Question 1

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

Accepted Answer

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.

Question 2

When teaching a patient with type 2 diabetes about taking glipizide (Glucotrol), the nurse determines that additional teaching about the medication is needed when the patient says,

Accepted Answer

A)  "Since I can take oral drugs rather than insulin, my diabetes is not serious and won't cause many complications." 
B)  "If I overeat at a meal, I will still take just the usual dose of medication." 
C)  "If I become ill, I may have to take insulin to control my blood sugar." 
D)  "I should check with my doctor before taking any other medications because there are many that will affect glucose levels."

Question 3

The health care provider orders oral glucose tolerance testing for a patient seen in the clinic. Which information from the patient's health history is most important for the nurse to communicate to the health care provider?

Accepted Answer

A)  The patient had a viral illness 2 months ago. 
B)  The patient uses oral contraceptives. 
C)  The patient runs several days a week. 
D)  The patient has a family history of diabetes.

Question 4

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

Accepted Answer

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.

Question 5

A patient receives a daily injection of 70/30 NPH/regular insulin premix at 7:00 AM. The nurse expects that a hypoglycemic reaction is most likely to occur between

Accepted Answer

A)  8:00 and 10:00 AM. 
B)  4:00 and 6:00 PM. 
C)  7:00 and 9:00 PM. 
D)  10:00 PM and 12:00 AM.

Question 6

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

Accepted Answer

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.

Question 7

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,

Accepted Answer

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."

Question 8

When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question should the nurse ask?

Accepted Answer

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?"

Question 9

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

Accepted Answer

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 (OT
C)  callus remover may be used to remove callus and prevent pressure.

Question 10

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?

Accepted Answer

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?"

Question 11

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

Accepted Answer

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.

Question 12

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

Accepted Answer

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.

Question 13

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

Accepted Answer

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.

Question 14

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?

Accepted Answer

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.

Question 15

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis (DKA). The nurse recognizes that this measure is important to identify

Accepted Answer

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.

Question 16

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

Accepted Answer

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.

Question 17

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

Accepted Answer

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.

Question 18

A diabetic patient is started on intensive insulin therapy. The nurse will plan to teach the patient about mealtime coverage using _____ insulin.

Accepted Answer

A)  NPH 
B)  lispro 
C)  detemir 
D)  glargine

Exam 49: Nursing Management: Diabetes Mellitus