: B
Tricyclic antidepressants (TCAs) decrease the transmission of pain impulses to the
spinal cord and brain. TCAs also improve sleep quality and are used for depression, but
that is not the major purpose for their use in diabetic neuropathy. The blood vessel
changes that contribute to neuropathy are not affected by TCAs.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Implementation
REF: 1150
MSC: NCLEX: Physiological Integrity
47. After change-of-shift report, which patient should the nurse assess first?

a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12%
b. A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL
c. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202
mg/dL

d. A 50-yr-old patient who uses exenatide (Byetta) and is complaining of acute

abdominal pain
ANS: B
Because the brain requires glucose to function, untreated hypoglycemia can cause
unconsciousness, seizures, and death. The nurse will rapidly assess and treat the
patient with low blood glucose. The other patients also have symptoms that require
assessments or interventions, but they are not at immediate risk for life-threatening
complications.

DIF: Cognitive Level: Analyze (analysis) REF: 1146

OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
29. A patient who has type 2 diabetes is being prepared for an elective coronary
angiogram. Which information would the nurse anticipate might lead to rescheduling the
test?

a. The patient's most recent A1C was 6.5%.

b. The patient's blood glucose is 128 mg/dL.
c. The patient took the prescribed metformin today.
d. The patient took the prescribed captopril this
morning.
ANS: C
To avoid lactic acidosis, metformin should be discontinued a day or 2 before the
coronary angiogram and should not be used for 48 hours after IV contrast media are
administered. The other patient data will also be reported but do not indicate any need
to reschedule the procedure.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: AssessmREF: 1130
MSC: NCLEX: Physiological Integrity
1. To monitor for complications in a patient with type 2 diabetes, which tests will the
nurse in the diabetic clinic schedule at least annually (select all that apply)?

a. Chest x-ray
b. Blood pressure
c. Serum creatinine
d. Urine for microalbuminuria
e. Complete blood count (CBC)
f. Monofilament testing of the foot
ANS: B, C, D, F
Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament
testing of the foot are recommended at least annually to screen for possible
microvascular and macrovascular complications of diabetes. Chest x-ray and CBC
might be ordered if the patient with diabetes presents with symptoms of respiratory or
infectious problems but are not routinely included in screening.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Planning
REF: 1148
MSC: NCLEX: Physiological Integrity
30. Which action by a patient indicates that the home health nurse's teaching about
glargine and regular insulin has been successful?

a. The patient administers the glargine 30 minutes before each meal.

b. The patient's family prefills the syringes with the mix of insulins weekly.
c. The patient discards the open vials of glargine and regular insulin after 4 weeks.
d. The patient draws up the regular insulin and then the glargine in the same syringe.
ANS: C
Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed
with other insulins or prefilled and stored. Short-acting regular insulin is administered
before meals, and glargine is given once daily.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation
REF: 1127
MSC: NCLEX: Physiological Integrit
1. In which order will the nurse take these steps to prepare NPH 20 units and regular
insulin 2 units using the same syringe? (Put a comma and a space between each
answer choice [A, B, C, D, E]).
a. Rotate NPH vial.
b. Withdraw regular insulin.
c. Withdraw 20 units of NPH.
d. Inject 20 units of air into NPH vial.
e. Inject 2 units of air into regular insulin vial.
ANS:
A,D,E,B,C

When mixing regular insulin with NPH, it is important to avoid contact between the
regular insulin and the additives in the NPH that slow the onset, peak, and duration of
activity in the longer-acting insulin.

DIF: Cognitive Level: Analyze (analysis)

OBJ: Special Questions: Prioritization

TOP:
REF: 1126
Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
31. A patient with diabetes rides a bicycle to and from work every day. Which site
should the nurse teach the patient to use to administer the morning insulin?

a. thigh.
b. buttock.
c. abdomen.
d. upper arm.
ANS: C
Patients should be taught not to administer insulin into a site that will be exercised
because exercise will increase the rate of absorption. The thigh, buttock, and arm are all
exercised by riding a bicycle.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Implementation
REF: 1128
MSC: NCLEX: Physiological Integrit
32. The nurse is interviewing a new patient with diabetes who takes rosiglitazone
(Avandia). Which information would the nurse anticipate resulting in the health care
provider discontinuing the medication?

a. The patient's blood pressure is 154/92.

b. The patient's blood glucose is 86 mg/dL.
c. The patient reports a history of emphysema.
d. The patient has chest pressure when walking.
ANS: D
Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the
health care provider and expect orders to discontinue the medication. A blood glucose
level of 86 mg/dL indicates a positive effect from the medication. Hypertension and a
history of emphysema do not contraindicate this medication.

DIF: Cognitive Level: Apply (application) REF: 1130

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
33. The nurse is taking a health history from a 29-yr-old pregnant patient at the first
prenatal visit. The patient reports that she has no personal history of diabetes, but her
mother has diabetes. Which action will the nurse plan to take?

a. Teach the patient about administering regular insulin.

b. Schedule the patient for a fasting blood glucose level.
c. Teach about an increased risk for fetal problems with gestational diabetes.
d. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.
ANS: B
Patients at high risk for gestational diabetes should be screened for diabetes on the
initial prenatal visit. An oral glucose tolerance test may also be used to check for
diabetes, but it would be done before the twenty-fourth week. Teaching plans would
depend on the outcome of a fasting blood glucose test and other tests.

DIF: Cognitive Level: Apply (application) REF: 1138

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
34. A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose
level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by
the health care provider should the nurse take first?

a. Place the patient on a cardiac monitor.

b. Administer IV potassium supplements.
c. Ask the patient about home insulin doses.
d. Start an insulin infusion at 0.1 units/kg/hr.
ANS: A
Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia
and ventricular fibrillation, which would be detected with electrocardiogram (ECG)
monitoring. Because potassium must be infused over at least 1 hour, the nurse should
initiate cardiac monitoring before infusion of potassium. Insulin should not be
administered without cardiac monitoring because insulin infusion will further decrease
potassium levels. Discussion of home insulin and possible causes can wait until the
patient is stabilized.

DIF: Cognitive Level: Analyze (analysis) REF: 1146

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
35. A patient with diabetic ketoacidosis is brought to the emergency department. Which
prescribed action should the nurse implement first?

a. Infuse 1 L of normal saline per hour.

b. Give sodium bicarbonate 50 mEq IV push.
c. Administer regular insulin 10 U by IV push.
d. Start a regular insulin infusion at 0.1 units/kg/hr.
ANS: A

The most urgent patient problem is the hypovolemia associated with diabetic
ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be done
after the infusion of normal saline is initiated.

DIF: Cognitive Level: Analyze (analysis)

OBJ: Special Questions: Prioritization
TOP:
REF: 1144
Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
36. A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract
infection has been weaned off an insulin drip 30 minutes ago. The patient reports
feeling lightheaded and sweaty. Which action should the nurse take first?

a. Infuse dextrose 50% by slow IV push.

b. Administer 1 mg glucagon subcutaneously.
c. Obtain a glucose reading using a finger stick.
d. Have the patient drink 4 ounces of orange juice.
ANS: C
The patient's clinical manifestations are consistent with hypoglycemia, and the initial
action should be to check the patient's glucose with a finger stick or order a stat blood
glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate,
such as orange juice. Glucagon or dextrose 50% might be given if the patient's
symptoms become worse or if the patient is unconscious.

DIF: Cognitive Level: Analyze (analysis)

OBJ: Special Questions: Prioritization
TOP:
REF: 1135
Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
37. A female patient is scheduled for an oral glucose tolerance test. Which information
from the patient's health history is important for the nurse to communicate to the health
care provider regarding this test?

a. The patient uses oral contraceptives.

b. The patient runs several days a week.
c. The patient has been pregnant three times.
d. The patient has a family history of diabetes.
ANS: A
Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values.
Exercise and a family history of diabetes both can affect blood glucose but will not lead
to misleading information from the OGTT. History of previous pregnancies may provide
informational about gestational glucose tolerance but will not lead to misleading
information from the OGTT.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Assessment
REF: 1124
MSC: NCLEX: Physiological Integrity
38. Which laboratory value reported to the nurse by the unlicensed assistive personnel
(UAP) indicates an urgent need for the nurse's assessment of the patient?

a. Bedtime glucose of 140 mg/dL

b. Noon blood glucose of 52 mg/dL
c. Fasting blood glucose of 130 mg/dL
d. 2-hr postprandial glucose of 220 mg/dL
ANS: B

The nurse should assess the patient with a blood glucose level of 52 mg/dL for
symptoms of hypoglycemia and give the patient a carbohydrate- containing beverage
such as orange juice. The other values are within an acceptable range or not
immediately dangerous for a patient with diabetes.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Assessment
REF: 1152
MSC: NCLEX: Physiological Integrity
39. When a patient with type 2 diabetes is admitted for a cholecystectomy, which
nursing action can the nurse delegate to a licensed practical/vocational nurse
(LPN/LVN)?

a. Communicate the blood glucose level and insulin dose to the circulating nurse in
surgery.
b. Discuss the reason for the use of insulin therapy during the immediate postoperative
period.
c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to
surgery.
d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the
postoperative period.
ANS: C
LPN/LVN education and scope of practice includes administration of insulin.
Communication about patient status with other departments, planning, and patient
teaching are skills that require RN education and scope of practice.

DIF: Cognitive Level: Apply (application) REF: 1152

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
40. An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine
clinic. Which finding indicates a need for the nurse to discuss a possible a change in
therapy with the health care provider?

a. Hemoglobin A1C level of 6.2%

b. Blood pressure of 140/88 mmHg
c. Heart rate at rest of 58 beats/minute
d. High density lipoprotein (HDL) level of 65 mg/dL
ANS: B
To decrease the incidence of macrovascular and microvascular problems in patients
with diabetes, the goal blood pressure is usually 130/80 mm Hg. An A1C less than
6.5%, a low resting heart rate (consistent with regular aerobic exercise in a young
adult), and an HDL level of 65 mg/dL all indicate that the patient's diabetes and risk
factors for vascular disease are well controlled.

DIF: Cognitive Level: Apply (application)

TOP: Nursing Process: Assessment
REF: 1148
MSC: NCLEX: Physiological Integrity
The nurse 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.
ANS: 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.
he 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%
b. < 130 mg/dl
00:0200:53

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
b. Unlimited intake of total fat, saturated fat and cholesterol
The nurse working in the physician's 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 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. Greater than 106 mg/dl

b. Greater than 126 mg/dl
c. Higher than 140 mg/dl
d. Higher than 160 mg/dl
d. Higher than 160 mg/dl
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 of diabetes type I and
require follow-up investigation?

a. Excessive intake of calories, rapid weight gain, and difficulty losing weight

b. Poor circulation, wound healing, and leg ulcers,

c. Lack of energy, weight gain, and depression

d. An increase in three areas: thirst, intake of fluids, and hunger

D. 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).
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
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.
When working in the 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 woman who is at 90% of standard body weight after delivering an eight-pound baby

b. A middle-aged Caucasian male

c. An older client who is hypotensive

d. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl
d. 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.
The nurse assisting in the admission of a client with diabetic ketoacidosis will anticipate
the physician ordering which of the following types of intravenous solution if the client
cannot take fluids orally?

a. 0.45% normal saline solution

b. Lactated Ringer's solution
c. 0.9 normal saline solution
d. 5% dextrose in water (D5W)
a. 0.45% normal saline solution
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. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea
drug

d. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of
hypoglycemia
D. 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.
Which of the following things must the nurse working with diabetic clients keep in mind
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

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.
Which one of the following methods/techniques will the nurse use when giving insulin to
a thin person? [Hint]

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
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.
The nurse is performing discharge teaching for a patient with Addison's disease. It is
MOST important for the nurse to instruct the patient about:

a. signs and symptoms of infection

b. fluid and electrolyte balance
c. seizure precautions
d. steroid replacement
d. steroid replacement

steroid replacement is the most important information the client needs to know.
Risk factors for type 2 diabetes include all of the following except:

a. Advanced age
b. Obesity
c. Smoking
d. Physical inactivity
C: 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.
Prediabetes is associated with all of the following except:

a. Increased risk of developing type 2 diabetes

b. Impaired glucose tolerance
c. Increased risk of heart disease and stroke
d. Increased risk of developing type 1 diabetes
D: Increased risk of developing type 1 diabetes

Persons with elevated glucose levels that do not yet meet the criteria for diabetes are
considered to have prediabetes and are at increased risk of developing type 2 diabetes.
Weight loss and increasing physical activity can help people with prediabetes prevent or
postpone the onset of type 2 diabetes.
Blood sugar is well controlled when Hemoglobin A1C is:

a. Below 7%
b. Between 12%-15%
c. Less than 180 mg/dL
d. Between 90 and 130 mg/dL
a. Below 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.
Proliferative retinopathy is often treated using:

a. Tonometry
b. Fluorescein angiogram
c. Antibiotics
d. Laser surgery
d. Laser surgery

Scatter laser treatment is used to shrink abnormal blood vessels in an effort to preserve
vision. When there is significant bleeding in the eye, it is removed in a procedure known
as vitrectomy. Tonometry is a diagnostic test that measures pressure inside the eye. A
fluorescein angiogram is a diagnostic test that traces the flow of dye through the blood
vessels in the retina; it is used to detect macular edema.
Which of the following diabetes drugs acts by decreasing the amount of glucose
produced by the liver?

a. Sulfonylureas
b. Meglitinides
c. Biguanides
d. Alpha-glucosidase inhibitors
c. 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
Physician's orders for a client with acute pancreatitis include the following: strict NPO,
NG tube to low intermittent suction. The nurse recognizes that these interventions will:
a. Reduce the secretion of pancreatic enzymes
b. Decrease the client's need for insulin
c. Prevent secretion of gastric acid
d. Eliminate the need for analgesia
a. Reduce the secretion of pancreatic enzymes
The nurse is planning dietary changes for a client following an episode of pancreatitis.
Which diet is suitable for the client?

a. Low calorie, low carbohydrate

b. High calorie, low fat

c. High protein, high fat

d. Low protein, high carbohydrate

b. High calorie, low fat
A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A
nurse checking the patient's lab results would expect which of the following changes in
laboratory findings?

A. Elevated serum calcium.

B. Low serum parathyroid hormone (PTH).
C. Elevated serum vitamin D.
D. Low urine calcium.
Answer: A

The parathyroid glands regulate the calcium level in the blood.

In hyperparathyroidism, the serum calcium level will be elevated.

Parathyroid hormone levels may be high or normal but not low.

The body will lower the level of vitamin D in an attempt to lower calcium. Urine calcium
may be elevated, with calcium spilling over from elevated serum levels. This may cause
renal stones.
The nurse is caring for the client diagnosed with ascites from hepatic cirrhosis. What
information should the nurse report to the health-care provider?

a. A decrease in the client's daily weight of one (1) pound.

b. An increase in urine output after administration of a diuretic.
c. An increase in abdominal girth of two (2) inches.
d. A decrease in the serum direct bilirubin to 0.6 mg/dL.
c. An increase in abdominal girth of two (2) inches.

Rationale: An increase in abdominal girth would indicate that the ascites is increasing,
meaning that the client's condition is becoming more serious and should be reported to
the health-care provider.
The nurse is caring for a client with cirrhosis of the liver. The client has developed
ascites and requires a paracentesis. Which of the following symptoms is associated with
ascites and should be relieved by the paracentesis?

A. Pruritus.
B. Dyspnea.
C. Jaundice.
D. Peripheral neuropathy.
Correct answer: B

Ascites (fluid buildup in the abdomen) puts pressure on the diaphragm, resulting in
difficulty breathing and dyspnea. Paracentesis (surgical puncture of the abdominal
cavity to aspirate fluid) is done to remove fluid from the abdominal cavity and thus
reduce pressure on the diaphragm in order to relieve the dyspnea. Pruritus, jaundice,
and peripheral neuropathy are signs of cirrhosis that aren't relieved or treated by
paracentesis.
A client is admitted to the medical-surgical floor with a diagnosis of acute pancreatitis.
His blood pressure is 136/76 mm Hg, pulse 96 beats/minute, respirations 22
breaths/minute, temperature 99°F (38.3°C), and he has been experiencing severe
vomiting for 24 hours. His past medical history reveals hyperlipidemia and alcohol
abuse. The physician prescribes a nasogastric (NG) tube for the client. Which of the
following is the primary purpose for insertion of the NG tube?

A. Empty the stomach of fluids and gas to relieve vomiting.

B. Prevent spasms at the sphincter of Oddi.
C. Prevent air from forming in the small and large intestines.
D. Remove bile from the gallbladder.
Correct answer: A

An NG tube is no longer routinely inserted to treat pancreatitis, but if the client has
protracted vomiting, the NG tube is inserted to drain fluids and gas and relieve vomiting.

An NG tube doesn't prevent spasms at the sphincter of Oddi (a valve in the duodenum
that controls the flow of digestive enzymes) or prevent air from forming in the small and
large intestine.

The common bile duct connects to the pancreas and the gall bladder, and a T tube
rather than an NG tube would be used to collect bile drainage from the common bile
duct.
A 37-year-old forklift operator presents with shakiness, sweating, anxiety, and
palpitations and tells the nurse he has type 1 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.
Correct answer: C

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.
A client with cirrhosis of the liver develops ascites. Which of the following orders would
the nurse expect?

A. Restrict fluid to 1000 mL per day.

B. Ambulate 100 ft. three times per day.
C. High-sodium diet.
D. Maalox 30 ml P.O. BID.
Correct answer: A

Fluid restriction is a primary treatment for ascites. Restricting fluids decreases the
amount of fluid present in the body, thereby decreasing the fluid that accumulates in the
peritoneal space.

A high sodium diet would increase fluid retention. Physical activities are usually
restricted until ascites is relieved.

Loop diuretics (such as furosemide) are usually ordered, and Maalox® (a bismuth
subsalicylate) may interfere with the action of the diuretics.
A client who recently underwent cranial surgery develops syndrome of inappropriate
antidiuretic hormone (SIADH). Which of the following symptoms should the nurse
anticipate?
A. Edema and weight gain.
B. Excessive urinary output.
C. Fluid loss and dehydration.
D. Low urine specific gravity.
Correct answer: A

Syndrome of inappropriate antidiuretic hormone (SIADH) results in an abnormally high

release of antidiuretic hormone, which causes water retention as serum sodium levels
fall, leading to edema and weight gain. Because of fluid retention, urine output is low.

Fluid is restricted to prevent fluid overload rather than replaced. As the urine becomes
more concentrated, the specific gravity increases. Other symptoms include nausea,
vomiting, seizures, altered mentation, and coma.

SIADH is most common with diseases of the hypothalamus but can also occur with
heart failure, Guillain-Barré syndrome, meningitis, encephalitis, head trauma, or brain
tumors. It may also be triggered by medications.
The nurse is doing teaching with the family of a client with liver failure. Which of the
following foods should the nurse advise them to limit in the client's diet?

A. Meats and beans.

B. Butter and gravies.
C. Potatoes and pasta.
D. Cakes and pastries.
Correct answer: A

Meats and beans are high-protein foods and are restricted with liver failure.

In liver failure, the liver is unable to metabolize protein adequately, causing protein by-
products to build up in the body rather than be excreted.

This causes problems such as hepatic encephalopathy (neurologic syndrome that

develops as a result of rising blood ammonia levels). Although other nutrients, such as
fat and carbohydrates, may be regulated, it's most important to limit protein in the diet of
the client with liver failure.
Colon cancer is most closely associated with which of the following conditions?

a. appendicitis
b. hemorroids
c. hiatal hernia
d. ulcerative colitis
d. ulcerative colitis

Chronic ulcerative colitis, granulomas, and familial polyps seem to increase a person's
chance of developing colon cancer. The other conditions listed have no known effect on
the colon cancer risk.
Which of the following diets is most commonly associated with colon cancer?

a. low fiber, high fat

b. low fat high fiber
c. low protein, high carb
d. low carb, high protein
a. a. low fiber, high fat

low fiber, high fat diet reduced motility and increases the chance of constipation. The
metabolic end products of this type of diet are carcinogenic. A LOW FAT HIGH FIBER
diet is recommended to help avoid colon cancer. Carbohydrates and protein aren't
necessarily associated with colon cancer.
Which of the following diagnostic tests should be performed annually over age 50 to
screen for colon cancer?
a. Abdominal CT scan
b. Abdominal x-ray
c. Colonoscopy
d. Fecal occult blood test
d. Fecal occult blood test

Surface blood vessels of polyps and cancers are fragile and often bleed with the
passage of stools.

Abdominal x-ray and CT scan can help establish tumor size and metastasis.

A colonoscopy can help locate a tumor as well as polyps, which can be removed before
they become malignant.
Radiation therapy is used to treat colon cancer before surgery for which of the following
reasons?

a. Reducing the size of the tumor

b. Eliminating the malignant cells
c. Curing the cancer
d. Helping the bowel heal after surgery
a. Reducing the size of the tumor

Radiation therapy is used to treat colon cancer before surgery to reduce the size of the
tumor, making it easier to be resected.

Radiation therapy isn't curative, can't eliminate the malignant cells (though it helps
define tumor margins), can could slow postoperative healing.
Which of the following symptoms is a client with colon cancer most likely to exhibit?

a. A change in appetite
b. A change in bowel habits
c. An increase in body weight
d. An increase in body temperature
b. A change in bowel habits

The most common complaint of the client with colon cancer is a change in bowel habits.

The client may have anorexia, secondary abdominal distention, or weight loss.

Fever isn't associated with colon cancer.

A client has just had surgery for colon cancer. Which of the following disorders might
the client develop?

a. Peritonitis
b. Diverticulosis
c. Partial bowel obstruction
d. Complete bowel obstruction
a. Peritonitis

Bowel spillage could occur during surgery, resulting in peritonitis. Complete or partial
bowel obstruction may occur before bowel resection. Diverticulosis doesn't result from
surgery or colon cancer.
A 60 year old patient has an abrupt onset of anorexia, nausea and vomiting,
hepatomegaly, and abnormal liver function studies. Serologic testing is negative for viral
causes of hepatitis. During assessment of the patient, it is most important for the nurse
to question the patient regarding

A. any prior exposure to people with jaundice

B. the use of all prescription and OTC (over the counter) medications
C. treatment of chronic diseases with corticosteriods
D. exposure to children recently immunized for hepatitis B
A and D assess for exposure to hepatitis. Hepatitis was ruled out this is inappropriate.

C is incorrect because corticosteroids do not commonly cause liver disease

B is correct because overdose of medications can cause liver disease.

A patient with cirrhosis is being treated with spironolactone (Aldactone) tid and
furosemide (Lasix) bid. The patient's most recent laboratory results indicate a serum
sodium of 134 mEq/L (134 mmol/L) and a serum potassium of 3.2 mEq/L (3.2 mmol/L).
Before notifying the physician, the nurse should

A. administer only the furosemide

B. administer both drugs as ordered
C. administer only the spironolactone
D. Withhold the furosemide and spironolactone
C. administer only the spironolactone

The potassium level is dangerously low. Lasix is potassium depleting, while

spironolactone is potassium sparing. You would hold the Lasix and call the physician.
This is a good NCLEX question that integrates this course with pharmacology.
When obtaining a health history from a patient with acute pancreatitis, the nurse asks
the patient specifically about a history of

A. smoking
B. alcohol use
C. diabetes mellitus
D. high-fat dietary intake
Answer: B pancreatitis is associated with alcoholism
After having a transverse colostomy constructed for colon cancer, discharge planning
for home care would include teaching about the ostomy appliance. Information
appropriate for this intervention would include:

a. Instructing the client to report redness, swelling, fever, or pain at the site to the
physician for evaluation of infection

b. Nothing can be done about the concerns of odor with the appliance.

c. Ordering appliances through the client's health care provider

d. The appliance will not be needed when traveling.

a. Instructing the client to report redness, swelling, fever, or pain at the site to the
physician for evaluation of infection

Signs and symptoms for monitoring infection at the ostomy site are a priority evaluation
for clients with new ostomies. The remaining actions are not appropriate. There are
supplies avaliable for clients to help control odor that may be incurred because of the
ostomy. Although a prescription for ostomy supplies is needed, you can order the
supplies from any medical supplier. Dependent on the location and trainability of the
ostomy, appliances are almost always worn throughout the day and when traveling
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) continuously infuses small amounts of NPH insulin into the bloodstream while
regularly monitoring blood glucose levels

c) is surgically attached to the pancreas and infuses regular insulin into the pancreas,
which in turn releases the insulin into the bloodstream
d) gives a small continuously dose of regular insulin subcutaneously, and the client can
self-administer a bolus with an additional dose form the pump before each meal
D.) gives a small continuously dose of regular insulin subcutaneously, and the client can
self-administer a bolus with an additional dose form 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.
A client is brought to the emergency room in an unresponsive state, and a diagnosis of
hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would
immediately prepare to initiate which of the following anticipated physician's orders?

a) endotracheal intubation
b) 100 units of NPH insulin
c) intravenous infusion of normal saline
d) intravenous infusion of sodium bicarbonate
c) intravenous infusion of normal saline

The primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome

(HHNS) is to rehydrate the client to restore fluid volume and to correct electrolyte
deficiency.

Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis

(DKA) and begins with IV infusion of normal saline.

Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate
to correct acidosis is avoided because it can precipitate a further drop in serum
potassium levels. Intubation and mechanical ventilation are not required to treat HHNS.
client newly diagnosed with diabetes mellitus has been stabilized with daily insulin
injections. A nurse prepares a discharge teaching plan regarding the insulin and plans
to reinforce which of the following concepts?

a) always keep insulin vials refrigerated

b) ketones in the urine signify a need for less insulin
c) increase the amount of insulin before unusual exercise
d) systematically rotate insulin injections within one anatomic site
d) systematically rotate insulin injections within one anatomic site

Insulin doses should not be adjusted nor increased before unusual exercise. If ketones
are found in the urine, it possibly may indicate the need for additional insulin. To
minimize the discomfort associated with insulin injections, insulin should be
administered at room temperature. Injection sites should be rotated systematically
within one anatomic site.
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.
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.
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
a. Age over 45 years
b. Overweight with a waist/hip ratio >1
d. Maintaining a sedentary lifestyle

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.
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
a. Fasting Plasma Glucose (FPG)
b. Two-hour Oral Glucose Tolerance Test (OGTT)

When an older person is identified as high-risk for diabetes, appropriate testing would
include FPG and OGTT. A 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.
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
d. Perineal itching
A thirty five year old male has been an insulin-dependent diabetic for five years and now
is unable to urinate. Which of the following would you most likely suspect?

A: Atherosclerosis
B: Diabetic nephropathy
C: Autonomic neuropathy
D: Somatic neuropathy
C: Autonomic neuropathy
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.
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.
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.

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.
A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with
pneumonia. The client's 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
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.
The nurse 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
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.
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
c. diaphoresis and trembling

indicates hypoglycemia
The nurse is caring for patients in the student health center. A patient confides to the
nurse that the patient's boyfriend informed her that he tested positive for Hepatitis B.
Which of the following responses by the nurse is BEST?

a. "That must have been a real shock to you"

b. "You should be tested for Hepatitis B"
c. "You'll receive the Hepatitis B immune globulin HBIG
d. "Have you had unprotected sex with your boyfriend"
D.

Hepatitis B is transmitted through parenteral drug abuse and sexual contact.

Determine exposure before implementing.
A patient newly diagnosed with Type I DM 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 an pulse of 110

b. lethargic with hot dry dkin 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.
a. confused with cold, clammy skin an pulse of 110

hypoglycemia
Liver biopsy:
Right side position post procedure to prevent patient from bleeding.
Thyroidectomy:
Semi Fowler and avoid hyperflexion and hyperextension of the neck
While preparing the client for a colonoscopy, the nurse's responsibilities include:

a. Explaining the risks and benefits of the exam

b. Instructing the client about the bowel preparation prior to the test
c, Instructing the client about medication that will be used to sedate the client
d. Explaining the results of the exam
b. Instructing the client about the bowel preparation prior to the test

The nurse is responsible for instructing the client about the bowel preparation prior to
the test.
Answers 1, 3, 4 are the physician's responsibility.
The nurse is having difficulty obtaining a capillary blood sample from a client's finger to
measure blood glucose using a blood glucose monitor. Which procedure will increase
the blood flow to the area to ensure an adequate specimen?

a. Raise the hand on a pillow to increase venous flow.

b. Pierce the skin with the lancet in the middle of the finger pad.
c. Wrap the finger in a warm cloth for 30-60 seconds.
d. Pierce the skin at a 45-degree angle.
c. Wrap the finger in a warm cloth for 30-60 seconds.

The hand is lowered to increase venous flow.

The finger is pierced lateral to the middle of the pad perpendicular to the skin surface.
A nurse cares for a client following a liver biopsy. Which nursing care plan reflects
proper care?

a. Position in a dorsal recumbent position, with one pillow under the head
b. Bed rest for 24 hours, with a pressure dressing over the biopsy site
c. Position to a right side-lying position, with a pillow under the biopsy site
d. Neurological checks of lower extremities every hour
c. Position to a right side-lying position, with a pillow under the biopsy site

Positioning the client in a right side-lying position with a pillow under the biopsy site
reflects proper care.

Answer 1 does not permit the necessary pressure applied to the biopsy site. B

ed rest is only required for several hours.

There is no reason to do neurological checks.

Mr. L. has a seven-year history of hepatic cirrhosis. He was brought to the emergency
room because he began vomiting large amounts of dark-red blood. An Esophageal
Balloon Tamponade tube was inserted to tamponade the bleeding esophageal varices.
While the balloon tamponade is in place, the nurse caring for Mr. L. gives the highest
priority to

a. assessing his stools for occult blood.

b. evaluating capillary refill in extremities.
c. auscultating breath sounds.
d. performing frequent mouth care.
c. auscultating breath sounds.

Rationale: Airway obstruction and aspiration of gastric contents are potential serious
complications of balloon tamponade. Frequent assessment of the client's respiratory
status is the priority.
A newly diagnosed type 1 diabetic patient likes to run 3 miles several mornings a week.
Which teaching will the nurse implement about exercise for this patient?

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

Rationale: Blood sugar increases after meals, so this will be the best time to exercise.

NPH insulin will not peak until mid-afternoon and is safe to take before a morning run.

Running can be done in either the morning or afternoon. If the glucose is very elevated,
the patient should postpone the run.
A patient with type 1 diabetes has received diet instruction as part of the treatment plan.
The nurse determines a need for additional instruction when the patient says,

a. "I may have an occasional alcoholic drink if I include it in my meal plan."

b. "I will need a bedtime snack because I take an evening dose of NPH insulin."
c. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia."
d. "I may eat whatever I want, as long as I use enough insulin to cover the calories."
D

Rationale: Most patients with type 1 diabetes need to plan diet choices very carefully.

Patients who are using intensified insulin therapy have considerable flexibility in diet
choices but still should restrict dietary intake of items such as fat, protein, and alcohol.

The other patient statements are correct and indicate good understanding of the diet
instruction.
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.
A

Rationale: Rebound hypoglycemia can occur after glucagon administration, but having a
meal containing complex carbohydrates plus protein and fat will help prevent
hypoglycemia.

Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and
crackers will stabilize blood sugar.

Administration of glucose intravenously might be used in patients who were unable to

take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia
after glucagon administration.
Which of these laboratory values noted by the nurse when reviewing the chart of a
diabetic patient indicates the need for further assessment of the patient?

a. Fasting blood glucose of 130 mg/dl

b. Noon blood glucose of 52 mg/dl
c. Glycosylated hemoglobin of 6.9%
d. Hemoglobin A1C of 5.8%
b. Noon blood glucose of 52 mg/dl

The nurse should assess the patient with a blood glucose level of 52 mg/dl for
symptoms of hypoglycemia, and give the patient some carbohydrate-containing
beverage such as orange juice. The other values are within an acceptable range for a
diabetic patient.
A 63-year-old patient is newly diagnosed with type 2 diabetes. When developing an
education plan, the nurse's first action should be to

a. assess the patient's perception of what it means to have type 2 diabetes.

b. demonstrate how to check glucose using capillary blood glucose monitoring.
c. ask the patient's family to participate in the diabetes education program.
d. discuss the need for the patient to actively participate in diabetes management.
A

Rationale: Before planning education, the nurse should assess the patient's interest in
and ability to self-manage the diabetes.

After assessing the patient, the other nursing actions may be appropriate, but planning
needs to be individualized to each patient.
A patient recovering from DKA asks the nurse how acidosis occurs. The best response
by the nurse is that

a. insufficient insulin leads to cellular starvation, and as cells rupture they release
organic acids into the blood.

b. when an insulin deficit causes hyperglycemia, then proteins are deaminated by the
liver, causing acidic by-products.

c. excess glucose in the blood is metabolized by the liver into acetone, which is acidic.

d. an insulin deficit promotes metabolism of fat stores, which produces large amounts of
acidic ketones.
D

Rationale: Ketoacidosis is caused by the breakdown of fat stores when glucose is not
available for intracellular metabolism. The other responses are inaccurate.
A patient using a split mixed-dose insulin regimen asks the nurse about the use of
intensive insulin therapy to achieve tighter glucose control. The nurse should teach the
patient that
a. intensive insulin therapy requires three or more injections a day in addition to an
injection of a basal long-acting insulin.
b. intensive insulin therapy is indicated only for newly diagnosed type 1 diabetics who
have never experienced ketoacidosis.
c. studies have shown that intensive insulin therapy is most effective in preventing the
macrovascular complications characteristic of type 2 diabetes.
d. an insulin pump provides the best glucose control and requires about the same
amount of attention as intensive insulin therapy.
A
Rationale: Patients using intensive insulin therapy must check their glucose level four to
six times daily and administer insulin accordingly. A previous episode of ketoacidosis is
not a contraindication for intensive insulin therapy.

Intensive insulin therapy is not confined to type 2 diabetics and would prevent
microvascular changes as well as macrovascular changes.

Intensive insulin therapy and an insulin pump are comparable in glucose control.
A college student who has type 1 diabetes normally walks each evening as part of an
exercise regimen. The student now plans to take a swimming class every day at 1:00
PM. The clinic nurse teaches the patient to

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

Rationale: The change in exercise will affect blood glucose, and the patient will need to
monitor glucose carefully to determine the need for changes in diet and insulin
administration.

Because exercise tends to decrease blood glucose, patients are advised to eat before
exercising.

Increasing the morning NPH or timing the insulin to peak during exercise may lead to
hypoglycemia, especially with the increased exercise.
A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin
develops a sore throat, cough, and fever. When the patient calls the clinic to report the
symptoms and a blood glucose level of 210 mg/dl, the nurse advises the patient to

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

Rationale: Infection and other stressors increase blood glucose levels and the patient
will need to test blood glucose frequently, treat elevations appropriately with insulin, and
call the health care provider if glucose levels continue to be elevated.

Discontinuing the glargine will contribute to hyperglycemia and may lead to DKA.

Decreasing carbohydrate or caloric intake is not appropriate as the patient will need
more calories when ill.

Glycosylated hemoglobins are not used to test for short-term alterations in blood
glucose.
Amitriptyline (Elavil) is prescribed for a diabetic patient with peripheral neuropathy who
has burning foot pain occurring mostly at night. Which information should the nurse
include when teaching the patient about the new medication?
a. Amitriptyline will help prevent the transmission of pain impulses to the brain.
b. Amitriptyline will improve sleep and make you less aware of nighttime pain.
c. Amitriptyline will decrease the depression caused by the pain.
d. Amitriptyline will correct some of the blood vessel changes that cause pain.
A
Rationale: Tricyclic antidepressants decrease the transmission of pain impulses to the
spinal cord and brain. Tricyclics also improve sleep quality and are used for depression,
but that is not the major purpose for their use in diabetic neuropathy. The blood vessel
changes that contribute to neuropathy are not affected by tricyclics.
A patient who has just been diagnosed with type 2 diabetes is 5 ft 4 in (160 cm) tall and
weighs 182 pounds (82 kg). A nursing diagnosis of imbalanced nutrition: more than
body requirements is developed. Which patient outcome is most important for this
patient?

a. The patient will have a diet and exercise plan that results in weight loss.
b. The patient will state the reasons for eliminating simple sugars in the diet.
c. The patient will have a glycosylated hemoglobin level of less than 7%.
d. The patient will choose a diet that distributes calories throughout the day.
C
Rationale: The complications of diabetes are related to elevated blood glucose, and the
most important patient outcome is the reduction of glucose to near-normal levels. The
other outcomes are also appropriate but are not as high in priority.
A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type
2 diabetes. The patient tells the nurse, "I hate to exercise! Can't I just follow the diet to
keep my glucose under control?" The nurse teaches the patient that the major purpose
of exercise for diabetics is to

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

Rationale: Exercise is essential to decrease insulin resistance and improve blood

glucose control. Increased energy, improved cardiovascular endurance, and setting a
pattern of success are secondary benefits of exercise, but they are not the major
reason.
The nurse teaches the diabetic patient who rides a bicycle to work every day to
administer morning insulin into the

a. thigh.
b. buttock.
c. arm.
d. abdomen.
D

Rationale: Patients should be taught not to administer insulin into a site that will be
exercised because exercise will increase the rate of absorption.

The thigh, buttock, and arm are all exercised by riding a bicycle.
A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG)
as part of diabetes management. During evaluation of the patient's technique of SMBG,
the nurse identifies a need for additional teaching when the patient

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

b. washes the puncture site using soap and water.
c. says the result of 130 mg indicates good blood sugar control.
d. hangs the arm down for a minute before puncturing the site.
A

Rationale: The patient is taught to choose a puncture site at the side of the finger pad.
The other patient actions indicate that teaching has been effective.
A diabetic patient is admitted with ketoacidosis and the health care provider writes all of
the following orders. Which order should the nurse implement first?

a. Start an infusion of regular insulin at 50 U/hr.

b. Give sodium bicarbonate 50 mEq IV push.
c. Infuse 1 liter of normal saline per hour.
d. Administer regular IV insulin 30 U.
C
Rationale: The most urgent patient problem is the hypovolemia associated with DKA,
and the priority is to infuse IV fluids.

The other actions can be accomplished after the infusion of normal saline is initiated.
A diabetic patient is started on intensive insulin therapy. The nurse will plan to teach the
patient about mealtime coverage using _____ insulin.

a. NPH
b. lispro
c. detemir
d. glargine
B
Rationale: Rapid or short acting insulin is used for mealtime coverage for patients
receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal
insulin.
A patient with type 2 diabetes is scheduled for an outpatient coronary arteriogram.
Which information obtained by the nurse when admitting the patient indicates a need for
a change in the patient's regimen?

a. The patient's most recent hemoglobin A1C was 6%.

b. The patient takes metformin (Glucophage) every morning.
c. The patient uses captopril (Capoten) for hypertension.
d. The patient's admission blood glucose is 128 mg/dl.
B
Rationale: To avoid lactic acidosis, metformin should not be used for 48 hours after IV
contrast media are administered.

The other patient data indicate that the patient is managing the diabetes appropriately.
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis (DKA). The nurse
recognizes that this measure is important to identify

a. electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia.

b. fluid overload resulting from aggressive fluid replacement.
c. the presence of hypovolemic shock related to osmotic diuresis.
d. cardiovascular collapse resulting from the effects of hyperglycemia.
A

Rationale: The hypokalemia associated with metabolic acidosis can lead to potentially
fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which
would be detected with ECG monitoring.

Fluid overload, hypovolemia, and cardiovascular collapse are possible complications of

DKA, but cardiac monitoring would not detect theses.
A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage)
also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's
arthritis, the health care provider prescribes prednisone (Deltasone) to control
inflammation. The nurse will anticipate that the patient may

a. require administration of insulin while taking prednisone.

b. develop acute hypoglycemia during the RA exacerbation.
c. have rashes caused by metformin-prednisone interactions.
d. need a diet higher in calories while receiving prednisone.
A
Rationale: Glucose levels increase when patients are taking CORTICOsteroids, and
insulin may be required to control blood glucose.

Hypoglycemia is not a complication of RA exacerbation or prednisone use.

Rashes are not an adverse effect caused by taking metformin and prednisone
simultaneously.

The patient is likely to have an increased appetite when taking prednisone, but it will be
important to avoid weight gain for the patient with RA.
A program of weight loss and exercise is recommended for a patient with impaired
fasting glucose (IFG). When teaching the patient about the reason for these lifestyle
changes, the nurse will tell the patient that

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

Rationale: The patient with IFG is at risk for developing type 2 diabetes, but this risk can
be decreased with lifestyle changes.

Glycosylated hemoglobin levels will not be elevated in IFG and the Hb A1C test is not
included in prediabetes testing. Elevated insulin levels do not cause the damage to
blood vessels that can occur with IFG. The liver does not produce increased levels of
glucose in IFG
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120
mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about

a. use of low doses of regular insulin.

b. self-monitoring of blood glucose.
c. oral hypoglycemic medications.
d. maintenance of a healthy weight.
D

Rationale: The patient's impaired fasting glucose indicates pre-diabetes and the patient
should be counseled about LIFESTYLE CHANGES to prevent the development of type
2 diabetes.

The patient with prediabetes does not require insulin or the oral hypoglycemics for
glucose control and does not need to self-monitor blood glucose.
A hospitalized diabetic patient receives 12 U of regular insulin mixed with 34 U of NPH
insulin at 7:00 AM. The patient is away from the nursing unit for diagnostic testing at
noon, when lunch trays are distributed. The most appropriate action by the nurse is to

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

Rationale: Consistency for mealtimes assists with regulation of blood glucose, so the
best option is for the patient to have lunch at the usual time.

Waiting to eat until after the procedure is likely to cause hypoglycemia.

Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk
or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in
blood glucose because of the rapid absorption of the simple carbohydrate in these
items.
When assessing the patient experiencing the onset of symptoms of type 1 diabetes,
which question should the nurse ask?

a. "Have you lost any weight lately?"

b. "Do you crave fluids containing sugar?"
c. "How long have you felt anorexic?"
d. "Is your urine unusually dark-colored?"
A

Rationale: Weight loss occurs because the body is no longer able to absorb glucose
and starts to break down protein and fat for energy. The patient is thirsty but does not
necessarily crave sugar- containing fluids. Increased appetite is a classic symptom of
type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.
While hospitalized and recovering from an episode of diabetic ketoacidosis, the patient
calls the nurse and reports feeling anxious, nervous, and sweaty. Based on the patient's
report, the nurse should

a. obtain a glucose reading using a finger stick.

b. administer 1 mg glucagon subcutaneously.
c. have the patient eat a candy bar.
d. have the patient drink 4 ounces of orange juice.
A

Rationale: The patient's clinical manifestations are consistent with hypoglycemia and
the initial action should be to check the patient's glucose with a finger stick or order a
stat blood glucose.

If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as
orange juice.

Glucagon might be given if the patient's symptoms become worse or if the patient is
unconscious.

Candy bars contain fat, which would slow down the absorption of sugar and delay the
response to treatment.
A patient with type 2 diabetes has sensory neuropathy of the feet and legs and
peripheral vascular disease evidenced by decreased peripheral pulses and dependent
rubor. The nurse teaches the patient that

a. the feet should be soaked in warm water on a daily basis.

b. flat-soled leather shoes are the best choice to protect the feet from injury.
c. heating pads should always be set at a very low temperature.
d. over-the-counter (OTC) callus remover may be used to remove callus and prevent
pressure.
B

Rationale: The patient is taught to avoid high heels and that leather shoes are preferred.

The feet should be washed, but not soaked, in warm water daily.

Heating pad use should be avoided.

Commercial callus and corn removers should be avoided; the patient should see a
specialist to treat these problems.
A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a
patient with type 2 diabetes who is brought to the emergency department in an
unresponsive state. The nurse will anticipate the need to
a. administer glargine (Lantus) insulin.
b. initiate oxygen by nasal cannula.
c. insert a large-bore IV catheter.
d. give 50% dextrose as a bolus.
C

Rationale: HHNC is initially treated with large volumes of IV fluids to correct

hypovolemia.

Regular insulin is administered, not a long-acting insulin. There is no indication that the
patient requires oxygen. Dextrose solutions will increase the patient's blood glucose and
would be contraindicated.
After the home health nurse has taught a patient and family about how to use glargine
and regular insulin safely, which action by the patient indicates that the teaching has
been successful?

a. The patient disposes of the open insulin vials after 4 weeks.

b. The patient draws up the regular insulin in the syringe and then draws up the
glargine.
c. The patient stores extra vials of both types of insulin in the freezer until needed.
d. The patient's family prefills the syringes weekly and stores them in the refrigerator.
A
Rationale: Insulin can be stored at room temperature for 4 weeks. Glargine should not
be mixed with other insulins or prefilled and stored. Freezing alters the insulin molecule
and should not be done.
A type 1 diabetic patient who was admitted with severe hypoglycemia and treated tells
the nurse, "I did not have any of the usual symptoms of hypoglycemia." Which question
by the nurse will help identify a possible reason for the patient's hypoglycemic
unawareness?

a. "Do you use any calcium-channel blocking drugs for blood pressure?"
b. "Have you observed any recent skin changes?"
c. "Do you notice any bloating feeling after eating?"
d. "Have you noticed any painful new ulcerations or sores on your feet?"
C
Rationale: Hypoglycemic unawareness is caused by autonomic neuropathy, which
would also cause delayed gastric emptying.

Calcium-channel blockers are not associated with hypoglycemic unawareness, although

-adrenergic blockers can prevent patients from having symptoms of hypoglycemia.

Skin changes can occur with diabetes, but these are not associated with autonomic
neuropathy. If the patient can feel painful areas on the feet, neuropathy has not
occurred.
A health care provider who has not been immunized for hepatitis B is exposed to the
hepatitis B virus (HBV) through a needle stick from an infected patient. The infection
control nurse informs the individual that treatment for the exposure should include

a. baseline hepatitis B antibody testing now and in 2 months.

b. active immunization with hepatitis B vaccine.
c. hepatitis B immune globulin (HBIG) injection.
d. both the hepatitis B vaccine and HBIG injection.
D

Rationale: The recommended treatment for exposure to hepatitis B in unvaccinated

individuals is to receive both HBIG and the hepatitis B vaccine, which would provide
temporary passive immunity and promote active immunity.

Antibody testing may also be done, but this would not provide protection from the
exposure.
A patient in the outpatient clinic has positive serologic testing for anti-HCV. Which action
by the nurse is appropriate?

a. Schedule the patient for HCV genotype testing.

b. Teach the patient that the HCV will resolve in 2 to 4 months.
c. Administer immune globulin and the HCV vaccine.
d. Instruct the patient on self-administration of -interferon.
A
Rationale: Genotyping of HCV has an important role in managing treatment and is done
before drug therapy with -interferon or other medications is started. HCV has a high
percentage of conversion to the chronic state so the nurse should not teach the patient
that the HCV will resolve in 2 to 4 months. Immune globulin or vaccine is not available
for HCV.
A homeless patient with severe anorexia, fatigue, jaundice, and hepatomegaly is
diagnosed with viral hepatitis and has just been admitted to the hospital. In planning
care for the patient, the nurse assigns the highest priority to the patient outcome of

a. maintaining adequate nutrition.

b. establishing a stable home environment.
c. increasing activity level.
d. identifying the source of exposure to hepatitis.
A
Rationale: The highest priority outcome is to maintain nutrition because adequate
nutrition is needed for hepatocyte regeneration. Finding a home for the patient and
identifying the source of the infection would be appropriate activities, but they do not
have as high a priority as having adequate nutrition. Although the patient's activity level
will be gradually increased, rest is indicated during the acute phase of hepatitis.
A patient is admitted with an abrupt onset of jaundice, nausea and vomiting,
hepatomegaly, and abnormal liver function studies. Serologic testing is negative for viral
causes of hepatitis. Which question by the nurse is most appropriate?

a. "Have you been around anyone with jaundice?"

b. "Do you use any prescription or over-the-counter (OTC) drugs?"
c. "Are you taking corticosteroids for any reason?"
d. "Is there any history of IV drug use?"
B

Rationale: The patient's symptoms, lack of antibodies for hepatitis, and the ABRUPT
onset of symptoms suggest toxic hepatitis, which can be caused by commonly used
OTC drugs such as acetaminophen (Tylenol).

Exposure to a jaundiced individual and a history of IV drug use are risk factors for
VIRAL hepatitis.

Corticosteroid use does not cause the symptoms listed.

A patient with cirrhosis has 4+ pitting edema of the feet and legs and massive ascites.
The data indicate that it is most important for the nurse to monitor the patient's

a. temperature.
b. albumin level.
c. hemoglobin.
d. activity level.
B

Rationale: The low oncotic pressure caused by hypoalbuminemia is a major

pathophysiologic factor in the development of ascites and edema. The other parameters
should also be monitored, but they are not contributing factors to the patient's current
symptoms.
A 32-year-old patient has early alcoholic cirrhosis diagnosed by a liver biopsy. When
planning patient teaching, the priority information for the nurse to include is the need for

a. vitamin B supplements.
b. abstinence from alcohol.
c. maintenance of a nutritious diet.
d. long-term, low-dose corticosteroids.
B
Rationale: The disease progression can be stopped or reversed by alcohol abstinence.

The other interventions may be used when cirrhosis becomes more severe to decrease
symptoms or complications, but the priority for this patient is to stop the progression of
the disease.
. A patient with cirrhosis who is being treated with spironolactone (Aldactone) and
furosemide (Lasix) has a serum sodium level of 135 mEq/L (135 mmol/L) and serum
potassium 3.2 mEq/L (3.2 mmol/L). Before notifying the health care provider, the nurse
should

a. administer the furosemide and withhold the spironolactone.

b. give both drugs as scheduled.
c. administer the spironolactone.
d. withhold both drugs until talking with the health care provider.
C

Rationale: Spironolactone is a potassium-sparing diuretic and will help to increase the

patient's potassium level.

The nurse does not need to talk with the doctor before giving the spironolactone,
although the health care provider should be notified about the low potassium value.

The furosemide will further decrease the patient's potassium level and should be held
until the nurse talks with the health care provider.
When assessing the neurologic status of a patient with a diagnosis of hepatic
encephalopathy, the nurse asks the patient to

a. stand on one foot.

b. ambulate with the eyes closed.
c. extend both arms.
d. perform the Valsalva maneuver.
C
Rationale: Extending the arms allows the nurse to check for asterixis, a classic sign of
hepatic encephalopathy. The other tests might also be done as part of the neurologic
assessment but would not be diagnostic for hepatic encephalopathy.
When lactulose (Cephulac) 30 ml QID is ordered for a patient with advanced cirrhosis,
the patient complains that it causes diarrhea. The nurse explains to the patient that it is
still important to take the drug because the lactulose will

a. promote fluid loss.

b. prevent constipation.
c. prevent gastrointestinal (GI) bleeding.
d. improve nervous system function.
d. improve nervous system function.

Rationale: The purpose for lactulose in the patient with cirrhosis is to lower ammonia
levels and prevent encephalopathy.

Although the medication may promote fluid loss through the stool, prevent constipation,
and prevent bearing down during bowel movements (which could lead to esophageal
bleeding), the medication is not ordered for these purposes for this patient.
A patient who is admitted with acute hepatic encephalopathy and ascites receives
instructions about appropriate diet. The nurse determines that the teaching has been
effective when the patient's choice of foods from the menu includes

a. an omelet with cheese and mushrooms and milk.

b. pancakes with butter and honey and orange juice.
c. baked beans with ham, cornbread, potatoes, and coffee.
d. baked chicken with french-fries, low-fiber bread, and tea.
b. pancakes with butter and honey and orange juice.

B
Rationale: The patient with acute hepatic encephalopathy is placed on a LOW-protein
diet to decrease ammonia levels.

The other choices are all higher in protein and would not be as appropriate for this
patient.

In addition, the patient's ascites indicate that a low-sodium diet is needed and the other
choices are all high in sodium.
A patient with cirrhosis has a massive hemorrhage from esophageal varices. In planning
care for the patient, the nurse gives the highest priority to the goal of

a. controlling bleeding.
b. maintenance of the airway.
c. maintenance of fluid volume.
d. relieving the patient's anxiety.
B

Rationale: Maintaining gas exchange has the highest priority because oxygenation is
essential for life.

The airway is compromised by the bleeding in the esophagus and aspiration easily
occurs.

The other goals would also be important for this patient, but they are not as high a
priority as airway maintenance.
During treatment of a patient with a Minnesota balloon tamponade for bleeding
esophageal varices, which nursing action will be included in the plan of care?

a. Encourage the patient to cough and deep breathe.

b. Insert the tube and verify its position q4hr.
c. Monitor the patient for shortness of breath.
d. Deflate the gastric balloon q8-12hr.
c. Monitor the patient for shortness of breath.

Rationale: The most common complication of balloon tamponade is aspiration

pneumonia.

In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and
occlude the airway.

Coughing increases the pressure on the varices and increases the risk for bleeding.

The health care provider inserts the tube and verifies the position. The esophageal
balloon is deflated every 8 to 12 hours to avoid necrosis, but if the gastric balloon is
deflated, the esophageal balloon may occlude the airway.
A patient with severe cirrhosis has an episode of bleeding esophageal varices. To
detect possible complications of the bleeding episode, it is most important for the nurse
to monitor

a. prothrombin time.
b. bilirubin levels.
c. ammonia levels.
d. potassium levels.
C

Rationale: The blood in the GI tract will be absorbed as protein and may result in an
increase in ammonia level since the liver cannot metabolize protein well.
The prothrombin time, bilirubin, and potassium levels should also be monitored, but
these will not be affected by the bleeding episode.
The nurse identifies a nursing diagnosis of risk for impaired skin integrity for a patient
with cirrhosis who has ascites and 4+ pitting edema of the feet and legs. An appropriate
nursing intervention for this problem is to

a. restrict dietary protein intake.

b. arrange for a pressure-relieving mattress.
c. perform passive range of motion QID.
d. turn the patient every 4 hours.
B

Rationale: The pressure-relieving mattress will decrease the risk for skin breakdown for
this patient.

Dietary protein intake may be increased in patients with ascites to improve oncotic
pressure.

Turning the patient every 4 hours will not be adequate to maintain skin integrity.

Passive range of motion will not take pressure off areas like the sacrum that are
vulnerable to breakdown.
A patient with cancer of the liver has severe ascites, and the health care provider plans
a paracentesis to relieve the fluid pressure on the diaphragm. To prepare the patient for
the procedure, the nurse

a. asks the patient to empty the bladder.

b. positions the patient on the right side.
c. obtains informed consent for the procedure.
d. assists the patient to lie flat in bed.
A

Rationale: The patient should empty the bladder to decrease the risk of bladder
perforation during the procedure.

The patient would be positioned in Fowler's position and would not be able to lie flat
without compromising breathing.

The health care provider is responsible for obtaining informed consent.

A patient hospitalized with possible acute pancreatitis has severe abdominal pain and
nausea and vomiting. The nurse would expect the diagnosis to be confirmed with
laboratory testing that reveals elevated serum

a. calcium.
b. bilirubin.
c. amylase.
d. potassium.
C
Rationale: Amylase is elevated early in acute pancreatitis.

Changes in bilirubin, calcium, and potassium levels are not diagnostic for pancreatitis.
A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO.
The nurse explains to the patient that the major purpose of this treatment is

a. control of fluid and electrolyte imbalance.

b. relief from nausea and vomiting.
c. reduction of pancreatic enzymes.
d. removal of the precipitating irritants.
c. reduction of pancreatic enzymes.

Rationale: Pancreatic enzymes are released when the patient eats. NG suction and
NPO status decrease the release of these enzymes.

Fluid and electrolyte imbalances will be caused by NG suction and require that the
patient receive IV fluids to prevent this.

The patient's nausea and vomiting may decrease, but this is not the major reason for
these treatments. The pancreatic enzymes that precipitate the pancreatitis are not
removed by NG suction.
The nurse identifies the collaborative problem of potential complication: electrolyte
imbalance for a patient with severe acute pancreatitis. Assessment findings that alert
the nurse to electrolyte imbalances associated with acute pancreatitis include

a. muscle twitching and finger numbness.

b. paralytic ileus and abdominal distention.
c. hypotension.
d. hyperglycemia.
A
Rationale: Muscle twitching and finger numbness indicate hypocalcemia, a potential
complication of acute pancreatitis.

The other data indicate other complications of acute pancreatitis but are not indicators
of electrolyte imbalance.
When obtaining a health history from a patient with acute pancreatitis, the nurse asks
the patient specifically about a history of

a. cigarette smoking.
b. alcohol use.
c. diabetes mellitus.
d. high-protein diet.
B
Rationale: Alcohol use is one of the most common risk factors for pancreatitis in the
United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.
A client has recently been diagnosed with Type I diabetes and asks the nurse 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. Eating small meals with two or three snacks may be more helpful in maintaining
blood glucose levels than three large meals.

b. Eat small meals with two or three snacks throughout the day to keep blood glucose
levels steady

c. Increase consumption of simple carbohydrates

d. Skip meals to help lose weight

A
Eating small meals with two or three snacks may be more helpful in maintaining blood
glucose levels than three large meals.
When a client learned that the symptoms of diabetes were caused by high levels of
blood glucose the client decided to stop eating carbohydrates. In this instance, the
nurse would be concerned that the client would develop what complication?

a. acidosis
b. atherosclerosis
c. glycosuria
d. retinopathy
A
When a client's 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.
The doctor is interested in how well a client has controlled their blood glucose since
their last visit. What lab values could the nurse evaluate to determine how well the client
has controlled their blood glucose over the past three months?
C
HbgA1c is a blood test used to determine how well blood glucose has been controlled
for the last three months.
The client tells the nurse that the client really misses having sugar with tea in the
morning. What is an alternative that the nurse could advise them to help sweeten their
drink.

a. Oatrim c. sucralose
b. Olestra d. tannin
C
Aspartame is the generic name for a sweetener composed of two amino acids,
phenylalanine and aspartic acid. Olestra and Oatrim are fat replacers and tannin is an
acid found in some foods such as tea.
During a teaching session, the nurse tells the client 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. Simple carbohydrates are absorbed more rapidly than complex carbohydrates.

b. Simple sugars cause a rapid spike in glucose levels and should be avoided

c. Simple sugars should never be consumed by someone with diabetes.

d. Try to limit simple sugars to between 10% and 20% of daily calories.
D

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. Research provides no evidence
that carbohydrates from simple sugars are digested and absorbed more rapidly than are
complex carbohydrates, and they do not appear to affect blood sugar control.
Blood glucose needs to maintained in what range?
60-100 mg/dL
Hyperglycemia symptoms
polyuria, polydipsia, polyphagia
Conversion of fatty acids into ___ provides a backup energy source which can lead to
___?
ketone bodies; metabolic acidosis
Hyperglycemia may cause ___ vision
blurred
Hypoglycemia may cause ___ vision
double
Damage to sensory nerve fibers results in
pain or loss of sensation
Type 1 diabetes
autoimmune disorder in which beta cells are destroyed in genetically susceptible people
Type 2 diabetes
a progressive disorder in which the person has a combination of insulin resistance and
decreased secretion of insulin by pancreatic cells
Normal fasting blood glucose
<100
A fasting blood glucose >100 but < 126 indicate
impaired fasting glucose, prediabetic
Normal glucose tolerance test
<140
Normal HbA 1c test
6.5% or less
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HbA 1c levels >8% indicate
poor diabetic control and need for adherence to regimen or changes in therapy
HbA 1c can now be used for what?
to help diagnose DM
ADA outcome: Preprandial glucose levels should be
70 - 160
ADA outcome: Postprandial glucose levels should be
< 180
Metformin should not be used in anyone who has
kidney disease
Metformin can cause
metabolic acidosis
To prevent kidney damage, Metformin should be withheld after using what?
contrast material or after any surgery requiring anesthesia until adequate kidney
function is established
Insulin detemir onset
1 hr
Insulin detemir peak
6-8 hr
Insulin detemir duration
5.7-24 hr
Rapid-acting insulins
insulin aspart, insulin glulisine
Short-Acting insulin
Humulin R (U-500)
Intermediate-acting insulin
isophane insulin NPH, insulin detemir
"1. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what ""type
2"" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes
differs from type 1 diabetes primarily in that with type 2 diabetes
a. the pt is totally dependent on an outside source of insulin
b. there is a decreased insulin secretion and cellular resistance to insulin that is
produced
c. the immune system destroys the pancreatic insulin-producing cells
d. the insulin precurosr that is secreted by the pancreas is not activated by the liver
Answer B - Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin
is insufficient for the body's needs or the cells do not respond to the insulin
appropriately. The other information describes the physiology of type 1 diabetes
18. The benefits of using an insulin pump include all of the following except: "a. By
continuously providing insulin they eliminate the need for injections of insulin
b. They simplify management of blood sugar and often improve A1C
c. They enable exercise without compensatory carbohydrate consumption
d. They help with weight loss
D: Using an insulin pump has many advantages, including fewer dramatic swings in
blood glucose levels, increased flexibility about diet, and improved accuracy of insulin
doses and delivery; however, the use of an insulin pump has been associated with
weight gain.
A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2"
means. Which of the following is the most appropriate response by the nurse?
"1. ""With type 2 diabetes, the body of the pancreas becomes inflamed."
2. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is
increased."
3. "With type 2 diabetes, the patient is totally dependent on an outside source of
insulin."
4. "With type 2 diabetes, the body produces autoantibodies that destroy b-cells in the
pancreas.""
"Right Answer: 2
Rationale: In type 2 diabetes mellitus, the secretion of insulin by the pancreas is
reduced and/or the cells of the body become resistant to insulin"
"A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which
findings is the nurse most likely to observe in this client? Select all that apply:
"1. Excessive thirst
2. Weight gain
3. Constipation
4. Excessive hunger
5. Urine retention
6. Frequent, high-volume urination
1, 4, 6 Rationale: Classic signs of diabetes mellitus include polydipsia (excessive thirst),
polyphagia (excessive hunger), and polyuria (excessive urination). Because the body is
starving from the lack of glucose the cells are using for energy, the client has weight
loss, not weight gain. Clients with diabetes mellitus usually don't present with
constipation. Urine retention is only a problem is the patient has another renal-related
condition.
A client is brought to the emergency department in an unresponsive state, and a
diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse
would immediately prepare to initiate which of the following anticipated physician's
prescriptions? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous
infusion of normal saline 4. Intravenous infusion of sodium bicarbonate
CORRECT ANSWER: 3. Intravenous infusion of normal saline Rationale: The primary
goal of treatment is hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is to
rehydrate the client to restore the fluid volume and to correct electrolyte deficiency.
Intravenous fluid replacement is similar to that administered in diabetic keto acidosis
(DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin,
would be administered. The use of sodium bicarbonate to correct acidosis is avoided
because it can precipitate a further drop in serum potassium levels. Intubation and
mechanical ventilation are not required to treat HHNS.
"A client is taking Humulin NPH insulin daily every morning. The nurse instructs the
client that the mostlikely time for a hypoglycemic reaction to occur is:
A) 2-4 hours after administration
B) 4-12 hours after administration
C) 16-18 hours after administration
D) 18-24 hours after administration
B: Rationale: Humulin is an intermediate acting insulin. The onset of action is 1.5 hours,
it peaks in 4-12 hours, and its duration is 24 hours. Hypoglycemic reactions to insulin
are most likely to occur during the peak time.
"A client who is started on metformin and glyburide would have initially presented with
which symptoms?
"a. Polydispisa, polyuria, and weight loss
b. weight gain, tiredness, & bradycardia
c. irritability, diaphoresis, and tachycardia
d. diarrhea, abdominal pain, and weight loss
"a. Polydispisa, polyuria, and weight loss"Symptoms of hyperglycemia include
polydipsia, polyuria, and weight loss. Metformin and sulfonylureas are commonly
ordered medications.

Weight gain, tiredness, and bradycardia are symptoms of hypothyroidism.

Irritability, diaphoresis, and tachycardia are symptoms of hypoglycemia.

Symptoms of Crohn's disease include diarrhea, abdominal pain, and weight loss."
A client with diabetes mellitus demonstratees acute anxiety when first admitted for the
treatment of hyperglycemia. The most appropriate intervention to decrease the client's
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
4. The most appropriate intervention is to address the client's feelings related to the
anxiety
A client with diabetes melllitus has a blood glucose of 644mg/dl. The nurse intreprets
that this client is most at risk of developing which type of acid base imbalance? "A.
Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis"
"Correct Answer: A, Metabolic Acidosis
Rationale: DM can lead to metabolic acidosis. When the body does not have sufficient
circulating insulin, the blood glucose level rises. At the same time, the cells of the body
use all available glucose. The body then breaks down glycogen and fat for fuel. The by-
products of fat metabolism are acidotic and can lead to the condition known as diabetic
ketoacidosis."
A client with DKA is being treated in the ED. What would the nurse suspect? 1.
Comatose state 2. Decreased Urine Output 3. Increased respirations and an increase in
pH. 4. Elevated blood glucose level and low plasma bicarbonate level.
Correct Answer: 4 Rationale: In DKA the arteriole pH is lower than 7.35, plasma
bicarbonate is lower than 15 mEq/L, the blood glucose is higher than 250, 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.
A client with type I diabetes is placed on an insulin pump. The most appropriate short-
term goal when teaching this client to control the diabetes is: "1) adhere to the medical
regimen
2) remain normoglycemic for 3 weeks
3) demonstrate the correct use of the administration equipment.
4) list 3 self care activities that are necessary to control the diabetes"
3.) is correct
"1) this is not a short-term goal
2) this is measurable, but it's a long-term goal
3) this is a short-term goal, client oriented, necessary for the client to control the
diabetes, and measurable when the client performs a return demonstration for the nurse
4) although this is measurable and a short-term goal, it is not the one with the greatest
priority when a client has an insulin pump that must be mastered before discharge"
"A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is
unresponsive. Following assessment of the patient, the nurse suspects diabetic
ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of
"a. polyuria
b. severe dehydration
c. rapid, deep respirations )
d. decreased serum potassium"
C is correct, Signs and symptoms of DKA include manifestations of dehydration such as
poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension.
Early symptoms may include lethargy and weakness. As the patient becomes severely
dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken.
Abdominal pain is another symptom of DKA that may be accompanied by anorexia and
vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea)
are the body's attempt to reverse metabolic acidosis through the exhalation of excess
carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory
findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less
than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to large ketone
levels in the urine or blood ketones.
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"A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with
pneumonia. The cliet's 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 occuring.
C. Hypoglycemia unawareness is developing.
D. Hyperglycemic hyperosmolar non-ketotic coma.
D.Illness, especially with the frail elderly patient whose appetite is poor, can result in
dehydration and HHNC. Insulin resisitance is inidcated 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.
A home health nurse is at the home of a client with diabetes and arthritis. The client has
difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client
to:
"A) A social worker from the local hospital
B) An occupational therapist from the community center
C) A physical therapist from the rehabilitation agency
D) Another client with diabetes mellitus and takes insulin"
B) An occupational therapist can assist a client to improve the fine motor skills needed
to prepare an insulin injection.
A nurse is caring for a cient with type 1 diabetes mellitus. which client complaint would
alert the nurse to the presence of a possible hypoglycemic reaction?
"1. Tremors
2. Anorexia
3. Hot, dry skin
4. Muscle cramps
1) tremorsdecreased blood glucose levels produce autonomic nervous system
symptoms, which are manifested classically as nervousness, irritability, and tremors.
option 3 is more likely for hyperglycemia, and options 2 and 4 are unrelated to the signs
of hypoglycemia.
"A nurse is caring for a client admitted to the emergency department with diabetic
ketoacidosis (DKA). In the acute phase, the priority nursing action is to prepare to:
"A. Correct the acidosis
B. Administer 5% dextrose intravenously
C. Administer regular insulin inraVenously
D. Apply a monitor for an electrocardiogram."
C. Administer regular insulin inraVenously Lack (absolute or relative) of insulin is the
primary cause of DKA. Treatment consists of insulin administration (regular insulin),
intravenous fluid administration (normal saline initially), and potassium replacement,
followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority
action.
A nurse is caring for a client with type 1 diabetes mellitus. Which client complaint would
alert the nurse to the presence of a possible hypoglycemic reaction ?
A. Tremors B. Anorexia C. Hot, Dry skin D. Muscle cramps
Correct Answer A Decreased blood glucose levels produce autonomic nervous system
symptoms, which are manifested classsically as nervousness, irritability, and tremors.
Option C is more likely to occur with hyperglycemia. Options B and D are unrealted to
the signs of hyperglycemia
a nurse is interviewing a client with type 2 diabetes mellitus. which statement by the
client indicated an understanding of the treatment for this disorder? "1. ""i take oral
insulin instead of shots""
2. ""by taking these medications I am able to eat more""
3. ""when I become ill, I need to increase the number of pills I take""
4. ""the medications I'm taking help release the insulin I already make""
4.)Clients with type 2 diabetes mellitus have decreased or imparied insulin secretion.
Oral hypoglycemic agents are given to these clients to facilitate glucose uptake. Insulin
injections may be given during times of stress-induced hyperglycemia. Oral insulin is not
available because of the breakdown of the insulin by digestion. Options 1, 2 and 3 are
incorrect
A nurse is preparing a plan of care for a client with diabetes mellitus who has
hyerglycemia. The priority nursing diagnosis would be: 1. Deficient knowledge 2.
Deficient fluid volume 3. Compromised family coping 4. Imbalanced nutrition less than
body requirements
2) deficient fluid volumeAn increased blood glucose level will cause the kidneys to
excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes,
causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced
when it becomes severe.
A nurse is preparing a teaching plan for a client with diabetes Mellitus regarding proper
foot care. Which instruction is included in the plan? 1. Soak feet in hot water 2. apply a
moisturizing lotion to dry feet but not between the toes 3. Always have a podiatrist cut
your toenails, never cut them yourself 4. avoid using mild soap on the feet
2. The client is instructed to use a moisturizing lotion on the feet and to avoid applying
the lotion between the toes.
"A nurse performs a physical assessment on a client with type 2 diabetes mellitus.
Findings include a fasting blood glucose of 120 mg/dL, temp of 101 F, pulse of 88 bpm,
respirations of 22, and blood pressure of 100/72. Which finding would be of most
concern to the nurse?
"1. Pulse
2. Respiration
3. Temperature
4. Blood pressure"
3) temp. An elevated temperature may indicate infection. Infection is a leading cause of
hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis. The other
findings noted in the question are within normal limits.
"A nurse shoud recognize which symptom as a cardinal sign of diabetes mellitus?
"a. Nausea
b. Seizure
c. Hyperactivity
d. Frequent urination
"D. Frequent Urination

Polyphagia, polyuria, polydipsia, and weight loss are cardinal signs of DM. Other signs
include irritability, shortened attention span, lowered frustration tolerance, fatigue, dry
skin, blurred vision, sores that are slow to heal, and flushed skin."
A patient is admitted with diabetes mellitus, has a glucose level of 380 mg/dl, and a
moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis,
which of the following respiratory patterns would the nurse expect to find?"A-Central
apnea
B-Hypoventilation
C-Kussmaul respirations
D- Cheyne-Stokes respirations"
C-Kussmaul respirationsIn diabetic ketoacidosis, the lungs try to compensate for the
acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of
Kussmaul respirations, which are deep and nonlabored.
"A patient with type 1 diabetes has received diet instruction as part of the treatment
plan. The nurse
determines a need for additional instruction when the patient says,
"a. ""I may have an occasional alcoholic drink if I include it in my meal plan.""

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

c. ""I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia.""

d. ""I may eat whatever I want, as long as I use enough insulin to cover the calories.
"D. ""I may eat whatever I want, as long as I use enough insulin to cover the calories.""

Rationale: Most patients with type 1 diabetes need to plan diet choices very carefully.
Patients who are using intensified insulin therapy have considerable flexibility in diet
choices but still should restrict dietary intake of items such as fat, protein, and alcohol.
The other patient statements are correct and indicate good understanding of the diet
instruction."
"An 18-year-old female client, 5'4'' tall, weighing 113 kg, comes to the
clinic for a non-healing wound on her lower leg, which she has had for two weeks.
Which disease process should the nurse suspect the client is developing?

"A. Type 1 diabetes

B. Type 2 diabetes
C. Gestational diabetes
D. Acanthosis nigricans"
"A: Type 1 diabetes usually occurs in young clients who are underweight.
In this disease, there is no production of insulin from the beta cells
in the pancreas. People with type 1 diabetes are insulin dependent with a
rapid onset of symptoms, including polyuria, polydipsia, and
polyphagia.

CORRECT -->B. Type 2 diabetes is a disorder usually occurring

around the age of 40, but it is now being detected in children and young
adults as a result of obesity and sedentary lifestyles. Non-healing
wounds are a hallmark sign of type 2 diabetes. This client weights 248.6
lbs and is short.

C. Gestational diabetes occurs during pregnancy. There is no mention of this.

D.
Acanthosis nigricans (AN), dark pigmentation and skin creases in the
neck, is a sign of hyperinsulinemia. The pancreas is secreting excess
amounts of insulin as a result of excessive caloric intake. It is
identified in young children and is a precursor to the development of
type 2 diabetes."
"An adolescent client with type I diabetes mellitus is
admitted to the emergency department for treatment of
diabetic ketoacidosis. Which assessment findings
should the nurse expect to note? "a) sweating and tremors
b) hunger and hypertension
c) cold, clammy skin
and irritability
d) fruity breath and decreasing
level of consciousness
d) fruity breath and decreasing
level of consciousness"Hyperglycemia occurs with diabetic ketoacidosis. Signs
of hyperglycemia include fruity breath and a decreasing
level of consciousness. Hunger can be a sign of
hypoglycemia or hyperglycemia, but hypertension is not
a sign of diabetic ketoacidosis. Instead, hypotension
occurs because of a decrease in blood volume related to the dehydrated state
that occurs during diabetic ketoacidosis. Cold, clammy
skin, irritability, sweating, and tremors are all signs of
hypoglycemia."
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: "a. 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.
b. Is timed to release programmed doses of regular or NPH insulin into the bloodstream
at specific intervals.
c. Is surgically attached to the pancreas and infuses regular insulin into the pancreas,
which in turn releases the insulin into the bloodstream.
d. Continuously infuses small amounts of NPH insulin into the bloodstream while
regularly monitoring blood glucose levels"
ANSWER A. 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.
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which
result will need further assessment?
A) BP 126/80 B) A1C 9% C)FBG 130mg/dL D) LDL cholesterol 100mg/dL
"B) A1C 9%
Rationale: Lowering hemoglobin A1C (to average of 7%) reduces microvascular and
neuropathic complications. Tighter glycemic control(normal A1C < 6%) may further
reduce complications but increases hypoglycemia risk."
Blood sugar is well controlled when Hemoglobin A1C is...
"a. Below 7%
b. Between 12%-15%
c. Less than 180 mg/dL
d. Between 90 and 130 mg/dL"
"a. Below 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."
During a diabetes screening program, a patient tells the nurse, "My mother died of
complications of type 2 diabetes. Can I inherit diabetes?" The nurse explains that "a.) as
long as the patient maintains normal weight and exercises, type 2 diabetes can be
prevented.
b.) the patient is at a higher than normal risk for type 2 diabetes and should have
periodic blood glucose level testing.
c.) there is a greater risk for children developing type 2 diabetes when the father has
type 2 diabetes.
d.) although there is a tendency for children of people with type 2 diabetes to develop
diabetes, the risk is higher for those with type 1 diabetes."
"B
Rationale: Offspring of people with type 2 diabetes are at higher risk for developing type
2 diabetes. The risk can be decreased, but not prevented, by maintenance of normal
weight and exercising. The risk for children of a person with type 1 diabetes to develop
diabetes is higher when it is the father who has the disease. Offspring of people with
type 2 diabetes are more likely to develop diabetes than offspring of those with type 1
diabetes."
"Excessive thirst and volume of very dilute urine may be symptoms of:
"A. Urinary tract infection
B. Diabetes insipidus
C. Viral gastroenteritis
D.Hypoglycemia"
"Correct answer: B
Diabetes insipidus is a condition in which the kidneys are unable to conserve water,
often because there is insufficient antidiuretic hormone (ADH) or the kidneys are unable
to respond to ADH. Although diabetes mellitus may present with similar symptoms, the
disorders are different. Diabetes insipidus does not involve hyperglycemia."
In educating a client with diabetes, what response would reveal need for further
education? "A. I should avoid tights
B. I should take good care of my toe nails
C. I should not go more than 3 days without washing my feet
D. I should avoid going barefoot and should wear clean socks
C)I should not go more than 3 days w/o washing my feet"The recommended self-care
routine is to wash feet on a daily basis without
soaking and carefully cleaning."
Of which of the following symptoms might an older woman with diabetes mellitus
complain? wps.prenhall.com 1) anorexia 2)pain intolerance 3) weight loss 4) perineal
itching
4) perineal itchingRationale: Older women might complain of perineal itching due to
vaginal candidiasis.
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.
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.
Patients with type 1 diabetes mellitus may require which of the following changes to
their daily routine during times of infection? "a. no change
b. less insulin
c. more insulin
d. oral diabetic agents"
answer C: during times of infection and illness diabetic patients may need even more
insulin to compensate for increased blood glucose levels.
Polydipsia and poly uria related to diabetes mellitus are primarily due to: "a.The release
of ketones from cells during fat metabolism
b. Fluid shifts resulting from exposure to high levels of hyperglycemia
c. Damage to the kidneys from exposure to high levels of glucose
d. changes in RBCs resulting from attachemnt of excessibe glucose to hemoglobin"
"Coorect answer: d.
Rationale: The osmotic effect of glucose produces the manifesatiaions of polydispsia
and poly uria."
"Polydipsia and polyuria related to diabetes mellitus are primarily due to:
"a. The release of ketones from cells during fat metabolism
b. Fluid shifts resulting from the osmotic effect of hyperglycemia
c. Damage to the kidneys from exposure to high levels of glucose
d. Changes in RBCs resulting from attachment of excessive glucose to hemoglobin"
b. Fluid shifts resulting from the osmotic effect of hyperglycemia Rationale: The osmotic
effect of glucose produces the manifestations of polydipsia and polyuria.
"Polydipsia and polyuria related to diabetes mellitus are primarily due to:
"a. The release of ketones from cells during fat metabolism
b. Fluid shifts resulting from the osmotic effect of hyperglycemia
c. Damage to the kidneys from exposure to high levels of glucose
d. Changes in RBCs resulting from attachment of excessive glucose to hemoglobin
b. Fluid shifts resulting from the osmotic effect of hyperglycemia Rationale: The osmotic
effect of glucose produces the manifestations of polydipsia and polyuria.
"Prediabetes is associated with all of the following except:
" a. Increased risk of developing type 2 diabetes
b. Impaired glucose tolerance
c. Increased risk of heart disease and stroke
d. Increased risk of developing type 1 diabetes"
"ANSWER: D
Persons with elevated glucose levels that do not yet meet the criteria for diabetes are
considered to have prediabetes and are at increased risk of developing type 2 diabetes.
Weight loss and increasing physical activity can help people with prediabetes prevent or
postpone the onset of type 2 diabetes."
Risk factors for type 2 diabetes include all of the following except: "a. Advanced age
b. Obesity
c. Smoking
d. Physical inactivity"
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."
"The client diagnosed with Type 1 diabetes has a glycosylated hemoglobin (A1
c) of 8.1%. Which interpretation should the nurse make based on this result? 1.This
result is below normal levels.2.This result is within acceptable levels. 3.This result is
above recommended levels 4.This result is dangerously high.
"1.The acceptable level for an A1c for a client with diabetes is between 6% and 7%,
which corresponds to a 120-140 mg/dL average blood glucose level. 2.This result is not
within acceptable levelsfor the client with diabetes, which is 6% to7%.
3.(CORRECT) This result parallels a serum blood glucoselevel of approximately 180 to
200 mg/dL. An A1
c is a blood test that reflects average blood glucose levels over a period of 2-3months;
clients with elevated blood glucose levels are at risk for developing long-term
complications.
4.An A1c of 13% is dangerously high; it reflects a 300-mg/dL average blood glucose
level overthe past 3 months."
"The client diagnosed with type 1 diabetse is receiving Humalog, a rapid-acting insulin,
by sliding scale. The order reads blood glucose level: <150, zero (0) units; 151 to 200,
three (3) units; 201 to 250, six (6 units); >251, contact health-care provider. The
unlicensed assistive personnel (UAP) reports to thenurse the client's glucometer
reading is 189. How much insulin should the nurse administer to the client?
3 unitsThe client's result is 189, which is between 151 and 200, so the nurse should
administer 3 units of Humalog insulin subcutaneously.
The client diagnosed with Type I diabetes is found lying unconscious on the floor of the
bathroom. Which interventions should the nurse implement first? A. Administer 50%
dextrose IVP. B. Notify the health-care provider. C. Move the client to ICD. D. Check the
serum glucose level.
A) admin 50% dextrose IVPThe nurse should assume the client is hypoglycemic and
administer IVP dextrose, which will rouse the client immediately. If the collapse is the
result of hyperglycemia, this additional dextrose will not further injure the client.
"The client, an 18-year-old female, 5'4'' tall, weighing 113 kg, comes to the clinic for a
wound on her lower leg that has not healed for the last two (2) weeks. Which
diseaseprocess would the nurse suspect that the client has developed?
"1.Type 1 diabetes.
2.Type 2 diabetes.
3.Gestational diabetes.
4.Acanthosis nigricans"
"Correct Answer: 2
Type 2 diabetes is a disorder that usually occurs around the age of 40, but it is now
being detected in children and young adultsas a result of obesity and sedentary life-
styles. Wounds that do not heal are a hall-mark sign of Type 2 diabetes. This client
weighs 248.6 pounds and is short"
"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 mellitusb. Unlimited intake of total
fat, saturated fat and cholesterol"
B. You want to be careful of how much you eat in any food group.
"The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a
client diagnosed with Type 1 diabetes at 1600. Which action should the nurse
implement?
"1. Ensure the client eats the bedtime snack.
2. Determine how much food the client ate at lunch.
3. Perform a glucometer reading at 0700.
4. Offer the client protein after administering insulin.
1: ensure the client eats the bedtime snack"1. Humulin N peaks in 6-8 hours, making
the client at risk for hypoglycemia around midnight, which is why the client should
receive a bedtime snack. This snack will prevent nighttime hypoglycemia. (Correct)
2. The food intake at lunch will not affect the client's blood glucose level at midnight.
3. The client's glucometer reading should be done around 2100 to assess the
effectiveness of insulin at 1600.
4. Humulin N is an intermediate-acting insulin that has an onset in 2-4 hours but does
not peak until 6-8 hours."
The nurse assisting in the admission of a client with diabetic ketoacidosis will anticipate
the physician ordering which of the following types of intravenous solution if the client
cannot take any fluids orally? "
a. 0.45% normal saline solution
b. Lactated Ringer's solution
c. 0.9 normal saline solution
d. 5% dextrose in water (D5W)"
a. 0.45% normal saline solution Helps to hydrate patient and keep electrolyte levels
balanced
"The nurse caring for a 54-year-old patient hospitalized with diabetes mellitus would
look for which of the following laboratory test results to obtain information on the
patient's past glucose control?
a. prealbumin level
b. urine ketone level
c. fasting glucose level
d. glycosylated hemoglobin level
Answer d: A glycosylated hemoglobin level detects the amount of glucose that is bound
to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to
the RBCs and remains there for the life of the blood cell, which is approximately 120
days. Thus the test can give an indication of glycemic control over approximately 2 to 3
months.
The nurse is caring for a client who has normal glucose levels at bedtime, hypoglycemia
at 2am and hyperglycemia in the morning. What is this client likely experiencing?
"A. Dawn phenomenon
B. Somogyi effect
C. An insulin spike
D. Excessive corticosteroids"
"1. B
The Somogyi effect is when blood sugar drops too low in the morning causing rebound
hyperglycemia in the morning. The hypoglycemia at 2am is highly indicative. The Dawn
phenomenon is similar but would not have the hypoglycemia at 2am."
The nurse is caring for a client with long-term Type 2 diabetes and is assessing the feet.
Which assessment data would warrant immediate intervention by the nurse?
"1)The client has crumbling toenails
2)The client has athlete's feet
3)The client has a necrotic big toe
4)The client has thickened toenails."
3) Nectrotic big toe"1)Crumbling toenails indicate tinea unguium, which is a fungus
infection of the toenail.
2)Athlete's foot is a fungal infection that is not life threatening.
3)A necrotic big toe indicates "dead" tissue. The client does not feel pain in the lower
extremity and does not realize there has been an injury and therefore does not seek
treatment. Increased blood glucose levels decrease oxygen supply that is needed to
heal the wound and increase the risk for developing an infection.
4)Big, thick toenails are fungal infections and would not require immediate intervention
by the nurse; 50% of the adult population has this."
"The nurse is caring for a patient whose blood glucose level is 55mg/dL. What is the
likely nursing response?
"A. Administer a glucagon injection
B. Give a small meal
C. Administer 10-15 g of a carbohydrate
D. Give a small snack of high protein food"
"C
The client has low hypoglycemia. This is generally treated with a small snack."
"The nurse is caring for a woman at 37 weeks gestation. The client was diagnosed with
insulin-dependent diabetes mellitis (IDDM) at age 7. The client states, ""I am so thrilled
that I will be breastfeeding my baby."" Which of the following responses by the nurse is
best?
"1. You will probably need less insulin while you are breastfeeding.
2. You will need to initially increase your insulin after the baby is born.
3. You will be able to take an oral hypoglycemic instead of insulin after the baby is born.
4. You will probably require the same dose of insulin that you are now taking."
"1. breastfeeding has an antidiabetogenic effect, less insulin is needed. (correct)
2. insulin needs will decrease due to antidiabetogenic effect of breastfeeding and
physiological changes during immediate postpartum period.
3. client has IDDM, insulin required.
4. during third trimester insulin requirements increase due to increased insulin
resistance"
"The nurse is discharging a client diagnosed with diabetes insipidus. Which
statementmade by the client warrants further intervention?
"1."I will keep a list of my medications in my wallet and wear a Medi bracelet."
2."I should take my medication in the morning and leave it refrigerated at home."
3."I should weigh myself every morning and record any weight gain."
4."If I develop a tightness in my chest, I will call my health-care provider."
2."I should take my medication in the morning and leave it refrigerated at home.""1.The
client should keep a list of medication being taken and wear a Medic Alert bracelet.
2. Medication taken for DI is usually every 8-12 hours, depending on the client.
Theclient should keep the medication close at hand.
3.The client is at risk for fluid shifts. Weighing every morning allows the client to follow
thefluid shifts. Weight gain could indicate too much medication.
4.Tightness in the chest could be an indicator that the medication is not being tolerated;
if this occurs the client should call the health-care provider"
"The nurse is discussing the importance of exercising to a client diagnosed with Type
2diabetes whose diabetes is well controlled with diet and exercise. Which
informationshould the nurse include in the teaching about diabetes?
"1.Eat a simple carbohydrate snack before exercising.
2.Carry peanut butter crackers when exercising.
3.Encourage the client to walk 20 minutes three (3) times a week.
4.Perform warmup and cooldown exercises
4.Perform warmup and cooldown exercises "The client diagnosed with Type 2 diabetes
whois not taking insulin or oral agents does notneed extra food before exercise.2.The
client with diabetes who is at risk forhypoglycemia when exercising should carry asimple
carbohydrate, but this client is not atrisk for hypoglycemia.3.Clients with diabetes that is
controlled by dietand exercise must exercise daily at the sametime and in the same
amount to control theglucose level.
4. [correct] All clients who exercise should perform warmup and cooldown exercises to
helpprevent muscle strain and injury"
The nurse 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.
"ANS: 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"
"The nurse is teaching a class on atherosclerosis. Which statement describes the scien-
tific rationale as to why diabetes is a risk factor for developing atherosclerosis?
(1.Glucose combines with carbon monoxide, instead of with oxygen, and this leads
tooxygen deprivation of tissues.2.Diabetes stimulates the sympathetic nervous system,
resulting in peripheralconstriction that increases the development of
atherosclerosis.3.Diabetes speeds the atherosclerotic process by thickening the
basement membraneof both large and small vessels.4.The increased glucose combines
with the hemoglobin, which causes deposits of plaque in the lining of the vessels.
3.Diabetes speeds the atherosclerotic process by thickening the basement membraneof
both large and small vessels."1.Glucose does not combine with
carbonmonoxide.2.Vasoconstriction is not a risk factor for devel-oping atherosclerosis.
3.This is the scientific rationale why diabetesmellitus is a modifiable risk factor for
atherosclerosis.
4.When glucose combines with the hemoglobinin a laboratory test called glycosylated
hemo-globin, the result can determine the client'saverage glucose level over the past
three (3)months"
"The nurse is teaching a community class to peole with Type 2 diabetes mellitus. Which
explanation would explain the development of Type 2 diabetes?
1. The islet cells in the pancreas stop producing insulin.
2. The client eats too many foods that are high in sugar.
3 The pituitary gland does not produce vasopression.
4. The cells become resistant to the circulating insulin.
"1. This is the cause of Type 1 diabetes mellitus.
2. This may be a reason for obesity, which may lead to Type 2 diabetes, but eating too
much sugar does not cause diabetes.
3. This is the explanation for diabetes insipidus, which should not be confused with
diabetes mellitus.
4. (CORRECT) Normally insulin binds to special receptor sites on the cells and initiates
a series of reactions involved in metabolism. In Type 2 diabetes these reactions are
diminished primarily as a result of obesity and aging."
"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"
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.
"The principal goals of therapy for 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."
"D. All of the above.

Rationale: 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."
"The risk factors for type 1 diabetes include all of the following except:
"a. Diet
b. Genetic
c. Autoimmune
d. Environmental"
A: Type 1 diabetes is a primary failure of pancreatic beta cells to produce insulin. It
primarily affects children and young adults and is unrelated to diet.
"What insulin type can be given by IV? Select all that apply:
"A. Glipizide (Glucotrol)
B. Lispro (Humalog)
C. NPH insulin
D. Glargine (Lantus)
E. Regular insulin
E) Regular insulinThe only insulin that can be given by IV is regular insulin.
"What will the nurse teach the client with diabetes regarding exercise in his or
her treatment program?
1. During exercise the body will use carbohydrates for energy production, which
in turn will decrease the need for insulin. 2. With an increase in activity, the body will
use more carbohydrates; therefore
more insulin will be required. 3. The increase in activity results in an increase in the use
of insulin;
therefore the client should decrease his or her carbohydrate intake. 4. Exercise will
improve pancreatic circulation and stimulate the islets of
Langerhans to increase the production of intrinsic insulin.
1. During exercise the body will use carbohydrates for energy production, which in turn
will decrease the need for insuli"Rationale: As carbohydrates are used for energy,
insulin needs decrease.
Therefore during exercise, carbohydrate intake should be increased to cover the
increased energy requirements. The beneficial effects of regular exercise may
result in a decreased need for diabetic medications in order to reach target
blood glucose levels. Furthermore, it may help to reduce triglycerides, LDL
cholesterol levels, increase HDLs, reduce blood pressure, and improve
circulation."
"When an older adult 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?
"1.Impaired glucose tolerance
2.Gestational diabetes mellitus
3.Pituitary tumor
4. Pancreatic tumor
"Pancreatic tumor
Rationale: 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."
"When assessing the patient experiencing the onset of symptoms of type 1 diabetes,
which question should the nurse ask?
a. ""Have you lost any weight lately?""
b. ""Do you crave fluids containing sugar?""
c. ""How long have you felt anorexic?""
d. ""Is your urine unusually dark-colored?""
A) lost any weight?"a. Weight loss occurs because the body is no longer able to absorb
glucose and starts to break down protein and fat for energy.
b. The patient is thirsty but does not necessarily crave sugar- containing fluids.
c. Increased appetite is a classic symptom of type 1 diabetes.
d. With the classic symptom of polyuria, urine will be very dilute."
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 of diabetes type I and
require follow-up investigation? "a. Excessive intake of calories, rapid weight gain, and
difficulty losing weight
b. Poor circulation, wound healing, and leg ulcers,
c. Lack of energy, weight gain, and depression
d. An increase in three areas: thirst, intake of fluids, and hunger
d. 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).
Excessive calorie intake, weight gain, and difficulty losing weight are common risk
factors for type 2 diabetes.
Poor circulation, wound healing and leg ulcers are signs of chronic diabetes.
Lack of energy, weight gain and depression are not necessarily indicative of any type of
diabetes."
which are symptoms of hypoglycemia? A. irritability, B. drowsiness c. Abdominal pain D.
nausea and vomiting
A. Irritability: signs of hypoglycemia include irritability, shaky feeling, hunger, headache,
dizziness. Other symptoms are hyperglycemia.
Which electrolyte replacement should the nurse anticipate being ordered by thehealth-
care provider in the client diagnosed with DKA who has just been admitted tothe ICD?
1.Glucose.
2.)Potassium.
3.Calcium.
4.Sodium
Potassium"1.Glucose is elevated in DKA; therefore, theHCP would not be replacing
glucose.
2.(CORRECT)-->The client in DKA loses potassium from increased urinary output,
acidosis, cata-bolic state, and vomiting. Replacement isessential for preventing cardiac
dysrhyth-mias secondary to hypokalemia.
3.Calcium is not affected in the client with DKA.4.The IV that is prescribed 0.9% normal
salinehas sodium, but it is not specifically orderedfor sodium replacement. This is an
isotonicsolution.
TEST-TAKING HINT:
Option "1" should be elim-inated because the problem with DKA iselevated glucose so
the HCP would not bereplacing it. The test taker should use physiol-ogy knowledge and
realize potassium is in thecell."
"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
Correct: a,b,d"Rationale: 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.
"Which of the following is accurate pertaining to physical exercise and type 1 diabetes
mellitus?
"1. Physical exercise can slow the progression of diabetes mellitus.
2. Strenuous exercise is beneficial when the blood glucose is high.
3. Patients who take insulin and engage in strenuous physical exercise might
experience hyperglycemia.
4. Adjusting insulin regimen allows for safe participation in all forms of exercise."
1) physical exercise can slow the progression of diabetes mellitusRationale: 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.
"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
"Correct answer: African-American woman
Rationale: 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."
Which statement by the patient with type 2 diabetes is accurate. "a. ""I am supposed to
have a meal or snak if I drink alcohol""
b. ""I am not allowed to eat any sweets because of my diabetes.""
c. I do not need to watch what I eat because my diabetes is not the bad kind.""
d. The amunt of fat in my diet is not important; it is just the carbohydrates that raise my
blood sugar."""
"Correct Answer: A
Alcohol should be consumed with food to reduce the risk of hypoglycemia."
A client asks the nurse why the provider bases his medication regimen on his HbA1C
instead of his log of morning fasting blood glucose results. Which of the following is an
appropriate response by the nurse?

A. HB A1C measures how well insulin is regulating your blood glucose between meals.
B. HB A1 C indicates how well your blood glucose has been regulated over the past
three months.
C. A test of HB A1C is the first test to determine if an individual has diabetes.
D. A test of HB A1C determines if the dosage of insulin needs to be adjusted.
B.
HB A1C measures the client's BC control over the past 2 to 4 months.
The nurse is reviewing the health record of a client who has syndrome of inappropriate
antidiuretic hormone (SIADH). Which of the following laboratory findings should the
nurse anticipate? Select all that apply.

A. Low serum sodium

B. High serum potassium
C. Decreased urine osmolality
D. High urine sodium
E. Increased urine specific gravity
A, D, E
SIADH results in water retention, causing a low serum sodium level.
SIADH results in water retention, causing a high urine sodium level.
SIADH results in water retention, causing an increase in urine specific gravity.
00:0200:53

A nurse is caring for a client who has primary diabetes insipidus (DI). Which of the
following manifestations should the nurse expect to find? Select all that apply.

A. Serum sodium of 155 mEq/L

B. Fatigue
C. Serum osmolality of 250 mOsm/L
D. Polyuria
E. Nocturia
A, B, D, E
Primary DI is caused by a reduction in the secretion of antidiuretic hormone (ADH),
which can result in an increased serum sodium.
Can also result in fatigue due to electrolyte imbalance.
Serum osmolality will be greater than 300 mOsm/L.
Can also result in polyuria.
Can also result in nocturia.
A nurse is caring for a client who has DI. Which of the following urinalysis laboratory
findings should the nurse anticipate?

A. Absence of glucose
B. Decreased specific gravity
C. Presence of ketones
D. Presence of RBCs
B.
The urine of a client who has DI will be dilute with a urine specific gravity of less than
1.005.
A nurse is caring for a client who has SIADH. Which of the following findings should the
nurse expect? Select all that apply.

A. Decreased serum sodium

B. Urine specific gravity of 1.001
C. Serum osmolarity 230 MOSM/liter
D. Polyuria
E. increased thirst
A, C
A decrease in serum sodium is caused by an increase in the secretion of ADH.
A decrease in serum osmolarity is caused by an increase in the secretion of ADH.
The nurse is assessing a client who has SIADH. Which of the following findings indicate
the client is experiencing a complication?

A. Decreased central venous pressure (CVP)

B. Increased urine output
C. Distended neck veins
D. Extreme thirst
C.
Distended neck veins are a manifestation of fluid overload, which can lead to pulmonary
edema and heart failure.
Decreased CVP is indicative of shock.
Increased urine output is indicative of DI.
Extreme thirst is indicative of DI.
A nurse is providing teaching to a client who has a new diagnosis of DI. Which of the
following statements by the client requires further teaching?

A. I can drink up to 2 quarts of fluid a day.

B. I should expect to urinate frequently at night.
C. I may experience headaches.
D. I may experience a dry mouth.
A.
Excessive thirst is a manifestation of DI. Consumption of 4 to 30 L per day can be
expected, and fluid intake should not be limited.
A nurse in a providers office is reviewing the health record of a client who is being
evaluated for Graves' disease. Which of the following is an expected laboratory finding
for this client?

A. Decreased thyrotropin receptor antibodies

B. Decreased thyroid stimulating hormone
C. Decreased free thyroxine index
D. Decreased triiodothyronine
B.
In the presence of Graves' disease, a low thyroid stimulating hormone (TSH) is an
expected finding. The pituitary gland increases the production of TSH when thyroid
hormone levels are elevated.
A nurse is reviewing the clinical manifestations of hyperthyroidism with the client. Which
of the following findings should the nurse include? Select all that apply.

A. Dry skin
B. Heat intolerance
C. Constipation
D. Palpitations
E. Weight loss
F. Bradycardia
B, D, E
Hyperthyroidism increases the client's metabolism. Therefore, heat intolerance,
palpitations, and weight loss are expected findings.
A nurse is providing instructions to client who has Graves' disease and has a new
prescription for propanolol (Inderal). Which of the following information should the nurse
include?

A. An adverse affects of this medication is jaundice.

B. Take your pulse before each dose.
C. The purpose of this medication is to decrease production of thyroid hormones.
D. You should stop taking the medication if you have a sore throat.
B.
Propanolol can cause bradycardia. The client should take his pulse before each dose. If
there is a significant change, he should withhold the dose and consult his provider.
The nurse is preparing to receive a client from the PACU who is post operative following
a thyroidectomy. The nurse should ensure that which of the following equipment is
available? Select all that apply.

A. Suction equipment
B. Humidified air
C. Flashlight
D. Tracheostomy tray
E. 02 delivery equipment
A, B, D, E
A nurse in a providers office is planning care for a client who has a new diagnosis of
Graves' disease and a new prescription for methimazole (Tapazole). Which of the
following should the nurse include in the plan of care? Select all that apply.

A. Monitor CBC
B. Monitor T3
C. Inform the client that the medication should not be taken for more than three months
D. Advise the client to take the medication at the same time every day
E. Inform the client that an adverse effects of this medication is iodine toxicity
A, B, D
Methimazole can cause a number of hematologic effects, including leukopenia and
thrombocytopenia. Therefore, the nurse should monitor the clients CBC.
Methimazole reduce his thyroid hormone production.
And it should be taken the same time every day to maintain blood levels.
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A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy.
Which of the following findings are indicative of a thyroid crisis? Select all that apply.

A. Bradycardia
B. Hypothermia
C. Tremors
D. Abdominal pain
E. Mental confusion
C, D, E
Excessive levels of thyroid hormone can cause a client to experience tremors.
When thyroid crisis occurs, the client can experience G.I. conditions, such as vomiting,
diarrhea, and abd pain.
Excessive thyroid hormone levels can cause the client to experience mental confusion.
A nurse in a providers office is reviewing the laboratory findings of the client who's being
evaluated for primary hypothyroidism. Which of the following laboratory findings is
expected for a client who has hypothyroidism?

A. Serum T4 10 mcg/dL
B. Serum T3 200 ng/dL
C. Hematocrit 34%
D. Serum cholesterol 100 mg/dL
C.
Hematocrit of 34% indicates anemia, which is an expected result for a client who has
hypothyroidism.
A nurse is collecting an admission history from a female client who has hypothyroidism.
Which of the following findings are expected with this condition? Select all that apply.

A. Diarrhea
B. Menorrhagia
C. Dry skin
D. Increased libido
E. Hoarseness
B, C, E
Abnormal menstrual periods, including menorrhagia and amenorrhea, are clinical
manifestations of hypothyroidism.
Dry skin and hoarseness are clinical manifestations of hypothyroidism.
The nurse is reinforcing teaching with a client who has been prescribed levothyroxine
(Synthroid) to treat hypothyroidism. Which of the following should the nurse include in
the teaching? Select all that apply.

A. Weight gain is expected while taking this medication.

B. Medication should not be discontinued without the advice of the provider.
C. Follow up serum TSH levels should be obtained.
D. Take the medication on an empty stomach.
E. Use fiber laxatives for constipation.
B, C, D
The provider carefully titrate the dosage of this medication. It should be increased to
slowly until the client reaches an euthyroid state. Therefore the client should not
discontinue the medication unless directed by PCP.
A nurse in an intensive care unit is admitting a client who has myxedema coma. Which
of the following should the nurse anticipate in caring for this client? Select all that apply.

A. Observe cardiac monitor for inverted T-wave

B. Observe evidence of urinary tract infection
C. Initiate IV fluids using 0.9% sodium chloride
D. Expect a prescription for levothyroxine IV bolus
E. Provide warmth using a heating pad
A, B, C, D
The client who has myxedema you may have a flat or inverted T-wave, as well as ST
deviations; an infection such as a UTI, may precipitate myxedema coma; hyponatremia
is a typical finding the presence of myxedema coma. Therefore, intravenous therapy is
administered using either isotonic hypertonic fluids.
Myxedema coma is a severe complication of hypothyroidism and can lead to come or
death. Levothyroxine is administered IV bolus to treat the condition.
A nurse is presenting information to a group of clients about nutrition habits that prevent
type 2 diabetes mellitus. Which of the following should the nurse include in the
information? Select all that apply.

A. Eat less meat and processed foods.

B. Decreased intake of saturated fat.
C. Increase daily fiber intake.
D. Limit saturated fat intake to 15% of daily caloric intake.
E. Include omega-3 fatty acid in the diet
A, B, C, E
Healthy nutrition should include decreasing consumption of meats and processed foods,
which can prevent diabetes and hyperlipidemia.
Healthy nutrition should include lowering LDL by decreasing intake of saturated fats.
Healthy nutrition should include increasing dietary fiber to control weight gain and
decrease the risk of diabetes and hyperlipidemia.
Healthy nutrition should include omega-3 fatty acid for secondary prevention of diabetes
and heart disease.
The nurse is teaching care to client who has DM. Which of the following information
should the nurse include in the teaching? Select all that apply.

A. Remove calluses using over-the-counter remedies

B. Apply lotion between toes
C. Perform nail care after bathing
D. Trim toenails straight across
E. Wear closed-toe shoes
C, D, E
perform nail care after bathing, when toenails are softer and easier to trim
Trim toenails straight across to prevent injury to soft tissues of the toes.
Wear closed-toe shoes to prevent injury to soft tissue the toes and feet.
A nurse is reviewing the health record of the client Who has HHS. Which of the
following data confirms the diagnosis? Select all that apply.

A. Evidence of recent myocardial infarction

B. BUN 35 mg/dL
C. Takes a calcium channel blocker
D. Age of 77 years
E. No insulin production
A, B, C, D
A nurse is assessing a client who has DKA and ketones in the urine. Which of the
following are expected findings? Select all that apply.

A. Weight gain
B. Fruity odor or breath
C. Abdominal pain
D. Kussmaul respirations
E. Metabolic acidosis
B, C, D, E
The nurse is reviewing laboratory reports of a client who has HHS. Which of the
following is an expected finding?

A. Serum pH 7.2
B. Serum osmolarity 350 mOsm/L
C. Serum potassium 3.8 mg/dL
D. Serum creatinine 0.8 mg/dL
B
A nurse is preparing to administer IV fluids to client who has DKA. Which of the
following is an appropriate nursing action?

A. Administering IV infusion of regular insulin at 0.3 units per kilogram per hour
B. Administer and IV infusion of 0.45% sodium chloride
C. Rapidly administering IV infusion of 0.9% sodium chloride
D. Add glucose to the IV infusion when serum glucose is 350 mg/dL
c
A nurse is providing discharge teaching to a client who experienced DKA. Which of the
following should the nurse include in the teaching? Select all that apply.
A. Drink 3 L of fluid daily
B. Monitor blood glucose every 4 hrs when ill
C. Administer insulin as prescribed when ill
D. Notify provider when BG is 200 mg/dL
E. Report ketones in the urine after 24 hours of illness
A, B, C, E
Which statement by the patient demonstrates an understanding of discharge
instructions on the use of levothyroxine (Synthroid)?
"I will take this medication in the morning so as not to interfere with sleep."
"I will double my dose if I gain more than 1 pound per day."
"I will stop the medication immediately if I lose more than 2 pounds in a week."
"I can expect to see relief of my symptoms within 1 week."
"I will take this medication in the morning so as not to interfere with sleep."
A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help
relieve his symptoms. What is the nurse's best response?
A. "Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs
and symptoms of hyperthyroidism."
B. "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually
returning your metabolism to normal."
C. "Propylthiouracil helps your thyroid gland use iodine and synthesize hormones
better."
D. "Propylthiouracil stimulates the pituitary gland to secrete thyroid-stimulating hormone
(TSH), which inhibits the production of hormones by the thyroid gland."
B. "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually
returning your metabolism to normal."
Which is a rapid-acting insulin with an onset of action of less than 15 minutes?
A. insulin glargine (Lantus)
B. insulin aspart (NovoLog)
C. regular insulin (Humulin R)
D. insulin detemir (Levemir)
B. insulin aspart (NovoLog)
Which long-acting insulin mimics natural, basal insulin with no peak action and a
duration of 24 hours?
A. insulin glargine (Lantus)
B. insulin glulisine (Apidra)
C. regular insulin (Humulin R)
D. NPH insulin
A. insulin glargine (Lantus)
Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM,
he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at
what time?
A. 10:00 AM
B. 2:00 PM
C. 5:00 PM
D. 8:00 PM
C. 5:00 PM
The patient is prescribed 30 units regular insulin and 70 units NPH insulin
subcutaneously every morning. The nurse will provide which instruction to the patient?
A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."
B. "Mixing insulins will help increase insulin production."
C. "Rotate sites at least once weekly."
D. "Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption."
A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."
The nurse would include which statement when teaching a patient about insulin
glargine?
A. "You should inject this insulin just before meals because it is very fast acting."
B. "The duration of action for this insulin is approximately 8 to10 hours, so you will need
to take it twice a day."
C. "You can mix this insulin with NPH insulin to enhance its effects."
D. "You cannot mix this insulin with regular insulin and thus will have to take two
injections."
D. "You cannot mix this insulin with regular insulin and thus will have to take two
injections."
The nurse will advise the patient to treat hypoglycemia with which drug?
A. propranolol (Inderal)
B. glucagon
C. acarbose (Precose)
D. bumetanide (Bumex)
B. glucagon
When caring for a patient newly diagnosed with gestational diabetes, the nurse would
question an order for which drug?
A. insulin glargine (Lantus)
B. glipizide (Glucotrol)
C. insulin glulisine (Apidra)
D. NPH insulin
B. glipizide (Glucotrol)
Which information should be included in a teaching plan for patients taking oral
hypoglycemic drugs? (Select all that apply.)
A. Limit your alcohol consumption.
B. Report symptoms of anorexia and fatigue.
C. Take your medication only as needed.
D. Notify your physician if blood glucose levels rise above the level set for you.
A. Limit your alcohol consumption.
B. Report symptoms of anorexia and fatigue.
D. Notify your physician if blood glucose levels rise above the level set for you.
Which actions describe the beneficial effects produced by sulfonylurea oral
hypoglycemics? (Select all that apply.)
A. Stimulate insulin secretion from beta cells
B. Increase hepatic glucose production
C. Enhance action of insulin in various tissues
D. Inhibit breakdown of insulin by liver
A. Stimulate insulin secretion from beta cells
B. Enhance action of insulin in various tissues
D. Inhibit breakdown of insulin by liver
The nurse is providing information to a teenager newly diagnosed with diabetes and his
parents. The nurse teaches them that the signs of diabetic ketoacidosis (DKA) include:
Standard Text: Select all that apply.
1. Change in mental status.
2. Tachycardia.
3. Fruity breath odor.
4. Rapid, shallow respirations.
5. Abdominal pain.
Correct Answer: 1,3,5
Rationale 1: A change in mental state can be associated with DKA.
Rationale 2: Tachycardia is not a typical symptom of DKA.
Rationale 3: A fruity breath odor is common when the client is in a state of ketoacidosis.
Rationale 4: Respirations are rapid, but deep (Kussmaul's breathing) in DKA.
Rationale 5: Abdominal pain is commonly seen with DKA.
A child weighing 18.2 kg with a history of diabetes insipidus has been admitted to the
hospital. Which of the physician's orders would the nurse question?
1. Stat electrolytes
2. Urine specific gravity with each void
3. DDAVP (desmopressin) PO
4. Restrict oral fluids to 500 mL every 24 hours.
Correct Answer: 4
Rationale 1: Stat electrolytes would be an appropriate order to check for hypernatremia.
Rationale 2: Urine specific gravity is checked because it is often low.
Rationale 3: DDAVP is the drug of choice for a child with DI.
Rationale 4: Fluid replacement, not fluid restriction, is necessary for child with DI.
An adolescent female with untreated Graves' disease is admitted to the hospital. The
nurse expects to find which signs and symptoms in this client?
1. Hyperglycemia, ketonuria, and glucosuria
2. Weight gain, hirsutism, and muscle weakness
3. Tachycardia, fatigue, and heat intolerance
4. Dehydration, metabolic acidosis, and hypertension
Correct Answer: 3
Rationale 1: Hyperglycemia, ketonuria, and glucosuria are signs of diabetes.
Rationale 2: Weight gain, hirsutism, and muscle weakness are seen in clients with
Cushing's disease.
Rationale 3: Clinical manifestations of Graves' disease are tachycardia, fatigue, and
heat intolerance, seen with hyperthyroidism.
Rationale 4: Dehydration, metabolic acidosis, and hypertension are signs of congenital
adrenal hyperplasia.
A hospitalized child has been diagnosed with SIADH (syndrome of inappropriate
antidiuretic hormone), a complication of his meningitis. What would the nurse expect to
see on this child's lab results?
1. Hyponatremia
2. Hypocalcemia
3. Hyperglycemia
4. Hypernatremia
Correct Answer: 1
Rationale 1: SIADH is associated with increased permeability in distal renal tubes,
leading to water intoxication and low sodium.
Rationale 2: Hypocalcemia is not seen with SIADH.
Rationale 3: Hyperglycemia is not related to SIADH.
Rationale 4: Hypernatremia is seen with DI, not SIADH.
The nurse is caring for a child just admitted with diabetic ketoacidosis (DKA). Which of
the physician's orders should the nurse question?
1. Neurological checks hourly
2. Insert urinary catheter and measure output hourly.
3. NPH insulin IV at 0.1 units/kg per hour
4. Stat serum electrolytes
Correct Answer: 3
Rationale 1: Hourly neuro checks are an appropriate order.
Rationale 2: Urinary catheter and hourly outputs are appropriate.
Rationale 3: NPH insulin is never administered IV. A short-acting insulin needs to be
ordered.
Rationale 4: Stat electrolytes are an appropriate order.
A teenager has arrived in the emergency department (ED) with confusion. The
physician suspects diabetic ketoacidosis (DKA). A stat serum glucose is done, and the
result is 76l5 mg/dL. The nurse expects that this teen has which symptoms?
1. Tachycardia, dehydration, and abdominal pain
2. Sweating, photophobia, and tremors
3. Dry mucous membranes, blurred vision, and weakness
4. Dry skin, shallow rapid breathing, and dehydration
Correct Answer: 3
Rationale 1: Tachycardia is seen in hypoglycemia.
Rationale 2: Sweating, photophobia, and tremors are indicative of hypoglycemia.
Rationale 3: Dry mucous membranes, blurred vision, and weakness are seen with
hyperglycemia.
Rationale 4: Dry skin and dehydration are signs of hyperglycemia, but shallow breathing
is a sign of hypoglycemia.
A 12-year-old has been selected to be a cheerleader for her middle school. This child
has been recently diagnosed with type 1 diabetes. In teaching this child's mother about
care for her child, the nurse wants the mother to understand that with increased
physical activity, the child will need:
1. Decreased food intake.
2. Increased doses of insulin.
3. Increased food intake.
4. Decreased doses of insulin.
Correct Answer: 3
Rationale 1: Decreased food intake would increase the chance of hypoglycemia.
Rationale 2: Increased dose of insulin would cause hypoglycemia. Exercise causes
insulin to be used more efficiently by the body, so an increase in insulin would not be
needed.
Rationale 3: An increase in physical activity requires an increase in caloric intake to
prevent hypoglycemia.
Rationale 4: A decreased dose of insulin would not allow the sugar to enter the cells
where it is needed during exercise.
The nurse is teaching a teenage client newly diagnosed with type 1diabetes about
complications of the disease. The nurse explains that clients with type 1 diabetes can
avoid lipoatrophy by:
1. Rotating injection sites.
2. Checking blood sugars at mealtime and bedtime.
3. Using a sliding scale for additional coverage.
4. Administration of insulin via insulin pump.
Correct Answer: 1
Rationale 1: Lipoatrophy is caused by using the same insulin injection site.
Rationale 2: Checking blood sugars does not influence lipoatrophy.
Rationale 3: A sliding scale does not influence lipoatrophy.
Rationale 4: Insulin administration via pump doesn't influence lipoatrophy.
The nurse is teaching the caregiver of a child who is newly diagnosed with type 1
diabetes mellitus how to minimize pain with insulin injections. Which interventions to
minimize pain will the nurse include in the teaching?
Standard Text: Select all that apply.
1. Do not reuse needles.
2. Remove all bubbles from the syringe before injecting.
3. Have the child flex the muscle during injection.
4. Inject insulin when it is cold.
5. Do not change the direction of the needle during insertion or withdrawal.
Correct Answer: 1,2,5
Rationale 1: Reusing needles leads to more pain on injection.
Rationale 2: Removing bubbles from the syringe minimizes pain.
Rationale 3: Flexing or tensing muscles during injection causes more discomfort.
Rationale 4: Insulin should be injected when it is at room temperature to minimize pain.
Rationale 5: Keeping the direction of the syringe constant will minimize pain.
The nurse is caring for a hospitalized three-year-old admitted with a history of syndrome
of inappropriate antidiuretic hormone (SIADH). He has just received his breakfast tray.
Which food should the nurse remove from his tray?
1. Oatmeal
2. Yogurt
3. Biscuit
4. Cantaloupe
Correct Answer: 4
Rationale 1: A child with SAIDH may have carbohydrates and fiber, such as in oatmeal.
Rationale 2: A child with SIADH may have dairy products, such as yogurt.
Rationale 3: A child with SIADH may have carbohydrates, such as in a biscuit.
Rationale 4: A child with SIADH is on a fluid restriction. Cantaloupe contains significant
fluid volume, so it would not be a good food for this child to consume.
Mandatory testing in the newborn nursery determines that the infant has
hypothyroidism. When discussing the treatment with the new mother, the mother states
that she doesn't believe in taking medications. The nurse would explain that failure to
treat the infant with the appropriate medication will result in:
1. Heart disease.
2. Mental retardation.
3. Renal failure.
4. Thyroid storm.
Correct Answer: 2
Rationale 1: If the hypothyroidism is left untreated, the child will experience bradycardia
but will not develop heart disease.
Rationale 2: Untreated hypothyroidism will lead to mental retardation.
Rationale 3: Untreated hypothyroidism does not lead to renal failure.
Rationale 4: Thyroid storm is a complication of hyperthyroidism, not hypothyroidism.
The school nurse has noticed an increase in the number of children in the school being
diagnosed with type 2 diabetes. Which changes could the nurse implement at school to
help reduce students' risk for developing type 2 diabetes?
Standard Text: Select all that apply.
1. Increase the amount of daily physical activity.
2. Meet with all parents and explain the risk that is associated with obesity.
3. Test each child's urine monthly.
4. Teach the parents to avoid administering aspirin to their children.
5. Work with the cafeteria to decrease the amount of fat in the foods served.
Correct Answer: 1,2,5
Rationale 1: Increased physical activity will decrease a child's risk of developing type 2
diabetes.
Rationale 2: Obese children have an increased risk of type 2 diabetes. Working with the
parents, the nurse can reduce the obesity in the school.
Rationale 3: Testing urine will not decrease the risk of developing type 2 diabetes,
although it may lead to earlier diagnosis of the disease.
Rationale 4: Aspirin administration is not related to type 2 diabetes.
Rationale 5: A diet high in fat is associated with type 2 diabetes.
The child was diagnosed with phenylketonuria shortly after birth and has been treated
by the endocrine clinic for the last four years. The mother has missed the last three
appointments. When the child keeps the next appointment, the mother assures the
nurse that the child has followed the dietary restrictions. Which finding would make the
nurse question this statement?
1. The child's body has a musty odor.
2. This child is a blue-eyed blond.
3. The child appears sleepy and uninterested in the surroundings.
4. The child has a sunburn over his entire body.
Correct Answer: 1
Rationale 1: The odor is caused by the excretion of phenylketone by-products through
the skin and would indicate noncompliance with the dietary restrictions.
Rationale 2: While this is a characteristic of most children with PKU, it is not related to
dietary intake or restrictions.
Rationale 3: This is not a symptom of untreated phenylketonuria.
Rationale 4: Photophobia is not associated with PKU. The child with untreated PKU has
an eczema rash.
Based on physical findings, including a webbed neck and low hairline, the newborn
female infant is suspected of having Turner's syndrome. The baby is in the newborn
nursery while preparations are made for further evaluation including karyotyping. The
nurse will want to monitor this baby for common associated conditions including:
1. Club foot (talipes equinovarus).
2. Congenital heart anomalies.
3. Hyperbilirubinemia due to liver abnormalities.
4. Diaphragmatic hernia.
Correct Answer: 2
Rationale 1: Club foot is not associated with Turner's syndrome.
Rationale 2: Congenital heart anomalies, including coarctation of the aorta, frequently
are associated with Turner's syndrome.
Rationale 3: The girl with Turner's syndrome has the normal risk for hyperbilirubinemia.
It is not associated with Turner's syndrome.
Rationale 4: Diaphragmatic hernias are not associated with Turner's syndrome.
During the hospital stay in the newborn nursery, the infant is tested for galactosemia.
When the test is positive, the parents are educated about treatment for galactosemia.
The infant will be placed on what type of infant feeding?
1. Goat's milk formula
2. Breast milk
3. Cow's milk-based formula
4. Meat-based formula such as Nutramigen
Correct Answer: 4
Rationale 1: Goat's milk formula contains galactose and is excluded from the infant's
diet.
Rationale 2: Breast milk contains galactose and is excluded from the infant's diet.
Rationale 3: Cow's milk-based formula contains galactose and is excluded from the
infant's diet.
Rationale 4: The meat-based formula does not contain galactose and is appropriate for
the infant's diet.
The thyroid gland produces the thyroid hormones triiodothyronine (T3) and
tetraiodothyronine (T4), which are dependent on the availability of
a. iodine produced in the liver
b. iodine found in the diet
c. iron absorbed from the GI tract
d. parathyroid hormone (PTH) to promote iodine building
B
Iodine in the diet
Thyroid replacement therapy is indicated for the treatment of
a. obesity
b. myxedema
c. Graves' disease
d. acute thyrotoxicosis
B
myxedema
Goiter, or enlargement of the thyroid gland, is usually associated with
a. hypothyroidism
b. iodine deficiency
c. hyperthyroidism
d. underactive thyroid tissue
C
hyperthyroidism
Administration of propylthiouracil would include giving the drug
a. once a day in the morning
b. around the clock to assure therapeutic levels
c. once a day at bedtime to decrease adverse effects
d. if the patient is experiencing slow heart rate, skin rash, or excessive bleeding
B
Around the clock to assure therapeutic levels
The thyroid gland is dependent on the hypothalamic-pituitary axis for regulation.
Increasing the levels of thyroid hormone (by taking replacement thyroid hormone) would
a. increase hypothalamic release of thyrotropin-releasing hormone (TRH)
b. increase pituitary release of thyroid-stimulating hormone
c. suppress hypothalamic release of TRH
d. stimulate the thyroid gland to produce more T3 and T4
C
suppress hypothalamic release of TRH
Assessing a patient's knowledge of his or her thyroid replacement therapy would show
good understanding if he patient stated:
a. "My wife may use some of my drug, since she wants to lose weight."
b. "I should only need this drug for about 3 months."
c. "I can stop taking this drug as soon as I feel like my old self."
d. "I should call if I experience unusual sweating, weight gain, or chills and fever."
D
Hypothyroidism is a very common and often missed disorder. Signs and symptoms of
hypothyroidism include: Select All That Apply
a. increased body temperature
b. thickening of the tongue
c. bradycardia
d. loss of hair
e. excessive weight loss
f. oily skin
A, B, D

incr body temp

thickening tongue
loss of hair
The parathyroid glands produce PTH, which is important in the body as
a. a modulator of the thyroid hormone
b. a regulator of potassium
c. a regulator of calcium
d. an activator of vitamin D
C
regulates calcium
Which of the following would the nurse expect to assess in a patient experiencing
hyperthyroidism?
a. slow and deep tendon reflexes
b. bradycardia
c. flushed, warm skin
d. intolerance to cold
C
flushed warm skin
Which of the following would be the initial substance responsible for thyroid hormone
regulation?
a. iodine intake
b. thyrotropin-releasing hormone
c. thyroid-stimulating hormone
d. Levothyroxine
B

Initial substance for thyroid hormone release is thyrotropin-releasing hormone form the
hypothalamus. It then stimulates TSH.
The patient is receiving propylthiouracil (PTU), a thyomide. The nurse anticipates a
reduction in the patients dosage based on assessment of which of the following?
a. nervousness
b. tachycardia
c. weight loss
d. decreased appetite
D
decreased appetite

PTU can cause thyroid suppression leading to s/s of hypothyroidism such as decreased
appetite.
What are the uses of antithyroid drugs?
SELECT ALL THAT APPLY
a. emergency treatment of thyrotoxicosis
b. to treat myxedema coma
c. preparation for thyroid surgery
d. Graves disease
A, C, D

myxedema coma is treated with thyroid drugs via IV therapy. Its a coma brought on my
hypOthyroidism
A patient is prescribed levothyroxine, thyroid drug. The nurse understands that this drug
contains which of the following?
a. T3
b. iodine
c. T4
d. Vitamin D
C
T4
Which of the following describe the therapeutic actions of antithyroid drugs? SELECT
ALL THAT APPLY
a. blocks synthesis of thyroid
b. blocks conversion of T4 to T3
c. prevents oxidation of iodine
d. blocks conversion of T3 to T4
e. initiates oxidation of iodine
A, B, C
Which of the following is thyroid drugs used for?
SELECT ALL THAT APPLY
a. hypothyroidism
b. hyperthyroidism
c. Grave's disease
d. Myxedema coma
e. emergency tx of thyrotoxicosis
A, D

Graves disease and emergency tx of thyrotoxicosis is treated with ANTIthyroid drugs

Side effects of thyroid drugs include:
SELECT ALL THAT APPLY
a. anxiety
b. hypertension
c. narcolepsy
d. skin rash
e. metallic taste in mouth
A, B

thyroid drugs cause sleeplessness not narcolepsy

skin rash and metallic taste are seen with ANTIthyroid drugs
Which of the following are common side effects of thiomides? SELECT ALL THAT
APPLY
a. skin rash
b. bradycardia
c. diarrhea
d. cold
e. nausea
A, B, E

diarrhea and cold are SE of iodine solution drugs

All of the following are common adverse effects of iodine solution drugs except:
a. metallic taste
b. mouth burning
c. cold
d. bradycardia
e. diarrhea
D

bradycardia is seen in thiomides

A client with hyperthyroidism has been given methimazole (a antithyroid med). Which
nursing considerations are associated with this medication? SELECT ALL THAT APPLY
a. Administer with food
b. put client on low-calorie, low-protein diet
c. assess for unexplained bruising or bleeding
d. instruct client to report SE such as sore throat, fever and HAs
e. use special radioactive precautions when handling the clients urine for the first 24
hours following initial administration
A,C, D
The nurse is monitoring a client receiving levothyroxine sodium, thyroid drug, for
hypothyroidism. Which findings indicate the presence of a side effect associated with
this medication? SELECT ALL THAT APPLY
a. insomnia
b. weight loss
c. bradycardia
d. constipation
e. mild heat intolerance
A, B, E
The nurse is providing education to a client recently diagnosed with type 1 diabetes
mellitus. What information will the nurse include when teaching about the characteristics
of this disease?

a. Hyperosmolar hyperglycemia state

b. Insulin resistance
c. Rapid onset of disease
d. Breakdown of fats and proteins
d. Breakdown of fats and proteins
The nurse caring for a client with diabetes mellitus understands that this client is at risk
for a number of complications. What complication is this client at greatest risk for
developing?

a. Bowel obstruction
b. Coronary artery disease
c. Acute renal disease
d. Memory impairment
b. Coronary artery disease
The nurse is completing a health history on a client with type 1 diabetes mellitus. Which
manifestations indicate the client is experiencing hyperglycemia?
Select all that apply.

a. Weight gain
b. Polyphagia
c. Polydipsia
d. Fatigue
e. Polyuria
b. Polyphagia
c. Polydipsia
d. Fatigue
e. Polyuria
A client is seen in the health care providers office. What data should alert the nurse as a
risk factor associated with the development of type 2 diabetes mellitus?

a. HDL cholesterol level of 38 mg/dL

b. Blood pressure of 140/90 mmHg
c. Triglyceride level of 180 mg/dL
d. History of delivering a baby weighing less than 8 lb
b. Blood pressure of 140/90 mmHg
The nurse is educating a client newly diagnosed with type 1 diabetes mellitus. What
information should the nurse include in client education about ongoing monitoring of
glucose levels?

a. Urine testing will assist in measuring hypoglycemia.

b. Urine testing is only used until glucose goals are achieved.
c. Self-monitoring blood glucose is painless and noninvasive.
d. Self-monitoring blood glucose should occur three or four times a day.
d. Self-monitoring blood glucose should occur three or four times a day.
The nurse has completed educating a client diagnosed with type 1 diabetes mellitus
about medication, nutrition, and exercise. What statement by the client indicates the
client has a good understanding of how to properly treat diabetes mellitus?

a. "I will take oral hypoglycemic agents to control my blood glucose."

b. "I need to exercise at least 120 minutes each week."
c. "I need to learn sick day management rules."
d. "I will prevent prolonged sessions of exercise because they cause hyperglycemia."
c. "I need to learn sick day management rules."
When planning care for a client with diabetes mellitus, the nurse addresses the potential
problem of risk for infection. Which intervention will assist in addressing this potential
problem?

a. Monitor sensation to extremities daily.

b. Instruct the client to have an oral examination yearly.
c. Teach using lukewarm water and soap for skin care.
d. Promote smoking cessation.
c. Teach using lukewarm water and soap for skin care.
The nurse is admitting a client with diabetes mellitus. Which information should the
nurse specifically include in the health history?
Select all that apply.

a. Numbness in feet
b. Vision changes
c. Infections
d. Frequent voiding
e. Hypotension
a. Numbness in feet
b. Vision changes
c. Infections
d. Frequent voiding
A client is diagnosed with type 2 diabetes mellitus. What information about type 2
diabetes mellitus should the nurse include when providing client education?

a. Insulin resistance occurs in peripheral tissues.

b. The onset of hyperglycemia is rapid.
c. Metabolism of dietary carbohydrates is enhanced.
d. The liver suppresses glucose being released.
a. Insulin resistance occurs in peripheral tissues.
The nurse is caring for a 70-year-old client admitted for possible type 2 diabetes
mellitus. When obtaining the client's history, what conditions are potential indicators for
diabetes mellitus in an older client?
Select all that apply.

a. Gastroparesis
b. Glaucoma
c. Periodontal disease
d. Hypertension
e. Impotence
a. Gastroparesis
b. Glaucoma
c. Periodontal disease
e. Impotence
A client is admitted to the medical unit for possible diabetes mellitus. Which
manifestations should the nurse monitor for that indicate the client is experiencing type
2 diabetes mellitus?
Select all that apply.

a. Skin infection
b. Blurred vision
c. Ketoacidosis
d. Polydipsia
e. Polyuria
a. Skin infection
b. Blurred vision
d. Polydipsia
e. Polyuria
The nurse is educating a group of older clients at a senior center about manifestations
of diabetes mellitus. Which manifestations should the nurse include about diabetes
mellitus that may be altered because of the aging process?
Select all that apply.

a. Decreased thirst
b. Increased hunger
c. Hypotension
d. Peripheral neuropathy
e. Urinary incontinence
a. Decreased thirst
d. Peripheral neuropathy
e. Urinary incontinence
What acute complication will the nurse monitor for in a client with type 2 diabetes
mellitus?

a. Diabetic ketoacidosis
b. Atherosclerosis
c. Hyperosmolar hyperglycemic state
d. Neuropathy
c. Hyperosmolar hyperglycemic state
The nurse is caring for a client with diabetes mellitus who is at risk for developing
chronic complications. For which conditions should the nurse monitor?
Select all that apply.
a. Nephropathy
b. Stroke
c. Dementia
d. Retinopathy
e. Neuropathy
a. Nephropathy
b. Stroke
d. Retinopathy
e. Neuropathy
A client with diabetes mellitus is admitted to the medical unit for chronic complications.
The nurse ensures that the floor is free of clutter, uses a night light, and checks the
water temperature before bathing the client. What potential problem do these
interventions address when caring for this client?

a. Ineffective coping
b. Risk for injury
c. Risk for infection
d. Acute pain
b. Risk for injury
Diabetes mellitus is the leading cause of which of the following complications?

a. Encephalopathy
b. End-stage renal disease
c. Coronary artery disease
d. Heart failure
b. End-stage renal disease
Which of the following best describes the pathophysiology of Type 1 diabetes mellitus?

a. Production of pancreatic beta cells

b. Production of pancreatic alpha cells
c. Destruction of pancreatic alpha cells
d. Destruction of pancreatic beta cells
d. Destruction of pancreatic beta cells
Which of the following are features of type 2 diabetes mellitus?
Select all that apply.

a. Inadequate insulin production

b. Ketone production
c. Complete insulin deficiency
d. Complete destruction of beta cells
e. Insulin resistance
a. Inadequate insulin production
e. Insulin resistance
Walter Wariner, an 82-year-old man, is complaining of frequent bouts of nausea and
indigestion. He also states that he has been experiencing numbness and tingling in his
feet. Which of the following statements should you say to Mr. Wariner?

a. "These may be signs of hypertension. You should have your blood pressure
checked."
b. "These may be symptoms of diabetes mellitus. You should have your blood sugar
checked."
c. "These are normal signs of aging. There is no need to worry."
d. "These may be signs of renal failure. You should have your kidneys checked."
b. "These may be symptoms of diabetes mellitus. You should have your blood sugar
checked."
Which of the following are manifestations of type 1 diabetes mellitus?
Select all that apply.

a. Weight gain
b. Glucosuria
c. Blurred vision
d. Fever
e. Polyuria
b. Glucosuria
c. Blurred vision
e. Polyuria
Which of the following are risk factors associated with type 2 diabetes mellitus?
Select all that apply.

a. Weight loss
b. Physical inactivity
c. Blood pressure greater than or equal to 130/85 mmHg
d. HDL cholesterol greater than or equal to 50 mg/dl
e. Triglyceride level greater than or equal to 250 mg/dl
b. Physical inactivity
c. Blood pressure greater than or equal to 130/85 mmHg
e. Triglyceride level greater than or equal to 250 mg/dl
Which of the following may be a manifestation of diabetes mellitus in the older client?

a. Palpitations
b. Increased thirst
c. Urinary incontinence
d. Increased hunger
c. Urinary incontinence
Gladys Lewis is a 48-year-old woman with a history of hypertension who is admitted to
the hospital with an infected wound on her right ankle that does not seem to be healing.
She reports that she has been experiencing fatigue, blurred vision, polyuria, and
polydipsia for the past month. Upon reviewing her medical record, you note that she has
a BMI of 32 and a blood glucose level of 225 mg/dL. Her blood and urine are negative
for ketones. Which of the following do you suspect may be happening to Ms. Lewis?

a. Type 1 diabetes mellitus

b. Type 2 diabetes mellitus
c. Diabetes insipidus
d. Hypoglycemia
b. Type 2 diabetes mellitus
Which of the following lab values indicate that the client may have diabetes mellitus?

a. Casual plasma glucose greater than 150 mg/dL

b. Glycosylated hemoglobin (A1C) less than 5.7%
c. Glycosylated hemoglobin (A1C) greater than 6.5%
d. Fasting plasma glucose less than 126 mg/dl
c. Glycosylated hemoglobin (A1C) greater than 6.5%
Nutritional recommendations for clients with diabetes mellitus include which of the
following?

a. 20% carbohydrates, 10% protein, and 65% fat

b. 65% carbohydrates, 20% protein, and 10% fat
c. 10% carbohydrates, 65% protein, and 20% fat
d. 15% carbohydrates, 30% protein, and 55% fat
b. 65% carbohydrates, 20% protein, and 10% fat
Greer Bell is a 59-year-old man who was admitted to the hospital with complaints of
chest pain, dyspnea, polyuria, polydipsia, and polyphagia. His glycosylated hemoglobin
(A1C) is 9%. While taking Mr. Greer's admission history, he mentions that his feet feel
numb. Which of the following complications would you assess Mr. Greer for first?

a. Retinopathy
b. Hepatitis
c. A foot ulcer
d. Nephropathy
c. A foot ulcer
A patient has been recently diagnosed with type 1 diabetes mellitus. The patient states,
"I am thin and eat all the time. How can I have diabetes?" Which response by the nurse
is most appropriate?
1. "Thin people can be diabetic, too."
2. "Your condition makes it impossible for you to gain weight."
3. "People with type 1 diabetes are usually thin or of normal weight at diagnosis."
4. "Your lab tests indicate the presence of diabetes."
Correct Answer: 3
Rationale 1 : Although this statement is correct, it does not answer the patient's
question.
Rationale 2 : It is not impossible for diabetics to gain weight.
Rationale 3 : The diabetic patient is unable to obtain the needed glucose for the body's
cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus
experience polyphagia and are often thin.
The community nurse is teaching a group of members with type 1 or 2 diabetes mellitus
who are planning to participate in an athletic triathlon. On which potential complication
from this event should the nurse focus when teaching?
a. impaired glucose tolerance
b. diabetic ketoacidosis
c. hyperosmolar hyperglycemic state
d. hypoglycemia
d. hypoglycemia
Which of the following symptoms would you ask about while taking a health history to
help determine if a client has developed complications from diabetes mellitus?
Select all that apply.

a. Numbness in the feet

b. Dizziness
c. Frequent voiding
d. Quick wound healing
e. Vision changes
a. Numbness in the feet
b. Dizziness
c. Frequent voiding
e. Vision changes
Which of the following should the nurse perform when caring for the diabetic client's
feet?

a. Let the feet air dry.

b. Cut the toenails as short as possible.
c. Remove all corns on the feet with a commercial product.
d. Wash the feet with mild soap and lukewarm water.
d. Wash the feet with mild soap and lukewarm water.
Which of the following items should be considered when developing a care plan for the
older client with diabetes mellitus?
Select all that apply.

a. Increased hunger
b. Exercises adjusted for physical limitations
c. Excess fluid intake
d. Insufficient financial resources to afford medications
e. Visual deficits that might interfere with insulin administration
b. Exercises adjusted for physical limitations
d. Insufficient financial resources to afford medications
e. Visual deficits that might interfere with insulin administration
Richard Cortez, a 68-year-old man with history of type 2 diabetes mellitus, is admitted to
the hospital with community-acquired pneumonia. What should you teach Mr. Cortez to
help him prevent injuries while he is in the hospital?

a. Monitor blood glucose levels once a week.

b. Turn off lights around the bed and room.
c. Walk slowly when feeling dizzy from medications.
d. Wear shoes or slippers when out of bed.
d. Wear shoes or slippers when out of bed.
The nurse is assessing a patient who has a family history of type 2 diabetes mellitus.
Which finding would require follow-up by the nurse?

a. decreased waist-to-hip ratio through dietary changes

b. a new prescription for levothyroxine (Synthroid) for hypothyroidism
c. a fasting blood glucose level of 89 mg/dL
d. delivery of a baby that weighed 8 pounds and 12 ounces
b. a new prescription for levothyroxine (Synthroid) for hypothyroidism
The nurse is reviewing the healthcare record of a patient with type 2 diabetes mellitus
who has a foot wound. Which outcome of care would be the most important at this
time?

a. The patient will obtain a thermometer for monitoring bath water temperature.
b. The patient will bring a caregiver to the next healthcare appointment.
c. The patient will explain why patients with diabetes should not go barefoot.
d. The patient will describe the steps of effective diabetic foot care.
b. The patient will bring a caregiver to the next healthcare appointment.
A patient with type 1 diabetes mellitus has a serum hematocrit level of 24%. What
additional finding should the nurse report to the health care provider?

a. capillary blood glucose of 60 mg/dL

b. the presence of glucose in urine
c. glycosylated hemoglobin of 7.0
d. the presence of albumin in urine
a. capillary blood glucose of 60 mg/dL
The nurse is reviewing instruction provided to a graduate nurse regarding insulin
therapy. Which statement made by the graduate indicates that further instruction is
needed?
Select all that apply.

a. Regular insulin can be administered intravenously.

b. Lispro is a rapid-acting insulin.
c. Insulin detemir is administered prior to each meal.
d. NPH insulin may be mixed with lispro insulin.
e. Insulin glargine may be used to treat gestational diabetes.
c. Insulin detemir is administered prior to each meal.
e. Insulin glargine may be used to treat gestational diabetes.
The nurse is reviewing data collected from a patient with a predisposition to developing
insulin resistance. Which medications should the nurse identify as potentially causing
this patient to develop diabetes?
Select all that apply.

a. furosemide (Lasix)
b. nicotinic acid (Niacor)
c. phenytoin (Dilantin)
d. acetaminophen (Tylenol)
e. levothyroxine (Synthroid)
a. furosemide (Lasix)
b. nicotinic acid (Niacor)
c. phenytoin (Dilantin)
e. levothyroxine (Synthroid)
The nurse is conducting an educational session with a patient who is newly diagnosed
with diabetes. The nurse knows further education is needed when the patient states, "In
the U.S.:

a. 25.8 million people have diabetes."

b. 6 million people are diagnosed with diabetes per year."
c. 7 million people have diabetes but have not been diagnosed."
d. 18.8 million people have been diagnosed with diabetes."
b. 6 million people are diagnosed with diabetes per year."
The nurse is caring for a healthy patient who has a serum glucose level of 60 mg/dL.
The nurse anticipates which counterregulatory serum hormonal changes to occur in this
patient?
Select all that apply.

a. increased growth hormone levels

b. decreased thyroxine levels
c. decreased glucocorticoid levels
d. increased epinephrine levels
e. increased insulin levels
a. increased growth hormone levels
d. increased epinephrine levels
The nurse is teaching a patient with diabetes about self-management. What should the
nurse include regarding medications to treat diabetes mellitus?

a. Patients with type 1 diabetes may progress to type 2 if blood glucose levels are not
well controlled.
b. Patients with type 2 diabetes may achieve normal blood glucose levels with a
combination of oral medications and insulin.
c. Patients with type 2 diabetes will always need an exogenous source of insulin.
d. Patients with type 1 diabetes may achieve normal blood glucose levels with oral
medications.
b. Patients with type 2 diabetes may achieve normal blood glucose levels with a
combination of oral medications and insulin.
A 78-year-old patient without polyuria, polydipsia, or polyphagia has a serum glucose
level of 130 mg/dL. What should the nurse conclude about this patient?

a. The patient will need to be assessed for other manifestations of diabetes.

b. The patient has type 1 diabetes mellitus.
c. The patient might have eaten a meal with high sugar content prior to the testing.
d. The laboratory results might be erroneous.
a. The patient will need to be assessed for other manifestations of diabetes.
The nurse is reviewing data collected for a patient's health history. Which factor should
the nurse identify as increasing the patient's risk of developing type 2 diabetes mellitus?

a. physical inactivity
b. low waist-to-hip ratio
c. blood pressure of 120/70
d. body mass index of 23 kg/m2
a. physical inactivity
The nurse is planning care for a patient with type 1 diabetes mellitus. Which action
should the nurse identify as being the most effective to reduce the development of
complications?

a. the necessity of a yearly eye exam

b. knowing symptoms of urinary tract infections
c. performance of effective foot care
d. self-monitoring of blood glucose levels
d. self-monitoring of blood glucose levels
The nurse is assessing a patient with type 2 diabetes mellitus. What questions should
the nurse ask to determine the patient's risk for a lower extremity amputation?
Select all that apply.

a. "When were you first diagnosed with diabetes mellitus?"

b. "Do you use insulin or oral hypoglycemic agents?"
c. "Do you have any problems with your kidney related to diabetes?"
d. "Do you have any problems with your eyes related to diabetes?"
e. "What were your glycosylated hemoglobin values over the past year?"
c. "Do you have any problems with your kidney related to diabetes?"
d. "Do you have any problems with your eyes related to diabetes?"
e. "What were your glycosylated hemoglobin values over the past year?"
A patient at risk for the development of type 2 diabetes mellitus asks why weight loss
will reduce risk of the condition. Which response by the nurse is most accurate?
a. "The physical inactivity associated with obesity causes a reduced ability by the body
to produce insulin."
b. "The amount of foods taken in require more insulin to adequately metabolize them,
resulting in diabetes."
c. "Thin people are less likely to become diabetic."
d. "Excess body weight impairs the body's release of insulin."
d. "Excess body weight impairs the body's release of insulin."
The nurse notes that a patient with type 2 diabetes mellitus is not prescribed aspirin 81
mg as recommended for the prevention of cardiovascular complications. What
information in the patient's health history should the nurse use to understand why this
medication has not been prescribed for the patient?
Select all that apply.

a. Patient prescribed warfarin (Coumadin) 5 mg by mouth every day.

b. Patient receives a vitamin B12 injection every month.
c. Patient develops a rash and urticaria when taking medications with sulfa.
d. Patient treated for chronic alcoholism and liver cirrhosis the past year.
e. Patient admitted for gastrointestinal bleeding 3 months ago.
a. Patient prescribed warfarin (Coumadin) 5 mg by mouth every day.
d. Patient treated for chronic alcoholism and liver cirrhosis the past year.
e. Patient admitted for gastrointestinal bleeding 3 months ago.
A patient recently diagnosed with diabetes wants to check the urine for glucose instead
of using capillary blood because of the cost. Which response should the nurse make to
the patient?

a. "Urine testing is as reliable as finger stick testing."

b. "Yes, urine testing is cheaper than glucose test strips."
c. "Would you like to switch to this method of monitoring?"
d. "Urine testing is best when combined with serum testing."
d. "Urine testing is best when combined with serum testing."
A patient beginning insulin for type 2 diabetes is experiencing blurred vision and is
concerned about becoming blind. What response by the nurse is most appropriate?

a. "Blurry vision is very common. Do not worry."

b. "I will call the physician to report your symptoms."
c. "I will make an appointment for you to see an ophthalmologist."
d. "This is a normal response when insulin therapy is initiated."
d. "This is a normal response when insulin therapy is initiated."
An older patient with type 2 diabetes mellitus is upset because family members do not
believe the patient has an illness and resist helping with diet and activity modifications.
What should the nurse suggest to help this patient?

a. Explain the risk for family also to develop the illness.

b. Invite family to participate in a support group.
c. Limit discussions about the illness with family members.
d. Store health-related items away from common family areas in the home.
b. Invite family to participate in a support group.
A patient recently diagnosed with type 1 diabetes mellitus does not understand why the
disease developed because the patient is thin and eats all of the time. What is the most
appropriate response by the nurse?

a. "Diabetes makes it difficult for your body to obtain energy from the foods you eat."
b. "Your condition makes it impossible for you to gain weight."
c. "Thin people can be diabetic, too."
d. "Your lab tests indicate the presence of diabetes."
a. "Diabetes makes it difficult for your body to obtain energy from the foods you eat."
A nurse is teaching a group of patients about the prevalence of type 2 diabetes in older
adults. The nurse knows teaching has been effective when a patient states,
"Statistically, in a group of 100 older adults in the United States, approximately:

a. 17 will have type 2 diabetes."

b. 27 will have type 2 diabetes."
c. 10 will have type 2 diabetes."
d.33 will have type 2 diabetes."
b. 27 will have type 2 diabetes."
A patient with type 1 diabetes mellitus has difficulty swallowing and takes milk of
magnesium every day for nausea and constipation. What should the nurse suspect is
occurring with this patient?

a. reaction to insulin injections

b. visceral neuropathy
c. peripheral neuropathy
d. age-related changes
b. visceral neuropathy
The nurse instructs a patient with type 2 diabetes mellitus on the use of a glucometer for
self-monitoring. Which patient statements about glucometer performance indicate that
teaching has been effective?
Select all that apply.

a. Grapefruit juice should not be ingested when using the glucometer.

b. A patient with sickle cell anemia may need another way to check blood glucose
levels.
c. A sufficient amount of blood must be applied to the strip.
d. Follow manufacturer's recommendation regarding cleaning of meter.
e. Correctly apply the blood to the meter strip.
b. A patient with sickle cell anemia may need another way to check blood glucose
levels.
c. A sufficient amount of blood must be applied to the strip.
d. Follow manufacturer's recommendation regarding cleaning of meter.
e. Correctly apply the blood to the meter strip.
The nurse is identifying patients at risk for needing insulin. Which patients should the
nurse identify as potentially needing insulin to maintain a normal blood glucose level?
Select all that apply.

a. patients receiving total parenteral nutrition

b. patients with type 2 diabetes who are undergoing surgical procedures
c. patients who are fasting or malnourished
d. patients with type 2 diabetes who are diagnosed with an infection
e. patients with gestational diabetes
b. patients with type 2 diabetes who are undergoing surgical procedures
d. patients with type 2 diabetes who are diagnosed with an infection
e. patients with gestational diabetes
The nurse is reviewing the actions that a patient with type 1 diabetes mellitus should
take if mild hypoglycemia is experienced. What should the nurse include in this
teaching?
Select all that apply.

a. Ingest additional 15 grams of carbohydrate if blood glucose remains low after 15

minutes.
b. Ingest 4 ounces of fruit juice when blood glucose is below 70 mg/dL.
c. Measure blood glucose 15 minutes after ingesting a carbohydrate source.
d. Add table sugar to 8 ounces of fruit juice when blood glucose is below 70 mg/dL.
e. Test blood glucose 30 minutes after reaching 70 mg/dL.
a. Ingest additional 15 grams of carbohydrate if blood glucose remains low after 15
minutes.
b. Ingest 4 ounces of fruit juice when blood glucose is below 70 mg/dL.
c. Measure blood glucose 15 minutes after ingesting a carbohydrate source.
The nurse is preparing to administer insulin to an underweight patient. Which actions
should the nurse take when providing this injection?
Select all that apply.

a. Make sure no air bubbles are present in the syringe.

b. Insert the needle at a 90-degree angle.
c. Massage the site of insertion.
d. Rotate injection sites.
e. Ensure insulin is at room temperature.
a. Make sure no air bubbles are present in the syringe.
d. Rotate injection sites.
e. Ensure insulin is at room temperature.
The nurse is teaching a patient with type 2 diabetes mellitus about glyburide (DiaBeta).
The nurse knows teaching has been effective when the patient states, "I need to
monitor for dizziness, lightheadedness, and sweating if I take:
Select all that apply.

a. metoprolol (Lopressor) for hypertension."

b. docusate sodium (Colace) for constipation."
c. cetirizine (Zyrtec) for allergies."
d. ranitidine (Zantac) for heartburn."
e. ibuprofen (Motrin) for pain."
a. metoprolol (Lopressor) for hypertension."
d. ranitidine (Zantac) for heartburn."
e. ibuprofen (Motrin) for pain."
The nurse is caring for a patient experiencing diabetic ketoacidosis. What actions
should the nurse take when preparing this patient's insulin infusion?
Select all that apply.

a. Prepare an infusion of Dextrose 5% and 0.45% normal saline.

b. Flush the tubing with the insulin solution before connecting.
c. Discontinue the infusion after first dose of subcutaneous insulin.
d. Have one ampule of Dextrose 10% at the bedside.
e. Attach insulin infusion to an intravenous pump.
b. Flush the tubing with the insulin solution before connecting.
c. Discontinue the infusion after first dose of subcutaneous insulin.
e. Attach insulin infusion to an intravenous pump.
A patient with type 1 diabetes mellitus who had one episode of vomiting in the past 2
hours asks if the routine insulin injection should be taken. What action by the nurse is
best at this time?

a. Contact the physician.

b. Check the patient's fasting serum glucose level.
c. Explain the need to take the insulin.
d. Document the refusal and continue on with the planned care.
c. Explain the need to take the insulin.
A patient with type 2 diabetes mellitus is scheduled for laparoscopic adjustable gastric
banding (LAGB) surgery. What should the nurse explain to the patient about this
procedure and diabetes?

a. "Surgical procedures can be dangerous for patients with diabetes."

b. "This procedure is more appropriate for a patient who has a diagnosis of type 1
diabetes mellitus."
c. "Do you feel that a surgical weight loss procedure will cure your obesity?"
d. "Evidence indicates positive outcomes for many patients with diabetes who undergo
surgical weight loss procedures."
d. "Evidence indicates positive outcomes for many patients with diabetes who undergo
surgical weight loss procedures."
The nurse is caring for a patient with type 1 diabetes mellitus. Which patient statement
requires immediate intervention by the nurse?

a. "I will not use insulin detemir in my insulin pump."

b. "I won't mix my cloudy regular insulin with other insulins."
c. "I will take my lispro insulin 15 minutes before I eat breakfast."
d. "I am allergic to eggs."
b. "I won't mix my cloudy regular insulin with other insulins."
The community nurse is teaching a group of members with type 1 or 2 diabetes mellitus
who are planning to participate in an athletic triathlon. On which potential complication
from this event should the nurse focus when teaching?
a. impaired glucose tolerance
b. diabetic ketoacidosis
c. hyperosmolar hyperglycemic state
d. hypoglycemia
d. hypoglycemia
A patient with diabetes mellitus has albuminuria, hypertension, and edema. What
should the nurse expect to be prescribed for this patient?

a. Review weight loss strategies.

b. Increase salt intake.
c. Provide antibiotic therapy as prescribed.
d. Restrict activity.
a. Review weight loss strategies.
A patient with no previous history of diabetes mellitus has ketones in the urine. Which
question should the nurse ask this patient?

a. "Have you donated blood recently?"

b. "Have you ever been told you have albumin in your urine?"
c. "What did you eat for breakfast and lunch today?"
d. "Can you please describe any weight loss strategies you've been using?"
d. "Can you please describe any weight loss strategies you've been using?"
A patient with diabetes is diaphoretic, has a heart rate of 112 beats per minute, and is
feeling nervous and shaky. What action should the nurse take first?

a. Provide the patient with a snack of milk and crackers.

b. Contact the laboratory and order a serum glucose level.
c. Obtain a capillary serum glucose level reading with a glucose meter.
d. Administer insulin utilizing the prescribed sliding scale dosages.
c. Obtain a capillary serum glucose level reading with a glucose meter.
A patient with diabetes asks what can be done to prevent the development of corns on
the feet. How should the nurse respond to this patient?

a. "Use corn pads to gradually remove the growths."

b. "Make sure that you select shoes that are appropriately fitted."
c. "Corns are best treated by shaving them off."
d. "A mild abrasive soap can be used to scrub the area to remove them."
b. "Make sure that you select shoes that are appropriately fitted."
The nurse is teaching a patient with diabetes about the illness. The nurse knows the
teaching has been effective when the patient identifies which statements as being true
of pancreatic cells?
Select all that apply.

a. Beta cells secrete insulin.

b. Cephalon cells produce creatine.
c. Delta cells produce somatostatin.
d. Alpha cells produce glucagon.
e. Epsilon cells produce erythropoietin.
a. Beta cells secrete insulin.
c. Delta cells produce somatostatin.
d. Alpha cells produce glucagon.
A patient with type 1 diabetes mellitus voided 4,000 mL of urine in the past 24 hours.
The patient's skin turgor is poor, and the patient is reporting polyphagia and polydipsia.
Which blood glucose level should the nurse expect when assessing this patient?

a. 180 mg/dL
b. 60 mg/dL
c. 125 mg/dL
d. 110 mg/dL
a. 180 mg/dL
A patient with diabetes mellitus and poor circulation has thick and ingrown toenails.
What should the nurse instruct the patient to do?
a. Cut toenails immediately prior to bathing.
b. Soak feet in Epsom salts daily.
c. Use a clean sharp razor blade to trim nails.
d. Make an appointment with a podiatrist.
d. Make an appointment with a podiatrist.
The nurse is concerned that a patient with type 1 diabetes mellitus is at risk for
developing diabetic ketoacidosis. What did the nurse assess to come to this
conclusion?

a. ulcer on plantar aspect of right foot

b. reports of anxiety
c. serum glucose level of 325 mg/dL
d. pale, cool skin
c. serum glucose level of 325 mg/dL
The nurse notes that a 41-year-old patient's fasting blood glucose level is 125 mg/dL.
What should the nurse suspect is occurring with the patient?

a. consistent with diabetes

b. consistent with prediabetes
c. severe hyperglycemia
d. normal results
b. consistent with prediabetes
The manager observes a graduate nurse teaching a 5-year-old patient with diabetes
mellitus. The manager determines that content being instructed is appropriate when the
nurse states, "Insulin acts like:

a. a mud pie that makes the blood vessels thick and sticky."
b. a wagon that carries sugar into the cells of the body."
c. salty potato chips that make people feel very thirsty."
d. building blocks that help make protein into strong muscles."
b. a wagon that carries sugar into the cells of the body."
The nurse is trying to determine if a patient is experiencing manifestations of type 1 or
type 2 diabetes mellitus. Which question should the nurse ask the patient to help
determine the type?

a. "Have you been hungrier than in the past?"

b. "Have you been drinking more liquids than in the past?"
c. "Have you noticed any changes in your vision?"
d. "Have you been urinating in greater amounts than in the past?"
a. "Have you been hungrier than in the past?"
During care of a patient with syndrome of inappropriate ADH (SIADH), the nurse should
a. monitor neurologic status Q2H or more often if needed
b. keep the head of the bed elevated to prevent ADH release
c. teach the patient receiving treatment with diuretics to restrict sodium intake
d. notify the physician if the patient's blood pressure decreases more than 20mmHg
from baseline
a. monitor neurologic status Q2H or more often if needed
Rationale- the patient with SIADH has marked dilution hyponatremia and should be
monitored for decreased neurologic function and convulsions every 2 hours. ADH
release is reduced by keeping the head of the bed flat to increase left atrial filling
pressure, and sodium intake is supplemented because of hyponatremia and sodium
loss caused by diuretics. A reduction in blood pressure indicates a reduction in total fluid
volume and is an expected outcome of treatment.)
A patient with SIADH is treated with water restriction and administration of IV fluids. The
nurses evaluates that treatment has been effective when the patient experiences
a. increased urine output, decreased serum sodium, and increased urine specific gravity
b. increased urine output, increased serum sodium, and decreased urine specific gravity
c. decreased urine output, increased serum sodium, and decreased urine specific
gravity
d. decreased urine output, decreased serum sodium, and increased urine specific
gravity
b. increased urine output, increased serum sodium, and decreased urine specific gravity
(rationale- the patient with SIADH has water retention with hyponatremia, decreased
urine output and concentrated urine with high specific gravity. improvement in the
patient's condition reflected by increased urine output, normalization of serum sodium,
and more water in the urine, decreasing the specific gravity.)
In a patient with central diabetes insipidus, administration of aqueous vasopressin
during a water deprivation test will result in a
a. decrease in body weight
b. increase in urinary output
c. decrease in blood pressure
d. increase in urine osmolality
d. increase in urine osmolality
(rationale- a patient with DI has a deficiency of ADH with excessive loss of water from
the kidney, hypovolemia, hypernatreamia, and dilute urine with a low specific gravity.
When vasopressin is administered, the symptoms are reversed, with water retention,
decreased urinary output that increases urine osmolality, and an increase in blood
pressure.)
A patient with DI is treated with nasal desmopression. The nurse recognize that the
drug is not having an adequate therapeutic effect the the patient experiences
a. headache and weight gain
b. nasal irritation and nausea
c. a urine specific gravity of 1.002
d. an oral intake greater than urinary output
A patient with DI is treated with nasal desmopression. The nurse recognize that the
drug is not having an adequate therapeutic effect the the patient experiences
a. headache and weight gain
b. nasal irritation and nausea
c. a urine specific gravity of 1.002
d. an oral intake greater than urinary output c. a urine specific gravity of 1.002
(rationale- normal urine specific gravity is 1.003 to 1.030, and urine with a specific
gravity of 1.002 is very dilute, indicating that there continues to be excessive loss of
water and that treatment of DI is inadequate. H/A, weight gain, and oral intake greater
the urinary output are signs of volume excess that occur with overmedication. Nasal
irritation & nausea may also indicate overmedication.)
When caring for a patient with nephrogenic DI, the nurse would expect treatment to
include
a. fluid restriction
b. thiazide diuretics
c. a high-sodium diet
d. chlorpropamide (DIabinese)
b. thiazide diuretics
(Rationale- in nephrogenic Di the kidney is unable to respond to ADH, so vasopressin or
hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate
in the kidney and produce a decrease in urine output. Low-sodium diets are also
thought to decrease urine output. Fluids are not restricted, because the patient could
become easily dehydrated.)
A patient with Grave's dz asks the nurse what caused the disorder. The best response
by the nurse is
a. "The cause of Grave's disease is not known, although it is thought to be genetic."
b. "It is usually associated with goiter formation from an iodine deficiency over a long
period of time."
c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of
thyroid hormones"
d. "In genetically susceptible persons antibodies form that attack thyroid tissue and
stimulate overproduction of thyroid hormones."
d. "In genetically susceptible persons antibodies form that attack thyroid tissue and
stimulate overproduction of thyroid hormones."
(rationale- The antibodies present in Graves' disease that attack thyroid tissue cause
hyperplasia of the gland and stimulate TSH receptors on the thyroid and activate the
production of thyroid hormones, creating hyperthyroidism. The disease is not directly
genetic, but individuals appear to have a genetic susceptibility to become sensitized to
develop autoimmune antibodies. Goiter formation from insufficient iodine intake is
usually associated with hypothyroidism.)
A patient is admitted to the hospital in thyrotoxic crisis. On physical assessment of the
patient, the nurse would expect to find
a. hoarseness and laryngeal stridor
b. bulging eyeballs and arrhythmias
c. elevated temperature and signs of heart failure
d. lethargy progressing suddenly to impairment of consciousness