NCLEX practice questions Diabetes

The UAP on the medical floor tells the nurse the client diagnosed with DKA wants something else to eat for lunch. Which intervention should the nurse implement? 1. Instruct the UAP to get the client additional food. 2. Notify the dietitian about the client's request. 3. Request the HCP increase the client's caloric intake. 4. Tell the UAP the client cannot have anything else.

2. Notify the dietitian about the client's request.

The client diagnosed with HHNS was admitted yesterday with a blood glucose level of 780 mg/dL. The client's blood glucose level is now 300 mg/dL. Which intervention should the nurse implement? 1. Increase the regular insulin IV drip. 2. Check the client's urine for ketones. 3. Provide the client with a therapeutic diabetic meal. 4. Notify the HCP to obtain an order to decrease insulin.

4. Notify the HCP to obtain an order to decrease insulin.

A female diabetic patient who weighs 130b has an ideal body weight of 116 lb. For weight reduction of 2 lb/week, approximately what should her daily caloric intake be? a. 1000 calories b. 1200 calories c. 1500 calories d. 1800 calories

a. 1000 calories

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? a. NPH b. Iletin II c. Humalog (lispro) d. Glargine (lantus)

a. NPH

A patient newly diagnosed with type 1 diabetes has an usual increase in blood glucose from bedtime to morning. The physician suspects the patient is experiencing insulin waning. Based on this diagnosis, the nurse will expect which of the following changes to the patient's medication regimen? a. administering a dose of intermediate-acting insulin before the evening meal b. increasing morning dose of long-acting insulin c. decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack d. changing the time of injection of evening intermediate-acting insulin from dinnertime to bed time

a. administering a dose of intermediate-acting insulin before the evening meal

A 60-year-old patient comes to the ED with complaints of weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the patient has diabetes. Which of the following classic symptoms should the nurse watch for to confirm the diagnosis of diabetes? a. increased hunger b. dizziness c. fatigue d. numbness

a. increased hunger

An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? a. systemic inflammatory response syndrome b. hyperglycemic hyperosmolar syndrome c. multiple-organ dysfunction syndrome d. Diabetic ketoacidosis

b. hyperglycemic hyperosmolar syndrome

A patient with diabetes mellitus is receiving an oral anti diabetic agent. The nurse observes for which of the following symptoms when caring for this patient? a. polyuria b. hypoglycemia c. blurred vision d. polydipsia

b. hypoglycemia

The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids would the nurse anticipate infusing for this patient? a. D5W b. 0.9% normal saline c. 0.45 normal saline d. D5 normal saline

c. 0.45 normal saline

A patient with type 2 diabetes complains about waking up in the middle of the night nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood sugar readings have been 110 to 140 m/dL; the patient admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse will plan to instruct the patient to do which of the following? a. eat complex carbohydrate snack in the evening before bed. b. skip the evening NPH insulin dose on days when exercising and skipping meals. c. Check blood glucose at 3:00 in the morning d. Administer an increased dose of neutral protamine Hagedorn (NPH) insulin in the evening

c. Check blood glucose at 3:00 in the morning

A patient is admitted with diabetic ketoacidosis (DKA). The physician writes all of the following orders. Which order should the nurse implement first? a. Administer regular insulin 30 U IV push b. start an infusion of regular insulin at 50 U/hr c. Infuse 0.9% normal saline solution 1L/hr for 2 hours d. Administer sodium bicarbonate 50 mEq IV push

c. Infuse 0.9% normal saline solution 1L/hr for 2 hours

A nurse is caring for a diabetic patient with a diagnosis of neuropathy. What would the nurse expect the urinalysis report to indicate? a. Bacteria b. Red blood cells c. Albumin d. White blood cells

c. albumin

A patient with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestations associated with this classic symptom? a. weight gain b. dehydration c. muscle wasting and tissue loss d. altered mental state

c. muscle wasting and tissue loss

An older adult patient that has diabetes type 2 comes to the emergency department with second-degree burns to the bottom of both feet and stats, " I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation. a. a faulty heater b. autonomic neuropathy c. peripheral neuropathy d. sudomotor neuropathy

c. peripheral neuropathy

Which of the following factors is the focus of nutrition intervention for patients with type 2 diabetes? a. protein metabolism b. blood glucose level c. weight loss d. carbohydrate intake

c. weight loss

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? a. making sure that the patient is aware that quantity of food s will be limited b. ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found c. determining whether the patient is on insulin or taking oral anti diabetic medication d. reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns.

d. reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

health-care provider in the client diagnosed with DKA who has just been admitted to the ICU? 1. Glucose. 2. Potassium. 3. Calcium. 4. Sodium.

2. Potassium.

The charge nurse is making client assignments in the intensive care unit. Which client should be assigned to the most experienced nurse? 1. The client with type 2 diabetes who has a blood glucose level of 348 mg/dL. 2. The client diagnosed with type 1 diabetes who is experiencing hypoglycemia. 3. The client with DKA who has multifocal premature ventricular contractions. 4. The client with HHNS who has a plasma osmolarity of 290 mOsm/L.

3. The client with DKA who has multifocal premature ventricular contractions.

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (select all that apply) a. Ketosis-pron b. Little endogenous insulin c. obesity at diagnosis d. younger than 30 years of age e. Older than 65 years of age

A, b, d

A nurse is preparing to discharge a patient with coronary artery disease (CAD) and hypertension (HTN) who is at risk for type 2 diabetes. Which of the following information is important to include in the discharge teaching? a. How to control blood glucose through lifestyle modification with diet and exercise b. how to monitor ketones daily c . How to recognize signs of diabetic ketoacidosis (DKA) d. How to self-inject insulin

A. How to control blood glucose through lifestyle modification with diet and exercise

A patient is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the patient's symptoms to be that of diabetic ketoacidosis (DKA). Which of the following actions will help the nurse confirm the diagnosis? a. assessing the patient's breath odor b. assessing the patient's ability to move all extremities c. assessing the patient;s ability to take a deep breath d. assessing for excessive sweating

a. assessing the patient's breath odor

Which of the following clinical manifestations of type 2 diabetes occurs if glucose levels are very high? a. blurred vision b. oliguria c. hyperactivity d. increased energy

a. blurred vision

The nurse is assessing a patient with non proliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? (select all that apply) a. Detachment b. leakage of fluid or serum (exudates) c.Focal capillary single closure d. Blurred optic discs e. Microaneurysms

b, c, e

Which of the following statements is true regarding gestational diabetes? a. it occurs in most pregnancies b. a glucose challenge test should be performed between 24 and 28 weeks. c. Its onset is usually in the first trimester. d. there is a low risk for perinatal

b. a glucose challenge test should be performed between 24 and 28 weeks.

The nurse is administering lisper (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? a. 3 hours b. 1 to 2 hours c. 10 to 15 minutes d. 30 to 40 minutes

c. 10 to 15 minutes

The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively? a. 10% to 20% b. 25% to 40% c. 50% to 60% d. 85% to 90%

c. 50% to 60%

A patient receives a daily injection of glargine (lantus) insulin at 7:00am. When should the nurse monitor this patient for a hypoglycemic reaction? a. between 8:00 and 10:00am b. between 4:00 and 6:00pm c. This insulin has no peak action and does not cause a hypoglycemia reaction d. Between 7:00 and 9:00pm

c. This insulin has no peak action and does not cause a hypoglycemia reaction

Which of the following is an age-related change that may affect diabetes and its management? a. hypotension b. increased thirst c. increased bowel motility d. decreased renal

d. decreased renal

Which of the following would be included in the teaching plan for a patient diagnosed with diabetes mellitus? a. once insulin injections are started for treatment of type 2 diabetes, they can never be discontinued b. sugar is found only in dessert foods c. The only diet change needed in the treatment of diabetes is to stop eating sugar d. elevated blood glucose levels contribute to complications of diabetes, such as diminished vision

d. elevated blood glucose levels contribute to complications of diabetes, such as diminished vision

Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus? a. the patient has no been exercising. b. the patient has not been compliant with the prescribed treatment regimen c. the patient has consumed for and has not taken or received insulin d. the patient has not consumed food and continues to take insulin or oral anti diabetic medications

d. the patient has not consumed food and continues to take insulin or oral anti diabetic medications

The client diagnosed with type 1 diabetes is found lying unconscious on the floor of the bathroom. Which intervention should the nurse implement first? 1. Administer 50% dextrose IVP. 2. Notify the health-care provider. 3. Move the client to the ICU. 4. Check the serum glucose level.

1. Administer 50% dextrose IVP.

The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement? 1. Ensure the client eats the bedtime snack. 2. Determine how much food the client ate at lunch. 3. Perform a glucometer reading at 0700. 4. Offer the client protein after administering insulin.

1. Ensure the client eats the bedtime snack.

The elderly client is admitted to the intensive care department diagnosed with severe HHNS. Which collaborative intervention should the nurse include in the plan of care? 1. Infuse 0.9% normal saline intravenously. 2. Administer intermediate-acting insulin. 3. Perform blood glucometer checks daily. 4. Monitor arterial blood gas results.

1. Infuse 0.9% normal saline intravenously

The client received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030 the unlicensed assistive personnel (UAP) tells the nurse the client has a headache and is really acting "funny." Which intervention should the nurse implement first? 1. Instruct the UAP to obtain the blood glucose level. 2. Have the client drink eight (8) ounces of orange juice. 3. Go to the client's room and assess the client for hypoglycemia. 4. Prepare to administer one (1) ampule 50% dextrose intravenously.

3. Go to the client's room and assess the client for hypoglycemia.

The client is admitted to the ICU diagnosed with DKA. Which interventions should the nurse implement? Select all that apply. 1. Maintain adequate ventilation. 2. Assess fluid volume status. 3. Administer intravenous potassium. 4. Check for urinary ketones. 5. Monitor intake and output.

All of them 1. Maintain adequate ventilation. 2. Assess fluid volume status. 3. Administer intravenous potassium. 4. Check for urinary ketones. 5. Monitor intake and output.

A patient with type 2 diabetes has recently been placed on acarbose (Precose); the nurse is explaining how to take this medication. The teaching is determined to be effective based on which of the following statements? a." I will take this medication in the morning, with my first bite of breakfast" b. " It does to matter what time of day I take this medication" c. " I will take this medication in the morning, 15 minutes before breakfast" d. "This medication needs to be taken after the midday meal"

a." I will take this medication in the morning, with my first bite of breakfast"

A 16 year old patient newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The patient is upset because friends frequently state, "You look anorexic." Which of the following statements would be the best response by the nurse to help this patient understand the cause of weight loss due to this condition? a."your body is using protein and fat for energy instead of glucose" b. "don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism" c. "I will refer you to a dietician who can help you with your weight" d. " you may be having undiagnosed infections causing you to lose extra weight"

a."your body is using protein and fat for energy instead of glucose"

A nurse is teaching a patient recovering from diabetic ketoacidosis (DKA) about management of "sick days". The patient asked the nurse why it is important to monitor the urine for ketones. Which of the following statements is the nurse's best response? a. when the body does not have enough insulin hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic byproducts to be released b. Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood. c. Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy. d. Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid

c. Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy.

A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? a. hypokalemia b. hyperkalemia c. hyperglycemia d. hyponatremia

a. hypokalemia

The diabetic educator is teaching a class on diabetes type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion? Select all that apply. 1. Take diabetic medication even if unable to eat the client's normal diabetic diet. 2. If unable to eat, drink liquids equal to the client's normal caloric intake. 3. It is not necessary to notify the health-care provider if ketones are in the urine. 4. Test blood glucose levels and test urine ketones once a day and keep a record. 5. Call the health-care provider if glucose levels are higher than 180 mg/dL.

1,2, 5

The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, " What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse? a. "Eating the fruit is more satisfying than drinking the juice. You will get full faster." b. "Eating the fruit will give you more vitamins and minerals than the the juice will." c. "the fruit has less sugar than the juice." d. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."

d. Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which of the following factors as a cause of type 1 diabetes? a. rare ketosis b. obesity c. altered glucose metabolism d. presence of autoantibodies against islet cells

d. presence of autoantibodies against islet cells

The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result? 1. This result is below normal levels. 2. This result is within acceptable levels. 3. This result is above recommended levels. 4. This result is dangerously high.

3. This result is above recommended levels.

The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included in the plan of care? 1. Assess the client's ability to read small print. 2. Monitor the client's serum PT level. 3. Teach the client how to perform a hemoglobin A1c test daily. 4. Instruct the client to check the feet weekly.

1. Assess the client's ability to read small print.

he nurse is developing a care plan for the client diagnosed with type 1 diabetes. The nurse identifies the problem "high risk for hyperglycemia related to noncompliance with the medication regimen." Which statement is an appropriate short-term goal for the client? 1. The client will have a blood glucose level between 90 and 140 mg/dL. 2. The client will demonstrate appropriate insulin injection technique. 3. The nurse will monitor the client's blood glucose levels four (4) times a day. 4. The client will maintain normal kidney function with 30-mL/hr urine output.

1. The client will have a blood glucose level between 90 and 140 mg/dL.

The nurse at a freestanding health care clinic is caring for a 56-year-old male client who is homeless and is a type 2 diabetic controlled with insulin. Which action is an example of client advocacy? 1. Ask the client if he has somewhere he can go and live. 2. Arrange for someone to give him insulin at a local homeless shelter. 3. Notify Adult Protective Services about the client's situation. 4. Ask the HCP to take the client off insulin because he is homeless.

2. Arrange for someone to give him insulin at a local homeless shelter.

The client with type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a computed tomography (CT) scan with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement? 1. Provide a high-fat diet 24 hours prior to test. 2. Hold the biguanide medication for 48 hours prior to test. 3. Obtain an informed consent form for the test. 4. Administer pancreatic enzymes prior to the test.

2. Hold the biguanide medication for 48 hours prior to test.

Which assessment data indicate the client diagnosed with diabetic ketoacidosis is responding to the medical treatment? 1. The client has tented skin turgor and dry mucous membranes. 2. The client is alert and oriented to date, time, and place. 3. The client's ABG results are pH 7.29, PaCO2 44, HCO3 15. 4. The client's serum potassium level is 3.3 mEq/L.

2. The client is alert and oriented to date, time, and place.

An 18-year-old female client, 5′4′′ tall, weighing 113 kg, comes to the clinic for a nonhealing wound on her lower leg, which she has had for two (2) weeks. Which disease process should the nurse suspect the client has developed? 1. Type 1 diabetes. 2. Type 2 diabetes. 3. Gestational diabetes. 4. Acanthosis nigricans.

2. Type 2 diabetes.

The emergency department nurse is caring for a client diagnosed with HHNS who has a blood glucose of 680 mg/dL. Which question should the nurse ask the client to determine the cause of this acute complication? 1. "When is the last time you took your insulin?" 2. "When did you have your last meal?" 3. "Have you had some type of infection lately?" 4. "How long have you had diabetes?"

3. "Have you had some type of infection lately?"

The client diagnosed with type 2 diabetes is admitted to the intensive care unit with hyperosmolar hyperglycemic nonketonic syndrome (HHNS) coma. Which assessment data should the nurse expect the client to exhibit? 1. Kussmaul's respirations. 2. Diarrhea and epigastric pain. 3. Dry mucous membranes. 4. Ketone breath odor.

3. Dry mucous membranes.

The nurse is discussing ways to prevent diabetic ketoacidosis with the client diagnosed with type 1 diabetes. Which instruction is most important to discuss with the client? 1. Refer the client to the American Diabetes Association. 2. Do not take any over-the-counter medications. 3. Take the prescribed insulin even when unable to eat because of illness. 4. Explain the need to get the annual flu and pneumonia vaccines.

3. Take the prescribed insulin even when unable to eat because of illness.

The nurse is assessing the feet of a client with long-term type 2 diabetes. Which assessment data warrant immediate intervention by the nurse? 1. The client has crumbling toenails. 2. The client has athlete's foot. 3. The client has a necrotic big toe. 4. The client has thickened toenails.

3. The client has a necrotic big toe.

The nurse is discussing the importance of exercising with a client diagnosed with type 2 diabetes whose diabetes is well controlled with diet and exercise. Which information should the nurse include in the teaching about diabetes? 1. Eat a simple carbohydrate snack before exercising. 2. Carry peanut butter crackers when exercising. 3. Encourage the client to walk 20 minutes three (3) times a week. 4. Perform warmup and cool-down exercises.

4. Perform warmup and cool-down exercises.

Which arterial blood gas results should the nurse expect in the client diagnosed with diabetic ketoacidosis? 1. pH 7.34, PaO2 99, PaCO2 48, HCO3 24. 2. pH 7.38, PaO2 95, PaCO2 40, HCO3 22. 3. pH 7.46, PaO2 85, PaCO2 30, HCO3 26. 4. pH 7.30, PaO2 90, PaCO2 30, HCO3 18.

4. pH 7.30, PaO2 90, PaCO2 30, HCO3 18.

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? a. hypoglycemia b. hyponatremia c. ketonuria d. polyphagia

A. hypoglycemia

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? (select all that apply) a. may improve blood glucose levels b. decrease the need for exogenous insulin c. help reduce cholesterol levels d. may reduce postprandial glucose levels e. increase potassium levels

a, b, c

The nurse is caring for a patient with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results? a. lower than 50-60 mg/dl b. between 60 and 80 mg/dL c. Between 75 and 90 mg/dL d. 95 mg/dL

a. lower than 50-60 mg/dl

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? a. NPH b. Regular c. Lispro d. Lantus

b. regular

A patient with type 1 diabetes mellitus is being taught about self-injection of insulin. Which of the following facts about site rotation should the nurse include in the teaching? a. avoid the abdomen because absorption is irregular b. Use all available injection sites within one area c. rotate sites from area to area every other day d. Choose a different site at random for each injection

b. use all available injection sites within one area

A 1,200- calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The nurse is teaching the patient about meal planning using exchange lists. The teaching is determined to be effective based on which of the following statements? a. :for dinner I ate 2 cups of cooked pasta with 3-ounces of boiled shrimp, 1 cup plum tomatoes, half a cup of peas and garlic-win sauce, 2 cups fresh strawberries, and ice water with lemon" b. For dinner I ate 4- ounces of sliced roast beef on a bagel with lettuce, tomato, and onion, 1 ounce low-fat cheese, 1 tablespoon mayonnaise, 1 cup fresh strawberry shortcake, and unsweetened iced tea" c. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion, a green salad with 1 teaspoon Italian dressing, 1 cup of watermelon, and a diet soda" d. For dinner I ate 2 ounces of sliced turkey, 1 cup mashed sweet potatoes, half a cup of carrots, half a cup of peas, a 3- ounce dinner roll, 1 medium banana, and a diet soda"

c. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion, a green salad with 1 teaspoon Italian dressing, 1 cup of watermelon, and a diet soda"

During a follow- up visit 2 months following a new diagnosis of type 2 diabetes, a patient reports exercising and following a reduced-calorie diet. Assessment reveals that the patient has only lost 2 pound and did not bring the glucose-monitoring record. Which of the following tests will the nurse plan to obtain? a. oral glucose tolerance test b. urine dipstick for glucose c. fasting blood glucose level d. glycosylated hemoglobin level

d. glycosylated hemoglobin level