Chapter 67: Care of Patients with Diabetes Mellitus Test Bank
MULTIPLE CHOICE
1. In preparing a staff in-service presentation about diabetes
... [Show More] mellitus, the nurse includes which information?
a. Diabetes increases the risk for development of epilepsy.
b. The cure for diabetes is the administration of insulin.
c. Diabetes increases the risk for development of cardiovascular disease.
d. Carbohydrate metabolism is altered in diabetes, but protein metabolism is normal.
2. A client with diabetes asks the nurse why it is necessary to maintain blood glucose levels no lower than about 60 mg/dL. Which is the nurse’s best response?
a. “Glucose is the only fuel used by the body to produce the energy that it needs.”
b. “Your brain needs a constant supply of glucose because it cannot store it.”
c. “Without a minimum level of glucose, your body does not make red blood cells.”
d. “Glucose in the blood prevents the formation of lactic acid and prevents acidosis.”
3. The nurse is monitoring a client with hypoglycemia. Glucagon provides which function?
a. It enhances the activity of insulin, restoring blood glucose levels to normal more quickly after a high-calorie meal.
b. It is a storage form of glucose and can be broken down for energy when blood glucose levels are low.
c. It converts excess glucose into glycogen, lowering blood glucose levels in times of excess.
d. It prevents hypoglycemia by promoting release of glucose from liver storage sites.
4. A client with untreated diabetes mellitus has polyuria, is lethargic, and has a blood glucose of 560 mg/dL. The nurse correlates the polyuria with which finding?
a. Serum sodium, 163 mEq/L
b. Serum creatinine, 1.6 mg/dL
c. Presence of urine ketone bodies
d. Serum osmolarity, 375 mOsm/kg
5. A client with diabetes has a serum creatinine of 1.9 mg/dL. The nurse correlates which urinalysis finding with this client?
6. A young adult client newly diagnosed with type 1 diabetes mellitus has been taught about self- care. Which statement by the client indicates a good understanding of needed eye examinations?
7. During assessment of a client with a 15-year history of diabetes, the nurse notes that the client has decreased tactile sensation in both feet. Which action does the nurse take first?
8. A client’s father has type 1 diabetes mellitus. The client asks if she is in danger of developing the disease as well. Which is the nurse’s best response?
9. A client has newly diagnosed diabetes. To delay the onset of microvascular and macrovascular complications in this client, the nurse stresses that the client take which action?
10. Which client is at greatest risk for undiagnosed diabetes mellitus?
11. The nurse is teaching a client about self-monitoring of blood glucose levels. To prevent bloodborne infection, which statement by the nurse is best?
12. A client with diabetes has frequent blood glucose readings higher than 300 mg/dL. Which action does the nurse teach the client about self-care?
13. A client who has type 2 diabetes is prescribed glipizide (Glucotrol). Which precautions does the nurse include in the teaching plan related to this medication?
14. The client with type 2 diabetes has recently been changed from the oral antidiabetic agents glyburide (Micronase) and metformin (Glucophage) to glyburide-metformin (Glucovance). The nurse includes which information in the teaching about this medication?
15. Which statement made by a client with type 2 diabetes taking nateglinide (Starlix) indicates understanding of this therapy?
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16. A client who has been taking pioglitazone (Actos) for 6 months reports to the nurse that his urine has become darker since starting the medication. Which is the nurse’s first action?
17. A client with diabetes asks why more than one injection of insulin is required each day. Which is the nurse’s best response?
18. A client has been taught to inject insulin. Which statement made by the client indicates a need for further teaching?
19. A client who has used insulin for diabetes control for 20 years has a spongy swelling at the site used most frequently for insulin injection. Which is the nurse’s best action?
20. A client with diabetes is prescribed insulin glargine once daily and regular insulin four times daily. One dose of regular insulin is scheduled at the same time as the glargine. How does the nurse instruct the client to administer the two doses of insulin?
21. A client on an intensified insulin regimen consistently has a fasting blood glucose level between 70 and 80 mg/dL, a postprandial blood glucose level below 200 mg/dL, and a hemoglobin A1c level of 5.5%. Which is the nurse’s interpretation of these findings?
22. A client with diabetes is visually impaired and wants to know whether syringes can be prefilled and stored for later use. Which is the nurse’s best response?
23. A client has a new insulin pump. Which is the nurse’s priority instruction in teaching the client?
24. A client has been newly diagnosed with diabetes mellitus. Which statement made by the client indicates a need for further teaching regarding nutrition therapy?
25. A client newly diagnosed with type 2 diabetes tells the nurse that since increasing fiber intake, he is having loose stools, flatulence, and abdominal cramping. Which is the nurse’s best response?
26. The nurse has been reviewing options for insulin therapy with several clients. For which client does the nurse choose to recommend the pen-type injector insulin delivery system?
27. A client is learning to inject insulin. Which action is important for the nurse to teach the client?
28. To reduce complications of diabetes, the nurse teaches a client with normal kidney function to modify intake of which nutritional group?
29. A client with diabetes has proliferative retinopathy, nephropathy, and peripheral neuropathy. Which statement by the client indicates a good understanding of the disease and exercise?
30. A client in the emergency department has been diagnosed with ketoacidosis. Which manifestation does the nurse correlate with this condition?
31. The nurse determines that which arterial blood gas values are consistent with ketoacidosis in the client with diabetes?
32. A client has diabetic ketoacidosis and manifests Kussmaul respirations. What action by the nurse takes priority?
33. A client with type 1 diabetes asks whether an occasional glass of wine is allowed in the diet. Which is the nurse’s best response?
34. The home care nurse visits an older client with diabetes. For which nutritional problem does the nurse monitor this client?
35. The nurse is teaching a client with diabetes about self-care. Which activity does the nurse teach that can decrease insulin needs?
36. The nurse is teaching a client with diabetes about exercise. Which statement by the client indicates a need for further teaching?
37. Two months after a simultaneous pancreas-kidney (SPK) transplantation, a client is diagnosed as being in acute rejection. The client states, “I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing.” Which is the nurse’s best response?
38. Which statement made by a client getting ready for discharge after pancreas transplantation indicates a need for further teaching about the prescribed drug regimen?
39. The nurse correlates which laboratory value with inadequate functioning of a transplanted pancreas?
40. Three hours after surgery, the nurse notes that the breath of the client with type 1 diabetes has a “fruity” odor. Which is the nurse’s best first action?
41. A client with type 1 diabetes has a blood glucose level of 160 mg/dL on arrival at the operating room. Which is the nurse’s best action?
42. A diabetic client has numbness and reduced sensation. Which intervention does the nurse teach this client to prevent injury?
43. A client with a 20-year history of diabetes mellitus is reviewing his medications with the nurse. The client holds up the bottle of duloxetine (Cymbalta) and states, “My cousin has depression and is on this drug. Do you think I’m depressed?” What is the nurse’s best response?
44. A client has long-standing diabetes mellitus. Which finding alerts the nurse to decreased kidney function in this client?
45. A client with a history of diabetes mellitus has new onset of microalbuminuria. Which component of the diet must the client reduce?
46. Which statement made by a diabetic client who has a urinary tract infection indicates that teaching was effective regarding antibiotic therapy?
47. The home care nurse finds a client who has diabetes awake and alert, but shaky, diaphoretic, and weak. The nurse gives the client cup of orange juice. The client’s clinical manifestations have not changed 5 minutes later. Which is the nurse’s best next action?
48. The nurse has given a client an injection of glucagon. Which action does the nurse take next?
49. A client is receiving IV insulin for hyperglycemia. Which laboratory value requires immediate intervention by the nurse?
50. The nurse is teaching a client about sick day management. Which statement by the nurse is most accurate?
51. The nurse is teaching a client with type 2 diabetes about acute complications. Which teaching point by the nurse is most accurate?
52. A client is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted?
53. The nurse administers 6 units of regular insulin and 10 units NPH insulin at 7 AM. At what time does the nurse assess the client for problems related to the NPH insulin?
54. The nurse has been teaching a client about a new diagnosis of diabetes mellitus. Which statement by the client indicates a good understanding of self-management?
55. A client was admitted with diabetic ketoacidosis (DKA). Which manifestations does the nurse monitor the client most closely for?
56. A client has been taught about lifestyle changes to help manage newly diagnosed diabetes mellitus type 2. Which statement by the client indicates good understanding?
57. Which statement by a client with type 2 diabetes indicates a need for further teaching about diabetic management and follow-up care?
58. A client recently diagnosed with type 1 diabetes tells the nurse, “I will never be able to stick myself with a needle.” Which is the nurse’s best response?
59. The nurse is caring for a critically ill client who has diabetic ketoacidosis (DKA). The nurse finds the following assessment data: blood pressure, 90/62; pulse, 120 beats/min; respirations, 28 breaths/min; urine output, 20 mL/1 hour per catheter; serum potassium, 2.6 mEq/L. The health care provider orders a 40 mEq potassium bolus and an increase in the IV flow rate. Which action by the nurse is most appropriate?
MULTIPLE RESPONSE
1. The nurse is performing health screening in a local mall. Which people does the nurse counsel to be tested for diabetes? (Select all that apply.)
a. African-American or American Indian
b. Person with history of pancreatic trauma
c. Woman with a 30-pound weight gain during pregnancy
d. Male with a body mass index greater than 25 kg/m2
OTHER
1. In mixing regular and NPH insulin, the nurse completes the following actions. Place these actions in the correct order. (Separate letters by a comma and space as follows: a, b, c, d.)
a. Inspect bottles for expiration dates.
b. Gently roll bottle of NPH in hands.
c. Wash your hands.
d. Inject air into the regular insulin.
e. Withdraw the NPH insulin.
f. Withdraw the regular insulin.
g. Inject air into the NPH bottle.
h. Clean rubber stoppers with an alcohol swab. [Show Less]
