Question 1

After teaching a client who is recovering from pancreas transplantation,the nurse assesses the client's understanding.Which statement made by the client indicates a need for additional education?

Accepted Answer

A)  "If I develop an infection, I should stop taking my corticosteroid." 
B)  "If I have pain over the transplant site, I will call the surgeon immediately." 
C)  "I should avoid people who are ill or who have an infection." 
D)  "I should take my cyclosporine exactly the way I was taught."

Question 2

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria.Which component of the client's diet should the nurse decrease?

Accepted Answer

A)  Carbohydrates 
B)  Proteins 
C)  Fats 
D)  Total calories

Question 3

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen:
•Fasting blood glucose: 75 mg/dL
•Postprandial blood glucose: 200 mg/dL
•Hemoglobin A1c level: 5.5%
How should the nurse interpret these laboratory findings?

Accepted Answer

A)  Increased risk for developing ketoacidosis 
B)  Good control of blood glucose 
C)  Increased risk for developing hyperglycemia 
D)  Signs of insulin resistance

Question 4

A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS).Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted?

Accepted Answer

A)  Serum potassium level has increased. 
B)  Blood osmolarity has decreased. 
C)  Glasgow Coma Scale score is unchanged. 
D)  Urine remains negative for ketone bodies.

Question 5

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol).Which statement should the nurse include in this client's teaching?

Accepted Answer

A)  "Change positions slowly when you get out of bed." 
B)  "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." 
C)  "If you miss a dose of this drug, you can double the next dose." 
D)  "Discontinue the medication if you develop a urinary infection."

Question 6

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure.The client's blood glucose level is 160 mg/dL.Which action should the nurse take?

Accepted Answer

A)  Document the finding in the client's chart. 
B)  Administer a bolus of regular insulin IV. 
C)  Call the surgeon to cancel the procedure. 
D)  Draw blood gases to assess the metabolic state.

Question 7

After teaching a client with type 2 diabetes mellitus,the nurse assesses the client's understanding.Which statement made by the client indicates a need for additional teaching?

Accepted Answer

A)  "I need to have an annual appointment even if my glucose levels are in good control." 
B)  "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick." 
C)  "I can still develop complications even though I do not have to take insulin at this time." 
D)  "If I have surgery or get very ill, I may have to receive insulin injections for a short time."

Question 8

A nurse teaches a client with diabetes mellitus about foot care.Which statements should the nurse include in this client's teaching? (Select all that apply.)

Accepted Answer

A)  "Do not walk around barefoot." 
B)  "Soak your feet in a tub each evening." 
C)  "Trim toenails straight across with a nail clipper." 
D)  "Treat any blisters or sores with Epsom salts." 
E)  "Wash your feet every other day."

Question 9

A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant.The client states,"I was doing so well with my new organs,and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." How should the nurse respond?

Accepted Answer

A)  "Following the drug regimen more closely would have prevented this." 
B)  "One acute rejection episode does not mean that you will lose the new organs." 
C)  "Dialysis is a viable treatment option for you and may save your life." 
D)  "Since you are on the national registry, you can receive a second transplantation."

Question 10

An emergency department nurse assesses a client with ketoacidosis.Which clinical manifestation should the nurse correlate with this condition?

Accepted Answer

A)  Increased rate and depth of respiration 
B)  Extremity tremors followed by seizure activity 
C)  Oral temperature of 102° F (38.9° 
C)  
D)  Severe orthostatic hypotension

Question 11

A nurse cares for a client who has diabetes mellitus.The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700.At which time should the nurse assess the client for potential problems related to the NPH insulin?

Accepted Answer

A)  0800 
B)  1600 
C)  2000 
D)  2300

Question 12

A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin.The nurse notes a spongy,swelling area at the site the client uses most frequently for insulin injection.Which action should the nurse take?

Accepted Answer

A)  Apply ice to the site to reduce inflammation. 
B)  Consult the provider for a new administration route. 
C)  Assess the client for other signs of cellulitis. 
D)  Instruct the client to rotate sites for insulin injection.

Question 13

A nurse cares for a client who is prescribed pioglitazone (Actos).After 6 months of therapy,the client reports that his urine has become darker since starting the medication.Which action should the nurse take?

Accepted Answer

A)  Assess for pain or burning with urination. 
B)  Review the client's liver function study results. 
C)  Instruct the client to increase water intake. 
D)  Test a sample of urine for occult blood.

Question 14

After teaching a client who has diabetes mellitus and proliferative retinopathy,nephropathy,and peripheral neuropathy,the nurse assesses the client's understanding.Which statement made by the client indicates a correct understanding of the teaching?

Accepted Answer

A)  "I have so many complications; exercising is not recommended." 
B)  "I will exercise more frequently because I have so many complications." 
C)  "I used to run for exercise; I will start training for a marathon." 
D)  "I should look into swimming or water aerobics to get my exercise."

Question 15

A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis:

Which action should the nurse take?

Accepted Answer

A)  Administer the potassium and then consult with the provider about the fluid order. 
B)  Increase the intravenous rate and then consult with the provider about the potassium prescription. 
C)  Administer the potassium first before increasing the infusion flow rate. 
D)  Increase the intravenous flow rate before administering the potassium.

Question 16

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning,has capillary blood glucose of 33 g/dL,and has an intravenous line that is infiltrated with 0.45% normal saline.Which action should the nurse take first?

Accepted Answer

A)  Administer 1 mg of intramuscular glucagon. 
B)  Encourage the client to drink orange juice. 
C)  Insert a new intravenous access line. 
D)  Administer 25 mL dextrose 50% (D50) IV push.

Question 17

A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert,but shaky,diaphoretic,and weak.Five minutes after administering a half-cup of orange juice,the client's clinical manifestations have not changed.Which action should the nurse take next?

Accepted Answer

A)  Administer another half-cup of orange juice. 
B)  Administer a half-ampule of dextrose 50% intravenously. 
C)  Administer 10 units of regular insulin subcutaneously. 
D)  Administer 1 mg of glucagon intramuscularly.

Question 18

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation.Which statement should the nurse include in this client's teaching to prevent injury?

Accepted Answer

A)  "Examine your feet using a mirror every day." 
B)  "Rotate your insulin injection sites every week." 
C)  "Check your blood glucose level before each meal." 
D)  "Use a bath thermometer to test the water temperature."

Question 19

A nurse assesses clients who are at risk for diabetes mellitus.Which client is at greatest risk?

Accepted Answer

A)  A 29-year-old Caucasian 
B)  A 32-year-old African-American 
C)  A 44-year-old Asian 
D)  A 48-year-old American Indian

Question 20

A nurse teaches a client with type 1 diabetes mellitus.Which statement should the nurse include in this client's teaching to decrease the client's insulin needs?

Accepted Answer

A)  "Limit your fluid intake to 2 liters a day." 
B)  "Animal organ meat is high in insulin." 
C)  "Limit your carbohydrate intake to 80 grams a day." 
D)  "Walk at a moderate pace for 1 mile daily."

Exam 64: Care of Patients with Diabetes Mellitus