Type II Diabetes - Pearson Questions
The parents of a child with type 2 diabetes mellitus call the urgent care center because the child's skin is clammy and diaphoretic. Which question should the nurse first ask the parents? 1. "Has your child been drinking a lot of water?" 2. "Have you checked your child's blood sugar?" 3. "When did your child last have a meal or snack?" 4. "What is your child's body temperature?"
"Have you checked your child's blood sugar?" When the patient with diabetes mellitus develops cool and clammy skin, the nurse would immediately instruct the caregiver to obtain a blood glucose level. This would rule out hypoglycemia and lead to immediate treatment. Asking about body temperature would be appropriate, but it should not be the first question asked. Increased water consumption occurs with hyperglycemia, not hypoglycemia. The nurse would want to know how long it has been since the child last ate, but it is not the first question to ask.
The nurse is teaching a group of parents about ways to prevent type 2 diabetes mellitus in children. Which parent statement indicates a need for further teaching? 1. I should limit the amount of time my child spends watching television." 2. "I should decrease the amount of sugared beverages in my child's daily diet." 3. "I should monitor the amount of carbohydrates in my child's meals." 4. "I should have my child include 30 minutes of activity every day."
"I should decrease the amount of sugared beverages in my child's daily diet." A preventive measure to decrease the risk of developing type 2 diabetes mellitus during childhood is to completely eliminate, not just decrease, sugared beverages from the diet.
The nurse is assessing the feet of a patient with type 2 diabetes mellitus and notes a sore on the left great toe. Which patient statement indicates a need for further teaching on diabetic foot care? 1. "I check my feet on a daily basis, even using a mirror to look at areas I cannot see." 2. "I wear cotton or wool socks with my shoes to absorb the extra sweat." 3. "I stubbed my toe the other day walking around the house in bare feet." 4. "I refrain from trimming my own toenails. I regularly see the podiatrist."
"I stubbed my toe the other day walking around the house in bare feet." Patients with diabetes mellitus should never go barefoot or wear open-toed shoes, including flip-flops. Therefore, this action indicates a need for further teaching. The patient stating that a podiatrist trims the toenails is appropriate and would not lead to foot ulcer formation. Using a mirror to check the feet every day is good practice to look for sores. Cotton or wool socks wick excess perspiration from the feet to prevent maceration.
The parents of a pediatric patient call the nurse to report that the child's blood glucose levels have not decreased after a week of taking metformin (Glucophage). Which response by the nurse is best? 1. "Is it possible that you have inadvertently missed giving any doses?" 2. "Let me speak to the healthcare provider regarding adjusting the medication." 3. "How often are you giving the metformin (Glucophage) to your child? 4. "It can take up to 3 months to see the full benefit of metformin (Glucophage)."
"It can take up to 3 months to see the full benefit of metformin (Glucophage)." The nurse should instruct the parents that the full effect of the metformin (Glucophage) may not be seen for up to 3 months.
The diabetes nurse educator is teaching a patient the cause of type 2 diabetes mellitus. Which patient statement indicates an understanding of the instruction given? 1. "Type 2 diabetes mellitus is caused by an overproduction of ketones." 2. "Type 2 diabetes mellitus is caused by inadequate insulin production." 3. "Type 2 diabetes mellitus is related to a complete insulin deficiency." 4. "Type 2 diabetes mellitus is caused by a complete destruction of beta cells."
"Type 2 diabetes mellitus is caused by inadequate insulin production." Type 2 diabetes mellitus is associated with a reduction in insulin production by pancreatic beta cells along with cellular resistance to insulin. Although the pancreas produces some insulin, enough to keep the body from breaking down fats into ketones, there is not enough to keep the patient's blood glucose level within normal limits. Type 1 diabetes results from an autoimmune process that destroys all pancreatic beta cells, resulting in a complete insulin deficiency. Patients with type 1 diabetes mellitus will start to break down free fatty acids and produce ketones if they do not receive insulin injections.
The nurse is caring for four patients. Which patient is at highest risk for the development of type 2 diabetes mellitus? 1. 35-year-old man with an autoimmune disease 2. 50-year-old wheelchair-bound woman who is obese 3. 70-year-old woman with congestive heart failure 4. 15-year-old man who is thin and athletic
50-year-old wheelchair-bound woman who is obese Two major risk factors for type 2 diabetes mellitus are obesity and inactivity. Therefore, the 50-year-old wheelchair-bound patient with obesity is at highest risk for type 2 diabetes mellitus. The patient with the autoimmune disease and the patient who is thin and athletic may be at higher risk for type 1 diabetes mellitus. The patient with congestive heart failure is at risk for edema and fluid volume overload.
The nurse is planning care for a school-age child diagnosed with type 2 diabetes mellitus who will be seen every 3 months. Which task is a priority for the nurse to include in the plan of care every 12 months? 1. Administer a psychosocial assessment. 2. Assess dietary needs. 3. Establish a baseline hemoglobin A1C. 4. Administer an influenza vaccine.
Administer an influenza vaccine. On a yearly basis the nurse should plan to administer an influenza vaccine for a child with type 2 diabetes mellitus. The nurse would draw labs to establish hemoglobin A1C and administer a psychosocial assessment during the initial visit after diagnosis. Assessing dietary needs would occur at the first visit after diagnosis.
A 12-year-old child with type 2 diabetes mellitus states, "I don't like outdoor activities, but I like to to play video games." Which suggestion should the nurse make to the parents to help increase the child's activity level? 1. Punish the child when they choose not to exercise. 2. Advise interactive video games that involve movement. 3. Encourage walking or running outside every afternoon. 4. Sign the child up for a neighborhood sports team.
Advise interactive video games that involve movement. The nurse should encourage the child with type 2 diabetes mellitus who prefers to play video games to try interactive games that make them get up and move around.
A morbidly obese adult patient with type 2 diabetes mellitus has tried dietary modifications, oral hypoglycemic medications, and exercise, but has not seen any significant decrease in the hemoglobin A1C. Which intervention should the nurse recommend that the patient explore to prevent long-term complications of type 2 diabetes mellitus? 1. Revising the current diabetic diet 2. Baby aspirin taken once a day 3. Short- and long-acting insulin 4. Bariatric surgery
Bariatric surgery Patients who are morbidly obese and have uncontrolled type 2 diabetes mellitus may benefit from bariatric surgery. This surgery allows the patient to lose weight and diminish or eliminate diabetes.
A patient with type 2 diabetes mellitus states, "I have increased hunger at the evening meal and know I'm eating more than I should." Which blood glucose level would be impacted by overeating at the evening meal? 1. Afternoon 2. Midday 3. Fasting 4. Bedtime
Bedtime If the patient is consuming a larger evening dinner meal, the blood sugars would increase at bedtime. Elevated blood glucose levels at other times of the day would reflect other dietary changes with meals.
An overweight patient with type 2 diabetes mellitus who takes an oral hypoglycemic medication just discovered that she is pregnant. Which collaborative treatment should the nurse expect? 1. Adhere to strict carbohydrate counting and calorie restriction during pregnancy. 2. Limit weight gain to between 10-20 pounds during the pregnancy. 3. Perform self-blood glucose testing once per week. 4. Discontinue the oral hypoglycemic medication and prescribe insulin.
Discontinue the oral hypoglycemic medication and prescribe insulin. The patient has type 2 diabetes mellitus and is taking an oral hypoglycemic, which is often not safe during pregnancy. Therefore, the nurse anticipates the healthcare provider to discontinue this medication and prescribe the use of insulin. The patient taking insulin would need to watch her carbohydrate intake but does not require calorie restriction during pregnancy. The patient is overweight, not obese; therefore, weight gain during pregnancy should be 15-25 pounds. If the patient is prescribed insulin, blood glucose +3+6 monitoring would occur several times per day.
A pediatric patient with new-onset type 2 diabetes mellitus has been prescribed metformin (Glucophage). Which information should the nurse provide the parents regarding the use of this drug? 1. The drug is only effective when combined with insulin. 2. Drug effectiveness may take several weeks. 3. Stress the importance of monitoring urine for ketones. 4. Monitor blood glucose levels several times a day.
Drug effectiveness may take several weeks. The nurse should instruct the patient and the parents that metformin (Glucophage) therapy takes several weeks to show improvement and that full glucose control may take up to 3 months. Therefore, the dose should not be adjusted right away. Blood glucose levels need to be performed several times a day when using insulin, not metformin. Metformin is effective when prescribed alone and does not require insulin to increase its effectiveness. Urine is tested for ketones in diabetic ketoacidosis or during sick days.
The nurse is providing teaching for an obese patient with a new diagnosis of type 2 diabetes mellitus. Which information should the nurse include that could eliminate the disease? 1. Check blood glucose levels daily. 2. Take insulin with meals. 3. Follow a low-fat, low-calorie diet. 4. Monitor urine for ketones.
Follow a low-fat, low-calorie diet. Type 2 diabetes mellitus can be eliminated in obese patients by following a low-fat, low-calorie diet and incorporating exercise into the patient's lifestyle. Taking insulin, checking blood glucose levels, and monitoring urine for ketones help with disease management, not eradication.
The nurse notes that a patient with no history of diabetes has a blood glucose level of 215 mg/dL. Which test should the nurse expect the healthcare provider to prescribe? 1. Urinalysis for ketones 2. Hemoglobin A1C 3. Oral glucose tolerance test 4. Fingerstick blood glucose
Hemoglobin A1C A hemoglobin A1C in conjunction with symptoms is used to diagnose type 2 diabetes mellitus. Other testing would include fasting blood glucose levels. Oral glucose tolerance tests are usually reserved for pregnant patients. Random fingerstick blood glucose is not used to diagnose for type 2 diabetes mellitus, but to monitor trends. Urine will be tested for ketones during diabetic ketoacidosis in patients with type 1 diabetes.
A patient with a history of hypertension is admitted with an infected, poorly healing wound on the right ankle. Other reported symptoms include fatigue, blurred vision, polyuria, and polydipsia for the past month. The patient has a blood glucose level of 225 mg/dL and urine is negative for ketones. Which condition should the nurse suspect in this patient? 1. Diabetes insipidus 2. New-onset type 1 diabetes mellitus 3. Hyperglycemia 4. Hypoglycemic reaction
Hyperglycemia The patient's risk factors of hypertension and elevated blood glucose, as well as symptoms of fatigue, blurred vision, polyuria, and polydipsia are all consistent with hyperglycemia and more than likely type 2 diabetes. Diabetes insipidus is a condition that occurs when there is an insufficient amount of antidiuretic hormone and is not associated with hyperglycemia. The patient's blood glucose is elevated, so hypoglycemia is not the condition. New-onset type 1 diabetes is typically seen in young children, adolescents, and young adults, and is associated with ketonemia.
The nurse is caring for an older adult patient with type 2 diabetes mellitus who is recovering from a colon resection for cancer. The patient is febrile, has increased urine output, and has a fasting blood glucose level of 650 mg/dL. Which complication of type 2 diabetes mellitus should the nurse suspect is occurring? 1. Diabetic ketoacidosis (DKA) 2. Peripheral vascular disease (PVD) 3. Hyperosmolar hyperglycemic state (HHS) 4. Acute renal failure (ARF)
Hyperosmolar hyperglycemic state (HHS) This patient with type 2 diabetes mellitus is under stress related to surgery and now presents with a fever, increased urinary output, and elevated blood sugars. These symptoms indicate the onset of HHS. Diabetic ketoacidosis occurs in patients with type 1 diabetes mellitus. ARF would be manifested by decreased, not increased, urinary output. PVD occurs over years, not days.
The nurse is teaching a group of young adults about the risk factors for type 2 diabetes mellitus. In relation to metabolic syndrome, which factor should the nurse include? 1. Physically active 2. Hypertension 3. Weight loss 4. Hypocholesterolemia
Hypertension Metabolic syndrome is a constellation of risk factors that can put the patient at risk for type 2 diabetes mellitus and coronary artery disease. These risk factors include abdominal obesity, hypertension, triglyceridemia, hypercholesterolemia, and physical inactivity.
The nurse is assisting a patient with type 2 diabetes mellitus with meal planning. Which general rules should the nurse include in the plan? 1. Intake of 10 g of carbohydrate for every unit of regular insulin 2. Intake of 45-65% of carbohydrates 3. Intake of 10% protein 4. Intake of 20% fat
Intake of 45-65% of carbohydrates The total daily kilocalorie intake recommendations are 45-65% carbohydrates, 15-20% protein, and 10% fat. An intake of 10 g of carbohydrate for every unit of regular insulin does not apply to type 2 diabetes mellitus. However, an intake of 15 g of carbohydrates for every unit of regular insulin would be a recommendation for type 1 diabetes mellitus.
A child with a new diagnosis of type 2 diabetes mellitus is started on an oral hypoglycemic medication. Which medication should the nurse expect the healthcare provider to prescribe? 1. Liraglutide (Victoza) 2. Sitagliptin (Januvia) 3. Metformin (Glucophage) 4. Exenatide (Byetta)
Metformin (Glucophage) Metformin (Glucophage) is the only oral hypoglycemic that is safe to use in children. The nurse would not expect any other oral hypoglycemic to be prescribed for type 2 diabetes mellitus, because their safe use has not been determined.
A 10-year-old child is diagnosed with type 2 diabetes mellitus. Which nursing intervention should the nurse refrain from performing during outpatient office visits? 1. Performing blood glucose monitoring and insulin injections 2. Checking HbA1C levels to determine average blood glucose over the past 3 months 3. Assessing height, weight, and BMI, and plot on an appropriate growth curve for age and gender 4. Emphasizing the importance of annual evaluations to monitor for potential complications
Performing blood glucose monitoring and insulin injections The nurse would not perform blood glucose monitoring nor would the nurse administer the insulin to the patient during outpatient office visits. Instead, the nurse would teach the patient how to perform these tasks.
Which nursing assessment finding of a patient with type 2 diabetes mellitus may indicate the onset of microvascular complications? 1. Morning hyperglycemia 2. Microalbuminuria 3. Weight gain 4. Prolonged capillary refill
Prolonged capillary refill A prolonged capillary refill indicates poor peripheral circulation and likely microvascular complications. Hyperglycemia can happen due to illness, surgery, or noncompliance. Weight gain occurs from consuming more calories than burned or from fluid volume excess. Microalbuminuria results from protein spilling into the urine from uncontrolled diabetes mellitus.
The nurse is caring for a 14-year-old patient with a diagnosis of type 2 diabetes mellitus whose hemoglobin A1C has not decreased. The patient reports difficulty following the diet at school. Which factor should the nurse investigate as a possible barrier to health maintenance? 1. The child does not understand proper food choices. 2. The child is not at a developmental age to manage disease. 3. The child is noncompliant with the medication regimen. 4. The child is embarrassed about food restrictions among peers.
The child is embarrassed about food restrictions among peers. Adolescents have difficulty following dietary restrictions and making good food choices because of how it appears to their friends and peers. The child reports noncompliance with proper food choices at school, which therefore implies an understanding of the diet. The child does not report having difficulty with taking the medication. A 14-year-old child is at a developmental age where it is possible to manage the disease.
The nurse is developing a plan of care for a patient with new-onset type 2 diabetes mellitus and determines the patient has a nursing diagnosis of Deficit Knowledge related to new disease process. Which clinical finding indicates that the patient's goals have been met? 1. The patient is free of infection. 2. The patient has intact skin. 3. The patient is free of any type of injury. 4. The patient demonstrates accurate blood glucose monitoring.
The patient demonstrates accurate blood glucose monitoring. The nurse develops a care plan for a diagnosis of Deficit Knowledge related to new disease process. When the patient demonstrates independent and accurate blood glucose monitoring, this indicates that the goals are met.
The nurse is reviewing the laboratory results for a patient who was diagnosed with type 2 diabetes mellitus 6 months prior and notices the patient has a hemoglobin A1C of 10%. Which inference should the nurse draw from the patient's results? 1. The patient has incorporated exercise into daily life and has lowered blood sugars. 2. The patient is following the dietary restrictions set by the healthcare provider. 3. The patient is most likely not compliant with the diabetic diet and medication. 4. The patient has been ill, causing an alteration in the test result.
The patient is most likely not compliant with the diabetic diet and medication. A normal hemoglobin A1C should be 6-6.5% for a patient with type 2 diabetes mellitus. Therefore, a result of 10% indicates noncompliance with diet and medications and a lack of exercise. There is no indication that the patient has been sick, because this would be a short-term elevation in blood glucose levels, not an elevated A1C.
The nurse is assessing a patient with uncontrolled blood sugar and notices acanthosis nigricans on the back of the patient's neck. Which medical diagnosis should the nurse expect to find in the medical record? 1. Type 1 diabetes mellitus 2. Type 2 diabetes mellitus 3. Diet-controlled diabetes mellitus 4. Gestational diabetes mellitus
Type 2 diabetes mellitus The presence of acanthosis nigricans is found in patients with type 2 diabetes mellitus. Patients with type 1 diabetes mellitus may present with ketosis. Gestational diabetes mellitus involves hyperglycemia related to pregnancy. A diet-controlled diabetic does not take insulin or oral hypoglycemic agents to manage the disease.