Diabetes Mellitus NCLEX Style Questions
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify: 1. Dysrhythmias resulting from hypokalemia. 2. Fluid overload resulting from aggressive fluid replacement. 3. The presence of hypovolemic shock related to osmotic diuresis. 4. Cardiovascular collapse resulting from the effects of excess glucose on cardiac cells.
1. Dysrhythmias resulting from hypokalemia. Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate. Hypokalemia may lead to ventricular dysrhythmias such as premature ventricular complexes and bradycardia.
Case Study: 52-year-old woman was diagnosed with type 2 diabetes 6 years ago. Did not follow up with recommendations for care Complaining of weakness in her right foot Began 1 month ago Difficult to dorsiflex and feels numb Also complains of an itching rash in her groin area Has had rash on and off for many years Worse when weather is warm Increased thirst and frequent nighttime urination Denies other weakness, numbness, changes in vision She works as a banking executive and gets little exercise. She has gained 18 pounds over the past year and eats a high-fat diet. BP 162/98 Sensory exam to light touch, proprioception, and vibration slightly diminished on both feet Erythematous scaling rash in both inguinal areas and in axillae Random glucose test 253 mg/dL Hb A1C 9.1% Urine dipstick positive for glucose and negative for protein Wet prep of smear from rash consistent with Candida albicans ECG with evidence of early ventricular hypertrophy by voltage ------------------------------------ 1.She wants to know why all of these changes have been happening to her body. How would you explain this to her? 2. What is the priority nursing intervention? 3.What teaching should be done with her?
1. Her lack of glucose control has affected multiple other parts of her body, including the nerves in her lower extremities, cardiovascular function, and ability to fight off infection. 2. Treatment of hyperglycemia, neuropathy, and hypertension, and, more important, patient teaching. 3. Stress the importance of adhering to her medical regimen and monitoring her blood glucose regularly. Teach her the repercussions if she does not do these things.
A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to: 1. Hold the regular dose of insulin. 2. Drink cool fluids with high glucose content. 3. Check the blood glucose level every 2 to 4 hours. 4. Use a less strenuous form of exercise than usual until the illness resolves.
3. Check the blood glucose level every 2 to 4 hours. If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2-to-4-hour intervals to determine the effects of this stressor on the blood glucose level.
Ideally, the goal of patient diabetes education is to: 1. Make all patients responsible for the management of their disease. 2. Involve the patient's family and significant others in the care of the patient. 3. Enable the patient to become the most active participant in the management of the diabetes. 4. Provide the patient with as much information as soon as possible to prevent complications of diabetes.
3. Enable the patient to become the most active participant in the The goal of diabetes education is to enable the patient to become the most active participant in his or her own care.
A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dL (6.7 mmol/L). The nurse explains to the patient that this value: 1. Is diagnostic for diabetes. 2. Is normal, and diabetes is not a problem. 3. Reflects impaired glucose tolerance, which is an early stage of diabetes. 4. Indicates an intermediate stage between normal glucose use and diabetes.
3. Reflects impaired glucose tolerance, which is an early stage of diabetes. Impaired fasting glucose (fasting blood glucose level between 100 and 126 mg/dL) and impaired glucose tolerance (2-hour plasma glucose level between 140 and 199 mg/dL) represent an intermediate stage between normal glucose homeostasis and diabetes. This stage is called prediabetes
Which statement by the patient with type 2 diabetes is accurate. a. "I am supposed to have a meal or snack if I drink alcohol" b. "I am not allowed to eat any sweets because of my diabetes." c. "I do not need to watch what I eat because my diabetes is not the bad kind." d. "The amunt of fat in my diet is not important; it is just the carbohydrates that raise my blood sugar."
a. "I am supposed to have a meal or snack if I drink alcohol" Alcohol should be consumed with food to reduce the risk of hypoglycemia.
The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? a. "I will discard any insulin bottle that is cloudy in appearance." b. "The best injection site for insulin administration is in my abdomen." c. "I can wash the site with soap and water before insulin administration." d. "I may keep my insulin at room temperature (75o F) for up to a month."
a. "I will discard any insulin bottle that is cloudy in appearance." Intermediate-acting insulin and combination premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (less than 32° F [0° C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? a. A 48-year-old woman with a hemoglobin A1C of 8.4% b. A 58-year-old man with a fasting blood glucose of 111 mg/dL c. A 68-year-old woman with a random plasma glucose of 190 mg/dL d. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
a. A 48-year-old woman with a hemoglobin A1C of 8.4% Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL.
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 c. FBG 130 d. LDL 100mg
a. A1C 9%
The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention? a. Assess patient's perception of what it means to have diabetes. b. Ask the patient to write down current knowledge about diabetes. c. Set goals for the patient to actively participate in managing his diabetes. d. Assume responsibility for all of the patient's care to decrease stress level.
a. Assess patient's perception of what it means to have diabetes. In order for teaching to be effective, the first step is to assess the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.
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? a. Cheese b. Broccoli c. Chicken d. Oranges
a. Cheese 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.
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? a. Chooses a puncture site in the center of the finger pad. b. Washes hands with soap and water to cleanse the site to be used. c. Warms the finger before puncturing the finger to obtain a drop of blood. d. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.
a. Chooses a puncture site in the center of the finger pad The patient should select a site on the sides of the fingertips, not on the center of the finger pad as 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.
The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? a. Excessive thirst b. Gradual weight gain c. Overwhelming fatigue d. Recurrent blurred vision
a. Excessive thirst 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.
Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? a. Increased triglyceride levels b. Increased high-density lipoproteins (HDL) c. Decreased low-density lipoproteins (LDL) d. Decreased very-low-density lipoproteins (VLDL)
a. Increased triglyceride levels 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.
A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply)? a. The level may be increased as a result of dehydration that accompanies hyperglycemia. b. The patient may be excreting extra sodium and retaining potassium because of malnutrition. c. The level is consistent with renal insufficiency that can develop with renal nephropathy. d. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. e. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.
a. The level may be increased as a result of dehydration that accompanies hyperglycemia. c. The level is consistent with renal insufficiency that can develop with renal nephropathy. d. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.
Which are appropriate therapies for patients with diabetes mellitus? a. Use of statins to treat dyslipidemia b. use of diuretics to treat nephropathy c.Use of ACE inhibitors to treat nephropathy d. use of serotonin agonists to decrease appetite. e. Use of laser photocoagulation to treat retinopathy
a. Use of statins to treat dyslipidemia c.Use of ACE inhibitors to treat nephropathy e. Use of laser photocoagulation to treat retinopathy
You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (select all that apply) a. insulin administration b. elimination of sugar from diet c. need to reduce physical activity d. use of portable blood glucose monitor e. hypoglycemia prevention, symptoms, and treatment
a. insulin administration d. use of portable blood glucose monitor e. hypoglycemia prevention, symptoms, and treatment
The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? a. "Smokeless tobacco products decrease the risk of kidney damage." b. "I can help control my blood pressure by avoiding foods high in salt." c. "I should have yearly dilated eye examinations by an ophthalmologist." d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."
b. "I can help control my blood pressure by avoiding foods high in salt." Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.
The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? a. "I plan to lose 25 pounds this year by following a high-protein diet." b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." c. "I should include more fiber in my diet than a person who does not have diabetes." d. "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."
b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes mellitus. High-protein diets are not recommended for weight loss.
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? a. "I should only walk barefoot in nice dry weather." b. "I should look at the condition of my feet every day." c. "I am lucky my shoes fit so nice and tight because they give me firm support." d. "When I am allowed up out of bed, I should check the shower water with my toes."
b. "I should look at the condition of my feet every day." Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.
A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? a. "With type 2 diabetes, the body of the pancreas becomes inflamed." b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." c. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." d. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.
Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness? a. A 58-year-old patient with diabetic retinopathy b. A 73-year-old patient who takes propranolol (Inderal) c. A 19-year-old patient who is on the school track team d. A 24-year-old patient with a hemoglobin A1C of 8.9%
b. A 73-year-old patient who takes propranolol (Inderal) Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use â-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include? a. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. c. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. d. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.
b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.
A 51-year-old 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? a. 6:00 PM on the evening before the test b. Midnight before the test c. 4:00 AM on the day of the test d. 7:00 AM on the day of the test
b. Midnight before the test Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.
A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? a. Avoid sick people and wash hands. b. Obtain comprehensive dental care. c. Maintain hemoglobin A1 c below 7%. d. Coughing and deep breathing with splinting
b. Obtain comprehensive dental care. A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1c below 7%, and coughing and deep breathing with splinting would be important for any type of surgery, but not the priority with mitral valve replacement for this patient.
Polydipsia and polyuria related to diabetes mellitus are primarily due to: a. the release of ketones from cells during fat metabolism b. fluid shifts resulting from the osmotic effect of hyperglycemia c. damage to the kidneys from exposure to high levels of glucose. d. changes in RBCs resulting from attachment of excessive glucose to hemoglobin.
b. fluid shifts resulting from the osmotic effect of hyperglycemia
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? a. 8:40 PM to 9:00 PM b. 11:30 PM c. 10:30 PM to 1:30 AM d. 12:30 AM to 8:30 AM
c. 10:30 PM to 1:30 AM Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10-30 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.
A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? a. Routine insulin therapy and exercise b. Administer a different antibiotic for the UTI. c. Cardiac monitoring to detect potassium changes d. Administer IV fluids rapidly to correct dehydration.
c. Cardiac monitoring to detect potassium changes This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take? a. Eat a piece of pizza. b. Drink some diet pop. c. Eat 15 g of simple carbohydrates. d. Take an extra dose of rapid-acting insulin.
c. Eat 15 g of simple carbohydrates. When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing, she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease her blood glucose.
A patient, who is 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? a. Central apnea b. Hypoventilation c. Kussmaul respirations d. Cheyne-Stokes respirations
c. Kussmaul respirations 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.
The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works? a. Increases insulin production from the pancreas. b. Slows the absorption of carbohydrate in the small intestine. c. Reduces glucose production by the liver and enhances insulin sensitivity. d. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.
c. Reduces glucose production by the liver and enhances insulin sensitivity. Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? a. call the physician b. administer insulin as ordered c. check the patient's blood glucose level d. assess for other neurologic symptoms.
c. check the patient's blood glucose level
A diabetic patient has a serum glucose level of 824 mg/dL and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of? a. polyuria b. severe dehydration c. rapid, deep respirations d. decreased serum potassium
c. rapid, deep respirations
The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control his blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? a. "I want to go fishing for 30 minutes each day; I will drink fluids and wear sunscreen." b. "I will go running each day when my blood sugar is too high to bring it back to normal." c. "I will plan to keep my job as a teacher because I get a lot of exercise every school day." d. "I will take a brisk 30-minute walk 5 days per week and do resistance training 3 times a week."
d. "I will take a brisk 30-minute walk 5 days per week and do resistance training 3 times a week." The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days per week and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and teaching are light activity, and running is considered vigorous activity.
The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? a. Prealbumin level b. Urine ketone level c. Fasting glucose level d. Glycosylated hemoglobin level
d. Glycosylated hemoglobin level A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.
Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. the patient must receive insulin therapy to prevent ketoacidosis b. the patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin c. the patient has minimal or absent endogenous insulin secretion and requires daily insulin injections d. the patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome
d. the patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome