N4 test Diabetes Mellitus

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition
Chapter 65: Interventions for Clients with Diabetes Mellitus

1. Which factors/characteristics are more associated with type 2 diabetes mellitus than type 1 diabetes mellitus?

A. The presence of ketoacids when blood glucose levels are greatly elevated
B. The presence circulating levels of islet cell antibodies
C. Obesity and a sedentary lifestyle
D. Insulin absence

2. Which client is at greatest risk for development of type 2 diabetes?

A. 38-year-old woman who had gestational diabetes and whose mother is a type 2 diabetic
B. 48-year-old woman taking corticosteroids daily for rheumatoid arthritis
C. 58-year-old man with chronic obstructive pulmonary disease
D. 68-year-old man with alcoholism and chronic pancreatitis

3. What effect does insulin have on carbohydrate, protein, and fat metabolism?

A. The primary effect of insulin is binding to glucose and forming glycogen. Secondary effects include fat catabolism and protein anabolism.
B. Insulin has no effect on lipid metabolism but decreases blood glucose levels by stimulating the use of proteins for fuel instead of glucose.
C. The processes of gluconeogenesis, glycogenolysis, and ketogenesis are enhanced by the presence of insulin.
D. In the presence of insulin glucose enters cells, fats are stored, and proteins are synthesized.

4. The client who has been treated for diabetes mellitus for five years is being examined at a clinic. The results of the client’s blood testing indicate a fasting blood glucose level of 87 mg/dL and a hemoglobin A1c of 8.2%. What is your interpretation of these results?

A. The client’s therapy is effective in maintaining blood glucose levels within the normal range.
B. The client’s glucose control for the previous 24 hours is adequate, but overall the client has been hyperglycemic.
C. The client has a current normal blood glucose level but has been generally hypoglycemic.
D. The client has severe hyperglycemia.

5. What effect does mild to moderate exercise have on blood glucose levels and insulin needs of the client with type 1 diabetes? _______ blood glucose levels; _______ insulin needs.

A. Decreased; decreased
B. Decreased; increased
C. Increased; decreased
D. Increased; increased

6. What action should you take when a type 1diabetic client has ketone bodies present in his or her urine?

A. The client should eat immediately.
B. The client should have a dose of regular insulin immediately.
C. The client should be made NPO until the urine is free of ketone bodies.
D. No action is needed as this is an expected and normal finding for clients with type 1 diabetes.

7. How many total calories per day from each of the three nutrient groups can a client have if the prescribed diet is 1800 calories per day with 15% derived from fats, 20% from proteins, and the remainder from carbohydrates? _______ fat calories; _______ protein calories; _______ carbohydrate calories

A. 150; 270; 1380
B. 200; 400; 1200
C. 270; 360; 1170
D. 325; 450; 1025

8. Your client with type 2 diabetes is changing her oral antidiabetic agent from glyburide (Dia-Beta) to acarbose (Precose). She asks you if she should be worried about the new drug making her hypoglycemic. What is your best answer?

A. “Because your pancreatic function is improving, it does not need as much stimulation. Acarbose is not as powerful as glyburide.”
B. “Acarbose increases the cells’ uptake of glucose without the need for insulin, so you cannot become hypoglycemic even if you miss a meal on this medication.”
C. “Glyburide is actually an oral form of insulin and too much could make your blood sugar drop quickly. Acarbose reduces blood sugar by suppressing pancreatic release of glucagon.”
D. “Glyburide stimulated your pancreas to secrete insulin, increasing your risk for hypoglycemia. Acarbose does not stimulate insulin secretion, it reduces your intestinal uptake of sugar.”

9. What is the pathologic basis for the retinopathy, nephropathy, and neuropathy associated with long-term diabetes mellitus?

A. Hyperglycemia-induced abnormalities of blood vessel structure and function
B. Build-up of ketoacid metabolites within oxygen-sensitive tissues
C. Hypertension-induced coronary artery disease
D. Presence of chronic infections

10. Which client with diabetes mellitus is at greatest risk for hypoglycemia?

A. Newly diagnosed client with type 1 diabetes
B. Newly diagnosed client with type 2 diabetes
C. Client who has had type 1 diabetes for 20 years
D. Client who has had type 2 diabetes for 20 years

11. You are a nurse at a long-term care facility and find a client with type 1 diabetes mellitus awake, confused, sweaty, and having tremors of the hands. What is your best first action?

A. Quickly administer the client’s morning dose of insulin.
B. Document the finding as the only action.
C. Give the client a drink containing sugar.
D. Notify the physician.

12. Which client with diabetes mellitus do you consider to be at the greatest risk for ketoacidosis?

A. 28-year-old woman taking oral contraceptives
B. 48-year-old woman with a kidney infection
C. 28-year-old man with a sprained ankle
D. 48-year-old man with a gastric ulcer

13. What is the priority nursing diagnosis for the client in diabetic ketoacidosis?

A. Decreased cardiac output related to electrolyte imbalance and dehydration
B. Ineffective breathing pattern related to Kussmaul respirations
C. Knowledge deficit related to diabetes management
D. Altered nutrition: less than body requirements

14. Which strategy should you as the home care nurse teach the client with type 2 diabetes mellitus to prevent hyperglycemic, hyperosmolar, nonketotic syndrome (HHNK)?

A. “Avoid excessive intake of dietary fats.”
B. “Exercise at least 15 minutes each day.”
C. “Drink at least three liters of water each day.”
D. “If you are unable to eat, do not take your antidiabetic medication.”

15. Which monitoring parameter has the highest priority for the client being treated for HHNK?

A. Measuring urine output hourly
B. Taking the client’s temperature hourly
C. Testing all urine for the presence of ketone bodies
D. Assessing level of consciousness and pupillary responses hourly

16. Which clinical manifestation indicates that the therapy for your client in ketoacidosis is effective?

A. Respirations have slowed to 16 breaths per minute.
B. The client’s skin is warm, pink, and dry.
C. Urine output is greater than 30 mL/hour.
D. Pupils constrict in response to light.

17. You are preparing to draw up and administer a dose of NPH insulin and find that the insulin in the vial is uniformly cloudy. What is your best action?

A. Shake the vial vigorously.
B. Draw up the medication.
C. Add normal saline.
D. Open a new vial.

18. The client is prescribed to take 10 units of regular insulin and 15 units of NPH insulin each morning. How should you instruct this client to self-administer the prescribed dose of insulin?

A. “First draw up and administer the regular insulin, then draw up and administer the NPH insulin.”
B. “First draw up the regular insulin, then draw up the NPH insulin in the same syringe.”
C. “First draw up the NPH insulin, then draw up the regular insulin in the same syringe.”
D. “First draw up and administer the NPH insulin. Wait at least 15 minutes, then draw up and administer the regular insulin.”

19. You find the diabetic client unconscious. Which manifestation indicates to you that the client is experiencing hypoglycemia rather than hyperglycemia?

A. Handgrasps are absent.
B. Pulse is rapid and thready.
C. Skin is pale, cool, and clammy.
D. Pupils constrict in the presence of light.

20. Which statement made by the client who has type 1 diabetes and peripheral neuropathy indicates a need for clarification regarding foot care?

A. “I have three pairs of the same shoe so I can change them twice each day.”
B. “I will wear my new shoes all day to break them in as quickly as possible.”
C. “I am giving away all my socks that have tight bands at the tops.”
D. “None of my shoes have heels more than an inch high.”