Diabetes NCLEX Questions

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? A. "The best time for me to exercise is every afternoon." B. "The best time for me to exercise is right after I eat." C. "The best time for me to exercise is after breakfast." D. "The best time for me to exercise is after my morning snack."

Correct answer: A. "The best time for me to exercise is every afternoon." Option A: A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication. Options B, C, and D do not address peak action times.

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: A. Administer regular insulin intravenously B. Administer 5% dextrose intravenously C. Correct the acidosis D. Apply an electrocardiogram monitor

Correct answer: A. Administer regular insulin intravenously Option A: Lack (absolute or relative) of insulin is the primary cause of DKA. Options B and C: Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Option D: Applying an electrocardiogram monitor is not a priority action.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? A. Elevated blood glucose level and a low plasma bicarbonate B. Decreased urine output C. Increased respiration and an increase in pH D. Comatose state

Correct answer: A. Elevated blood glucose level and a low plasma bicarbonate Option A: In diabetic acidosis, the arterial pH is less than 7.35. plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. Options B and C: The client would be experiencing polyuria, and Kussmaul's respirations would be present. Option D: A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis

A nurse is providing a bedtime snack for his patient. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: A. 6-8 hours B. 10-14 hours C. 14-18 hours D. 24-28 hours

Correct answer: C. 14-18 hours Option C: Intermediate-acting insulins include Humulin N and Novolin N. They have an onset of two to four hours, peak of 4 to 12 hours, and a duration of 14 to 18 hours. Option A: Regular or short-acting insulins include Humulin R and Novolin R. They have an onset of half an hour, a peak of two to three hours, and a duration of six to eight hours. Option D: Long-acting insulins include Levemir and Lantus. They have an onset of several hours, minimal or no peak, and a duration of 24 hours or more.

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B. It is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

Correct answer: A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be: A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalanced nutrition: less than body requirements D. Disabled family coping: compromised

Correct answer: A. High risk for deficient fluid volume Option A: Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options B, C, and D are not related specifically to the issue of the question.

The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth

Correct answer: A. Hypoglycemia Option A: Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. Option B: Type 2 diabetes can affect blood circulation which makes it easier for the skin to bruise. Option C: The presence of ketones in the urine happens due to a lack of available insulin. Option D: Losing a lot of fluids caused by frequent urination can lead to dehydration hence patients can develop dry mouth.

A client with diabetes mellitus visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently, the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? A. prednisone (Deltasone) B. atenolol (Tenormin) C. phenelzine (Nardil) D. allopurinol (Zyloprim)

Correct answer: A. prednisone (Deltasone) Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330

Correct answer: B. 1330 and 1930 The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.

Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. <5.6%

Correct answer: B. 5.7-6.4% Option B: Glycosylated hemoglobin levels between 5.7%-6.4% is considered as pre-diabetes. Option A: Glycosylated hemoglobin levels over 6.5 % are considered diagnostic of diabetes. Options C and D: Glycosylated hemoglobin levels less than 5.6 % are normal.

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration

Correct answer: B. 6-14 hours after administration The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A. Blurred vision B. Diaphoresis C. Nausea D. Weakness

Correct answer: B. Diaphoresis A hypoglycemic reaction activates a fight-or-flight response in the body which then triggers the release of epinephrine and norepinephrine resulting in diaphoresis.

A nurse went to a patient's room to do routine vital signs monitoring and found out that the patient's bedtime snack was not eaten. This should alert the nurse to check and assess for: A. Elevated serum bicarbonate and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Symptoms of hyperglycemia during the peak time of NPH insulin D. Sugar in the urine

Correct answer: B. Signs of hypoglycemia earlier than expected. Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m.

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: A. Third day B. Every other day C. 1-2 weeks D. 2-4 weeks

Correct answer: C. 1-2 weeks Rotation of sites for insulin injection should be done every week or two. Frequently using the same spot over time can cause fat cells to break down or build up (lipodystrophy) causing lumps under the skin and may interfere with insulin absorption.

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide: A. Oxygen B. Carbohydrates C. Fluid replacement D. Dietary instruction

Correct answer: C. Fluid replacement As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin.

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to: A. Administer a sedative B. Make sure the client knows all the correct medical terms to understand what is happening C. Ignore the signs and symptoms of anxiety so that they will soon disappear D. Convey empathy, trust, and respect toward the client

Correct answer: D. Convey empathy, trust, and respect toward the client. Option D: The most appropriate intervention is to address the client's feelings related to anxiety. Option A: Administering a sedative is not the most appropriate intervention. Option B: A client will not relate to medical terms, particularly when anxiety exists. Option C: The nurse should not ignore the client's anxious feelings.

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following, except: A. Integumentary inspection for the presence of brown spots on the lower extremities B. Observation for paleness of the lower extremities C. Observation for blanching of the feet after the legs are elevated for 60 seconds D. Palpation for increased pulse volume in the arteries of the lower extremities

Correct answer: D. Palpation for increased pulse volume in the arteries of the lower extremities Option D: One of the signs and symptoms of impaired peripheral arterial circulation is the absence of a pulse or a weak pulse in the legs or feet. Option A: This happens when high pressure in the veins pushes blood into the skin tissue causing reddish-brown staining in the skin tissue. When skin is stained like this, it is very fragile and may break down or, if knocked, fail to heal as usual. Options B and C: When a person develops impaired peripheral arterial circulation, the extremities — usually the legs — don't receive enough blood flow and oxygen to keep up with demand leading to a change in the color of the legs.

A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse? A. Pulse B. Blood pressure C. Respiration D. Temperature

Correct answer: D. Temperature An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.

A 44-year-old woman with type 1 diabetes comes to the emergency department due to abdominal pain accompanied by nausea and vomiting. The patient had a history of chronic back pain due to a motor accident 20 years ago. Her situation renders her unable to work and pay for the increasing price of insulin, which has doubled during the last five years. The patient doesn't have medical coverage or insurance; therefore, she rations her insulin intake, making her unable to follow her prescribed therapeutic regimen for her diabetes. Because of her situation, the client is at high risk of developing diabetic ketoacidosis. As her nurse, which of the following symptoms would you anticipate the client to exhibit? Select all that apply. A. Fruity odor breath B. Deep and labored respirations C. Blurred vision D. Increased urination E. Increased thirst F. Fatigue G. Blood glucose level of 60 mg/dL H. Dehydration I. Respiratory rate of 8 bpm J. Hypernatremia K. Metabolic alkalosis

Correct answers: A, B, C, D, E, F, and H. Option A: Fruity odor breath or acetone breath occurs with elevated ketone levels. Insulin deficiency causes lipolysis into free fatty acids and glycerol. These free fatty acids are converted into ketones by the liver. Option B: Deep and labored respiration is another indication of high ketones in the body. This type of respiration (Kussmaul breathing) is an attempt of the respiratory system to decrease acidosis and counteracting the effects of ketone built up. Option C: Blurred vision occurs when an increase in blood glucose levels causes changes in retinal blood vessels causing them to swell up. Options D: Increased urination or polyuria is an attempt of the body to excrete excess glucose produced by the liver (gluconeogenesis). Option E: Increased thirst (polydipsia) occurs due to increased urination. Option F: DKA causes alterations in blood glucose levels which may result in fatigue. Altered blood glucose metabolism may result in acute and chronic hyperglycemic episodes, hypoglycemia, or blood glucose fluctuations. Option G: DKA is caused by a deficiency in insulin. Without insulin, the amount of glucose entering the cells is reduced causing hyperglycemia and not hypoglycemia. Option H: Excess glucose in the body causes the kidneys to excrete glucose along with water and electrolytes. This causes excessive urination leading to dehydration. Patients with DKA can lose up to 7 liters of water over a 24 hour period. Option I: DKA is characterized by hyperventilation and not hypoventilation due to the body's attempt to decrease acidosis caused by ketone buildup. Option J: Due to an increase in urination, there is hyponatremia in DKA rather than hypernatremia. Patients with DKA can lose 500 mEq of sodium, potassium, and chloride. Option K: Metabolic acidosis occurs in DKA due to ketone bodies which are acids. Their accumulation leads to metabolic acidosis and not metabolic alkalosis.