Which statement 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
... [Show More] 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
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood
glucose control. Insulin is frequently used for type 2 diabetes, complications are equally
severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory
testing or after a patient develops complications such as frequent yeast infections.
DIF: Cognitive Level: Understand (comprehension) REF: 1134
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7
mmol/L). 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
The patient’s impaired fasting glucose indicates prediabetes, and the patient should be
counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient
with prediabetes does not require insulin or oral hypoglycemics for glucose control and does
not need to self-monitor blood glucose.
DIF: Cognitive Level: Apply (application) REF: 1133
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
3. A 28-yr-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
When the patient is ketotic, exercise may result in an increase in blood glucose level. Patients
with type 1 diabetes should be taught to avoid exercise when ketosis is present. The other
statements are correct.
DIF: Cognitive Level: Apply (application) REF: 1134
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
4. The nurse is assessing a 22-yr-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?” c. “Have you lost weight lately?”
b. “Is your urine dark colored?” d. “Do you crave sugary drinks?”
ANS: C
Weight loss occurs because the body is no longer able to absorb glucose and starts to break
down protein and fat for energy. The patient is thirsty but does not necessarily crave sugarcontaining fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic
symptom of polyuria, urine will be very dilute.
DIF: Cognitive Level: Apply (application) REF: 1121
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
5. 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. Fasting blood glucose c. Glycosylated hemoglobin
b. Oral glucose tolerance d. Urine dipstick for glucose
ANS: C
The glycosylated hemoglobin (A1C) test shows the overall control of glucose over 90 to 120
days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing
is not an accurate reflection of blood glucose level and does not reflect the glucose over a
prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for
monitoring glucose control after diabetes has been diagnosed.
DIF: Cognitive Level: Apply (application) REF: 1124
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass
index (BMI) of 31 kg/m2
.Which goal in the plan of care is most important for this patient?
a. The patient will reach a glycosylated hemoglobin level of less than 7%.
b. The patient will follow a diet and exercise plan that results in weight loss.
c. The patient 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 complications of diabetes are related to elevated blood glucose and the most important
patient outcome is the reduction of glucose to near-normal levels. A BMI of 30?9?kg/m2
or
above is considered obese, so the other outcomes are appropriate but are not as high in
priority.
DIF: Cognitive Level: Analyze (analysis) REF: 1124
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
7. A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 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 the swimming class.
c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
d. time the morning insulin injection so that the peak occurs while swimming.
ANS: A
The change in exercise will affect blood glucose, and the patient will need to monitor glucose
carefully to determine the need for changes in diet and insulin administration. Because
exercise tends to decrease blood glucose, patients are advised to eat before exercising.
Increasing the morning NPH or timing the insulin to peak during exercise may lead to
hypoglycemia, especially with the increased exercise.
DIF: Cognitive Level: Apply (application) REF: 1132
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
8. The nurse determines a need for additional instruction when the patient with newly diagnosed
type 1 diabetes says which of the following?
a. “I will need a bedtime snack because I take an evening dose of NPH insulin.”
b. “I can choose any foods, as long as I use enough insulin to cover the calories.”
c. “I can have an occasional beverage with alcohol if I include it in my meal plan.”
d. “I will eat something at meal times to prevent hypoglycemia, even if I am not
hungry.”
ANS: B
Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are
using intensified insulin therapy have considerable flexibility in diet choices but still should
restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements
are correct and indicate good understanding of the diet instruction.
DIF: Cognitive Level: Apply (application) REF: 1132
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
9. 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
Because consistency with exercise is important, assessment for the types of exercise that the
patient finds enjoyable is the most important action by the nurse in ensuring adherence to an
exercise program. The other actions may be helpful but are not the most important in
improving compliance.
DIF: Cognitive Level: Analyze (analysis) REF: 1134
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
10. Which statement 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
Rotating sites is no longer recommended because there is more consistent insulin absorption
when the same site is used consistently. The other patient statements are accurate and indicate
that no additional instruction is needed.
DIF: Cognitive Level: Apply (application) REF: 1128
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance [Show Less]