Chapter 30: PrepU - Nursing Management: Diabetes Mellitus

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? 1- Control blood glucose levels. 2- Drink plenty of fluids. 3- Take the antidiabetic drugs regularly. 4- Eat a high-fiber diet.

1

What is the duration of regular insulin? 1- 4 to 6 hours 2- 3 to 5 hours 3- 12 to 16 hours 4- 24 hours

1

A nurse understands that a major concern with type 2 diabetes is: 1- Older age (> 60 years). 2- Obesity (>20% of IBW). 3- Insulin resistance. 4- Overactive insulin secretion.

3

After recently being admitted to the emergency department with signs and symptoms of hyperglycemia, a 33-year-old man was subsequently diagnosed with diabetes. The patient's blood sugars have been stabilized, and the man has begun diabetes education with a nurse educator. When working with this patient, the nurse educator should first: 1- Teach the patient about the essential concepts of nutrition 2- Explain the various insulin delivery devices to the patient 3- Ask the patient what questions he currently has about diabetes 4- Ascertain the patient's readiness and willingness to learn

4

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? 1- 7:45 AM 2- 8:00 AM 3- 8:15 AM 4- 8:30 AM

1

Insulin is secreted by which of the following types of cells? 1- Beta cells 2- Melanocytes 3- Neural cells 4- Basal cells

1

Which of the following insulins are used for basal dosage? 1- Glarginet (Lantus) 2- NPH (Humulin N) 3- Lispro (Humalog) 4- Aspart (Novolog)

1

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? 1- Glargine 2- Regular 3- NPH 4- Lente

2

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: 1- at least once per week. 2- at least three times per week. 3- at least five times per week. 4- every day.

2

Which type of insulin acts most quickly? 1- Regular 2- NPH 3- Lispro 4- Glargine

3

A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: 1- increasing saturated fat intake and fasting in the afternoon. 2- increasing intake of vitamins B and D and taking iron supplements. 3- eating a candy bar if light-headedness occurs. 4- consuming a low-carbohydrate, high-protein diet and avoiding fasting.

4

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? 1- Sweating, tremors, and tachycardia 2- Dry skin, bradycardia, and somnolence 3- Bradycardia, thirst, and anxiety 4- Polyuria, polydipsia, and polyphagia

1

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? 1- Albumin 2- Bacteria 3- Red blood cells 4- White blood cells

1

The greatest percentage of people have which type of diabetes? 1- Type 2 2- Type 1 3- Gestational 4- Impaired glucose tolerance

1

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? 1- "Don't take your insulin or oral antidiabetic agent if you don't eat." 2- "It's okay for your blood glucose to go above 300 mg/dl while you're sick." 3- "Test your blood glucose every 4 hours." 4- "Follow your regular meal plan, even if you're nauseous."

3

The nurse is teaching an older client how to self-administer insulin. Which of the following would be most helpful to the client who is having difficulty drawing up the correct dosage of insulin in the syringe? 1- Syringe magnifier 2- Insulin pen 3- Jet injector 4- Insulin pump

1

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. 1- Blurred or deteriorating vision 2- Fatigue and irritability 3- Polyuria and polydipsia 4- Sudden weight loss and anorexia 5- Wounds that heal slowly or respond poorly to treatment

1,2,3,5

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: 1- 10 g of carbohydrates. 2- 15 g of carbohydrates. 3- 20 g of carbohydrates. 4- 25 g of carbohydrates.

2

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? 1- Metformin 2- Glyburide 3- Repaglinide 4- Glipizide

1

A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching? 1- Avoid the abdomen because absorption there is irregular. 2- Choose a different site at random for each injection. 3- Rotate sites from area to area every other day. 4- Use all available injection sites within one area.

4

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 factor as a cause of type 1 diabetes? 1- Presence of autoantibodies against islet cells 2- Obesity 3- Rare ketosis 4- Altered glucose metabolism

1

Which statement is true regarding gestational diabetes? 1- It occurs in the majority of pregnancies. 2- Onset usually occurs in the first trimester. 3- A glucose challenge test should be performed between 24 to 28 weeks. 4- There is a low risk for perinatal complications.

3

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds: 1- 120 mg/dL 2- 140 mg/dL 3- 160 mg/dL 4- 180 mg/dL

4

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 1- 100 units of regular insulin in normal saline solution 2- 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution 3- 100 units of regular insulin in dextrose 5% in water 4- 100 units of NPH insulin in dextrose 5% in water

1

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? 1- The short-acting insulin is withdrawn before the intermediate-acting insulin. 2- The intermediate-acting insulin is withdrawn before the short-acting insulin. 3- Different types of insulin are not to be mixed in the same syringe. 4- If administered immediately, there is no requirement for withdrawing one type of insulin before another.

1

A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes? 1- increased thirst, hunger, and urination 2- Increased weight loss, dehydration, and fatigue 3- Loss of appetite, increased urination, and dehydration 4- Increased weight gain, appetite, and thirst

1

A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site? 1- Change the needle every 3 days. 2- Wear sterile gloves when inserting the needle. 3- Take the ordered antibiotics before initiating treatment. 4- Use clean technique when changing the needle.

1

A diabetes nurse is teaching an older adult patient who has been recently diagnosed with type 2 diabetes about the importance of foot care. To reduce this patient's risk of developing a diabetic foot ulcer, what practice should the nurse teach? 1- The correct technique for soaking the feet in Epsom salts each evening 2- Technique for daily inspection of all of the surfaces of both feet 3- The correct placement of pillows to prevent the feet from being placed in a dependent position 4- Exercises that can be used to promote circulation in the patient's feet

2

A hospital patient has been ordered a sliding scale of Humulin R for the duration of her admission. The patient's medication administration record specifies the first administration time of the day at 08:00 and the nurse knows that breakfast trays typically arrive on the unit between 07:45 and 07:50. When should the nurse administer the patient's insulin? 1- 07:30 2- 07:45 3- 08:00 4- 08:15

1

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? 1- It enhances the transport of glucose across the cell membrane. 2- It aids in the process of gluconeogenesis. 3- It stimulates the pancreatic beta cells. 4- It decreases the intestinal absorption of glucose.

1

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The father reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? 1- Give prescribed antiemetics. 2- Begin fluid replacements. 3- Administer prescribed dose of insulin. 4- Administer bicarbonate to correct acidosis.

2

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? 1- Cool, moist skin 2- Rapid, thready pulse 3- Arm and leg trembling 4- Slow, shallow respirations

2

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client: 1- prefers to take insulin orally. 2- has type 2 diabetes. 3- has type 1 diabetes. 4- is pregnant and has type 2 diabetes.

2

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? 1- Home health nurse 2- Dietitian 3- Psychiatrist 4- Social worker

2

A patient has just been diagnosed with type 2 diabetes. The health care provider has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent has been prescribed for this patient? 1- Sulfonylurea 2- Biguanide 3- Thiazolidinedione 4- Alpha glucosidase inhibitor

2

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 1- 2 to 5 g of a simple carbohydrate. 2- 10 to 15 g of a simple carbohydrate. 3- 18 to 20 g of a simple carbohydrate. 4- 25 to 30 g of a simple carbohydrate.

2

An elderly patient has come to the clinic with his daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and his daughter as the nurse realizes that foot care is extremely important. Why would the nurse believe that foot care is so important to this patient? 1- An elderly patient with foot ulcers experiences severe foot pain due to diabetic polyneuropathy. 2- Avoiding the complications associated with foot ulcers may mean the difference between institutionalization and continued independent living. 3- Hypoglycemia is a dangerous situation, and it may lead to unsteadiness and falls. 4- Drugs that patients are required to take for their diabetic condition often decrease circulation to the lower extremities.

2

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? 1- Nearly two-thirds of clients with diabetes mellitus are older than age 60. 2- Diabetes mellitus is more common in Hispanics and Blacks than in Whites. 3- Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. 4- Approximately one-half of the clients diagnosed with type 2 diabetes are obese.

2

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? 1- Systemic inflammatory response syndrome 2- Hyperglycemic hyperosmolar syndrome 3- Multiple-organ dysfunction syndrome 4- Diabetic ketoacidosis

2

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? 1- Onset most common during adolescence 2- Insufficient insulin production 3- Less common than type 1 diabetes 4- Little relation to prediabetes

2

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? 1- Onset most common during adolescence 2- Insulin production insufficient 3- Less common than type 1 diabetes 4- Little to relation to pre-diabetes

2

A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene? 1- Give the client 4 oz of milk and a graham cracker with peanut butter. 2- Obtain a serum glucose level. 3- Obtain a repeat fingerstick glucose level. 4- Notify the physician.

3

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? 1- Fasting blood glucose test 2- 6-hour glucose tolerance test 3- Serum glycosylated hemoglobin (Hb A1c) 4- Urine ketones

3

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? 1- With diabetes, drinking more results in more urine production. 2- Increased ketones in the urine promote the manufacturing of more urine. 3- High sugar pulls fluid into the bloodstream, which results in more urine production. 4- The body's requirement for fuel drives the production of urine.

3

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? 1- Serum potassium level 2- Serum sodium level 3- Arterial blood gas (ABG) values 4- Serum osmolarity

4

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? 1- "Your child will need less blood work as his glucose levels stabilize." 2- "Your child is young and will soon forget this experience." 3- "I'll see if the physician can reduce the number of blood draws." 4- "Our laboratory technicians use tiny needles and they're really good with children."

1

Lispro (Humalog) is an example of which type of insulin? 1- Rapid-acting 2- Intermediate-acting 3- Short-acting 4- Long-acting

1

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? 1- It carries glucose into body cells. 2- It aids in the process of gluconeogenesis. 3- It stimulates the pancreatic beta cells. 4- It decreases the intestinal absorption of glucose.

1

The nurse is preparing to administer a patient's scheduled dose of Novolin 70/30. When administering this dose of insulin, the nurse should: 1- Ensure that the insulin is not given near a previous injection site 2- Aspirate before injecting the insulin into the patient's subcutaneous tissue 3- Massage the injection site gently for 10 to 15 seconds after administration 4- Use a 3 mL syringe with a 24 gauge,- to-inch needle

1

Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? 1- Blood glucose can be controlled through diet and exercise 2- Client is usually thin at diagnosis 3- Client is prone to ketosis 4- Clients demonstrate islet cell antibodies

1

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? 1- Hypokalemia and hypoglycemia 2- Hypocalcemia and hyperkalemia 3- Hyperkalemia and hyperglycemia 4- Hypernatremia and hypercalcemia

1

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: 1- encourage the client to ask questions about personal sexuality. 2- provide time for privacy. 3- provide support for the spouse or significant other. 4- suggest referral to a sex counselor or other appropriate professional.

4

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. 1- Ketosis-prone 2- Little endogenous insulin 3- Obesity at diagnoses 4- Younger than 30 years of age 5- Older than 65 years of age

1,2,4

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? 1- Numbness 2- Increased hunger 3- Fatigue 4- Dizziness

2

A client with type 1 diabetes reports waking up in the middle of the night feeling nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood glucose readings have been 110 to 140 mg/dL. The client admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse plans to instruct the client to 1- administer an increased dose of neutral protamine Hagedorn insulin in the evening. 2- check blood glucose at 3:00 a.m. 3- eat a complex carbohydrate snack in the evening before bed. 4- skip the evening neutral protamine Hagedorn insulin dose on days when exercising and skipping meals.

2

A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client? 1- "I will take this medication in the morning, 15 minutes before breakfast." 2- "I will take this medication in the morning, with my first bite of breakfast." 3- "This medication needs to be taken after the midday meal." 4- "It does not matter what time of day I take this medication."

2

A client 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 client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? 1- Assess the client's ability to take a deep breath 2- Assess the client's ability to move all extremities 3- Assess the client's breath odor 4- Assess for excessive sweating

3

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? 1- Arterial pH 7.25 2- Plasma bicarbonate 12 mEq/L 3- Blood glucose level 1,100 mg/dl 4- Blood urea nitrogen (BUN) 15 mg/dl

3

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? 1- They have no effect. 2- They decrease the need for insulin. 3- They increase the need for insulin. 4- They cause wide fluctuations in the need for insulin.

3

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: 1- Impaired adjustment. 2- Defensive coping. 3- Deficient knowledge (treatment regimen). 4- Health-seeking behaviors (diabetes control).

3

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? 1- Autonomic neuropathy 2- Retinopathy 3- Sensory neuropathy 4- Nephropathy

3

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. In response, the nurse is explaining to the patient the etiology of type 1 diabetes. Which of the following is the most appropriate explanation by the nurse? 1- "The tissues in your body are resistant to the action of insulin, making insulin less effective." 2- "An acidic substance forms when your liver breaks down fatty acids because of the lack of insulin in your body." 3- "The secretion of placental hormones is causing your body to be resistant to insulin." 4- "Destruction of special cells in the pancreas causes a decrease in insulin production, and the level of sugar in your bloodstream increases."

4

A 30-year-old type 1 diabetic has been admitted to the critical care unit with a diagnosis of diabetic ketoacidosis following a drinking binge over the course of a weekend. The nurse should anticipate that this patient will require what immediate intervention? 1- IV administration of calcium gluconate 2- Subcutaneous administration of 30 units of insulin glargine (Lantus) 3- Oral administration of 2 g of metformin (Glucophage) 4- Rapid administration of intravenous normal saline

4

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? 1- Polyuria, headache, and fatigue 2- Polyphagia and flushed, dry skin 3- Polydipsia, pallor, and irritability 4- Nervousness, diaphoresis, and confusion

4

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? 1- "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." 2- "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." 3- "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." 4- "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

4

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? 1- "Eating the fruit is more satisfying than drinking the juice. You will get full faster." 2- "Eating the fruit will give you more vitamins and minerals than the juice will." 3- "The fruit has less sugar than the juice." 4- "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."

4

The nurse practitioner worked with a registered dietitian to customize a 1,800-calorie diabetic diet for a 53-year-old man with special dietary needs. Which of the following percent distribution of calories should be provided? 1- Carbohydrates 35%, fat 10%, and protein 5% 2- Carbohydrates 40%, fat 15%, and protein 10% 3- Carbohydrates 45%, fat 20%, and protein 15% 4- Carbohydrates 50%, fat 25%, and protein 20%

4

Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? 1- Thiazolidinediones 2- Biguanides 3- Alpha-glucosidase inhibitors 4- Sulfonylureas

4

Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? 1- Administer the total daily dosage in 2 doses. 2- Draw up the drug first, then add regular insulin. 3- Glargine is rapidly absorbed and has a fast onset of action. 4- Do not mix with other insulins.

4

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? 1- Polyuria 2- Hypoglycemia 3- Blurred vision 4- Polydipsia

2

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? 1- If two different types of insulin are ordered, they need to be given in separate injections. 2- When mixing insulin, the NPH insulin is drawn up into the syringe first. 3- When mixing insulin, the regular insulin is drawn up into the syringe first. 4- There is no need to inject air into the bottle of insulin before withdrawing the insulin.

3

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? 1- Applying a heating pad 2- Debriding the wound three times per day 3- Using sterile technique during the dressing change 4- Cleaning the wound with a povidone-iodine solution

3

Which statement is correct regarding glargine insulin? 1- Its peak action occurs in 2 to 3 hours. 2- It cannot be mixed with any other type of insulin. 3- It is absorbed rapidly. 4- It is given twice daily.

2

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? 1- Increased risk for urologic complications 2- Need for exocrine enzymatic drainage 3- Underlying problem of insulin resistance 4- Need for lifelong immunosuppressive therapy

3

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? 1- Coma, anxiety, confusion, headache, and cool, moist skin 2- Kussmaul's respirations, dry skin, hypotension, and bradycardia 3- Polyuria, polydipsia, hypotension, and hypernatremia 4- Polyuria, polydipsia, polyphagia, and weight loss

1

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: 1- 8:30 AM. 2- 10:30 AM. 3- 12:30 PM. 4- 2:30 PM.

1

A patient newly diagnosed with type 2 diabetes is attending a nutrition class specifically designed for type 2 diabetics. What general guideline would it be important to teach the patients at this class? 1- A low fat food generally contains low sugar. 2- Protein should be exclusively from animal sources. 3- Calorie intake should support a reasonable body weight. 4- Dietary fat should be eliminated from the diet.

3

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? 1- Fasting blood glucose level 2- Glucose via a urine dipstick test 3- Glycosylated hemoglobin level 4- Glucose via an oral glucose tolerance test

3

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: 1- Transport of potassium. 2- Release of glucose. 3- Synthesis of glucose from noncarbohydrate sources. 4- Storage of glucose as glycogen in the liver.

3

The nurse has cared for four patients with type 1 diabetes over the past few shifts. Based upon components of managing diabetes, which patient will likely have the greatest success in maintaining tight glucose control of his or her type 1 diabetes? 1- A patient who skips breakfast when her morning glucose reading is greater than 220 mg/dL. 2- A patient who never deviates from his prescribed dose of insulin. 3- A patient who adheres to a meal plan and meal schedule. 4- A patient who eliminates carbohydrates from her daily intake.

3

When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: 1- "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." 2- "The circulation in your feet can help us determine how severe your diabetes is." 3- "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." 4- "It's easier to get foot infections if you have diabetes."

3