Question 1

A patient says that following a high-fat, high-protein diet has helped with weight loss. What should the nurse respond about this patient's eating approach? Select all that apply.

Accepted Answer

A)  "Fats produce 9 kcal/g." 
B)  "Overeating protein can lead to weight gain." 
C)  "You might notice a fruity odor to your breath." 
D)  "Glycogenolysis is the formation of glucose from amino acids." 
E)  "Ketone bodies are produced when a high-fat diet is consumed."

Question 2

An older patient being treated for pneumonia has signs of metabolic syndrome but denies the presence of diabetes. Serum glucose is 220 mg/dL, and the hemoglobin A1C is 5%. What can be inferred from these findings?

Accepted Answer

A)  The nurse should anticipate discharge teaching related to insulin to manage blood sugars at home. 
B)  The nurse anticipates that the doctor will diagnose the patient with type 1 diabetes. 
C)  The nurse would anticipate treatment with sliding scale insulin even though diabetes is not yet evident. 
D)  The nurse anticipates that the doctor will diagnose the patient with type 2 diabetes.

Question 3

The certified diabetes educator (CDE) encourages a patient with metabolic syndrome who experienced hyperglycemia during hospitalization to attend outpatient diabetes education classes. The patient asks why the classes are needed if diabetes is not a health problem. What is the nurse's best response?

Accepted Answer

A)  "The certified diabetes educator (CD
E)  saw that you had high blood sugars while in the ICU. I will let her know that you are not diabetic." 
B)  "You will learn about healthy diet, weight management, and exercise. This knowledge can delay the onset of type 2 diabetes." 
C)  "If you maintain a healthy diet, correct weight, and exercise you can delay the onset of type 2 diabetes." 
D)  "The class is only for those with diabetes. If you become diabetic, you may attend the class."

Question 4

The nurse is concerned that a patient in the critical care area is experiencing short-term complications of diabetes. What did the nurse find when assessing this patient? Select all that apply.

Accepted Answer

A)  Infected leg wound 
B)  Declining hourly urine output 
C)  Numb feet 
D)  Vision changes 
E)  Dropping oxygen saturation level

Question 5

A patient with diabetes has a serum osmolarity level of 325 mmol/L. What is the correct interpretation and action for the nurse to take based on this result?

Accepted Answer

A)  The result is somewhat high, but no immediate action is necessary. 
B)  The result is very low, and the physician should be notified of the result. 
C)  The result is somewhat low, but no immediate action is necessary. 
D)  The result is very high, and the physician should be notified of the result.

Question 6

A newly admitted patient with HHNK has a serum glucose of 850 mg/dL and a potassium level of 3.9 mEq/L. What is an important nursing consideration that should precede replacement of potassium?

Accepted Answer

A)  Assessment of urine output 
B)  Assessment of lung sounds 
C)  Assessment of dehydration 
D)  Calculation of serum osmolarity

Question 7

The nurse is determining if a patient is experiencing DKA or HHNS. Which information should the nurse use to make this determination?

Accepted Answer

A)  Patients with DKA exhibit Kussmaul's respirations to blow off CO2 and reduce pH levels. 
B)  Patients with HHNS have lower arterial pH levels than those with DKA. 
C)  Patients with DKA have more visual disturbances than patients with HHNS. 
D)  Patients with HHNS have moderate hyperglycemia, whereas patients with DKA have more severe hyperglycemia.

Question 8

A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes. What is the best explanation for a high glucose in a patient without diabetes? Select all that apply.

Accepted Answer

A)  The physiologic stress of a large meal plus a myocardial infarction causes hyperglycemia. 
B)  Insulin resistance is caused by pro-inflammatory factors. 
C)  Insulin resistance is caused by beta blockers and nitroglycerin, which are commonly used to treat myocardial infarction. 
D)  Myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state. 
E)  Glucagon, cortisol, and epinephrine cause hyperglycemia.

Question 9

When calculating the initial rate of an insulin infusion as treatment for diabetic ketoacidosis in a patient weighing 80 kg, the nurse should expect to administer insulin at what rate?

Accepted Answer

A)  120 units per hour 
B)  80 units per hour 
C)  8 units per hour 
D)  12 units per hour

Question 10

When instructing a patient about metabolic syndrome, the nurse should include that which finding is a risk factor for the development of diabetes?

Accepted Answer

A)  Central obesity 
B)  Decreased triglycerides 
C)  Low LDL levels 
D)  Low insulin levels

Question 11

The nurse monitors the blood glucose levels of a patient being treated with insulin for diabetic ketoacidosis. Why should the nurse ensure glucose levels decline at the rate of 50-70 mg/dL/hour?

Accepted Answer

A)  When blood glucose drops rapidly, fluids shift out of the cell, which increases dehydration, causing severe hypovolemic shock. 
B)  When blood glucose drops rapidly, severe damage to the brain results from metabolic alkalosis. 
C)  A rapid drop in blood glucose can result in hypokalemia, causing life-threatening arrhythmias. 
D)  A rapid drop in blood glucose can result in formation of thromboses as a result of dehydration.

Question 12

The nurse is reviewing the purpose of insulin with a patient newly diagnosed with type 2 diabetes mellitus. What should the nurse teach the patient about the function of insulin in the body? Select all that apply.

Accepted Answer

A)  It moves glucose from the blood into the body cells to be used as fuel. 
B)  It stimulates the liver to store extra glucose. 
C)  It is used to create energy. 
D)  It helps to bind oxygen to the blood. 
E)  It aids in the digestion of protein.

Question 13

When creating the care plan for a patient in the critical care unit, the nurse includes checking capillary blood glucose levels every morning. Why is it important for the nurse to check blood glucose levels daily and maintain them at normal levels even though the patient does not have diabetes? Select all that apply.

Accepted Answer

A)  Prevent inflammation 
B)  Reduce risk for severe infections 
C)  Improve lipid levels 
D)  Protect endothelial tissue 
E)  Improve oxygenation

Question 14

The nurse reviews critically ill patients assigned for care. Which patients should the nurse expect to have a lower than expected blood glucose level? Select all that apply.

Accepted Answer

A)  The patient being treated for septic shock 
B)  The patient diagnosed with inflammatory bowel disease 
C)  The patient with exacerbation of chronic obstructive pulmonary disease 
D)  The patient being treated for end-stage renal disease who missed dialysis the day before 
E)  The patient who has experienced partial and full-thickness burns over 30% of total body surface area

Question 15

The nurse preparing instruction for a patient recovering from a critical illness will include ways to prevent the onset of type 2 diabetes. What caused the nurse to provide this patient teaching? Select all that apply.

Accepted Answer

A)  Patient is obese. 
B)  Patient's triglyceride level is elevated. 
C)  Patient is 55 years old. 
D)  Patient has high blood pressure. 
E)  Patient is Caucasian.

Question 16

A patient being treated with an insulin infusion for diabetic ketoacidosis (DKA) receives an injection of subcutaneous insulin. When should the nurse expect to discontinue the insulin infusion? Select all that apply.

Accepted Answer

A)  When the pH is 7.38 
B)  When the anion gap is normal 
C)  When the bicarbonate level is 20 mEq/L 
D)  When the patient tests negative for ketones in the urine 
E)  When the blood pressure is > 100/60 mm Hg

Question 17

When instructing a patient about metabolic syndrome, what should the nurse include?

Accepted Answer

A)  It is also called insulin resistance syndrome. 
B)  Fasting blood sugars are over 140 mg/dL. 
C)  It is seen more frequently in people who carry extra weight in their hips and legs. 
D)  It affects about 10% of the U.S. population.

Exam 14: Care of the Patient With Problems in Glucose Metabolism