NCLEX Questions for Chapter 41 (Diabetes Mellitus)

A patient presents with a blood pressure of 162/ 88 mm Hg, heart rate of 100 bpm, triglycerides of 378 mg/dL, and HDL of 25 mg/dL. Which of the following are characteristics of metabolic syndrome? (Select all that apply.) A. blood pressure of 162/88 mm Hg B. heart rate of 100 bpm C. triglycerides of 378 mg/dL D. HDL of 25 mg/dL

A, C, and D. The characteristics of metabolic syndrome are high low-density lipoprotein (LDL) cholesterol and total cholesterol, low HDL, increased blood pressure, impaired glucose values, and abdominal obesity

A patient who is newly diagnosed with diabetes mellitus demonstrates extreme anxiety. The most appropriate intervention to decrease the patient's anxiety would be to A. Convey empathy, trust, and respect toward the patient. B. Administer an antianxiety medication. C. Ensure that the patient knows the correct medical terminology to understand what is going on. D. Ignore the signs and symptoms of anxiety so they will disappear more quickly.

A. The most appropriate intervention is to address the client's feelings related to anxiety using therapeutic communication.

The nurse is assessing a patient who has just begun taking glyburide (DiaBeta). Which of the following is a therapeutic outcome for this patient? (Select all that apply.) A. a glycosylated hemoglobin (hemoglobin A1C) of 10% B. a decrease in polyuria C. a decrease in polyphagia D. a fasting blood glucose of 108 mg/dL

B, C, and D. A decrease in polyuria, polyphagia, and a fasting blood glucose of 108 mg/dL are indicative of therapeutic outcomes of glyburide.

A 58-year-old woman with type 2 diabetes mellitus takes glyburide (DiaBeta) 5 mg by mouth daily, and this drug controls her diabetes well. However, recently her fasting blood glucose has measured between 200 and 220 mg/dL. Which of the following medications may have been added to the patient's regimen? A. atenolol (Tenormin) B. prednisone (Deltasone) C. enalapril maleate (Vasotec) D. levothyroxine sodium (Synthroid)

B. Prednisone can decrease the effect of oral hypoglycemic medications, insulin, diuretics, and potassium supplements.

The nurse is monitoring a patient newly diagnosed with type 2 diabetes mellitus taking repaglinide (Prandin) for complications. Which of the following, if exhibited by the patient, would indicate hypoglycemia and require immediate treatment? A. polyuria B. diaphoresis C. decreased heart rate D. hypertension

B. Symptoms of hypoglycemia include sweating, tremor, tachycardia, inability to concentrate, slurred speech, and drowsiness.

A patient is taking NPH insulin once daily in the morning. What is the most likely time for a hypoglycemic reaction? A. 1 to 3 hours after administration B. 4 to 12 hours after administration C. 12 to 18 hours after administration D. 18 to 24 hours after administration

B. The insulin begins to work in 1 to 1½ hours, and its peak of action occurs in 4 to 12 hours, the most likely time a client will experience hypoglycemia.

When teaching a patient who has recently received a diagnosis of diabetes how to self-administer short-acting and intermediate-acting insulin subcutaneously, which of the following instructions is correct? A. Understand that the order of drawing up the two insulins into the syringe does not matter. B. Draw the short-acting insulin into the syringe first, followed by the intermediate-acting insulin. C. Draw the intermediate-acting insulin into the syringe fi rst, followed by the short-acting insulin. D. Give yourself two injections because mixing these insulins together is unsafe.

B. The short-acting insulin (clear) should always be drawn up first because the intermediate-acting insulin (cloudy) can inversely affect the short-acting insulin if mixed in the vial.

A patient with type 2 diabetes calls the nurse to report the following symptoms: blood glucose of 378 mg/dL, excessive urination, and feelings of becoming drowsier. To determine a possible diagnosis, which of the following questions is most important? A. "Has there been any change in diet?" B. "Has there been any fever?" C. "Have there been any ketones in the urine?" D. "Have you increased the amount of fluid intake?"

C. Hyperglycemic hyperosmolar nonketotic syndrome is differentiated from diabetic ketoacidosis by the absence of ketones in the urine.

A man with type 2 diabetes mellitus has a blood glucose of more than 500 mg/dL. He is complaining of excessive urination, extreme thirst, and weakness, and he also notes recent weight loss. The nurse would expect to find which diagnosis in his chart? A. hypoglycemia B. diabetic ketoacidosis C. hyperglycemic hyperosmolar nonketotic syndrome D. hypothyroidism

C. Hyperglycemic hyperosmolar nonketotic syndrome is seen in clients with type 2 diabetes. Symptoms may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness.

A patient with newly diagnosed type 1 diabetes is beginning daily insulin injections. The nurse is preparing to teach the patient about insulin injections. What should the nurse include in the teaching plan? A. Understand that ketones in the urine indicate the need for a decrease in the number of units of insulin. B. Administer the insulin at the same time every day regardless of meals. C. Rotate the insulin injection sites. D. Increase the insulin dosage just prior to exercise.

C. Lipodystrophy (hypertrophy of subcutaneous tissue at the injection site) can occur when the clients uses the same injection sites. Hypertrophied tissue can affect the amount or degree to which subcutaneous insulin is absorbed and thereby affect blood glucose levels.

The nurse is educating a patient about proper foot care. Which instruction does the nurse include in the teaching plan? A. Always use a pumice stone on callused areas of the feet. B. Use a heavy moisturizing cream on the feet at all times. C. Wash feet in cold water only. D. Always have a podiatrist cut toenails

D. A podiatrist should cut only the toenails. Clients with diabetes are more prone to have injuries on the feet that do not heal well because decreased circulation and increased blood glucose levels make injuries less likely to heal.

A patient with type 2 diabetes is scheduled to have a cardiac catheterization in 1 week, and the nurse makes a pre-procedure phone call. The nurse instructs the patient to stop taking which medication 2 days before the procedure? A. sitagliptin (Januvia) B. insulin C. glyburide (DiaBeta) D. metformin (Glucophage)

D. Because a heart catheterization procedure uses contrast media, which places a stress on the kidneys, metformin, which is also excreted in the kidneys unchanged, should be stopped 48 hours prior to the procedure to prevent lactic acidosis.

A patient with type 2 diabetes begins taking sitagliptin (Januvia) for the management of blood glucose levels. Which statement by the patient indicates an understanding of this medication? A. "I will take two doses in the morning if my blood sugar is high." B. "By taking this medication, I am able to eat more." C. "Now that I am taking this medication, I don't have to exercise anymore." D. "I will take this medicine once a day."

D. Clients should always take sitagliptin in the morning to provide the best benefit.

A patient with DKA is admitted to the hospital. Which of the following does the nurse expect to see? A. increased pH and increased heart rate B. increased respiratory rate and decrease in urine output C. elevated potassium and increase in blood pressure D. elevated blood glucose and decreased plasma bicarbonate

D. In diabetic ketoacidosis, blood glucose is elevated, plasma bicarbonate is decreased, and ketones are present in the urine.

A patient who has just arrived at the emergency department may be suffering from diabetic ketoacidosis. Which of the following would confirm the diagnosis? A. elevated serum potassium B. increased respiratory rate C. increased pH D. elevated blood glucose level and low plasma bicarbonate level

D. In diabetic ketoacidosis, the arterial pH is less than 7.35, plasma bicarbonate is less than 15 mEq/L, blood glucose is usually higher than 250 mg/dL, and ketones are present in the urine. The client also usually has Kussmaul's respirations

Which of the following insulins cannot be administered in a continuous subcutaneous insulin infusion pump? A. regular insulin (Humulin R) B. insulin aspart (NovoLog) C. insulin glulisine (Apidra) D. insulin glargine (Lantus)

D. Insulin glargine is the only insulin not available for use in a continuous insulin pump because its pharmacokinetics does not match that of the human body; this insulin has a delayed absorption and a prolonged duration of action. This form of insulin is used solely for injectable use only

The nurse caring for a patient with diabetes mellitus has lipodystrophy of the abdomen. What should the nurse assess? A. Does the patient administer the injection at a 45-degree angle? B. Does the patient aspirate for blood prior to giving the injection? C. Does the patient pinch the skin appropriately? D. Does the patient rotate sites for giving each injection?

D. Lipodystrophy occurs when the same injection sites are used, and it can affect the degree and amount of insulin absorbed. Therefore, the nurse teaches the client to rotate injection sites.

Based on the action of pramlintide, which of the following is a primary nursing intervention? A. Administer glucagon during the peak of action. B. Assess blood sugar at 2.4 hours after medication administration. C. Assess respiratory status for the onset of an upper respiratory infection. D. Provide a meal immediately after the administration of the subcutaneous injection.

D. Pramlintide has a rapid onset of action, and the client should be fed a meal immediately after the medication is administered.

A nurse is caring for a patient who is "nothing by mouth" (NPO) before surgery scheduled at 10:00 AM. He routinely receives 30 units of Humulin 70/30 every morning at 7:00 AM. What is the appropriate nursing action in this situation? A. Administer 30 units of Humulin 70/30 subcutaneously. B. Hold the insulin because the patient is NPO. C. Give the patient a light breakfast and administer the insulin as ordered. D. Contact the physician for a presurgery insulin order.

D. The physician should be contacted for a presurgery order because the client is not allowed to eat prior to surgery; this should prevent a possible hypoglycemic reaction from the insulin. Also, the client is likely to have high glucose levels the day of surgery due to the additional emotional and physical stress of surgery.