Question 1

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?

Accepted Answer

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.

Question 2

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?

Accepted Answer

A) "Are you anorexic?" 
B) "Is your urine dark colored?" 
C) "Have you lost weight lately?" 
D) "Do you crave sugary drinks?"

Question 3

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

Accepted Answer

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%.

Question 4

Which statement by the patient indicates a need for additional instruction in administering insulin?

Accepted Answer

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."

Question 5

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?

Accepted Answer

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.

Question 6

After change-of-shift report,which patient should the nurse assess first?

Accepted Answer

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

Question 7

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?

Accepted Answer

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.

Question 8

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP)who are working in the diabetic clinic?

Accepted Answer

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.

Question 9

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

Accepted Answer

A) Assess the patient for symptoms of hyperglycemia. 
B) Give the patient a snack of peanut butter and crackers. 
C) Have the patient drink a glass of orange juice or nonfat milk. 
D) Administer a continuous infusion of 5% dextrose for 24 hours.

Question 10

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?

Accepted Answer

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.

Question 11

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first?

Accepted Answer

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.

Question 12

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 ?

Accepted Answer

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.

Question 13

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?

Accepted Answer

A) Fasting blood glucose 
B) Oral glucose tolerance 
C) Glycosylated hemoglobin 
D) Urine dipstick for glucose

Question 14

A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?

Accepted Answer

A) Lispro (Humalog) 
B) Glargine (Lantus) 
C) Detemir (Levemir) 
D) NPH (Humulin N)

Question 15

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?

Accepted Answer

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.

Question 16

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?

Accepted Answer

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.

Question 17

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

Accepted Answer

A) every 2 years. 
B) as soon as possible. 
C) when the patient is 39 years old. 
D) within the first year after diagnosis.

Question 18

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)?

Accepted Answer

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.

Question 19

Which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog)insulin?

Accepted Answer

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.

Question 20

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?

Accepted Answer

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."

Exam 48: Diabetes Mellitus

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?