Adaptive Quizzing Week 12 Diabetes Mellitus

What are components of metabolic syndrome? Select all that apply. 1. Abdominal obesity 2. Elevated glucose levels 3. Elevated blood pressure 4. Low levels of triglycerides 5. Increased levels of high-density lipoproteins (HDL)

1, 2, 3- Correct The components of metabolic syndrome are abdominal obesity, elevated glucose levels, and elevated blood pressure. Low levels of triglycerides and increased levels of HDL are not components of metabolic syndrome. Text Reference - p. 1156

What are the symptoms of peripheral arterial disease? Select all that apply. 1 . Cold feet 2 . Loss of hair 3 . Dependent rubor 4 . Urinary retention 5 . Bowel incontinence

1, 2, 3-Correct Peripheral arterial disease causes decreased blood flow to the lower extremities. Cold feet, loss of hair, and dependent rubor are the signs of peripheral arterial disease. Urinary retention and bowel incontinence are symptoms of autonomic neuropathy. Text Reference - p. 1184

A nurse in the outpatient setting is teaching a patient about the importance of self-monitoring of blood glucose (SMBG) using a glucometer. What should the nurse tell the patient? Select all that apply. 1. Test blood glucose whenever hypoglycemia is suspected. 2. Test blood glucose before and after exercise. 3. Take a blood sample immediately after a meal. 4. Take a blood sample from the side of the finger pad. 5. Wash hands in cold water when preparing to puncture.

1, 2, 4- Correct The nurse should instruct the patient to test blood glucose levels whenever hypoglycemia is suspected so that immediate action can be taken. The patient should test blood glucose before and after exercise to determine the effects of exercise on metabolic control. Blood sample should be taken from the side of the finger pad rather than near the center, because there are fewer nerve endings along the side of the finger. Blood glucose is generally tested two hours after a meal to determine if the bolus insulin dose was adequate for the meal. Blood glucose may also be tested before a meal by patients who use insulin pumps or multiple daily injections and base the insulin dose on the carbohydrates in a meal or make adjustments if the preprandial value is above or below target. Hands should be washed in warm water before the finger puncture is made to in order to promote blood flow to the fingers. Text Reference - p. 1168

Which symptoms may be observed in patients with diabetic ketoacidosis? Select all that apply. 1. Hypovolemia 2. Volume overload 3. visual disturbances 4. Soft and sunken eyes 5. Sweet fruity odor of breath

1, 3, 5- Correct Dehydration in patients with diabetic ketoacidosis results in hypovolemia, soft and sunken eyes, and sweet fruity odor of breath. Volume overload is common in diabetic patients with cardiac or renal compromise. Visual disturbances may result from severe hypoglycemia. Text Reference - p. 1176

The nurse provides education to a patient with newly diagnosed type 1 diabetes mellitus. Which statement made by the patient indicates a need for further instruction? 1. "If I skip breakfast, I can hold my insulin until noon." 2. "I'll have some options when it comes to food choices." 3. "If I feel sweaty, shaky, or dizzy, my blood sugar might be low." 4. "If I have to urinate a lot, feel thirsty all of the time, or have blurred vision, my blood sugar might be high."

1- Correct A diabetic patient should adhere to an American Diabetes Association diet and insulin regimen. These patients should not self-regulate insulin unless directed to do so by their primary healthcare provider. The statements in the other answer options are all correct in regard to self-management of diabetes at home. Text Reference - p. 1172

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? 1. Cheese 2. Broccoli 3. Chicken 4. Oranges

1- Correct Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes. Text Reference - p. 1166

The nurse is assigned to care for a patient with type 2 diabetes. To encourage the patient to become an active participant in his or her care, what action should the nurse take? 1. Assess the patient's understanding of the disease 2. Make a list of food restrictions for proper diabetes management 3. Refer the patient to a nutritionist 4. Set long-term goals to decrease the risk of complications

1- Correct For teaching to be effective, the first step is assessing the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. Food restrictions, nutritionist referral, and setting long-term goals can occur once the nurse is confident the patient understands what it means to have diabetes. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. Text Reference - p. 1171

Which complication of diabetes can be treated with hyperbaric oxygen? 1. Diabetic foot ulcers 2. Diabetic nephropathy 3. Neuropathic arthropathy 4. Peripheral vascular disease

1- Correct Hyperbaric oxygen is used for wound healing in diabetic foot ulcers. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used in the treatment of diabetic nephropathy. Neuropathic arthropathy results in ankle and foot changes and increases the chances of developing foot ulcers. Peripheral vascular disease is one of the macrovascular complications of diabetes. Management includes smoking cessation and control of hypertension. Text Reference - p. 118

A patient diagnosed with type 1 diabetes has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse should be performed initially? 1. Check the patient's blood sugar at 3 AM. 2. Provide the patient with an evening snack. 3. Rotate insulin injection sites between the abdomen, thigh, and arm. 4. Contact the health care provider to increase the evening insulin dose.

1- Correct Hyperglycemia in the morning may be caused by the Somogyi effect. If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 and 4:00 AM for hypoglycemia will help determine if the cause is the Somogyi effect. Diabetics should be given evening snacks to prevent hypoglycemia during the night, but glucose assessment is a priority to rule out the Somogyi effect. Injection sites are rotated to prevent lypodystrophy. An increased dose of evening insulin may cause further decrease in early morning glucose and increased rebound hyperglycemia. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1163

After administering an intramuscular (IM) glucagon injection in an unconscious patient, why does the nurse turns the patient on the side? 1. To prevent aspiration 2. To avoid postural hypotension 3. To promote the patient's comfort 4. To help the patient regain consciousness

1- Correct IM glucagon is administered for hypoglycemia. Because nausea is a common reaction after glucagon injection, the patient should be turned to one side until gaining consciousness in order to prevent aspiration if vomiting occurs. Because the patient is unconscious, turning to the side will not promote the patient's comfort. The patient who is unconscious due to severe hypoglycemia will regain consciousness due to administration of the glucagon injection. Text Reference - p. 1180

The nurse is reviewing laboratory results for the patient with diabetes and coronary artery disease. Which laboratory result would help predict possible macrovascular disease as a complication of diabetes? 1. Increased low-density lipoproteins 2. Decreased blood urea nitrogen 3. Increased white blood cell count 4. Decreased C-reactive protein

1- Correct Increased low-density lipoprotein levels are associated with the macrovascular changes in diabetes mellitus. For this reason, the patient should limit the amount of fat in the diet. A decreased blood urea nitrogen or C-reactive protein is not clinically significant. An increased white blood cell count would indicate infection. Text Reference - p. 1181

Which hormone regulates the normal blood glucose level in the body? 1. Insulin 2. Glucagon 3. Epinephrine 4. Growth hormone

1- Correct Insulin is a hormone secreted by beta cells in the Islet of Langerhans of the pancreas. It helps in regulating the blood glucose level. Glucagon is a hormone secreted by the alpha cells of the Islet of Langerhans. It increases the blood glucose level by counteracting the mechanism of insulin. Epinephrine is a hormone secreted by the adrenal gland. It may not be helpful in maintaining the blood glucose level. Growth hormone is secreted by the pituitary gland and it helps in growth of all tissues and bones in the body. Text Reference - p. 1154

Laboratory results have been obtained for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? 1. Increased triglyceride levels 2. Increased high-density lipoproteins (HDL) 3. Decreased low-density lipoproteins (LDL) 4. Decreased very-low-density lipoproteins (VLDL)

1- Correct Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development. Text Reference - p. 1181

Which laboratory parameter assesses the function of pancreatic beta cells? 1. C-peptide level 2. Hemoglobin level 3. Urine specific gravity 4. Serum creatinine level

1- Correct Proinsulin is the precursor of insulin. Enzymatic activity helps split proinsulin into insulin and C-peptide. Therefore, the function of pancreatic beta cells can be assessed by measuring C-peptide levels. Hemoglobin levels indicate the oxygen-carrying capacity of the blood. Urine specific gravity indicates fluid and electrolyte balance. Serum creatinine levels indicate renal function. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 1155

While caring for a patient with diabetic ketoacidosis, the nurse finds that the patient is experiencing rapid, deep breathing due to dyspnea. Which physiologic cause does the nurse suspect? 1. Altered pH balance 2. Dry mucous membranes 3. Increased serum osmolality 4. Increased endogenous insulin secretion

1- Correct Rapid, deep breathing due to dyspnea is a characteristic feature of Kussmaul respirations, which occur due to metabolic acidosis. Altered pH balance in the body is responsible for metabolic acidosis. Dry mucous membranes are one of the manifestations of severe dehydration. Increased serum osmolality results in neurologic manifestations such as somnolecence, coma, seizures, hemiparesis, and aphasia in patients with hyperosmolar hyperglycemic syndrome (HHS). Increased endogenous insulin secretion results in hypoglycemia. Text Reference - p. 1176

The nurse advises a diabetic patient on insulin therapy who reports headaches on waking and night sweats to reduce the dose of insulin and have a bedtime snack. Which finding supports the nurse's instructions? 1. Blood glucose levels <60 mg/dL between 2 AM and 4 AM 2. Blood glucose levels >60 mg/dL between 2 PM and 4 AM 3. Blood glucose levels <60 mg/dL between 2 AM and 4 PM 4. Blood glucose levels >60 mg/dL between 2 AM and 4 PM

1- Correct Reducing the dose of insulin and having a bedtime snack are the instructions given to a patient who is experiencing morning hyperglycemia. The Somogyi effect and dawn phenomenon are characterized by morning hyperglycemia. In the Somogyi effect, the blood glucose level is AM and 4 AM. Therefore, the insulin dose is reduced and a bedtime snack is advised. Blood glucose levels >60 mg/dL between 2 PM and 4 AM, blood glucose levels AM and 4 PM, and blood glucose levels >60 mg/dL between 2 AM and 4 PM are not associated with the Somogyi effect. Text Reference - p. 1163

Which complication can be monitored by annual screening using a monofilament? 1. Diabetic neuropathy 2. Diabetic retinopathy 3. Diabetic dermopathy 4. Diabetic nephropathy

1- Correct Sensory neuropathy is a type of diabetic neuropathy in which loss of protective sensation (LOPS) is common. LOPS may lead to lower extremity amputation. Therefore, annual screening using a monofilament is important in monitoring the patient for diabetic neuropathy. Diabetic retinopathy is monitored by annual fundoscopic examination. Examining the skin changes is important in diabetic patients to monitor for diabetic dermopathy. Serum creatinine and urinalysis for microalbuminuria help to monitor for diabetic nephropathy. Text Reference - p. 1183

The nurse is caring for a patient with newly diagnosed type 2 diabetes mellitus. Which symptoms indicate that the patient is experiencing hyperglycemia? Correct1 Polydipsia, polyuria, and polyphagia 2 Weight gain, fatigue, and bradycardia 3 Irritability, diaphoresis, and tachycardia 4 Loss of appetite, abdominal pain, and oliguria

1- Correct Symptoms of hyperglycemia, as seen in both forms of diabetes mellitus, include polydipsia, polyuria, polyphagia, and weight loss. Patients with hyperglycemia due to diabetes mellitus do not manifest weight gain, loss of appetite or oliguria, or bradycardia, but they may exhibit fatigue, tachycardia, and abdominal pain. Irritability and diaphoresis are manifestations of hypoglycemia (low blood sugar). Text Reference - p. 1175

The patient with diabetes should consume fiber as part of a healthy diet. The current recommendation for persons with diabetes is 1. 25 to 30 g/day 2. 20 to 25 g/day 3. 40 to 50 g/day 4. 10 to 20 g/day

1- Correct The American Diabetes Association (ADA) recommends that diabetics consume 25 to 30 grams of fiber daily. This is the same level recommended for the nondiabetics, because there is no evidence that a higher intake of fiber is essential. Forty to 45 grams is too much fiber for the patient to consume, and 10 to 25 grams is not enough fiber. Text Reference - p. 1166

A patient with diabetes mellitus has a neurogenic bladder leading to urinary retention. How is the Credé maneuver performed to help the patient completely empty the bladder? 1. By performing mild massage downward over the lower abdomen and bladder 2. By performing mild massage downward over the upper abdomen and bladder 3. By performing moderate massage downward over the lower abdomen and bladder 4. By performing moderate massage downward over the upper abdomen and bladder

1- Correct The Credé maneuver involves mild massage downward over the lower abdomen and bladder with low pressure. This massage helps in relaxing the lower abdominal muscles, which may in turn help in complete bladder emptying. The upper abdomen is not involved in the Credé maneuver. Moderate massage on the lower or upper abdomen involves applying high pressure, so reflux of urine may occur and result in renal infection. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1183

The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? 1. Excessive thirst 2. Gradual weight gain 3. Overwhelming fatigue 4. Recurrent blurred vision

1- Correct The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations. Text Reference - p. 1157

The nurse provides dietary instructions to a patient with type 1 diabetes mellitus. Which statement made by the patient indicates a need for further teaching? 1. "If I go over my calories, I can just increase my insulin." 2. "I'll need a bedtime snack, because I take an evening dose of NPH insulin." 3. "I can have an occasional low-calorie dessert as long as I include it in my meal plan." 4. "I should eat meals at the scheduled times, even if I'm not hungry, to prevent hypoglycemia."

1- Correct The goal of dietary therapy for the patient with diabetes mellitus is to attain and maintain an ideal body weight and a stable blood glucose level. Each patient should be prescribed a specific caloric intake and insulin regimen to help him or her achieve this goal. Insulin dosage should not be increased to account for an increased caloric intake. A bedtime snack for people taking evening NPH insulin, planning for an occasional low-calorie dessert, and eating at scheduled times are all part of correct diabetes management. Text Reference - p. 1167

The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? 1. Chooses a puncture site in the center of the finger pad 2. Washes hands with soap and water to cleanse the site to be used 3. Warms the finger before puncturing it to obtain a drop of blood 4. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes

1- Correct The patient should select a site on the sides of the fingertips, not on the center of the finger pad, because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct. Text Reference - p. 11

The nurse is caring for a patient admitted to the health care facility with type 1 diabetes. What leads to type 1 diabetes? 1. Autoimmune destruction of pancreatic β-cells 2. Presence of unresponsive insulin receptors 3. Decrease in the production of insulin 4. Inappropriate glucose production by the liver

1- Correct Type 1 diabetes is caused by autoimmune destruction of the pancreatic β-cells, resulting in a total absence of insulin production. Type 2 diabetes mellitus is caused by unresponsive insulin receptors, decrease in the production of insulin, inappropriate glucose production by the liver, or altered production of hormones and cytokines by adipose tissue. Text Reference - p. 1155

What is the primary defect factor associated with type 1 diabetes mellitus? 1. Absent or minimal insulin production 2. Alteration in production of adipokines 3. Decreased insulin production over time and insulin resistance 4. Abnormal increase in insulin production by the pancreas over time

1- Correct Type 1 diabetes mellitus is a result of the absence or minimal production of insulin by the pancreas. Alteration in production of adipokines, decreased insulin production over time, and insulin resistance are the defect factors associated with type 2 diabetes mellitus. An abnormal increase in the insulin over time does not cause diabetes. Text Reference - p. 1154

The nurse is caring for a patient in an outpatient diabetes clinic. Which statement by the patient indicates an understanding of the teaching? 1. "I will be sure to measure my finger stick blood glucose level four times a day, and more frequently when I am ill." 2. "When I am ill, I will eliminate my Lantus insulin and only cover my finger stick blood glucose if it is over 250." 3. "When I am ill, I will continue to take my Lantus insulin only." 4. "When I am ill I will only take my rapid acting insulin."

1- Correct When a patient with diabetes is ill, it is recommended he or she continues checking blood sugar every four hours and more frequently to prevent hyperglycemia and hypoglycemia during illness. The diabetic patient should adhere to the sick day rules, which indicate to continue with your basal dosing of insulin and continue to correct a finger stick blood sugar greater than 200. The patient also should be checking urine ketones for two blood sugars over 250 in a row. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies. Text Reference - p. 1168

A patient's blood glucose level was found to be 65 mg/dL during a follow-up visit to learn about management of hypoglycemia. Which action of the patient might be responsible for this? 1. Including whole milk in the diet 2. Including more fruits and juices in the diet 3. Performing moderate amounts of exercise 4. Including large quantities of rapid-acting carbohydrates in the diet

1- Correct Whole milk contains a high fat content and will reduce glucose absorption, and it may cause hypoglycemia. Fruit and juice in the diet cause a sudden rise in blood glucose level, resulting in hyperglycemia for a short period of time. Performing moderate amounts of exercise may help to maintain steady blood glucose levels. Including large quantities of rapid-acting carbohydrates may cause a rapid fluctuation to hyperglycemia. Text Reference - p. 1179

Which drug does the nurse expects to be beneficial in a patient with type 2 diabetes who has the presence of albumin in the urine? 1. Lisinopril 2. Duloxetin 3. Pregabalin 4. Bethanechol

1- Correct he presence of albumin in the urine indicates nephropathy in patients with diabetes. Angiotensin converting enzyme inhibitors such as lisinopril may delay the progression of nephropathy in diabetic patients. Duloxetin is a selective serotonin reuptake inhibitor, that is used for symptomatic treatment of sensory neuropathy. Pregabalin is an antiseizure medication used for neuropathic pain in diabetic patients. Bethanechol is a cholinergic agonist that is indicated for the treatment of neurogenic bladder. Text Reference - p. 1182

A patient with type 2 diabetes who takes metformin daily to manage blood sugar is scheduled for an intravenous pyelogram (IVP). Which question by the nurse is most important to ask the patient when preparing for the procedure? 1. "Have you ever skipped a dose of metformin?" 2. "When was the last time you took your metformin?" 3. "How many times a day do you take your metformin?" 4. "How long have you been taking metformin for diabetes?

2- Correct During an IVP, contrast dye is injected so that the urinary system can be visualized. To reduce risk of kidney injury, metformin should be discontinued a day or two before the procedure and for 48 hours following the procedure. Medication administration adherence, dosage, and history are important to assess, but will not affect the interaction. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 1163

Which complication of diabetes mellitus can be monitored by fundus photography? 1. Neuropathy 2. Retinopathy 3. Nephropathy 4. Dermatopathy

2- Correct Fundus photography helps to examine the interior surface of the eye (fundus). Therefore, fundus photography helps to detect the microvascular damage caused by chronic hyperglycemia to the retina, known as retinopathy. Neuropathy can be monitored by a comprehensive foot examination. Diabetic nephropathy can be monitored by checking for microalbuminuria and serum creatinine. Dermatopathy can be monitored by frequent skin examinations. Text Reference - p. 1181

Which statement by a patient shows ineffective learning about diabetes management? 1. "I will exercise daily." 2. "I will drink fruit juices daily." 3. "I will walk wearing shoes daily." 4. "I will have yearly influenza vaccination."

2- Correct Having fruit juices daily does not help in diabetes management, because it contains sugars that are easily absorbed. Exercising daily helps to maintain good health. Wearing shoes daily will avoid injuries to feet, which is important, because wound healing is delayed in diabetic patients. Diabetic patients have weakened immune systems and are more prone to flu. Therefore, annual vaccination against influenza is required. Text Reference - p. 1175

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? 1. "With type 2 diabetes, the body of the pancreas becomes inflamed." 2. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." 3. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." 4. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

2- Correct In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. In type 1 diabetes mellitus, the patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas. Test-Taking Tip: Attempt to select the answer that is most complete and includes the other answers within it. For example, a stem might read, "A child's intelligence is influenced by:" and three options might be genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer. Text Reference - p. 1156

The nurse is conducting a teaching session about nephropathy as a complication of diabetes. Which information would be appropriate for the nurse to include in the session? 1. Vessels may begin to bleed, resulting in permanent blindness. 2. Controlling blood sugar and blood pressure will reduce the risk of kidney injury. 3. Organ damage resulting from changes in large and medium-sized blood vessels can be prevented by careful glucose control. 4. This will not occur if one does not require insulin to control diabetes.

2- Correct Microangiopathy occurs in diabetes mellitus. When the kidneys are affected, the patient has nephropathy. Maintaining control of blood sugar and blood pressure will decrease microvascular organ damage and help to preserve kidney function. Blindness occurs as a result of microvascular damage, not bleeding. Organ damage is caused from small vessel damage. Regardless of the treatment type, nephropathy can occur if blood sugars are not controlled properly. Text Reference - p. 1181

Which process is related to nonproliferative retinopathy? 1. Hemorrhage 2. Micro aneurysm 3. Neovascularization 4. Retinal detachment

2- Correct Partial occlusion of the small blood vessels in the retina causes microaneurysms in nonproliferative retinopathy. Hemorrhage is seen in proliferative retinopathy because of fragile, newly formed blood vessels. In proliferative retinopathy, the retinal capillaries become occluded, resulting in the formation of new vessels. This process is called as neovascularization. Partial or complete retinal detachment occurs if the new blood vessels pull the retina while the vitreous contract. Text Reference - p. 1181

A patient with type 1 diabetes mellitus has received a prescription for propranolol. What does the nurse recognize as the major concern for this patient? 1. Frequent night sweats 2. Lessened ability to sense hypoglycemia 3. More frequent episodes of hyperglycemia 4. The need for an increased basal insulin dosage

2- Correct Patients who are hypoglycemic experience a drop in blood glucose level below normal and most often complain of weakness, nervousness, tremors, and diaphoresis. Propranolol (Inderal) can mask hypoglycemia-induced tachycardia, thereby decreasing the diabetic patient's ability to sense a drop in blood sugar. Propranolol does not cause night sweats or require an increased insulin dosage. Diabetic and nondiabetic patients may notice a slight increase in blood sugar, but this is not as significant a priority as the patient's not being able to sense hypoglycemia. Text Reference - p. 1175

Which patient will not respond to glucagon? 1. Patient with cerebral edema 2. Patient with alcoholic liver disease 3. Patient with chronic hyperglycemia 4. Patients with peripheral vascular disease

2- Correct Patients with alcohol-related hepatic disease may have minimal glycogen stores and will not respond to glucagon. Cerebral edema is related to a rapid decrease in the blood glucose levels. Patients with chronic hyperglycemia may develop chronic complications of diabetes mellitus. Peripheral vascular disease is one of the macrovascular complications of diabetes. Text Reference - p. 1180

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? 1. "I should only walk barefoot in nice dry weather." 2. "I should look at the condition of my feet every day." 3. "I am lucky my shoes fit so nice and tight because they give me firm support." 4. "When I am allowed up out of bed, I should check the shower water with my toes."

2- Correct Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. The patient should not walk barefoot. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first. Text Reference - p. 1173

Which statement of the patient with diabetes indicates ineffective learning about management of hypoglycemia? 1. "I will not eat large quantities of quick acting carbohydrates." 2. "I will recheck my glucose level 30 minutes after eating 15 g of carbohydrate." 3. "I will not contact the primary health care provider if my symptoms subside after two doses of carbohydrate." 4. "I will not eat candy bars and ice cream, because they have a lot of sugar and fat in them, which is not good for my health."

2- Correct The blood glucose level is less than 70 mg/dL in hypoglycemia. This is treated by ingesting 15 g of simple carbohydrate and rechecking the glucose levels 15 minutes later. If the levels are still below 70 mg/dL, the treatment is repeated two to three times. Overtreatment with large quantities of quick-acting carbohydrates should be avoided to prevent rapid fluctuation to hyperglycemia. If improvement is not observed, the primary health care provider should be contacted. Fats are present in candy bars and ice cream, which may slow down the absorption of glucose and delay the response to treatment. Text Reference - p. 1179

A patient calls the health care provider's office at 8:00 AM and states, "I just experienced an episode of low blood sugar, which responded to oral glucose tablets." To help identify the cause of the low blood sugar, an appropriate question the nurse should ask is: 1. "Did you check your urine for ketones?" 2. "Were you more active than usual yesterday?" 3. "Did you take a lower than normal dose of insulin today?" 4. "Have you been running a fever or do you have any illness symptoms?"

2- Correct The glucose-lowering effects of exercise can last up to 48 hours, so it is possible for hypoglycemia to occur after activity, particularly if exercise is at a greater intensity or time than normal. Asking the patient about activity level would be the most appropriate question for the nurse to ask. Ketones can be found in the urine with elevated blood glucose levels and may indicate the presence of diabetic ketoacidosis. Ketones would not be of concern with hypoglycemia. Taking a lower dose of insulin would result in higher blood glucose. Fever and illness can lead to hyperglycemia as well. Text Reference - p. 1179

The nurse is educating a diabetic patient about the use of premixed insulin neutral protamine hagedorn /regular 70/30. What should the nurse inform the patient about using this insulin? 1. Shake the bottle thoroughly to mix the insulin. 2. Rotate the injection within one anatomic site for a week. 3. Inject insulin at a 15 to 30 degree angle. 4. Inform that the fastest subcutaneous absorption is from the thigh.

2- Correct The nurse should teach the patient to rotate the injection within one anatomic site, such as the abdomen, for at least one week before using a different site to allow for better absorption of insulin. It is important to gently roll the insulin bottle between the palms 10 to 20 times to warm the insulin and resuspend the particles. Injections must be administered at a 45- to 90-degree angle, depending on the thickness of the patient's fat pad. The fastest subcutaneous absorption is from the abdomen, followed by the arm, thigh, and buttock. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience. Text Reference - p. 1160

Which class of drugs used to treat diabetes mellitus (DM) may be referred to as "insulin sensitizers"? 1. Sulphonylureas 2. Thiazolidinediones 3. α-glucosidase inhibitors 4. Dipeptidyl peptidase-4 (DPP-4) inhibitors

2- Correct Thiazolidinediones are a class of drugs used to treat diabetes mellitus (DM). They are often referred to as an "insulin sensitizers." This class of drugs improves insulin sensitivity, transport, and utilization at target tissues. Sulphonylureas increase insulin production by the pancreas. α-glucosidase inhibitors slow down absorption of carbohydrate in the small intestine. DPP-4 inhibitors enhance the activity of incretins, which stimulate release of insulin from pancreatic βcells. This class of drug also decreases hepatic glucose production. Text Reference - p. 1163

Which factor is most associated with type 1 diabetes mellitus? 1. Obesity 2. Viral infection 3. Sedentary lifestyle 4. High-carbohydrate diet

2- Correct Type 1 diabetes mellitus is caused due to a complete pancreatic shutdown. One of the many causes is a viral infection that may trigger production of antibodies against the pancreas. Obesity, sedentary lifestyle, and intake of a high-carbohydrate diet may increase the risk for type 2 diabetes mellitus. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1154

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? 1. 6:00 PM on the evening before the test 2. Midnight before the test 3. 4:00 AM on the day of the test 4. 7:00 AM on the day of the test

2- Correct Typically, a patient is prescribed to be nothing by mouth (NPO) for eight hours before a fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 AM should not have any food or beverages containing any calories after midnight. Text Reference - p. 1157

The nurse provides education to a patient with type 1 diabetes. Which statement made by the patient indicates a need for further instruction? 1. "I'll have a snack available when I exercise." 2. "I'll check my blood sugar level after every meal." 3. "I'll eat my meals and snacks at regular times every day." 4. "I'll start learning how to make high-fiber, low-fat foods."

2-Correct Fingerstick blood glucose testing should be performed before meals. Checking the blood glucose after meals will yield inaccurate results. This is of essential concern if the patient is basing insulin dosage on fingerstick blood glucose results. Having a snack nearby during exercise, eating meals and snacks at regular times, and eating high-fiber, low-fat foods are all correct in regard to diabetes management. Text Reference - p. 1169

Which intervention will be beneficial for a patient with a blood glucose level of 250 mg/dL who is receiving treatment for hyperosmolar hyperglycemic syndrome? 1. Administering 0.9% NaCl 2. Administering 0.1 u/kg/hr of insulin 3. Administering intramuscular (IM) glucagon 4. Administering intravenous (IV) fluids containing glucose

3- Correct A patient with hyperosmolar hyperglycemic syndrome whose blood glucose level approaches 250 mg/dL should receive IV fluids containing glucose to prevent hypoglycemia. NaCl 0.9% is administered in patients with diabetic ketoacidosis. Administering 0.1 u/kg/hr of insulin is indicated to correct hyperglycemia and hyperketonemia. IM glucagon is administered in hypoglycemic patients who are unconscious. Text Reference - p. 1178

The urinalysis of a patient with diabetes mellitus that has a blood glucose level of 680 mg/dL reveals a minimal ketone level. Which other finding can the nurse observe in the reports? 1. Decreased blood pH 2. Increased potassium 3. Increased serum osmolality 4. Decreased serum bicarbonate

3- Correct Blood glucose of 680 mg/dL and a minimal amount of ketones in the urine indicate that the patient has hyperosmolar hyperglycemic syndrome; the patient will also have increased serum osmolality. Decreased blood pH is associated with diabetic ketoacidosis. Patients with hyperosmolar hyperglycemic syndrome may have milder potassium deficits (hypokalemia) due to fluid losses. Decreased serum bicarbonate is observed with diabetic ketoacidosis. Text Reference - p. 1178

A patient presents with diabetic ketoacidosis (DKA). The nurse initiates the collaborative plan of care with the understanding that the initial goal of the treatment plan is: 1. Treatment for hypokalemia 2. Rapid reduction of elevated blood glucose 3. Rehydration through intravenous fluid replacement 4. Reduction of ketosis by encouraging oral nourishment

3- Correct Fluid imbalance is potentially life threatening for patients with DKA. The initial goal of therapy is to establish intravenous (IV) access and begin fluid replacement. Once urine output is established, electrolyte replacement will be addressed. Potassium levels will need to be monitored, because insulin therapy, which is needed to correct the hyperglycemia, may further reduce the potassium level. Insulin therapy will be used to lower the blood glucose gradually, to prevent rapid drops in serum glucose, which could lead to fluid shifts and the potential for cerebral edema. Ketosis results from the use of fat stores for energy, because excess glucose is not being transported to the cells and used as source of energy. Patients with DKA often present with nausea and vomiting; oral nourishment may be limited until symptoms lessen. Text Reference - p. 1176

A patient who was recently diagnosed with type 2 diabetes mellitus completed a teaching session about disease management. Which statement by the patient indicates understanding of type 2 diabetes mellitus? 1. "I will always be able to manage my diabetes with pills." 2. "As I get older, I will be able to decrease my diabetes medicine." 3. "If I become ill, I will need to check my blood sugar more frequently." 4. "As long as I take my medication, I do not have to follow a diabetic diet."

3- Correct Illness may increase blood glucose on people with type 2 diabetes. Diabetes is a progressive disease and as time goes on, patients with diabetes type 2 may need to increase oral medications or begin insulin therapy. Nutritional therapy is an integral part of diabetes management. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 1172

A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? 1. Central apnea 2. Hypoventilation 3. Kussmaul respirations 4. Cheyne-Stokes respirations

3- Correct In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis. Text Reference - p. 1175

An patient, admitted with type 1 diabetes, asks the nurse what "type 1" means. What is the nurse's best response? 1. "There is decreased insulin secretion, cellular resistance to insulin that is produced, or both." 2. "An increased amount of adipose tissue has led to an insufficient amount of insulin being produced." 3. "The body produces autoantibodies that destroy beta cells in the pancreas." 4. "The insulin being made is not used by the tissues properly, leading to high blood sugar."

3- Correct In type 1 diabetes mellitus, the pancreas is unable to make any insulin and the patient will require life-long exogenous insulin to control blood sugars. There is no cellular resistance and insulin secretion is absent, not decreased. Patients with type 1 diabetes are typically very thin; adipose tissue does not result in a decreased insulin production. It cannot be used by the tissues and cells because none is being produced. Text Reference - p. 1156

Which syndrome does the nurse suspect in a patient who has symptoms of hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein (HDL), and abdominal obesity? 1. Barret's esophagus 2. Cushing's syndrome 3. Metabolic syndrome 4. Irritable bowel syndrome

3- Correct Metabolic syndrome is a cluster of conditions such as increased blood pressure, body fat around the waist, and abnormal cholesterol levels, which increase the risk of diabetes. Barrett's esophagus is a condition where the inner lining of esophagus changes to resemble the intestinal lining, and it predisposes one to adenocarcinoma. Cushing's syndrome is a hormonal disorder that occurs due to abnormally high levels of cortisol in the body. Irritable bowel syndrome is characterized by chronic discomfort associated with defecation. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 1156

The nurse is teaching the caregiver about the manifestations of hypoglycemia in the diabetic patient. What should the caregiver identify as a manifestation of hypoglycemia? 1. Increase in urination 2. Abdominal cramps 3. Nervousness and tremors 4. Nausea and vomiting

3- Correct Nervousness and tremors, cold, clammy skin, and numbness of the fingers and toes are some of the manifestations of hypoglycemia for which the caregiver should watch out in the patient. An increase in urination, abdominal cramps, and nausea and vomiting are manifestations of hyperglycemia. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. Text Reference - p. 1179

hich drug is used for treating neurogenic bladder? 1. Valsartan 2. Gabapentin 3. Bethanechol 4. Amitryptyline

3- Correct Neurogenic bladder may develop as a sensation in the inner bladder wall causing urinary retention. A cholinergic agonist drug such as bethanechol is used for treating this condition. Valsartan is an angiotensin receptor blocker that is used in patients with diabetes and microalbuminuria. Gabapentin is an antiseizure medication used for treating neuropathic pain. Amitryptyline is a tricyclic antidepressant used in the treatment of neuropathic pain. Text Reference - p. 1183

What is the pathophysiologic cause of type 1 diabetes mellitus? 1. Insulin resistance of the body tissues 2. Decreased mass count of pancreatic β cells 3. Autoimmune destruction of pancreatic β cells 4. Fatigued pancreatic β cells due to overproduction of insulin

3- Correct Pancreatic β cells are the main source of insulin production in the body. Autoimmune destruction of pancreatic β cells results in minimal or no production of insulin. Absence of insulin is the factor associated with type 1 diabetes mellitus. Insulin resistance is the condition where insulin is produced by the pancreas but its uptake is resisted by the tissues. This factor is associated with type 2 diabetes mellitus. A decreased mass count of pancreatic β cells and fatigued pancreatic β cells produce insufficient insulin for the normal metabolism, so these factors are associated with type 2 diabetes. Text Reference - p. 1156

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? 1. 8:40 PM to 9:00 PM 2. 9:00 PM to 11:30 PM 3. 10:30 PM to 1:30 AM 4. 12:30 AM to 8:30 AM

3- Correct Regular insulin exerts peak action in two to five hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 to 30 minutes, with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM. Text Reference - p. 1159

Which is an insulin-dependent tissue? 1. Brain 2. Kidney 3. Skeletal muscle 4. Red blood cells

3- Correct Skeletal muscles have specific receptors, which are activated by insulin that permit the transportation of glucose into the cells. The brain, kidney, and red blood cells do not have receptors; instead they require only a specific amount of glucose for normal functioning. Text Reference - p. 1154

The nurse is instructing a diabetic patient who has infrequent voiding, difficulty voiding, and a weak stream of urine. Which action indicates the need for additional teaching? 1. Emptying the bladder for every three hours 2. Emptying the bladder in a sitting position 3. Loosening the abdominal muscles during voiding 4. Massaging downwards over the lower abdomen and bladder

3- Correct The abdominal muscles should be tightened for complete voiding of the urine and to prevent urine stasis. Difficulty in voiding the urine in patients with diabetes is due to autonomic neuropathy. Emptying the bladder every three hours helps to prevent stasis and subsequent infections. Emptying the bladder in a sitting position helps to void the urine completely. Massaging downwards over the lower abdomen and bladder may promote complete bladder emptying. Text Reference - p. 1183

Which complication of diabetes can be diagnosed by the ankle-brachial index? 1. Diabetic neuropathy 2. Diabetic nephropathy 3. Peripheral arterial disease 4. Hyperosmolar hyperglycemic syndrome

3- Correct The ankle-brachial index is used to diagnose peripheral arterial disease. Diabetic neuropathy is diagnosed based on the symptoms and by examining the patient's lower extremities. Increased serum creatinine, decreased glomerular filtration rate, and albuminuria is indicative of diabetic nephropathy. Hyperosmolar hyperglycemic syndrome is suspected if the blood glucose levels are more than 600 mg/dL, with a marked increase in serum osmolality. Text Reference - p. 1184

The nurse is caring for a patient diagnosed with diabetes mellitus (DM) who has developed insulin resistance. Which class of glucose-lowering agents can reduce insulin resistance? 1. DPP-IV inhibitors 2. Dopamine agonists 3. Thiazolidinediones 4. α- glucosidase inhibitors

3- Correct Thiazolidinediones are often referred to as "insulin sensitizers." These agents improve insulin sensitivity, transport, and utilization at target tissues. Because they do not increase insulin production, thiazolidinediones do not cause hypoglycemia when used alone. Examples of thiazolidinediones include rosiglitazone and piglitazone. DPP-IV inhibitors inactivate the hormone incretin. Dopamine agonists activate dopamine receptors and α- glucosidase inhibitors delay carbohydrate absorption in the small intestine. Text Reference - p. 1163

After a teaching session with the registered nurse, the newly diagnosed patient with type 1 diabetes mellitus is correct when he or she makes which statement? 1. "If I lose weight, I will be able to stop taking insulin." 2. "My pancreas will produce more insulin as I recover." 3. "I will need to be medicated with insulin for the rest of my life." 4. "I will be able to take insulin pills once my blood sugar is stabilized.

3- Correct Type 1 diabetes is caused by destruction of pancreatic β-cells, which causes permanent insulin insufficiency and eventual absence. Weight loss and recovery will not affect insulin production. Exogenous insulin is not absorbed in the GI system and therefore must be given parenterally. Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings. Text Reference - p. 1156

To determine how well a patient's diabetes mellitus has been controlled over the past two to three months, what assessment parameter should the nurse review? 1. Fasting blood glucose 2. Oral glucose tolerance 3. Glycosylated hemoglobin 4. Random fingerstick blood glucose

3- Correct When the glucose level is increased, glucose molecules attach to hemoglobin in the red blood cells (RBCs). This attachment lasts for the life of the RBC, two to three months. Monitoring the numbers of these attachments makes it possible to assess the average blood glucose for the previous two to three months. Fasting blood glucose, oral glucose tolerance, and random fingerstick blood glucose tests are used to measure the current blood glucose level, which is different from the glycosylated hemoglobin level. Text Reference - p. 1156

Which symptom reported by a patient would lead the nurse to suspect early undiagnosed type 2 diabetes? 1. Blurred vision 2. Gradual weight gain 3. A wound that will not heal 4. Insomnia

3- Correct Type 2 diabetes presents with vague complaints including fatigue, frequent infections, and delayed wound healing. Blurred vision is a late symptom of uncontrolled diabetes. The patient will present with weight loss. Insomnia is not related to symptoms of undiagnosed diabetes. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." Text Reference - p. 1157

Patients with metabolic syndrome have a higher risk of developing type 2 diabetes. Which of these components may result in metabolic syndrome? Select all that apply. 1. Low body weight 2. Low glucose levels 3. Low levels of triglycerides 4. Elevated blood pressure (BP) 5. Decreased levels of high density lipoproteins (HDL)

4, 5- Correct If an individual has elevated blood pressure (BP), he or she is at a greater risk of developing type 2 diabetes as a result of having metabolic syndrome. A decreased level of high-density lipoproteins (HDL) is also a risk factor for metabolic syndrome, which may lead to type 2 diabetes mellitus. Low body weight, low glucose levels, and low levels of triglycerides are not associated with the development of metabolic syndrome; therefore, these are not risk factors for the onset of type 2 diabetes. Text Reference - p. 1156

Which blood glucose level indicates hyperglycemia? 1. 60 to 70 mg/dL 2. 80 to 110 mg/dL 3. 100 to 125 mg/dL 4. 200 to 250 mg/dL

4- Correct

A nurse teaches a student nurse about pancreas transplantation. While caring for a patient whose pancreas has been transplanted, which instruction given by the student nurse strongly suggests ineffective learning? 1. "Exogenous insulin is not required." 2. "Dietary restrictions are not required." 3. "Immunosuppression is required for life." 4. "Regular monitoring of glucose level is required."

4- Correct After pancreatic transplantation, homeostasis of glucose level is achieved. There is no need for regular monitoring of the glucose level. Pancreatic transplantation helps in maintaining a normal glucose level, so exogenous insulin is not required. Many dietary restrictions can be lifted. Lifetime immunosuppression is very important to avoid organ rejection, which may happen after pancreatic transplantation. Text Reference - p. 1169

The nurse would encourage a patient with diabetes mellitus and coronary artery disease to limit intake of which of the following foods to help reduce the percentage of saturated fat in the diet? 1. Chicken and turkey 2. Frozen and canned vegetables 3. Enriched flour products 4. Dairy products

4- Correct Cheese and dairy products are higher in fat and calories than vegetables, fruit, enriched flour products, or poultry and should be limited. Test-Taking Tip: Make educated guesses when necessary. Text Reference - p. 1166

Which is a symptom of autonomic neuropathy? 1. Aphasia 2. Glaucoma 3. Paresthesias 4. Gastroparesis

4- Correct Gastroparesis is delayed gastric emptying, which is one of the complications of autonomic neuropathy. Aphasia is one of the severe neurologic manifestations of hyperosmolar hyperglycemic syndrome. Glaucoma may occur due to diabetic retinopathy. Paresthesias is seen in sensory neuropathy. Text Reference - p. 1183

The nurse has been teaching a patient newly diagnosed with diabetes mellitus to test his or her own blood glucose level. During evaluation of his or her technique, the nurse determines that the teaching has been adequate when the patient performs which task? 1. Reports control of diabetes is present when blood sugar level is less than 65 mg/dL. 2. Chooses a puncture site in the center of the finger pad. 3. Runs the hand under cool water for 30 seconds to cleanse the site. 4. Hangs the arm in the dependent position for one minute before puncturing.

4- Correct Hanging the hand down will promote blood flow to the finger and allow for an adequate blood sample. A blood sugar of 65 mg/dL is considered low and does not necessarily mean the diabetes is well controlled. The patient should select a site on the side of a fingertip, not on the center of a finger pad, and the site should be washed with soap and warm water. Text Reference - p. 1168

The nurse is reviewing diabetic self-care management with a patient newly diagnosed with diabetes. The patient is in need of further education when stating to the nurse: 1. "I am going to check my feet for pressure areas every morning before I take a bath." 2. "I need to be careful on how I cut my toenails. I should not cut down the corners of the nail." 3. "I have scheduled an eye examination with an ophthalmologist for next week. I will need to have an annual eye exam." 4. "To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath."

4- Correct Patients with diabetes are at great risk for skin breakdown because of peripheral vascular problems and peripheral neuropathy. Patients should avoid using rubbing alcohol on skin to prevent tissue damage. The best way to prevent foot ulcers is prevention and early detection. Inspecting the feet every day for cuts, abrasions, pressure areas, or sores is a good practice. Toenails should be cut with the rounded contour of the nail and not cut down the corners of the nail. Another complication of diabetes is retinopathy. Patients with a history of diabetes should have an eye examination annually by an ophthalmologist. Text Reference - p. 1184

Which statement by the patient with diabetes mellitus indicates that further education regarding exercise is required? 1. "I should exercise about 30 minutes five days a week." 2. "Because I take insulin daily, I should exercise about one hour after eating a meal." 3. "Exercise will help me to lose weight, which will help my body to better use insulin." 4. "It is especially important that I exercise if my blood sugar is above 250 mg/dL and my urine is positive for ketones."

4- Correct Strenuous activity can be perceived by the body as a stress and cause an increase in blood sugar by the release of counterregulatory hormones when the blood sugar is elevated and ketosis is present. The American Diabetes Association recommends that people with diabetes exercise 30 minutes per day, five days per week. To prevent hypoglycemia, it is important to exercise about an hour after consuming a meal or eat small carbohydrate snacks every 30 minutes during exercise. Weight loss decreases insulin resistance, which can lower blood glucose. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." Text Reference - p. 1168

The nurse is teaching a patient with type 2 diabetes about exercise as a method to control blood glucose levels. The nurse knows the patient understands when the patient elicits which exercise plan? 1. "I want to go fishing for 30 minutes each day. I will drink fluids and wear sunscreen." 2. "I will go running each day when my blood sugar is too high to bring it back to normal." 3. "I will plan to keep my job as a teacher because I get a lot of exercise every school day." 4. "I will take a brisk 30-minute walk five days per week and do resistance training three times a week."

4- Correct The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity five days per week and resistance training three times a week. Brisk walking is moderate activity. Fishing and teaching are light activity and running is considered vigorous activity. Text Reference - p. 1167

The nurse is caring for a diabetic patient with neurogenic bladder. What should the nurse tell the patient about emptying the bladder? 1 Empty the bladder every five hours. 2. Relax abdominal muscles during voiding. 3. Massage the lower abdomen horizontally. 4. Use the Credé maneuver to completely empty the bladder.

4- Correct The nurse should instruct the patient with neurogenic bladder to use the Credé maneuver to completely empty the bladder; the Credé maneuver involves mild downward massage over the lower abdomen and bladder. The nurse should also instruct the patient to empty the bladder every three hours in a sitting position to prevent stasis and subsequent infection. The patient should tighten the abdominal muscles and massage the lower abdomen downward to empty the bladder completely. Text Reference - p. 1183

he nurse is caring for a diabetic patient with neurogenic bladder. What should the nurse tell the patient about emptying the bladder? 1. Empty the bladder every five hours. 2. Relax abdominal muscles during voiding. 3. Massage the lower abdomen horizontally. 4. Use the Credé maneuver to completely empty the bladder.

4- Correct The nurse should instruct the patient with neurogenic bladder to use the Credé maneuver to completely empty the bladder; the Credé maneuver involves mild downward massage over the lower abdomen and bladder. The nurse should also instruct the patient to empty the bladder every three hours in a sitting position to prevent stasis and subsequent infection. The patient should tighten the abdominal muscles and massage the lower abdomen downward to empty the bladder completely. Text Reference - p. 1183