MSN Exam for Diabetes Mellitus 2

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1. Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:

  1. Document weight changes because of fatty acid mobilization
  2. Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation
  3. Protect the patient from sources of infection because of decreased cellular protein deposits
  4. Do all of the above

2. Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:

  1. Hypoglycemia
  2. Hyponatremia
  3. Ketonuria
  4. Polyphagia

3. The lowest fasting plasma glucose level suggestive of a diagnosis of DM is:

  1. 90mg/dl
  2. 115mg/dl
  3. 126mg/dl
  4. 180mg/dl

4. Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every:

  1. Third day
  2. Week
  3. 2-3 weeks
  4. 2-4 weeks

5. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

  1. Blurred vision
  2. Diaphoresing
  3. Nausea
  4. Weakness

6. Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

  1. Integumentary inspection for the presence of brown spots on the lower extremities
  2. Observation for paleness of the lower extremities
  3. Observation for blanching of the feet after the legs are elevated for 60 seconds
  4. Palpation for increased pulse volume in the arteries of the lower extremities

7. The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively:

  1. 10-20%
  2. 25-40%
  3. 50-60%
  4. 85-90%

8. 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:

  1. 1130 and 1330
  2. 1330 and 1930
  3. 1530 and 2130
  4. 1730 and 2330

9. A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of:

  1. 6-8 hours
  2. 10-14 hours
  3. 16-20 hours
  4. 24-28 hours

10. Albert refuses his bedtime snack. This should alert the nurse to assess for:

  1. Elevated serum bicarbonate and a decreased blood pH.
  2. Signs of hypoglycemia earlier than expected.
  3. Symptoms of hyperglycemia during the peak time of NPH insulin.
  4. Sugar in the urine

11. 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:

  1. 2-4 hours after administration
  2. 6-14 hours after administration
  3. 16-18 hours after administration
  4. 18-24 hours after administration

12. 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:

  1. Gives 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.
  2. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.
  3. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.
  4. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

13. 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?

  1. Elevated blood glucose level and a low plasma bicarbonate
  2. Decreased urine output
  3. Increased respirations and an increase in pH
  4. Comatose state

14. 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:

  1. Administer a sedative
  2. Make sure the client knows all the correct medical terms to understand what is happening.
  3. Ignore the signs and symptoms of anxiety so that they will soon disappear
  4. Convey empathy, trust, and respect toward the client.

15. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be:

  1. High risk for deficient fluid volume
  2. Deficient knowledge: disease process and treatment
  3. Imbalanced nutrition: less than body requirements
  4. Disabled family coping: compromised.

16. 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:

  1. Administer regular insulin intravenously
  2. Administer 5% dextrose intravenously
  3. Correct the acidosis
  4. Apply an electrocardiogram monitor.

17. A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse?

  1. Pulse
  2. BP
  3. Respiration
  4. Temperature

18. A client with type 1 DM 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?

  1. “The best time for me to exercise is every afternoon.”
  2. “The best time for me to exercise is right after I eat.”
  3. “The best time for me to exercise is after breakfast.”
  4. “The best time for me to exercise is after my morning snack.”

19.  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 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?

  1. Prednisone (Deltasone)
  2. Atenolol (Tenormin)
  3. Phenelzine (Nardil)
  4. Allopurinol (Zyloprim)

20.  Glucose is an important molecule in a cell because this molecule is primarily used for:

  1. Extraction of energy
  2. Synthesis of protein
  3. Building of genetic material
  4. Formation of cell membranes.

21. When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide:

  1. Oxygen
  2. Carbohydrates
  3. Fluid replacement
  4. Dietary instruction

22. The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.

  1. Thirst
  2. Palpitations
  3. Diaphoresis
  4. Slurred speech
  5. Hyperventilation

23. When a client is in diabetic ketoacidosis, the insulin that would be administered is:

  1. Human NPH insulin
  2. Human regular insulin
  3. Insulin lispro injection
  4. Insulin glargine injection

24. The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says:

  1. “I need to rub my forearm vigorously until warm before testing at this site.”
  2. “The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”
  3. “I have to make sure that my current glucose monitor can be used at an alternate site.”
  4. “Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.”

25. Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to exhibit? Select all that apply:

  1. Sweating
  2. Low PCO2
  3. Retinopathy
  4. Acetone breath
  5. Elevated serum bicarbonate

26. A client’s blood gases reflect diabetic acidosis. The nurse should expect:

  1. Increased pH
  2. Decreased PO2
  3. Increased PCO2
  4. Decreased HCO3

27. The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:

  1. Inhibits gluconeogenesis
  2. Stimulates the release of insulin
  3. Increases blood glucose levels
  4. Provides more storage of glucose.

28.  A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:

  1. Call the physician
  2. Encourage the intake of fluids
  3. Administer the insulin as ordered
  4. Give the client ½ c. of orange juice

29. The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order.

  1. Inject air equal to NPH dose into NPH vial
  2. Invert regular insulin bottle and withdraw regular insulin dose
  3. Inject air equal to regular dose into regular dose
  4. Invert NPH vial and withdraw NPH dose.

30. The insulin that has the most rapid onset of action would be:

  1. Lente
  2. Lispro
  3. Ultralente
  4. Humulin N

31. A client with DM states, “I cannot eat big meals; I prefer to snack throughout the day.” The nurse should carefully explain that the:

  1. Regulated food intake is basic to control
  2. Salt and sugar restriction is the main concern
  3. Small, frequent meals are better for digestion
  4. Large meals can contribute to a weight problem

32. A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse’s primary responsibility to:

  1. Check the client’s serum glucose level
  2.  Assist the client out of bed to the chair
  3. Place the client in a high-fowlers position
  4. Ensure that the client’s residual limb is elevated.

33. Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

  1. Give glyburide again
  2. Give subcutaneous insulin and monitor blood glucose
  3. Monitor blood glucose closely, and look for signs of hypoglycemia.
  4. Monitor blood glucose, and assess for signs of hyperglycemia.

34. Which of the following chronic complications is associated with diabetes?

  1. Dizziness, dyspnea on exertion, and coronary artery disease.
  2. Retinopathy, neuropathy, and coronary artery disease
  3. Leg ulcers, cerebral ischemic events, and pulmonary infarcts
  4. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s

35. Rotating injection sites when administering insulin prevents which of the following complications?

  1. Insulin edema
  2. Insulin lipodystrophy
  3. Insulin resistance
  4. Systemic allergic reactions

36. Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?

  1. Subcutaneous
  2. Intramuscular
  3. IV bolus only
  4. IV bolus, followed by continuous infusion.

37. Insulin forces which of the following electrolytes out of the plasma and into the cells?

  1. Calcium
  2. Magnesium
  3. Phosphorus
  4. Potassium

38. Which of the following causes of HHNS is most common?

  1. Insulin overdose
  2. Removal of the adrenal gland
  3. Undiagnosed, untreated hyperpituitarism
  4. Undiagnosed, untreated diabetes mellitus

39. A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?

  1. Kussmaul’s respirations and a fruity odor on the breath
  2. Shallow respirations and severe abdominal pain
  3. Decreased respirations and increased urine output.
  4. Cheyne-stokes respirations and foul-smelling urine

40. Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection?

  1. No changes
  2. Less insulin
  3. More insulin
  4. Oral antidiabetic agents

41. Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol what this means. What is the best response by the nurse? Select all that apply.

  1. “Your alpha cells should be able to secrete insulin, but cannot.”
  2. “The exocrine function of your pancreas is to secrete insulin.”
  3. “Without insulin, you will develop ketoacidosis (DKA).”
  4. “The endocrine function of your pancreas is to secrete insulin.”
  5. “It means your pancreas cannot secrete insulin.”

42. Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select all that apply.

  1. The nurse could have given the insulin subcutaneously.
  2. The nurse should have contacted the physician.
  3. The nurse should have used regular insulin (Humulin R).
  4. The nurse used the correct insulin.

43. Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal?

  1. The client will be very tasty.
  2. The client will complain of nausea.
  3. The client will need to urinate.
  4. The client will have moist skin.

44. A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes?

  1. The 50-year-old client who does not get any physical exercise
  2. The 56-year-old client who drinks three glasses of wine each evening
  3. The 42 year-old client who is 50 pounds overweight
  4. The 38 year-old client who smokes one pack of cigarettes per day

45. Steven John has type 1 diabetes mellitus and receives insulin. Which laboratory test will the nurse assess?

  1. Potassium
  2. AST (aspartate aminotransferase)
  3. Serum amylase
  4. Sodium

46. Jansen receives metformin (Glucophage). What will the best plan of the nurse include with regard to patient education with this drug? Select all that apply.

  1. It stimulates the pancreas to produce more insulin.
  2. It must be taken with meals.
  3. It decreases sugar production in the liver.
  4. It inhibits absorption of carbohydrates.
  5. It reduces insulin resistance.

47. Serafica who has diabetes mellitus type 1 is found unresponsive in the clinical setting. Which nursing action is a priority? arrange from 1 to 4.

  1. Treat the client for hypoglycemia.
  2. Call the physician STAT.
  3. Assess the vital signs.
  4. Call a code.
  1. 1, 2, 3, 4
  2. 1, 3, 2, 4
  3. 3, 1, 2, 4
  4. 4, 3, 2, 1

48. Serge who has diabetes mellitus is taking oral agents, and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the client his oral medications?

  1. Administer the oral agents immediately after the test.
  2. Notify the the diagnostic department and request orders.
  3. Notify the physician and request orders.
  4. Administer the oral agents with a sip of water before the test.

49. A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can’t just take pills instead. What is the best response by the nurse?

  1. “Insulin must be injected because it needs to work quickly.”
  2.  “Insulin can’t be in a pill because it is destroyed in stomach acid.”
  3. “Have you talked to your doctor about taking pills instead?”
  4. “I know it is tough, but you will get used to the shots soon.”

50. Nurse Andy has finished teaching a client with diabetes mellitus how to administer insulin. He evaluates the learning has occurred when the client makes which statement?

  1. “I should check my blood sugar immediately prior to the administration.”
  2. “I should provide direct pressure over the site following the injection.”
  3. “I should use the abdominal area only for insulin injections.”
  4. “I should only use calibrated insulin syringe for the injections.”

51. Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include?

  1. The alcohol could cause pancreatic disease.
  2. The alcohol could cause serious liver disease.
  3. The alcohol could predispose you to hypoglycemia.
  4. The alcohol could predispose you to hyperglycemia.

52. Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication?

  1. When the client is eating
  2. Thirty minutes before meals
  3. fifteen minutes before meals
  4. When the meal trays arrive on the floor

53. Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse Matt notes the client’s additional insulin vials are not refrigerated. What is the best action by the nurse at this time?

  1. Instruct the client to label each vial with the date when opened.
  2. Tell the client there is no need to keep additional vials.
  3. Have the client place the insulin vials in the refrigerator.
  4. Have the client discard the vials.

54. During the morning rounds, Nurse AJ accompanied the physician in every patient’s room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician?

  1. Use Humalog insulin for sliding scale coverage.
  2. Metformin (Glucophage) 1000 mg per day in divided doses.
  3. Administer regular insulin 30 minutes prior to meals.
  4. Lantus insulin 20U BID.

55. Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement?

  1. “My cells have increased their receptors, but there is enough insulin.”
  2.  “My peripheral cells have increased sensitivity to insulin.”
  3. “My beta cells cannot produce enough insulin for my cells.”
  4. “My cells cannot use the insulin my pancreas makes.”

56. The principal goals of therapy for older patients who have poor glycemic control are:

  1. Enhancing quality of life.
  2. Decreasing the chance of complications.
  3. Improving self-care through education.
  4. All of the above.

57. Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus?

  1. Physical exercise can slow the progression of diabetes mellitus.
  2. Strenuous exercise is beneficial when the blood glucose is high.
  3. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia.
  4. Adjusting insulin regimen allows for safe participation in all forms of exercise.

58. Harry is a diabetic patient who is experiencing a reaction of alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following?

  1. Uncontrolled diabetes
  2. Somogyi phenomenon
  3. Brittle diabetes
  4. Diabetes insipidus

59. Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus type 2. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase), is to:

  1. Induce hypoglycemia by decreasing insulin sensitivity.
  2. Improve insulin sensitivity and decrease hyperglycemia.
  3. Stimulate the beta cells of the pancreas to secrete insulin.
  4. Decrease insulin sensitivity by enhancing glucose uptake.

60. Rosemary has been taking Glargine (Lantus) to treat her condition. One of the benefits of Glargine (Lantus) insulin is its ability to:

  1. Release insulin rapidly throughout the day to help control basal glucose.
  2. Release insulin evenly throughout the day and control basal glucose levels.
  3. Simplify the dosing and better control blood glucose levels during the day.
  4. Cause hypoglycemia with other manifestation of other adverse reactions.

61. A 50-year-old widower is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the gerontology nurse should anticipate which of the following secondary medical diagnoses?

  1. Impaired glucose tolerance
  2. Gestational diabetes mellitus
  3. Pituitary tumor
  4. Pancreatic tumor

62. An older woman with diabetes mellitus visits the clinic concerning her condition. Of which of the following symptoms might an older woman with diabetes mellitus complain?

  1. Anorexia
  2. Pain intolerance
  3. Weight loss
  4. Perineal itching

63. Gregory is a 52-year-old man identified as high-risk for diabetes mellitus. Which laboratory test should a nurse anticipate a physician would order for him? (Select all that apply.)

  1. Fasting Plasma Glucose (FPG)
  2. Two-hour Oral Glucose Tolerance Test (OGTT)
  3. Glycosylated hemoglobin (HbA1C)
  4. Finger stick glucose three times daily

64. According to the National Diabetes Statistics Report, diabetes remains as one of the leading causes of death in the United States since 2010. Which of the following factors are risks for the development of diabetes mellitus? (Select all that apply.)

  1. Age over 45 years
  2. Overweight with a waist/hip ratio >1
  3. Having a consistent HDL level above 40 mg/dl
  4. Maintaining a sedentary lifestyle

65. During a visit in the hospital, the student nurses are asked which of the following persons would most likely be diagnosed with diabetes mellitus. They are correct if they answered a 44-year-old:

  1. Caucasian woman.
  2. Asian woman.
  3. African-American woman.
  4. Hispanic male.

66. An ailing 70-year-old woman with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client’s intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient?

  1. Insulin resistance has developed.
  2. Diabetic ketoacidosis is occurring.
  3. Hypoglycemia unawareness is developing.
  4. Hyperglycemic hyperosmolar non-ketotic coma.

67. Daniel is diagnosed of having hyperthyroidism (Graves’ disease). Which of the following is a drug of choice for his condition?

  1. Furosemide (Lasix)
  2. Digoxin (Lanoxin)
  3. Propranolol (Inderal)
  4. Propylthiouracil (PTU)

68. Which of the following medications are most likely to cause hypothyroidism? (Select all that apply.)

  1. Acetylsalicylic acid (aspirin)
  2. Furosemide (Lasix)
  3. Docusate sodium (Colace)
  4. Rifampin (Rifadin)

69. After visiting the physician, Angela found out that she has a thyroid problem. In line with her condition, which of the following diagnostic studies is done to determine the size and composition of the thyroid gland?

  1. Thyroid scan with RAI 123I
  2. Electrocardiography
  3. Ultrasonography
  4. Venous duplex Doppler study

70. Nurse Gil is caring for a patient with a diagnosis of hypothyroidism. Which nursing diagnosis should the nurse most seriously consider when analyzing the needs of the patient?

  1. High risk for aspiration related to severe vomiting
  2. Diarrhea related to increased peristalsis
  3. Hypothermia related to slowed metabolic rate
  4. Oral mucous membrane, altered related to disease process

71. During lecture, the clinical instructor tells the students that 50% to 60% of daily calories should come from carbohydrates. What should the nurse say about the types of carbohydrates that can be eaten?

  1. Try to limit simple sugars to between 10% and 20% of daily calories.
  2. Simple carbohydrates are absorbed more rapidly than complex carbohydrates.
  3. Simple sugars cause rapid spike in glucose levels and should be avoided.
  4. Simple sugars should never be consumed by someone with diabetes.

72. At the time Cherrie Ann found out that the symptoms of diabetes were caused by high levels of blood glucose, she decided to break the habit of eating carbohydrates. With this, the nurse would be aware that the client might develop what complication?

  1. retinopathy
  2. atherosclerosis
  3. glycosuria
  4. acidosis

73. Joko has recently been diagnosed with Type I diabetes and asks Nurse Jessica for help formulating a nutrition plan. Which of the following recommendations would the nurse make to help the client increase calorie consumption to offset absorption problems?

  1. Eat small meals with two or three snacks throughout the day to keep blood glucose levels steady
  2. Increase consumption of simple carbohydrates
  3. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals.
  4. Skip meals to help lose weight

74. Billy is being asked concerning his health in the emergency department. When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of

  1. alcohol use.
  2. cigarette smoking.
  3. diabetes mellitus.
  4. high-protein diet.

75. Nurse Shey is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply.

  1. Cakes, candies, cookies, and regular soft drinks should be avoided.
  2. Gestational diabetes increases the risk that the mother will develop diabetes later in life.
  3. Gestational diabetes usually resolves after the baby is born.
  4. Insulin injections may be necessary.
  5. The baby will likely be born with diabetes
  6. The mother should strive to gain no more weight during the pregnancy.

76. The goal for pre-prandial blood glucose for those with Type 1 diabetes mellitus is:

  1. <80 mg/dl
  2. <130 mg/dl
  3. <180 mg/dl
  4. <6%

77. The guidelines for Carbohydrate Counting as medical nutrition therapy for diabetes mellitus includes all of the following EXCEPT:

  1. Flexibility in types and amounts of foods consumed
  2. Unlimited intake of total fat, saturated fat and cholesterol
  3. Including adequate servings of fruits, vegetables and the dairy group
  4. Applicable to with either Type 1 or Type 2 diabetes mellitus

78. The nurse working in the physician’s office is reviewing lab results on the clients seen that day. One of the clients who has classic diabetic symptoms had an eight-hour fasting plasma glucose (FPG) test done. The nurse realizes that diagnostic criteria developed by the American Diabetes Association for diabetes include classic diabetic symptoms plus which of the following fasting plasma glucose levels?

  1. Higher than 106 mg/dl
  2. Higher than 126 mg/dl
  3. Higher than 140 mg/dl
  4. Higher than 160 mg/dl

79. When taking a health history, the nurse screens for manifestations suggestive of Diabetes Type I. Which of the following manifestations are considered the primary manifestations of Diabetes Type I and would be most suggestive and require follow-up investigation?

  1. Excessive intake of calories, rapid weight gain, and difficulty losing weight
  2. An increase in three areas: thirst, intake of fluids, and hunger
  3. Poor circulation, wound healing, and leg ulcers,
  4. Lack of energy, weight gain, and depression

80. The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of Type II Diabetes and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents?

  1. Comply with medication regimen 100% for 6 months
  2. Quit the use of any tobacco products by the end of three months
  3. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily
  4. Practice relaxation techniques for at least five minutes five times a day for at least five months

81. During a visit in a community, the nurse will recommend routine screening for diabetes when the person has one or more of seven risk criteria. Which of the following persons that the nurse comes in contact with most needs to be screened for diabetes based on the seven risk criteria?

  1. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl
  2. A woman who is at 90% of standard body weight after delivering an eight-pound baby
  3. A middle-aged Caucasian male
  4. An older client who is hypotensive

82. During the admission of a client with diabetic ketoacidosis, Nurse Kendra will anticipate the physician ordering which of the following types of intravenous solution if the client cannot take fluids orally?

  1. Lactated Ringer’s solution
  2. 0.9 normal saline solution
  3. 5% dextrose in water (D5W)
  4. 0.45% normal saline solution

83. You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent. The client mentions that he usually has a couple of beers each night and takes an aspirin each day to prevent heart attack and/or strokes. Which of the following responses would be best on the part of the nurse?

  1. As long as you only drink two beers and take one aspirin, this should not be a problem
  2. The aspirin is alright but you need to give up drinking any alcoholic beverages
  3. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of hypoglycemia
  4. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug

84. Which of the following if stated by the nurse is correct about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?

  1. This syndrome occurs mainly in people with Type I Diabetes
  2. It has a higher mortality rate than Diabetic Ketoacidosis
  3. The client with HHNS is in a state of overhydration
  4. This condition develops very rapidly

85. Nurse Robedee is teaching a thin client about the proper methods/techniques when giving insulin. Which one of the following is proper?

  1. Pinch the skin up and use a 90 degree angle
  2. Use a 45 degree angle with the skin pinched up
  3. Massage the area of injection after injecting the insulin
  4. Warm the skin with a warmed towel or washcloth prior to the injection

86. Nurse Pira is explaining to the client about Type II Diabetes. Risk factors of such condition include all of the following except:

  1. Advanced age
  2. Physical inactivity
  3. Obesity
  4. Smoking

87. Blood sugar is well controlled when Hemoglobin A1C is:

  1. Below 5.7%
  2. Between 12%-15%
  3. Less than 180 mg/dL
  4. Between 90 and 130 mg/dL

88. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?

  1. Alpha-glucosidase inhibitors
  2. Biguanides
  3. Meglitinides
  4. Sulfonylureas

89. A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has Type I Diabetes Mellitus. Which of the follow actions should the nurse do first?

  1. Inject 1 mg of glucagon subcutaneously.
  2. Administer 50 mL of 50% glucose I.V.
  3. Give 4 to 6 oz (118 to 177 mL) of orange juice.
  4. Give the client four to six glucose tablets.

90. An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

  1.  is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals
  2.  gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal
  3.  continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels
  4.  is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream

91. Which of the following persons would most likely be diagnosed with Diabetes Mellitus? A 44-year-old:

  1. Caucasian woman.
  2. Asian woman.
  3. African-American woman.
  4. Hispanic male.

92. Which of the following factors are risks for the development of Diabetes Mellitus? Select all that apply.

  1. Age over 45 years
  2. Overweight with a waist/hip ratio >1
  3. Having a consistent HDL level above 40 mg/dl
  4. Maintaining a sedentary lifestyle

93. Anton brought his grandfather to the clinic to confirm his blood sugar levels. Which laboratory test should a nurse anticipate a physician would order when an older person is identified as high-risk for Diabetes Mellitus? Select all that apply.

  1. Fasting Plasma Glucose (FPG)
  2. Two-hour Oral Glucose Tolerance Test (OGTT)
  3. Glycosylated hemoglobin (HbA1C)
  4. Finger stick glucose three times daily

94. A patient received 6 units of regular insulin 3 hours ago. The nurse would be MOST concerned if which of the following was observed?

  1. kussmaul respirations and diaphoresis
  2. anorexia and lethargy
  3. diaphoresis and trembling
  4. headache and polyuria

95. Mr. Wesley is newly diagnosed with Type I DM and is being seen by the home health nurse. The doctors orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be

  1. confused with cold, clammy skin and pulse of 110
  2. lethargic with hot dry skin and rapid deep respirations
  3.  alert and cooperative with BP of 130/80 and respirations of 12
  4.  short of breath, with distended neck veins and bounding pulse of 96.
Answers and Rationales
  1. Answer: D.
  2. Answer: A.
  3. Answer: C.
  4. Answer: C.
  5. Answer: B.
  6. Answer: D.
  7. Answer: C.
  8. Answer: B.
  9. Answer: C.
  10. Answer: B.
  11. Answer: B. NPH is intermediate acting insulin. The onset of action is 1-2 hours, it peaks in 6-14 hours, and it’s duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.
  12. Answer: A. 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 neede4. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.
  13. Answer: A. In diabetic acidiosis 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. The client would be experiencing polyuria, and Kussmauls respirations would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis
  14. Answer: D. The most appropriate intervention is to address the client’s feelings related to the anxiety. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client’s anxious feelings. A client will not relate to medical terms, particularly when anxiety exists.
  15. Answer: 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.
  16. Answer: A. lack (absolute or relative) of insulin is the primary cause of DK1. Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority action.
  17. Answer: D. An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.
  18. Answer: A. A hypoglycemic reaction may occur in the 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.
  19. Answer: A. Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.
  20. Answer: A. Glucose catabolism is the main pathway for cellular energy production.
  21. Answer: C. As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin.
  22. Answer: B, C, D. Palpitations, an adrenergic symptom, occur as the glucose levels fall; the sympathetic nervous system is activated and epinephrine and norepinephrine are secreted causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.
  23. Answer: B. Regular insulin (Humulin R) is a short-acting insulin and is administered via IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood glucose becomes <13.9 mmol/L (<250 mg/dL). At this point, insulin dose should be decreased by half, to 0.1 units/kg every 2 hours, until the resolution of DKA.
  24. Answer: B. The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected.
  25. Answer: B, C. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a lowered PCO2. A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis.
  26. Answer: D. The bicarbonate-carbonic acid buffer system helps maintain the pH of the body fluids; in metabolic acidosis there is a decrease in bicarbonate because of an increase of metabolic acids.
  27. Answer: C. Glucagon, an insulin antagonist produced by the alpha cells in the islets of langerhans, leads to the conversion of glycogen to glucose in the liver.
  28. Answer: C. A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered.
  29. Answer: 1, 3, 2, 4.
  30. Answer: B. Lispro has an immediate onset, a peak of 30-90 minutes, and duration of 2-4 hours.
  31. Answer: A. An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two-between meals snacks needs to be tailored to the client’s specific needs, with due regard for activity, diet, and therapy.
  32. Answer: A. Because the client has diabetes, it is essential that the blood glucose level be determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage.
  33. Answer: C. When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemic. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Giving insulin would also lower the glucose levels, causing hypoglycemic. The client wouldn’t have hyperglycemia if the glyburide was absorbed.
  34. Answer: B. These are all chronic complications of diabetes. Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism. Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia.
  35. Answer: B. Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites.
  36. Answer: D. An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose. After the client is stabilized, subcutaneous insulin is given. Insulin is never given intramuscularly.
  37. Answer: D. Insulin forces potassium out of the plasma, back into the cells, causing hypokalemia. Potassium is needed to help transport glucose and insulin into the cells. Calcium, magnesium, and phosphorus aren’t affected by insulin.
  38. Answer: D. Undiagnosed, untreated DM is one of the most common causes of HHNS.
  39. Answer: A. Coma and severe acidosis are ushered in with Kussmaul’s respirations (very deep but not labored respirations) and a fruity odor on the breath (academia).
  40. Answer: C. During periods of infection or illness, diabetics may need even more insulin to compensate for increased blood glucose levels.
  41. Answer: C, D, E. One function of your pancreas is to secrete insulin. The endocrine function of the pancreas is to secrete insulin. The endocrine, not the exocrine, function of the pancreas is to secrete insulin. Insulin is secreted by the beta, not the alpha, cells of the pancreas. A consequence of diabetes mellitus type 1 is that without insulin, severe metabolic disturbances, such as ketoacidosis (DKA) will result.
  42. Answer: B, C. Regular insulin is the only insulin that can be given intravenously (IV). The nurse did not use correct insulin as it was not regular insulin. Contact the provider to clarify the order, regular insulin is the only insulin that can be given intravenously (IV). The nurse cannot give the insulin subcutaneously when it is ordered to be given intravenously (IV).
  43. Answer: D. The client will have moist skin. Moist skin is the sign of hypoglycemia, which the client would experience if he injected himself with insulin and did not eat. Thirst, nausea, and and increased urination are signs of hyperglycemia.
  44. Answer: C. The 42 year-old client who is 50 pounds overweight. Obesity increases the likelihood of developing diabetes mellitus due to over stimulation of the endocrine system. Exercise is important, but lack of exercise is not as big a risk factor as obesity. Smoking is a serious health concern, but is not a specific risk factor for diabetes. Consuming alcohol is associated with liver disease but is not as high a risk factor for diabetes as obesity.
  45. Answer: A. Potassium. Insulin causes potassium to move into the cell and may cause hypokalemia. There is no need to monitor the sodium, serum amylase, and AST levels.
  46. Answer: B, C, E. Metformin (Glucophage) reduces insulin resistance, decreases sugar production in the liver, and should be taken with meals for the best absorption and effect. It does not stimulate the pancreas to produce more insulin and does not inhibit the absorption of carbohydrates.
  47. Answer: A. 1, 2, 3, 4. When a patient with diabetes mellitus type 1 is unresponsive, the the nurse should focus on and treat for hypoglycemia, as this is more likely than hyperglycemia. This is an emergency situation where the nurse must act before calling the physician. Vital signs should be taken after the client is treated for hypoglycemia. Assessment for ABCs should precede calling a code; there is no information that the client is not breathing.
  48. Answer: C. Notify the physician and request orders. It is best to notify the client’s physician and request orders. The client should not receive the medication during NPO status unless directed by the physician. The medications should not be given upon return unless the physician orders this; the client may still need to be NPO. The radiologist in the diagnostic department might give orders, but it would be best to check with the client’s physician first.
  49. Answer: B. “Insulin can’t be in a pill because it is destroyed in stomach acid.” Insulin must be injected because it is destroyed in the stomach acid if taken orally. Telling he will get used to shots does not answer his question and is condescending. Insulin must be injected because it is destroyed in stomach acid if taken orally; the onset of action is not the issue here. The nurse should answer the client’s question, not refer him back to the physician.
  50. Answer: D. “I should only use calibrated insulin syringe for the injections.” To ensure the correct insulin dose, a calibrated insulin syringe must be used. Insulin injections should be rotated to the arm and thigh, not just the abdominal area. There is no need to apply direct pressure over the site following an insulin injection. There is no need to check blood glucose immediately prior to the injection.
  51. Answer: C. The alcohol could predispose you to hypoglycemia. Alcohol can potentiate hypoglycemic, not hypoglycemic, effects in the client. Alcohol can cause pancreatic disease, but the client’s pancreas is not producing any insulin currently. Alcohol can cause liver disease, but the more immediate concern is hypoglycemia.
  52. Answer: A. When the client is eating. The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating to prevent hypoglycemia. It must be given when the client is eating, not when the meal trays arrive on the floor and not thirty minutes before meals.
  53. Answer: C. Have the client place the insulin vials in the refrigerator. Vials not in use should be refrigerated to preserve drug potency. There is no need to discard the vials. The client should always have additional vials of insulin available. Writing the date of opening on the vial is good practice, but does not address the need to refrigerate additional vials.
  54. Answer: D. Lantus insulin 20U BID. Lantus insulin is usually prescribed once-a-day so an order for BID dosing should be validated with the physician. Humalog insulin can be prescribed for sliding scale coverage. Regular insulin is administered 30 minutes before meals. Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day.
  55. Answer: D. “My cells cannot use the insulin my pancreas makes.” With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. Peripheral cells have a decreased, not an increased, sensitivity to insulin. The beta cells continue to produce insulin with type 2 diabetes. There is a decrease, not an increase, in receptor sites with type 2 diabetes.
  56. Answer: D. All of the above. The principal goals of therapy for older persons with diabetes mellitus and poor glycemic control are enhancing quality of life, decreasing the chance of complications, improving self-care through education, and maintaining or improving general health status.
  57. Answer: A. Physical exercise can slow the progression of diabetes mellitus. Physical exercise slows the progression of diabetes mellitus, because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity. Strenuous exercise can cause retinal damage, and can cause hypoglycemia. Insulin and foods both must be adjusted to allow safe participation in exercise.
  58. Answer: B. Somogyi phenomenon. Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and increase in ketones.
  59. Answer: C. Stimulate the beta cells of the pancreas to secrete insulin. Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin.
  60. Answer: B. Release insulin evenly throughout the day and control basal glucose levels. Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.
  61. Answer: D. Pancreatic tumor. The onset of hyperglycemia in the older adult can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumor.
  62. Answer: D. Perineal itching. Older women might complain of perineal itching due to vaginal candidiasis.
  63. Answer: A, B. When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.
  64. Answer: A, B, D. Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.
  65. Answer: C. African-American woman. Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
  66. Answer: D. Hyperglycemic hyperosmolar non-ketotic coma.Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly decreased amounts of insulin.
  67. Answer: D. Propylthiouracil (PTU). Propylthiouracil (PTU) initially is given in divided doses, and functions to block thyroid hormone synthesis.
  68. Answer: A, B, D. Acetylsalicylic acid (aspirin), Furosemide (Lasix), and Rifampin (Rifadin) are most likely to cause hypothyroidism.
  69. Answer: C. Ultrasonography. Although thyroid scans frequently are done to evaluate the thyroid gland, I 123 is used to destroy overactive thyroid cells such as are seen in thyroid cancer. Ultrasonography can be used early in the evaluation process to rule out Graves’ disease, nodular goiter, or other thyroid dysfunction.
  70. Answer: C. Hypothermia related to slowed metabolic rate. Thyroid hormone deficiency results in reduction in the metabolic rate, resulting in hypothermia, and does predispose the older adult to a host of other health-related issues. One quarter of affected elderly experience constipation.
  71. Answer: A. Try to limit simple sugars to between 10% and 20% of daily calories. It is recommended that carbohydrates provide 50% to 60% of the daily calories. Approximately 40% to 50% should be from complex carbohydrates. The remaining 10% to 20 % of carbohydrates could be from simple sugars. Studies give no evidence that carbohydrates from simple sugars are digested and absorbed more rapidly that are complex carbohydrates, and they do not appear to affect blood sugar control.
  72. Answer: D. acidosis. When a client’s carbohydrate consumption is inadequate, ketones are produced from the breakdown of fat. These ketones lower the pH of the blood, potentially causing acidosis that can lead to a diabetic coma.
  73. Answer: C. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals.
  74. Answer: A. alcohol use. Alcohol use is one of the most common risk factors for pancreatitis in the United States.
  75. Answer: A, B, C, D. Gestational diabetes can occur between the 16th and 28th week of pregnancy. If not responsive to diet and exercise, insulin injections may be necessary. Concentrated sugars should be avoided. Weight gain should continue, but not in excessive amounts. Usually, gestational diabetes disappears after the infant is born. However, diabetes can develop 5 to 10 years after the pregnancy.
  76. Answer: B. <130 mg/dl. The goal for pre-prandial blood glucose for those with Type 1 diabetes mellitus is <130 mg/dl.
  77. Answer: B. Unlimited intake of total fat, saturated fat and cholesterol. The guidelines for Carbohydrate Counting as medical nutrition therapy for diabetes mellitus includes all of the following EXCEPT option B, unlimited intake of total fat, saturated fat and cholesterol.
  78. Answer: B. Higher than 126 mg/dl. Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126 mg/dl.
  79. Answer: B. An increase in three areas: thirst, intake of fluids, and hunger. The primary manifestations of diabetes type I are polyuria (increased urine output), polydipsia (increased thirst), polyphagia (increased hunger).
  80. Answer: C. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily. When Type II diabetics lose weight through diet and exercise they sometimes have an improvement in insulin efficiency sufficient to the degree they no longer require oral hypoglycemic agents.
  81. Answer: A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl. The seven risk criteria include: greater than 120% of standard body weight, Certain races but not including Caucasian, delivery of a baby weighing more than 9 pounds or a diagnosis of gestational diabetes, hypertensive, HDL greater than 35 mg/dl or triglyceride level greater than 250 or a triglyceride level of greater than 250 mg/dl, and, lastly, impaired glucose tolerance or impaired fasting glucose on prior testing.
  82. Answer: D. 0.45% normal saline solution. 0.45% normal saline solution is recommended.
  83. Answer: C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of hypoglycemia. Alcohol and/or aspirin taken with a sulfonylurea can cause development of hypoglycemia.
  84. Answer: B. It has a higher mortality rate than Diabetic Ketoacidosis. HHNS occurs only in people with Type II Diabetes. It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. This condition develops very slowly over hours or days.
  85. Answer: A. Pinch the skin up and use a 90 degree angle. The best angle for a thin person is 90 degrees with the skin pinched up. The area is not massaged and it is not necessary to warm it.
  86. Answer: D. Smoking. Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.
  87. Answer: A. Below 5.7%. A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.
  88. Answer: B. Biguanides. Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels
  89. Answer: C. Give 4 to 6 oz (118 to 177 mL) of orange juice. Because the client is awake and complaining of symptoms, the nurse should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4 to 6 oz of fruit juice, five to six hard candies such as Lifesavers, or 1 tablespoon of sugar. When a client has worsening symptoms of hypoglycemia or is unconscious, treatment includes 1 mg of glucagon subcutaneously or intramuscularly, or 50 mL of 50% glucose I.V. The nurse may also give two to three glucose tablets for a hypoglycemic reaction.
  90. Answer: B. gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose 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 an additional dose 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.
  91. Answer: C. African-American woman. Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
  92. Answer: A, B, D. Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.
  93. Answer: A, B. When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 126 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.
  94. Answer: C. diaphoresis and trembling. Diaphoresis and trembling indicates hypoglycemia.
  95. Answer: A. confused with cold, clammy skin and pulse of 110. Confused with cold, clammy skin and pulse of 110 indicate hypoglycemia.
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