Deck 20: Nursing Care of Patients With Diabetes Mellitus

Question 1

The nurse is preparing to administer insulin to an underweight patient. Which actions should the nurse take when providing this injection?

A) Ensure insulin is at room temperature.
B) Make sure no air bubbles are present in the syringe.
C) Massage the site of insertion.
D) Rotate injection sites.
E) Insert the needle at a 90-degree angle.

Answer 1

Ensure insulin is at room temperature.
Make sure no air bubbles are present in the syringe.
Rotate injection sites.

Question 2

A patient with diabetes asks what can be done to prevent the development of corns on the feet. How should the nurse respond to this patient?

A) "Make sure that you select shoes that are appropriately fitted."
B) "Use corn pads to gradually remove the growths."
C) "Corns are best treated by shaving them off."
D) "A mild abrasive soap can be used to scrub the area to remove them."

Answer 2

"Make sure that you select shoes that are appropriately fitted."

Question 3

The nurse is teaching a patient with diabetes about the illness. The nurse knows the teaching has been effective when the patient identifies which statements as being true of pancreatic cells?

A) Alpha cells produce glucagon.
B) Beta cells secrete insulin.
C) Cephalon cells produce creatine.
D) Delta cells produce somatostatin.
E) Epsilon cells produce erythropoietin.

Answer 3

Alpha cells produce glucagon.
Beta cells secrete insulin.
Delta cells produce somatostatin.

Question 4

A patient recently diagnosed with type 1 diabetes mellitus does not understand why the disease developed because the patient is thin and eats all of the time. What is the most appropriate response by the nurse?

A) "Thin people can be diabetic, too."
B) "Your condition makes it impossible for you to gain weight."
C) "Diabetes makes it difficult for your body to obtain energy from the foods you eat."
D) "Your lab tests indicate the presence of diabetes."

Question 5

The nurse notes that a 41-year-old patient's fasting blood glucose level is 125 mg/dL. What should the nurse suspect is occurring with the patient?

A) severe hyperglycemia
B) consistent with diabetes
C) normal results
D) consistent with prediabetes

Question 6

A patient with diabetes is diaphoretic, has a heart rate of 112 beats per minute, and is feeling nervous and shaky. What action should the nurse take first?

A) Provide the patient with a snack of milk and crackers.
B) Administer insulin utilizing the prescribed sliding scale dosages.
C) Contact the laboratory and order a serum glucose level.
D) Obtain a capillary serum glucose level reading with a glucose meter.

Question 7

The nurse is concerned that a patient with type 1 diabetes mellitus is at risk for developing diabetic ketoacidosis. What did the nurse assess to come to this conclusion?

A) reports of anxiety
B) pale, cool skin
C) serum glucose level of 325 mg/dL
D) ulcer on plantar aspect of right foot

Question 8

A patient with diabetes mellitus and poor circulation has thick and ingrown toenails. What should the nurse instruct the patient to do?

A) Soak feet in Epsom salts daily.
B) Use a clean sharp razor blade to trim nails.
C) Make an appointment with a podiatrist.
D) Cut toenails immediately prior to bathing.

Question 9

A patient beginning insulin for type 2 diabetes is experiencing blurred vision and is concerned about becoming blind. What response by the nurse is most appropriate?

A) "I will make an appointment for you to see an ophthalmologist."
B) "I will call the physician to report your symptoms."
C) "Blurry vision is very common. Do not worry."
D) "This is a normal response when insulin therapy is initiated."

Question 10

The nurse is reviewing data collected from a patient with a predisposition to developing insulin resistance. Which medications should the nurse identify as potentially causing this patient to develop diabetes?

A) nicotinic acid (Niacor)
B) acetaminophen (Tylenol)
C) levothyroxine (Synthroid)
D) furosemide (Lasix)
E) phenytoin (Dilantin)

Question 11

The nurse is conducting an educational session with a patient who is newly diagnosed with diabetes. The nurse knows further education is needed when the patient states, "In the U.S.:

A) 6 million people are diagnosed with diabetes per year."
B) 25.8 million people have diabetes."
C) 18.8 million people have been diagnosed with diabetes."
D) 7 million people have diabetes but have not been diagnosed."

Question 12

The nurse is assessing a patient who has a family history of type 2 diabetes mellitus. Which finding would require follow-up by the nurse?

A) a new prescription for levothyroxine (Synthroid) for hypothyroidism
B) decreased waist-to-hip ratio through dietary changes
C) delivery of a baby that weighed 8 pounds and 12 ounces
D) a fasting blood glucose level of 89 mg/dL

Question 13

A patient recently diagnosed with diabetes wants to check the urine for glucose instead of using capillary blood because of the cost. Which response should the nurse make to the patient?

A) "Urine testing is best when combined with serum testing."
B) "Urine testing is as reliable as finger stick testing."
C) "Yes, urine testing is cheaper than glucose test strips."
D) "Would you like to switch to this method of monitoring?"

Question 14

A 78-year-old patient without polyuria, polydipsia, or polyphagia has a serum glucose level of 130 mg/dL. What should the nurse conclude about this patient?

A) The patient might have eaten a meal with high sugar content prior to the testing.
B) The laboratory results might be erroneous.
C) The patient has type 1 diabetes mellitus.
D) The patient will need to be assessed for other manifestations of diabetes.

Question 15

The nurse is reviewing data collected for a patient's health history. Which factor should the nurse identify as increasing the patient's risk of developing type 2 diabetes mellitus?

A) body mass index of 23 kg/m²
B) blood pressure of 120/70
C) physical inactivity
D) low waist-to-hip ratio

Question 16

A nurse is conducting an educational session for a group of patients regarding the incidence and prevalence of diabetes. The nurse explains that approximately 25.8 million people have been diagnosed with the disorder, but 7 million people have not. Statistically, what is the percentage of people who have undiagnosed diabetes?

Question 17

A patient at risk for the development of type 2 diabetes mellitus asks why weight loss will reduce risk of the condition. Which response by the nurse is most accurate?

A) "The amount of foods taken in require more insulin to adequately metabolize them, resulting in diabetes."
B) "Excess body weight impairs the body's release of insulin."
C) "Thin people are less likely to become diabetic."
D) "The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin."

Question 18

The nurse is caring for a healthy patient who has a serum glucose level of 60 mg/dL. The nurse anticipates which counterregulatory serum hormonal changes to occur in this patient?

A) increased epinephrine levels
B) increased growth hormone levels
C) increased insulin levels
D) decreased thyroxine levels
E) decreased glucocorticoid levels

Question 19

A patient with type 1 diabetes mellitus who had one episode of vomiting in the past 2 hours asks if the routine insulin injection should be taken. What action by the nurse is best at this time?

A) Contact the physician.
B) Explain the need to take the insulin.
C) Document the refusal and continue on with the planned care.
D) Check the patient's fasting serum glucose level.

Question 20

The manager observes a graduate nurse teaching a 5-year-old patient with diabetes mellitus. The manager determines that content being instructed is appropriate when the nurse states, "Insulin acts like:

A) building blocks that help make protein into strong muscles."
B) a wagon that carries sugar into the cells of the body."
C) a mud pie that makes the blood vessels thick and sticky."
D) salty potato chips that make people feel very thirsty."

Question 21

The nurse is identifying patients at risk for needing insulin. Which patients should the nurse identify as potentially needing insulin to maintain a normal blood glucose level?

A) patients who are fasting or malnourished
B) patients with type 2 diabetes who are diagnosed with an infection
C) patients with type 2 diabetes who are undergoing surgical procedures
D) patients with gestational diabetes
E) patients receiving total parenteral nutrition

Question 22

An older patient with type 2 diabetes mellitus is upset because family members do not believe the patient has an illness and resist helping with diet and activity modifications. What should the nurse suggest to help this patient?

A) Limit discussions about the illness with family members.
B) Store health-related items away from common family areas in the home.
C) Invite family to participate in a support group.
D) Explain the risk for family also to develop the illness.

Question 23

The nurse is teaching a patient with diabetes about self-management. What should the nurse include regarding medications to treat diabetes mellitus?

A) Patients with type 1 diabetes may achieve normal blood glucose levels with oral medications.
B) Patients with type 1 diabetes may progress to type 2 if blood glucose levels are not well controlled.
C) Patients with type 2 diabetes will always need an exogenous source of insulin.
D) Patients with type 2 diabetes may achieve normal blood glucose levels with a combination of oral medications and insulin.

Question 24

The nurse is reviewing instruction provided to a graduate nurse regarding insulin therapy. Which statement made by the graduate indicates that further instruction is needed?

A) Lispro is a rapid-acting insulin.
B) Regular insulin can be administered intravenously.
C) NPH insulin may be mixed with lispro insulin.
D) Insulin detemir is administered prior to each meal.
E) Insulin glargine may be used to treat gestational diabetes.

Question 25

The nurse is caring for a patient with type 1 diabetes mellitus. Which patient statement requires immediate intervention by the nurse?

A) "I am allergic to eggs."
B) "I will take my lispro insulin 15 minutes before I eat breakfast."
C) "I won't mix my cloudy regular insulin with other insulins."
D) "I will not use insulin detemir in my insulin pump."

Question 26

The nurse is trying to determine if a patient is experiencing manifestations of type 1 or type 2 diabetes mellitus. Which question should the nurse ask the patient to help determine the type?

A) "Have you been urinating in greater amounts than in the past?"
B) "Have you been drinking more liquids than in the past?"
C) "Have you been hungrier than in the past?"
D) "Have you noticed any changes in your vision?"

Question 27

The nurse instructs a patient with type 2 diabetes mellitus on the use of a glucometer for self-monitoring. Which patient statements about glucometer performance indicate that teaching has been effective?

A) Correctly apply the blood to the meter strip.
B) Follow manufacturer's recommendation regarding cleaning of meter.
C) A patient with sickle cell anemia may need another way to check blood glucose levels.
D) Grapefruit juice should not be ingested when using the glucometer.
E) A sufficient amount of blood must be applied to the strip.

Question 28

A patient with type 1 diabetes mellitus has a serum hematocrit level of 24%. What additional finding should the nurse report to the health care provider?

A) capillary blood glucose of 60 mg/dL
B) glycosylated hemoglobin of 7.0
C) the presence of albumin in urine
D) the presence of glucose in urine

Question 29

The community nurse is teaching a group of members with type 1 or 2 diabetes mellitus who are planning to participate in an athletic triathlon. On which potential complication from this event should the nurse focus when teaching?

A) diabetic ketoacidosis
B) hypoglycemia
C) hyperosmolar hyperglycemic state
D) impaired glucose tolerance

Question 30

The nurse is planning care for a patient with type 1 diabetes mellitus. Which action should the nurse identify as being the most effective to reduce the development of complications?

A) self-monitoring of blood glucose levels
B) performance of effective foot care
C) the necessity of a yearly eye exam
D) knowing symptoms of urinary tract infections

Question 31

A patient with type 2 diabetes mellitus is scheduled for laparoscopic adjustable gastric banding (LAGB) surgery. What should the nurse explain to the patient about this procedure and diabetes?

A) "Evidence indicates positive outcomes for many patients with diabetes who undergo surgical weight loss procedures."
B) "Surgical procedures can be dangerous for patients with diabetes."
C) "Do you feel that a surgical weight loss procedure will cure your obesity?"
D) "This procedure is more appropriate for a patient who has a diagnosis of type 1 diabetes mellitus."

Question 32

A patient with type 2 diabetes mellitus has been instructed on an eating plan where 65% of all daily calories are to be carbohydrates. The patient's daily caloric intake is to be 1600 calories. If each serving of carbohydrates is 15 grams and each gram is 4 kilocalories, how many servings of carbohydrates should the patient be instructed to consume each day?

Question 33

A nurse is teaching a group of patients about the prevalence of type 2 diabetes in older adults. The nurse knows teaching has been effective when a patient states, "Statistically, in a group of 100 older adults in the United States, approximately:

A) 10 will have type 2 diabetes."
B) 17 will have type 2 diabetes."
C) 27 will have type 2 diabetes."
D) 33 will have type 2 diabetes."

Question 34

The nurse is caring for a patient who is prescribed 120 units of U-100 regular insulin to be administered at 0700 and 1600 hours. The physician has written an order for an equivalent dose of U-500 insulin to be provided. The nurse reviews the order with the primary health care provider and states, "120 units of U-100 insulin is equivalent to _______ units of U-500 insulin."

Question 35

The nurse is reviewing the healthcare record of a patient with type 2 diabetes mellitus who has a foot wound. Which outcome of care would be the most important at this time? $$\begin{array} { | l | l | } \hline \begin{array} { l } \text { History and } \\\text { Physical: }\end{array} & \begin{array} { l } \text { The patient has a } 1 \mathrm {~cm} \times 1 \mathrm {~cm} \text { open area } \\\text { on the bottom of the left foot }\end{array} \\\hline \text { Vital Signs: } & \begin{array} { l } \text { Pulse } 85 \mathrm { bpm } , \text { Blood Pressure } 150 / 90 , \\\text { Weight } 425 \text { pounds, Height } 6 \text { feet, 1 } \\\text { inch. }\end{array} \\\hline \text { Vision Screening: } & \begin{array} { l } \text { Snellen Results 20/800. Extensive } \\\text { diabetic retinopathy. States is unable to } \\\text { read typically sized newsprint. }\end{array} \\\hline\end{array}$$

A) The patient will bring a caregiver to the next healthcare appointment.
B) The patient will describe the steps of effective diabetic foot care.
C) The patient will explain why patients with diabetes should not go barefoot.
D) The patient will obtain a thermometer for monitoring bath water temperature.

Question 36

A patient with diabetes mellitus has albuminuria, hypertension, and edema. What should the nurse expect to be prescribed for this patient?

A) Restrict activity.
B) Increase salt intake.
C) Review weight loss strategies.
D) Provide antibiotic therapy as prescribed.

Question 37

A patient with no previous history of diabetes mellitus has ketones in the urine. Which question should the nurse ask this patient?

A) "What did you eat for breakfast and lunch today?"
B) "Can you please describe any weight loss strategies you've been using?"
C) "Have you donated blood recently?"
D) "Have you ever been told you have albumin in your urine?"

Question 38

The nurse is teaching a patient with type 2 diabetes mellitus about glyburide (DiaBeta). The nurse knows teaching has been effective when the patient states, "I need to monitor for dizziness, lightheadedness, and sweating if I take:

A) ibuprofen (Motrin) for pain."
B) ranitidine (Zantac) for heartburn."
C) cetirizine (Zyrtec) for allergies."
D) metoprolol (Lopressor) for hypertension."
E) docusate sodium (Colace) for constipation."

Question 39

A patient with type 1 diabetes mellitus has difficulty swallowing and takes milk of magnesium every day for nausea and constipation. What should the nurse suspect is occurring with this patient?

A) age-related changes
B) visceral neuropathy
C) peripheral neuropathy
D) reaction to insulin injections

Question 40

The nurse is assessing a patient with type 2 diabetes mellitus. What questions should the nurse ask to determine the patient's risk for a lower extremity amputation?

A) "Do you use insulin or oral hypoglycemic agents?"
B) "What were your glycosylated hemoglobin values over the past year?"
C) "Do you have any problems with your eyes related to diabetes?"
D) "Do you have any problems with your kidney related to diabetes?"
E) "When were you first diagnosed with diabetes mellitus?"

Question 41

The nurse notes that a patient with type 2 diabetes mellitus is not prescribed aspirin 81 mg as recommended for the prevention of cardiovascular complications. What information in the patient's health history should the nurse use to understand why this medication has not been prescribed for the patient?

A) Patient receives a vitamin B₁₂ injection every month.
B) Patient admitted for gastrointestinal bleeding 3 months ago.
C) Patient prescribed warfarin (Coumadin) 2.5 mg by mouth every day.
D) Patient treated for chronic alcoholism and liver cirrhosis the past year.
E) Patient develops a rash and urticaria when taking medications with sulfa.

Question 42

The nurse is caring for a patient experiencing diabetic ketoacidosis. What actions should the nurse take when preparing this patient's insulin infusion?

A) Attach insulin infusion to an intravenous pump.
B) Have one ampule of Dextrose 10% at the bedside.
C) Flush the tubing with the insulin solution before connecting.
D) Prepare an infusion of Dextrose 5% and 0.45% normal saline.
E) Discontinue the infusion after first dose of subcutaneous insulin.

Question 43

The nurse is reviewing the actions that a patient with type 1 diabetes mellitus should take if mild hypoglycemia is experienced. What should the nurse include in this teaching?

A) Test blood glucose 30 minutes after reaching 70 mg/dL.
B) Ingest 4 ounces of fruit juice when blood glucose is below 70 mg/dL.
C) Measure blood glucose 15 minutes after ingesting a carbohydrate source.
D) Add table sugar to 8 ounces of fruit juice when blood glucose is below 70 mg/dL.
E) Ingest additional 15 grams of carbohydrate if blood glucose remains low after 15 minutes.