HCAL Exam 2 Practice Questions (Diabetes, Questions from Exam 1)

Which statement made by the patient indicates a need for additional instruction in administering insulin? a. "I need to rotate injection sites among my arms, legs, and abdomen each day." b. "I can buy the 0.5 mL syringes because the line markings will be easier to see." c. "I do not need to aspirate the plunger to check for blood before injecting insulin." d. "I should draw up the regular insulin first, after injecting air into the NPH bottle."

ANS: A "I need to rotate injection sites among my arms, legs, and abdomen each day."

Which patient action indicates a good understanding of the nurses teaching about the use of an insulin pump? a. the patient programs the pump for an insulin bolus after eating b. the patient changes the location of the insertion again each morning c. the patient takes the pump off at bedtime and starts it again each morning d. the patient plans a diet with more calories that usual when using the pump

ANS: A the patient programs the pump for an insulin bolus after eating

A nurse is providing dietary teaching to a patient with diabetes. Which patient action indicates a good understanding of dietary restrictions? a. using artificial sweeteners for beverages b. preparing meals that consist of 50% protein c. consuming 5 carb servings per day d. drinking 1-2 glasses of wine before going to bed

ANS: A using artificial sweeteners for beverages

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1 pm. The clinic nurse plans to teach the patient to a. Check glucose level before, during, and after swimming b. Delay eating the noon meal until after the swimming class c. Increase the morning dose of NPH insulin d. Time the morning insulin injection so that peak occurs during swimming.

ANS: A Check glucose levels before, during, and after swimming

The nurse is assessing a 55 year old female patient with type 2 diabetes who has a BMI of 31 kg/m2. Which goal in the plan of care is most important for this patient? a. the pt will reach a glycosylated hemoglobin level of less than 7% b. the pt will follow a diet and exercise plan that results in weight loss c. the pt will choose a diet that distributes calories throughout the day d. the patient will state the reasons for eliminating simple sugars in the diet.

ANS: A the pt will reach a glycosylated hemoglobin level of less than 7%

Which statement made by the patient indicates a need for additional instruction in administering insulin? a. I need to rotate injection sites among my arms, legs, and abdomen each day. b. I can buy the 0.5 mL syringes because the line markings will be easier to see c. I do not need to aspirate the plunger to check for blood before injecting insulin d. I should draw up regular insulin first, after injecting air into the NPH bottle.

ANS: A I need to rotate injection sites among my arms, legs, and abdomen each day.

A 53-year-old male type II diabetic treated with an oral hypoglycemic agent is 2 days post-op open cholecystectomy and insertion of T-tube. The client expresses concern that he has required insulin the rest of his life. After the nurse provides an explanation of the insulin, which of the following statements made by the client indicates an understanding? a. "The stress of surgery has caused temporary increase in glucose." b. "I won't know if I am going to be insulin dependent for a few more days." c. "I have to take insulin now that my gallbladder has been removed." d. "I am taking insulin until my oral medication can be changed because it is not working."

ANS: A "The stress of surgery has caused temporary increase in glucose."

A patient receives aspart (NovoLog) insulin at 8 am. At which time would the nurse anticipate the highest risk for hypoglycemia? a. 10:00 am b. 12:00 am c. 2:00 pm d. 4:00 pm

ANS: A 10:00 am

Which question during the assessment of a patient who has diabetes will help the nurse identify automatic neuropathy? a. "Do you feel bloated after eating?" b. "Have you seen any skin changes?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"

ANS: A "Do you feel bloated after eating?" Automatic neuropathy can cause delayed gastric emptying (gastritis), resulting in the patient feeling bloated.

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next? a. Give the patient 4 to 6 oz more orange juice. b. Administer the PRN glucagon (Glucagon) 1 mg IM. c. Have the patient eat some peanut butter with crackers. d. Notify the health care provider about the hypoglycemia.

ANS: A Give the patient 4 to 6 oz more orange juice.

The nurse is educating a patient about proper foot care. Which statement made by the patient indicates a need for FURTHER teaching? a. I will soak my feet in Epsom salts every night b. It is important to examine my feet every night c. I should refrain from wearing high-heeled shoes. d. I will go to the podiatrist to get my toenails trimmed

ANS: A I will soak my feet in Epsom salts every night can cause skin breakdown

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first? a. Infuse 1 L of normal saline per hour. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/hr.

ANS: A Infuse 1 L of normal saline per hour.

A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for meal time coverage? a. Lispro (Humalog) b. Glargine (Lantus) c. Detemir (Levemir) d. NPH (Humulin N)

ANS: A Lispro (Humalog)

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic? a. Measure the ankle-brachial index. b. Check for changes in skin pigmentation. c. Assess for unilateral or bilateral foot drop. d. Ask the patient about symptoms of depression.

ANS: A Measure the ankle-brachial index.

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the healthcare provider should the nurse take first? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Ask the patient about home insulin doses. d. Start an insulin infusion at 0.1 units/kg/hr.

ANS: A Place the patient on a cardiac monitor. Hypokalemia can cause fatal dysrhythmias such as v-tach and v-fib.

A diabetic client describes tingling and decreased sensation in the lower extremities, and describes having cold feet. For teaching the client potential complications related to diabetes, which of the following is a priority diagnosis based on the provided info? a. risk for impaired skin integrity b. altered nutrition: more than body requirements c. risk for infection d. ineffective coping

ANS: A risk for impaired skin integrity

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test? a. The patient uses oral contraceptives. b. The patient runs several days a week. c. The patient has been pregnant three times. d. The patient has a family history of diabetes.

ANS: A The patient uses oral contraceptives.

A patient with type 1 diabetes inadvertently administered a dose of insulin that was too high in the morning and now has a serum glucose level of 60 mg/dL. When managing this patient, the nurse should anticipate abnormal assessment findings related to which organ? a. brain b. heart c. lungs d. kidneys

ANS: A brain

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1 pm. The clinic nurse will plan to teach the patient to a. check glucose level before, during, and after swimming b, delay eating the noon meal until after swimming c. increase the morning dose of NPH insulin d. time the morning insulin injection so that the peak occurs while swimming

ANS: A check glucose level before, during, and after swimming

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? a. choose flat-soled leather shoes b. set heating pads on a low temp c. use callus remover for corns or calluses d. soak feet in warm water for an hour each day

ANS: A choose flat-soled leather shoes A patient should avoid high heels, and should choose leather shoes.

The home health nurse visits a patient with a new diagnosis of type 2 diabetes. Which patient finding would prompt the nurse to provide further education? a. consistently skipping meals b. walking for 30 mins every other day c. cleaning the side of the fingertip before blood sampling d. blood glucose readings between 150 and 155 mg/dL after dinner

ANS: A consistently skipping meals

Which dietary instructions should the nurse include when reviewing dietary needs with a patient newly diagnosed with diabetes? a. consume 45 to 60 g of carbs per meal b. fats should compromise 10% of daily food intake c. ensure that 30% of daily food intake is from protein d. men and women are allowed to consume up to 2 alcoholic beverages per day

ANS: A consume 45 to 60 g of carbs per meal

To assist an older patient with diabetes to engage in moderate daily exercise, which action is most important for the nurse to take? a. determine what types of activities the patient enjoys b. remind the patient that exercise improves self-esteem c. teach the patient about the effects of exercise on glucose level d. give the patient a list of activities that are moderate in intensity

ANS: A determine what types of activities the patient enjoys

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis (DKA). The nurse recognizes that this measure is important to identify a. electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia. b. fluid overload resulting from aggressive fluid replacement. c. the presence of hypovolemic shock related to osmotic diuresis. d. cardiovascular collapse resulting from the effects of hyperglycemia.

ANS: A dysrhythmias related to hypokalemia

Which source of fat should the nurse instruct the patient with diabetes to include in a diet at least twice a week? a. fish b. butter c. olive oil d. whole milk

ANS: A fish

A patient recently diagnosed with type 1 diabetes asks the nurse what insulin does in the body. Which description from the nurse is accurate? a. insulin allows for the uptake of glucose into cells b. insulin distributes glucose to end organs and tissues c. insulin converts glucose into glycogen in the kidneys d. insulin breaks down glucose in the GI tract

ANS: A insulin allows for the uptake of glucose into cells

A patient with newly diagnosed type 1 diabetes tells the nurse that they like to go camping, but are now afraid because of insulin needs. Which info should the nurse provide? a. insulin can be stored at room temp b. insulin can withstand temp between 20 and 90F c. pt should not go camping until disease is stabilized d. pt should have a cooler with ice available at all times to store insulin

ANS: A insulin can be stored at room temp

A nurse is evaluating a group of patients who are at risk for type 2 diabetes. Which factors concern the nurse in regard to type 2 diabetes risk? SATA a. obesity b. smoking c. old age d. family history d. caucasian race

ANS: A, B, C, D a. obesity b. smoking c. old age d. family history

A nurse is preparing a patient with suspected diabetes for a fasting blood glucose test. The nurse should ask the patient about which factors? SATA a. recent acute illness b. hx of alcohol use c. recent antibiotic therapy d. hx of recent exercise e. typical daily caloric intake

ANS: A, B, D a. recent acute illness b. hx of alcohol use d. hx of recent exercise

The nurse is providing patient education to a HS athlete with diabetes who was seen in the ER after a syncopal episode during a bball game. Which teaching interventions are appropriate for the nurse to provide? SATA a. carry a source of quick-acting carb with you b. wait to take oral agent until after you have finished exercising c. obtain a capillary blood glucose level before you exercise. d. monitor blood glucose levels every hour when exercising e. withhold your insulin before you begin any exercise session.

ANS: A, C a. carry a source of quick-acting carb with you c. obtain a capillary blood glucose level before you exercise.

A pregnant woman is worried that she may develop gestational diabetes after speaking with a friend who developed this condition during a recent pregnancy. Which factors should the nurse assess to determine whether the patient is at an increased risk for developing it?SATA a. obesity b. recent viral infection c. advanced maternal age d. family hx of diabetes e. drinking 4 glasses of milk per day

ANS: A, C, D a. obesity c. advanced maternal age d. family hx of diabetes

A patient with type 2 diabetes calls the health care provider's office and reports having the flu. Which interventions should the nurse give the patient? SATA a. "Continue taking your insulin and/or oral agent." b. "Check your urine for ketones every 3-4 hours." c. "Increase oral fluid intake to prevent dehydration." d. "Monitor your blood glucose level every hour because you are sick." e. "Increase your carb intake to prevent further nausea."

ANS: A, C, E a. "Continue taking your insulin and/or oral agent." c. "Increase oral fluid intake to prevent dehydration." e. "Increase your carb intake to prevent further nausea."

Which clinical manifestation would the nurse anticipate assessing in a patient diagnosed with diabetic keto acidosis (DKA)? SATA a. restlessness b. urinary retention c. increased HR d. high BP e. dry mucous membranes

ANS: A, C, E a. restlessness c. increased HR e. dry mucous membranes

Which interventions should the nurse perform for a patient with diabetes who appears confused and responds to questions with irritation? SATA a. give the patient a snack b. contact the HCP c. administer insulin as prescribed d. check the patient's blood glucose level e. administer the oral agent as prescribed

ANS: A, D a. give the patient a snack d. check the patient's blood glucose level

After the initial assessment of a new patient, the nurse notice a fruity smell on the patient's breath and rapid, deep breathing. Which actions should the nurse take to address these symptoms? SATA a. notify the HCP b. restrict the patient's fluid intake c. check the patient's feet for ulcers d. check the capillary glucose level e. give the patient a high-carbohydrate snack

ANS: A, D a. notify the HCP d. check the capillary glucose level

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the healthcare provider? a. Hemoglobin A1C level of 6.2% b. Blood pressure of 140/88 mmHg c. Heart rate at rest of 58 beats/minute d. High density lipoprotein (HDL) level of 65 mg/dL

ANS: B Blood pressure of 140/88 mmHg The goal BP in patients with diabetes in 130/80 to reduce the risk of micro and microvascular problems.

After change-of-shift report, which patient should the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12% b. A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL c. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202mg/dL d. A 50-yr-old patient who uses exenatide (Byetta) and is complaining of acute abdominal pain

ANS: B A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL

Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse's assessment of the patient? a. Bedtime glucose of 140 mg/dL b. Noon blood glucose of 52 mg/dL c. Fasting blood glucose of 130 mg/dL d. 2-hr postprandial glucose of 220 mg/dL

ANS: B Noon blood glucose of 52 mg/dL

The nurse is caring for a patient with diabetes who is also receiving tx for COPD. The nurse should obtain capillary blood glucose levels based on documentation of which medication in patient's chart? a. albuterol b. prednisone c. diphenhydramine d. dextromethorphan

ANS: B Prednisone

The nurse is taking a health history from a 29-yr-old pregnant patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take? a. Teach the patient about administering regular insulin. b. Schedule the patient for a fasting blood glucose level. c. Teach about an increased risk for fetal problems with gestational diabetes. d. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.

ANS: B Schedule the patient for a fasting blood glucose level.

A 24 year old female complains of nervousness and palpitations after playing baseball at a local park. A nurse is also present at the park and observes diaphoresis and tremors. The female acknowledges being a diabetic. Which of the following is the most appropriate immediate action? a. tell the female that she likely became too hot playing baseball. b. administer 15g of rapid-acting sugar, such as fruit juice, regular soda, or life savers c. activate the EMS system d. ask the female is she has her self-monitoring blood glucose kit with her

ANS: B administer 15g of rapid acting sugar, such as fruit juice, regular soda, or life savers

A 30-yr-old patient has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye examination... a. every 2 years. b. as soon as possible. c. when the patient is 39 years old. d. within the first year after diagnosis.

ANS: B as soon as possible

A nurse is preparing to teach a 43 year old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? a. ask the patient's family to participate in the diabetes education program b. assess the patient's perception of what it means to have DM c. demonstrate how to check glucose using capillary blood glucose monitoring d. discuss the need for the patient to actively participate in diabetes management.

ANS: B assess the patient's perception of what it means to have DM

The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose... a. washes the puncture site using warm water and soap b. chooses a puncture site in the center of the finger pad c. hangs the arm down a minute before puncturing the site d. says the result of 120 mg indicates good blood sugar control

ANS: B chooses a puncture site in the center of the finger pad A puncture site should be chosen on the side of the finger pad because there are fewer nerve endings, making it less painful.

Which action should the nurse take after a patient treated with IM glucagon for hypoglycemia regains consciousness. a. assess the patient for symptoms of hyperglycemia b. give the patient a snack of PB and crackers c. have the patient drink a glass of OJ and nonfat milk d. administer a continuous infusion of 5% dextrose for 24 hours

ANS: B give the patient a snack of PB and crackers

Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide? a. glyburide decreases glucagon secretion from the pancreas b. glyburide stimulates insulin production and release from the pancreas c. glyburide should be taken even if the morning blood glucose level is low d. glyburide should not be used for 48 hours after receiving IV contrast media

ANS: B glyburide stimulates insulin production and release from the pancreas

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to a. give a bolus of 50% dextrose. b. insert an IV catheter. c. initiate oxygen by nasal cannula. d. administer glargine (Lantus) insulin.

ANS: B insert an IV catheter

A patient who has diabetes and reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline? a. it decreases the depression caused by your foot pain b. it helps prevent transmission of pain impulses to the brain c. it corrects some of the BV changes that cause pain d. it improves sleep and makes you less aware of nighttime pain

ANS: B it helps prevent transmission of pain impulses to the brain

A 16 year old patient with diabetes reports to the nurse that morning blood glucose levels have been averaging around 200 mg/dL but are within an acceptable range the rest of the day. Which situation should the nurse suspect? a. pt is consuming large snacks at night b. pt is experiencing the dawn phenomenon c. pt has not been taking insulin as prescribed d. pt is not following dietary recommendations

ANS: B pt is experiencing the dawn phenomenon

Which patient action indicates a good understanding go the nurse's teaching about the administration of aspart (NovoLog) insulin? a. the patient avoids injecting the insulin in the upper abdominal area b. the patient cleans the skin with soap and water before insulin administration c. the patient stores the insulin in the freezer after administering the prescribed dose d. the patient pushes the plunger down while removing the syringe from the injection site.

ANS: B the patient cleans the skin with soap and water before insulin administration

A patient is admitted to the hospital for a colon resection as treatment for cancer. Which actions should the nurse include in the plan of care to manage the patient's diabetes? SATA a. provide continuous tele monitoring b. administer insulin subQ as prescribed c. provide foot care every shift and assess for ulcers d. assess the abdominal incision for signs of infection

ANS: B, C, D b. administer insulin subQ as prescribed c. provide foot care every shift and assess for ulcers d. assess the abdominal incision for signs of infection

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? a. Chest x-ray b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria e. Complete blood count (CBC) f. Monofilament testing of the foot

ANS: B, C, D, F b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria f. Monofilament testing of the foot

Which actions should the nurse take when administration of NPH and regular insulin is required for a patient with diabetes? SATA a. ask the provider to order a different formulation of insulin b. withdraw the regular insulin first, then NPH, in same syringe c. assess the patient's capillary blood glucose level before the injection d. administer the medication in 2 separate syringes using 2 injections e. have a second nurse check the insulin type and dosage before administration

ANS: B, C, E b. withdraw the regular insulin first, then NPH, in same syringe c. assess the patient's capillary blood glucose level before the injection e. have a second nurse check the insulin type and dosage before administration

The nurse is assessing a 22 year old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response? a. "Are you anorexic?" b. "Is your urine dark colored?" c. "Have you lost weight lately?" d. "Do you crave sugary drinks?"

ANS: C "Have you lost weight lately?"

The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? a. "I can have an occasional alcoholic drink if I include it in my meal plan." b. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I can choose any foods, as long as I use enough insulin to cover the calories." d. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."

ANS: C "I can choose any foods, as long as I use enough insulin to cover the calories."

After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective? a. "I may feel hungrier than usual when I take this medicine." b. "I will not need to worry about hypoglycemia with the Byetta." c. "I should take my daily aspirin at least an hour before the Byetta." d. "I will take the pill at the same time I eat breakfast in the morning."

ANS: C "I should take my daily aspirin at least an hour before the Byetta." B/c Byetta increases gastric emptying so oral meds should be taken at least 1 hour before hand.

A client with type I diabetes understands sick-day management of diabetes when which of the following statements are made? a. "If I am unable to eat for more than 2 days, I will contact my HCP." b. "I won't check my glucose level if I am sick and not eating, since my glucose won't increase." c. "I will continue to take the usual amount of insulin prescribed, even if I am sick." d. "I won't take my insulin if I am too sick to eat."

ANS: C "I will continue to take the usual amount of insulin prescribed, even if I am sick."

A nurse is evaluating a teaching plan on diabetic foot care. Which of the following statements made by the client indicates an understanding of proper foot care? a. "I will soak my feet in hot water daily to remove any calluses." b. "I will use a heating pad on my feet if they swell." c. "I will inspect my feet daily." d. "I will rub my feet dry after getting them wet."

ANS: C "I will inspect my feet daily."

After change-of-shift report, which patient will the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who was admitted with possible dawn phenomenon b. A 35-yr-old patient with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL c. A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa d. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain

ANS: C A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa Indicates dehydration

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Communicate the blood glucose level and insulin dose to the circulating nurse insurgery. b. Discuss the reason for the use of insulin therapy during the immediatepostoperative period. c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during thepostoperative period.

ANS: C Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.

A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has beenplaced on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider? a. Hemoglobin A1C level is 7.9%. b. Last eye examination was 18 months ago. c. Glomerular filtration rate is decreased. d. Patient has questions about the prescribed diet.

ANS: C Glomerular filtration rate is decreased. The decrease in renal function may indicate a need to adjust the dose of metformin.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. The nurse will anticipate that the patient may ... a. need a diet higher in calories while receiving prednisone. b. develop acute hypoglycemia while taking the prednisone. c. require administration of insulin while taking prednisone. d. have rashes caused by metformin-prednisone interactions.

ANS: C require administration of insulin while taking prednisone.

A 36 year old male presents with glucose of 620 mg/dL, arterial blood gases of pH 7.2, PC02 31, HCO3 13 mEq/L, and ketones are noted in the urine. The client is diagnosed with diabetic ketoacidosis (DKA). Which of the following admitting orders would the nurse question? a. IV 0.9% saline at 500 cc/hour b. monitor serum glucose every 30 mins c. IV bolus with 20 units of NPH, then begin NPH insulin drip at 5 units/hr d. cardiac monitor and VS every 15 mins

ANS: C IV bolus with 20 units of NPH, then begin NPH insulin drip at 5 units/hr

A patient with type 1 diabetes presents to the ER with generalized weakness, mild disorientation, increased thirst, and a fruity odor to breath. Which other manifestations should the nurse anticipate if DKA is suspected? a. severe drowsiness, seizures, excessive fluid loss b. mood swings, difficulty speaking, increased HR c. Kussmaul's respirations, restlessness, orthostatic HTN d. high BP, ankle and leg swelling, elevated serum creatinine level

ANS: C Kussmaul's respirations, restlessness, orthostatic HTN

The nurse is caring for a patient with diabetes who underwent MRI without IV contrast dye yesterday. Which medication should the nurse hold? a. Glipizide b. Exenatide c. Metformin d. Regular insulin

ANS: C Metformin

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice.

ANS: C Obtain a glucose reading using a finger stick.

A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin a. thigh b. buttock c. abdomen d. upper arm

ANS: C abdomen Exercise will increase the rate of absorption because abdomen will be least exercised compared to thigh, buttock, and upper arm.

Which statement made by a nurse to a patient newly diagnosed with type 2 diabetes is correct? a. insulin is not used to control blood glucose in patients with type 2 diabetes b. complications of type 2 diabetes are less serious than those of type 1 diabetes c. changes in diet and exercise may control blood glucose levels in type 2 diabetes d. type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.

ANS: C changes in diet and exercise may control blood glucose levels in type 2 diabetes

The HCP suspects the Somogyi effect in a 50 year old patient whose 6:00AM blood glucose is 230 mg/dl. Which action will the nurse plan to take? a. avoid snacking at bed time b. increase the rapid-acting insulin dose c. check the blood glucose during the night d. administer a larger dose of long-acting insulin

ANS: C check the blood glucose during the night

During the planning stage of a health teaching session for clients diagnosed with diabetes, the nurse recognizes that the most common cause of death in people with diabetes is which of the following? a. hyperglycemia b. diabetic nephropathy c. coronary artery disease d. diabetic neuropathies

ANS: C coronary artery disease

Which instruction should the nurse give to a patient who is scheduled for a fasting blood glucose test? a. Do not take your cardiac medication before the test. b. you will drink a glucose solution 2 hours before the test c. do not eat or drink anything for 8 hours before the test d. bring someone with you to drive you home after the test

ANS: C do not eat or drink anything for 8 hours before the test

A nurse is caring for a newly admitted patient with type 1 diabetes. Which assessment finding would cause the nurse to implement interventions for hyperglycemia? a. pale skin b. sweating c. dry mouth d. mood swings

ANS: C dry mouth

According to Erikson, adults 65 and older are in which stage? a. generatively vs. stagnation b. identity vs. role confusion c. ego integrity vs. despair d. trust vs. mistrust

ANS: C ego integrity vs despair

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL. The nurse will plan to teach the patient about ... a. self-monitoring of blood glucose b. using low doses of regular insulin c. lifestyle changes to lower blood glucose d. effects of oral hypoglycemic medications

ANS: C lifestyle changes to lower blood glucose

A 26 year old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to ... a. use only the lispro insulin until the symptoms are resolved b. limit the intake of calories until the glucose is less than 120 mg/dL c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise d. decrease intake of carbs until glycosylated hemoglobin is less than 7%

ANS: C monitor blood glucose every 4 hours and notify the clinic if it continues to rise

A patient reports new onset of thirst, hunger, and frequent urination. Which action should the nurse take first? a. review the patient's medical history b. obtain a diet hx from patient c. obtain a random plasma glucose level d. obtain hemoglobin A1C level immediately

ANS: C obtain a random plasma glucose level

Which lab finding warrants a repeat test to confirm a diagnosis of diabetes? a. hemoglobin A1C of 6.0% b. fasting plasma glucose level of 90 mg/dL c. random blood glucose level of 250 mg/dL d. oral glucose tolerance test with 2 hour glucose level of 150 mg/dL

ANS: C random blood glucose level of 250 mg/dL

Which subjective assessment finding indicates a need for further patient education about reducing the risk of complications from diabetes? a. sees an ophthalmologist 2x yearly b. walks 30 mins 5 days a week c. reports walking barefoot when it is warm outside d. checks capillary blood glucose level anytime he or she feels unwell

ANS: C reports walking barefoot when it is warm outside

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test? a. the patient's most recent A1C was 6.5% b. the patient's blood glucose is 128 mg/dL c. the patient took the prescribed metformin today d. the patient took the prescribed captopril this morning

ANS: C the patient took the prescribed metformin today Metformin should be discontinued for at least 2 days before a test using contrast media.

Ideally, the goal of patient diabetes education is to: a. Make all patients responsible for the management of their disease. b. Involve the patient's family and significant others in the care of the patient. c. Enable the patient to become the most active participant in the management of the diabetes. d. Provide the patient with as much information as soon as possible to prevent complications of diabetes.

ANS: C enable the patient to become the most active participant in the management of diabetes

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? a. "If I overeat at a meal, I will still take the usual dose of medication." b. "Other medications besides the Glucotrol may affect my blood sugar." c. "When I am ill, I may have to take insulin to control my blood sugar." d. "My diabetes won't cause complications because I don't need insulin."

ANS: D "My diabetes won't cause complications because I don't need insulin."

The nurse administers a dose of NPH insulin at 8am. Which time should the nurse provide a snack or meal? a. 9 am b. 4 pm c. 8 pm d. 12 pm

ANS: D 12 pm

The patient is diagnosed with type 1 diabetes. Which statement correctly describes the pathophysiology of this condition? a. cells cannot process insulin already present in the body b. antibodies to potassium receptors cause gradual hyperglycemia c. recurrent inflammation of the pancreas causes insulin resistance d. the body develops an immune response against cells in the pancreas

ANS: D the body develops an immune response against cells in the pancreas

A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? a. Urine dipstick for glucose b. Oral glucose tolerance test c. Fasting blood glucose level d. Glycosylated hemoglobin level (A1C)

ANS: D Glycosylated hemoglobin level This will show overall control of glucose over 90-120 days

A patient with type 2 diabetes, who is admitted with pneumonia, is most at risk for developing which acute complication associated with diabetes? a. stroke b. hypoglycemia c. DKA d. HHS

ANS: D HHS

The nurse is educating a patient with type 1 diabetes about disease self-management. Which statement indicates the patient understands the instructions given? a. I will take my oral agent every morning b. I should check my urine for ketones twice daily c. It is important to check my blood glucose level once a day d. I will record my blood glucose levels in a log book and bring these to my appointment.

ANS: D I will record my blood glucose levels in a log book and bring these to my appointment.

Which instruction should the nurse include when teaching a patient with type 1 diabetes about self-management? a. Keep your hemoglobin A1C level below 8.5% b. Take your oral hypoglycemic agent as prescribed c. Have your spouse perform your blood glucose testing. d. Keep your fasting glucose levels below 125 mg/dL.

ANS: D Keep your fasting glucose levels below 125 mg/dL.

A patient with diabetes asks the nurse about the option of using inhaled insulin because of a fear of self-administering injections. Which finding in the medical record would prevent the patient from using this form of insulin? a. decreased renal function b. presence of egg allergy c. hx of Hep B infection d. tobacco use

ANS: D tobacco use

Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful? a. The patient administers the glargine 30 minutes before each meal. b. The patient's family prefills the syringes with the mix of insulins weekly. c. The patient draws up the regular insulin and then the glargine in the same syringe. d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.

ANS: D The patient disposes of the open vials of glargine and regular insulin after 4 weeks. Insulin can be stored at room temp for 4 weeks.

The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication? a. The patient's blood pressure is 154/92. b. The patient's blood glucose is 86 mg/dL. c. The patient reports a history of emphysema. d. The patient has chest pressure when walking.

ANS: D The patient has chest pressure when walking. Avandia can cause myocardial ischemia.

A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.

ANS: D The patient increases daily exercise when ketones are present in the urine.

Which assessment finding would the nurse anticipate in a patient admitted with HHS? a. bradycardia b. HTN c. warm, clammy skin d. altered LOC

ANS: D altered LOC

Which action should the nurse take first when a patient's capillary blood glucose reading is 63 mg/dL? a. recheck the patients blood glucose b. teach the patient to carry a source of carbs c. obtain a blood glucose sample drawn by the lab d. give the patient a snack that equals 15g of carbs

ANS: D give the patient a snack that equals 15g of carbs

A nurse is caring for a patient newly diagnosed with type 2 diabetes who wants to learn about the condition. The nurse should initiate teaching by identifying which body function being impaired? a. insulin production b. insulin metabolism c. glucose production d. glucose metabolism

ANS: D glucose metabolism

Which diagnostic test result will the nurse review to evaluate a patient's blood glucose control over an extended period? a. fasting blood glucose b. random blood glucose c. oral glucose tolerance test d. glycosylated hemoglobin (HgbA1c)

ANS: D glycosylated hemoglobin (HgbA1c)

A diabetic client arrives in the ER after a neighbor activated EMS because the client was found unresponsive. The skin is dry, flushed, and warm. VS are BP 90/62, HR 126, RR 20 and unlabored, and T of 102F. The glucose level is 980 mg/dL, plasma osmolarity is 350 mmol/L, and no abnormal ketones are noted in the urine or plasma. The ABG reveal a pH of 7.40. Based on this assessment data, the nurse suspects which of the following? a. diabetic ketoacidosis b. hypoglycemia c. hyperglycemia d. hyperosmolar hyperglycemic state (HHS)

ANS: D hyperosmolar hyperglycemic state (HHS)

Which variable best differentiates between type 1 and 2 diabetes? a. diagnostic tests b. nutritional status c. age at onset of disease d. level of endogenous insulin

ANS: D level of endogenous insulin

Which finding indicates a need to contact the HCP before the nurse administers Metformin? a. patient's blood glucose level is 174 mg/dL b. patient is scheduled for a chest x-ray in an hour c. patient has gained 2 lbs in the past 24 hours d. patient's BUN is 52 mg/dL

ANS: D patient's BUN is 52 mg/dL BUN indicates possible renal failure, and Metformin should not be used in patients with renal failure.

A hospitalized diabetic patient received 38 units of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to a. save the lunch tray for the patient's later return to the unit. b. ask that diagnostic testing area staff to start a 5% dextrose IV. c. send a glass of milk or orange juice to the patient in the diagnostic testing area. d. request that if testing is further delayed, the patient be returned to the unit to eat.

ANS: D request that if testing is further delayed, the patient be returned to the unit to eat.

A nurse is caring for a patient admitted to the hospital with no history of diabetes but who has a blood glucose level consistently greater than 200 mg/dL. Which action should the nurse take? a. ask the patient about recent weight gain b. ask the patient if they exercise daily c. review the patient's surgical hx d. review the patient's current med list

ANS: D review the patient's current med list