MSN Exam for Diabetes Mellitus

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1) Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

  1. I.M. or subcutaneous glucagon.
  2. I.V. bolus of dextrose 50%.
  3. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
  4. 10 U of fast-acting insulin.

2) A client with diabetes mellitus has a prescription for Glucotrol XL (glipizide). The client should be instructed to take the medication:

  1. At bedtime
  2. With breakfast
  3. Before lunch
  4. After dinner

3) The glycosylated hemoglobin of a 40-year-old client with diabetes mellitus is 2.5%. The nurse understands that:

  1. The client can have a higher-calorie diet.
  2. The client has good control of her diabetes.
  3. The client requires adjustment in her insulin dose.
  4. The client has poor control of her diabetes.

4) A patient with severe hypoglycemia arrives at the ED unconscious by ambulance. The nurse would first…

  1. Give regular insulin by IV
  2. Give NPH by IV
  3. Give 10-15 g CHO or Orange juice
  4. Give 1 mg glucagon

5) A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:

  1. prefers to take insulin orally.
  2. has type 2 diabetes.
  3. has type 1 diabetes.
  4. is pregnant and has type 2 diabetes.

6) Which of the following conditions is not linked to diabetic ketoacidosis?

  1. Cerebral edema
  2. Arrhythmias
  3. Peptic ulcers
  4. Mucormycosis

7) Which of the following clinical characteristics is associated with Type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus [IDDM])?

  1. Presence of islet cell antibodies
  2. Obesity
  3. Rare ketosis
  4. Requirement for oral hypoglycemic agents

8) What are the micro vascular complications of uncontrolled diabetes?

  1. Delayed gastric emptying
  2. Diarrhea
  3. Glomuerular injury
  4. Bleeding of retinal caplillaries
  5. Numbness of feet
  6. Impotence

9) What is the number one complication of diabetes?

  1. Diabetic ketoacidosis
  2. Obesity
  3. Hypertension
  4. Cardiovascular disease

10) Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

  1. Oral anticoagulants
  2. Anabolic steroids
  3. Beta-adrenergic blockers
  4. Thiazide diuretics

11) The newly diagnosed diabetic patient asks the nurse why he needs to check his feet every day. The nurse’s best response is….

  1. To prevent leg amputation.
  2. To check for any cuts, sores, or dry cracked skin so they can be treated early to prevent infection or gangrene.
  3. To see if they hurt.
  4. You just need to do it.

12) What type of cells secrete glucagon?

  1. Beta cells
  2. Alpha cells
  3. Plasma cells
  4. Acinar cells

13) Nurse John is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he’s impotent and says he’s concerned about its effect on his marriage. In planning this client’s care, the most appropriate intervention would be to:

  1. Encourage the client to ask questions about personal sexuality.
  2. Provide time for privacy.
  3. Provide support for the spouse or significant other.
  4. Suggest referral to a sex counselor or other appropriate professional.

14) Which are potential complications of diabetes? (Choose all that applies)

  1. Amputations (BKA)
  2. Cardiovascular disease
  3. Edema
  4. Peripheral neuropathy
  5. Hyperthyroidism
  6. Retinopathy
  7. Cardio neuropathy
  8. Coma
  9. Nephropathy
  10. Arteriosclerosis
  11. Hypertension
  12. Obesity
  13. Infections

15) Which of the following is not an effect of diabetes?

  1. Small vessel occlusion
  2. Necrosis of extremities
  3. Ketone Body production
  4. Decreased fat metabolism

16) Which of the following is not an indicator of diabetic ketoacidosis?

  1. Hyperthermia
  2. Nausea/Vomiting
  3. Slow and shallow breathing
  4. Psychosis leading to dementia

17) Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

  1. “Be sure to take glipizide 30 minutes before meals.”
  2. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.”
  3. “You won’t need to check your blood glucose level after you start taking glipizide.”
  4. “Take glipizide after a meal to prevent heartburn.”

18) What type of cells secrete insulin?

  1. Beta cells
  2. Alpha cells
  3. Plasma cells
  4. Acinar cells

19) A 65-year-old female who has diabetes mellitus and has sustained a large laceration on her left wrist asks the nurse, “How long will it take for my scars to disappear?” which statement would be the nurse’s best response?

  1. “The contraction phase of wound healing can take 2 to 3 years.”
  2. “Wound healing is very individual but within 4 months the scar should fade.”
  3. “With your history and the type of location of the injury, it’s hard to say.”
  4. “If you don’t develop an infection, the wound should heal any time between 1 and 3 years from now.”

20) The nurse enters a patient’s room and sees the patient breathing rapidly with a fruity breath smell. This is known as…

  1. Trousseau’s
  2. Cullen’s
  3. Kussmaul’s
  4. Bitot’s

21) The nurse is performing wound care on a foot ulcer in a client with type 1 diabetes mellitus. Which technique demonstrates surgical asepsis?

  1. Putting on sterile gloves then opening a container of sterile saline.
  2. Cleaning the wound with a circular motion, moving from outer circles toward the center.
  3. Changing the sterile field after sterile water is spilled on it.
  4. Placing a sterile dressing ½” (1.3 cm) from the edge of the sterile field.

22) A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:

  1. “The test needs to be repeated following a 12-hour fast.”
  2. “It looks like you aren’t following the prescribed diabetic diet.”
  3. “It tells us about your sugar control for the last 3 months.”
  4. “Your insulin regimen needs to be altered significantly.”

23) A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?

  1. “You’ll need more insulin when you exercise or increase your food intake.”
  2. “You’ll need less insulin when you exercise or reduce your food intake.”
  3. “You’ll need less insulin when you increase your food intake.”
  4. “You’ll need more insulin when you exercise or decrease your food intake.”

24) An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, nurse Lily teaches the client to treat hypoglycemia by ingesting:

  1. 2 to 5 g of a simple carbohydrate.
  2. 10 to 15 g of a simple carbohydrate.
  3. 18 to 20 g of a simple carbohydrate.
  4. 25 to 30 g of a simple carbohydrate.

25) Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching when the client states:

  1. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
  2. “The drug makes my pancreas release more insulin.”
  3. “I should never take insulin while I’m taking this drug.”
  4. “It’s best if I take the drug with the first bite of a meal.”

26) Which of the following is not true about Type I DM?

  1. May be linked to autoimmunity
  2. Onset usually prior to age 20
  3. Beta islet cells destroyed
  4. Does not require insulin injections

27) Which of the following is caused by insulin release?

  1. Increased breakdown of fats
  2. Increase breakdown of proteins
  3. Decreased blood sugar
  4. Causes glucose to be phosphorylated in kidney

28) The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?

  1. “I will make sure I eat breakfast within 2 hours of taking my insulin.”
  2. “I will need to carry candy or some form of sugar with me all the time.”
  3. “I will eat a snack around three o’clock each afternoon.”
  4. “I can save my dessert from supper for a bedtime snack.”

29) Which of the following is not an accurate test for diabetes?

  1. Glucose tolerance test
  2. HbA
  3. Fasting glucagon test

30) A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to

  1. A social worker from the local hospital
  2. An occupational therapist from the community center
  3. A physical therapist from the rehabilitation agency
  4. Another client with diabetes mellitus and takes insulin

31) Which of the following is not true about Type II DM?

  1. Considered adult onset diabetes
  2. Cause unknown may be due to genetics
  3. Require insulin 80% of cases
  4. May take a drug that sensitize cells or increase insulin release

32) Which of the following is not an indicator of a hypoglycemic condition?

  1. Fatigue
  2. Poor appetite
  3. Tachycardia
  4. Confusion

33) Glucagon increases blood levels of glucose by causing liver to breakdown glycogen.

  1. TRUE
  2. FALSE

34) A patient with a history of diabetes mellitus is in the second post-operative day following cholecystectomy. She has complained of nausea and isn’t able to eat solid foods. The nurse enters the room to find the patient confused and shaky. Which of the following is the most likely explanation for the patient’s symptoms?

  1. Anesthesia reaction.
  2. Hyperglycemia.
  3. Hypoglycemia.
  4. Diabetic ketoacidosis.

35) A urine test in an undiagnosed diabetic may show……..

  1. glucose and ketones in the urine
  2. glucose and high amounts of bilirubin in the urine
  3. ketones in the urine
  4. ketones and adrenaline in the urine

36) A client has a medical history of rheumatic fever, type 1 (insulin dependent) diabetes mellitus, hypertension, pernicious anemia, and appendectomy. She’s admitted to the hospital and undergoes mitral valve replacement surgery. After discharge, the client is scheduled for a tooth extraction. Which history finding is a major risk factor for infective endocarditis?

  1. appendectomy
  2. pernicious anemia
  3. diabetes mellitus
  4. valve replacement

37) Of the following types of insulin, which is the most rapid acting?

  1. Humalog
  2. Regular
  3. NPH
  4. Ultralente

38) The nurse’s first action upon finding a patient with mild hypoglycemia is to…

  1. Call the rapid response team
  2. Give 1 mg of glucagon
  3. Give 10-15 g of CHO or Orange juice
  4. Give insulin

39) After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do?

  1. Initiate insulin therapy.
  2. Switch the client to a different oral antidiabetic agent.
  3. Prescribe an additional oral antidiabetic agent.
  4. Restrict carbohydrate intake to less than 30% of the total caloric intake.

40) When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?

  1. sulfisoxazole (Gantrisin)
  2. mexiletine (Mexitil)
  3. prednisone (Orasone)
  4. lithium carbonate (Lithobid)

41) A male client with diabetes mellitus is receiving insulin. Which statement correctly describes an insulin unit?

  1. It’s a common measurement in the metric system.
  2. It’s the basis for solids in the avoirdupois system.
  3. It’s the smallest measurement in the apothecary system.
  4. It’s a measure of effect, not a standard measure of weight or quantity.

42) The physician has prescribed Novalog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?

  1. “I will make sure I eat breakfast within 10 minutes of taking my insulin.”
  2. “I will need to carry candy or some form of sugar with me all the time.”
  3. “I will eat a snack around three o’clock each afternoon.”
  4. “I can save my dessert from supper for a bedtime snack.”

43) Which of the following would not be considered an acute effect of diabetes mellitus?

  1. Polyuria
  2. Weight gain
  3. Polydipsia
  4. Polyphagia

44) Which instruction about insulin administration should nurse Kate give to a client?

  1. “Always follow the same order when drawing the different insulins into the syringe.”
  2. “Shake the vials before withdrawing the insulin.”
  3. “Store unopened vials of insulin in the freezer at temperatures well below freezing.”
  4. “Discard the intermediate-acting insulin if it appears cloudy.”

45) Which of the following drugs may be given as an immunosuppressant soon after onset of Type I Diabetes?

  1. Torsemide
  2. Cyclosporine
  3. Clofibrate
  4. Ceftriaxone

46) As blood glucose decreases glucagon is inhibited.

  1. TRUE
  2. FALSE

47) Of the following categories of oral antidiabetic agents, which exert their primary action by directly stimulating the pancreas to secrete insulin?

  1. Sulfonylureas
  2. Thiazolidinediones
  3. Biguanides
  4. Alpha glucosidase inhibitors

48) The nurse enters a diabetic patient’s room at 11:30 and notices that the patient is diaphoretic, tachycardic, anxious, states she is hungry, and doesn’t remember where she is. This patient is most likely showing signs of what?

  1. hyperglycemic
  2. hypoglycemic
  3. diabetic ketoacidosis
  4. hyperosmolar hyperglycemic noketotic coma

49) A client with type 1 diabetes mellitus who’s a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 diabetes mellitus:

  1. Weekly fetal movement counts are made by the mother.
  2. Contraction stress testing is performed weekly.
  3. Induction of labor is begun at 34 weeks’ gestation.
  4. Nonstress testing is performed weekly until 32 weeks’ gestation

50) The diabetic patient’s lab work comes back with a pH of 7.4, serum blood sugar of 950, serum osmolarity of 460, pCO2 of 35, HCO3 of 25. The patient is confused and dehydrated. This patient is showing signs and symptoms of….

  1. Diabetic ketoacidosis
  2. hyperosmolar hyperglycemic noketotic coma
  3. Hypoglycemia
  4. diabetic neuropathy

51) The nurse teaches the patient about glargine (Lantus), a “peakless” basal insulin including which of the following statements?

  1. Do not mix the drug with other insulins
  2. Administer the total daily dosage in two doses.
  3. Draw up the drug first, then add regular insulin.
  4. The drug is rapidly absorbed and has a fast onset of action

52) Which of the following is not related to a chronic diabetes mellitus condition?

  1. Atherosclerosis
  2. Neuropathy
  3. Glaucoma
  4. Hypotension

53) During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise?

  1. At least once a week
  2. At least three times a week
  3. At least five times a week
  4. Every day

54) For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?

  1. They contain exudate and provide a moist wound environment.
  2. They protect the wound from mechanical trauma and promote healing.
  3. They debride the wound and promote healing by secondary intention.
  4. They prevent the entrance of microorganisms and minimize wound discomfort.

55) A client with type 1 diabetes mellitus has been on a regimen of multiple daily injection therapy. He’s being converted to continuous subcutaneous insulin therapy. While teaching the client bout continuous subcutaneous insulin therapy, the nurse would be accurate in telling him the regimen includes the use of:

  1. intermediate and long-acting insulins
  2. short and long-acting insulins
  3. short-acting only
  4. short and intermediate-acting insulins

56) Patients with Type 1 diabetes mellitus 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 diabetic agents.

57) At a senior citizens meeting a nurse talks with a client who has diabetes mellitus Type 1. Which statement by the client during the conversation is most predictive of a potential for impaired skin integrity?

  1. “I give my insulin to myself in my thighs.”
  2. “Sometimes when I put my shoes on I don’t know where my toes are.”
  3. “Here are my up and down glucose readings that I wrote on my calendar.”
  4. “If I bathe more than once a week my skin feels too dry.”

58) Which of the following is not considered an endocrine hormone?

  1. Renin
  2. Insulin
  3. Glucagon
  4. Somatostatin

59) A patient arrives at the ED with a blood sugar of 578, serum osmolarity of 300, pH of 7.3, severe thirst, dehydration, and confusion. The patient is breathing rapidly and has a fruity breath smell. This patient has symptoms of……

  1. Diabetic ketoacidosis
  2. hyperosmolar hyperglycemic noketotic coma
  3. Hypoglycemia
  4. diabetic neuropathy

60) A 27-year-old woman has Type I diabetes mellitus. She and her husband want to have a child so they consulted her diabetologist, who gave her information on pregnancy and diabetes. Of primary importance for the diabetic woman who is considering pregnancy should be

  1. a review of the dietary modifications that will be necessary.
  2. early prenatal medical care.
  3. adoption instead of conception.
  4. understanding that this is a major health risk to the mother.

61) Clients with diabetes mellitus require frequent vision assessment. The nurse should instruct the client about which of the following eye problems most likely to be associated with diabetes mellitus?

  1. Cataracts
  2. Retinopathy
  3. Astigmatism
  4. Glaucoma

62) Which of the following is not an adverse effect of glucagon?

  1. Allergic reaction
  2. Vomiting
  3. Nausea
  4. Fever

63) Which of the following is not an adverse effect of oral hypoglycemics?

  1. Hypoglycemia
  2. Headache
  3. Rashes
  4. Projectile vomiting

64) A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits, during which diabetic teaching has been implemented. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy?

  1. “Are you sure all this insulin won’t hurt my baby?”
  2. “I’ll probably need my daily insulin dose raised.”
  3. “I will continue to take my regular dose of insulin.”
  4. “These finger sticks make my hand sore. Can I do them less frequently?”

65) A nurse assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he’s impotent and says that he’s concerned about its effect on his marriage. In planning this client’s care, the most appropriate intervention would be to:

  1. Encourage the client to ask questions about personal sexuality
  2. Provide time for privacy
  3. Provide support for the spouse or significant other
  4. Suggest referral to a sex counselor or other appropriate professional

66) Patricia a 20 year old college student with diabetes mellitus requests additional information about the advantages of using a pen like insulin deliverydevices. The nurse explains that the advantages of these devices over syringes includes:

  1. Accurate dose delivery
  2. Shorter injection time
  3. Lower cost with reusable insulin cartridges
  4. Use of smaller gauge needle.

67) Which of the following clinical characteristics is associated with Type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus [NIDDM])?

  1. Can control blood glucose through diet and exercise
  2. Usually thin at diagnosis
  3. Ketosis-prone
  4. Demonstrate islet cell antibodies

68) The nurse teaches the patient about diabetes including which of the following statements?

  1. Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision.
  2. Sugar is found only in dessert foods.
  3. The only diet change needed in the treatment of diabetes is to stop eating sugar.
  4. Once insulin injections are started in the treatment of Type 2 diabetes, they can never be discontinued.

69) Glucagon causes increased blood sugar and causes slow breakdown of glycogen in the liver.

  1. TRUE
  2. FALSE

70) Insulin inhibits the release of _______.

  1. Glucagon
  2. ADH
  3. Beta cells
  4. Somatostatin
Answers and Rationales
  1. C. 15 to 20 g of a fast-acting carbohydrate such as orange juice. This client is having a hypoglycemic episode. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn’t administer insulin to a client who’s hypoglycemic; this action will further compromise the client’s condition.
  2. B. With breakfast. Glucotrol XL is given once a day with breakfast. Answer A is incorrect because the client would develop hypoglycemia while sleeping. Answers C and D are incorrect because the client would develop hypoglycemia later in the day or evening. 
  3. B. The client has good control of her diabetes. The client’s diabetes is well under control. Answer A is incorrect because it will lead to elevated glycosylated hemoglobin. Answer C is incorrect because the diet and insulin dose are appropriate for the client. Answer D is incorrect because the desired range for glycosylated hemoglobin in the adult client is 2.5%–5.9% 
  4. D. Give 1 mg glucagon
  5. B. has type 2 diabetes. Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren’t effective in type 1 diabetes. Pregnant and lactating women aren’t prescribed oral antidiabetic agents because the effect on the fetus is uncertain.
  6. C. Peptic ulcers
  7. A. Presence of islet cell antibodies . Individuals with Type 1 diabetes often have islet cell antibodies. Individuals with Type 1 diabetes are usually thin or demonstrate recent weight loss at the time of diagnosis. Individuals with Type 1 diabetes are ketosis-prone when insulin is absent. Individuals with Type 1 diabetes need insulin to preserve life.
  8. A. Delayed gastric emptying, C. Glomuerular injury D. Bleeding of retinal caplillaries , F. Impotence 
  9. D. Cardiovascular disease
  10. A. Oral anticoagulants . As a normal body protein, glucagon only interacts adversely with oral anticoagulants, increasing the anticoagulant effects. It doesn’t interact adversely with anabolic steroids, beta-adrenergic blockers, or thiazide diuretics.
  11. B. To check for any cuts, sores, or dry cracked skin so they can be treated early to prevent infection or gangrene.
  12. B. Alpha cells 
  13. D. Suggest referral to a sex counselor or other appropriate professional. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client’s care. The nurse doesn’t normally provide sex counseling.
  14. A. Amputations (BKA) , B. Cardiovascular disease , D. Peripheral neuropathy, F. Retinopathy , G. Cardio neuropathy , H. Coma, I. Nephropathy, J. Arteriosclerosis , M. Infections 
  15. D. Decreased fat metabolism
  16. C. Slow and shallow breathing 
  17. A. “Be sure to take glipizide 30 minutes before meals.”The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The drug doesn’t cause hyponatremia and therefore doesn’t necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy.
  18. A. Beta cells 
  19. C. “With your history and the type of location of the injury, it’s hard to say.”. Wound healing in a client with diabetes will be delayed. Providing the client with a time frame could give the client false information.
  20. C. Kussmaul’s
  21. C. Changing the sterile field after sterile water is spilled on it. A sterile field is considered contaminated when it becomes wet. Moisture can act as a wick, allowing microorganisms to contaminate the field. The outside of containers, such as sterile saline bottles, aren’t sterile. The containers should be opened before sterile gloves are put on and the solution poured over the sterile dressings placed in a sterile basin. Wounds should be cleaned from the most contaminated area to the least contaminated area—for example, from the center outward. The outer inch of a sterile field shouldn’t be considered sterile.
  22. C. “It tells us about your sugar control for the last 3 months.” The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn’t require a fasting period before blood is drawn. The nurse can’t conclude that the result occurs from poor dietary management or inadequate insulin coverage.
  23. B. “You’ll need less insulin when you exercise or reduce your food intake.” Exercise, reduced food intake, hypothyroidism, and certain medications decrease the insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase the insulin requirements.
  24. B. 10 to 15 g of a simple carbohydrate. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
  25. A. “If I have hypoglycemia, I should eat some sugar, not dextrose.”Acarbose delays glucose absorption, so the client should take an oral form of dextrose rather than a product containing table sugar when treating hypoglycemia. The alpha-glucosidase inhibitors work by delaying the carbohydrate digestion and glucose absorption. It’s safe to be on a regimen that includes insulin and an alpha-glucosidase inhibitor. The client should take the drug at the start of a meal, not 30 minutes to an hour before.
  26. D. Does not require insulin injections
  27. C. Decreased blood sugar
  28. C. “I will eat a snack around three o’clock each afternoon.” NPH insulin peaks in 8–12 hours, so a snack should be offered at that time. NPH insulin onsets in 90–120 minutes, so answer A is incorrect. Answer B is untrue because NPH insulin is time released and does not usually cause sudden hypoglycemia.
  29. C. Fasting glucagon test 
  30. B. An occupational therapist from the community center. An occupational therapist can assist a client to improve the fine motor skills needed to prepare an insulin injection.
  31. C. Require insulin 80% of cases
  32. B. Poor appetite 
  33. A. TRUE
  34. C. Hypoglycemia. A post-operative diabetic patient who is unable to eat is likely to be suffering from hypoglycemia. Confusion and shakiness are common symptoms. An anesthesia reaction would not occur on the second post-operative day. Hyperglycemia and ketoacidosis do not cause confusion and shakiness.
  35. A. glucose and ketones in the urine 
  36. D. valve replacement. A heart valve prosthesis, such as a mitral valve replacement, is a major risk factor for infective endocarditis. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, IV drug abuse, and immunosuppression. Although diabetes mellitus may predispose a person to cardiovascular disease, it isn’t a major risk factor for infective endocarditis, nor is an appendectomy or pernicious anemia.
  37. A. Humalog . The onset of action of rapid-acting Humalog is within 10-15 minutes. The onset of action of short-acting regular insulin is 30 minutes-1 hour. The onset of action of intermediate acting NPH is 3-4 hours. The onset of action of long-acting Ultralente is 6-8 hours.
  38. C. Give 10-15 g of CHO or Orange juice
  39. B. Switch the client to a different oral antidiabetic agent. Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldn’t be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent.
  40. A. sulfisoxazole (Gantrisin). Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn’t cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.
  41. D. It’s a measure of effect, not a standard measure of weight or quantity. An insulin unit is a measure of effect, not a standard measure of weight or quantity. Different drugs measured in units may have no relationship to one another in quality or quantity.
  42. A. “I will make sure I eat breakfast within 10 minutes of taking my insulin.”  Novalog insulin onsets very quickly, so food should be available within 10–15 minutes of taking the insulin. Answer B does not address a particular type of insulin, so it is incorrect. NPH insulin peaks in 8–12 hours, so a snack should be eaten at the expected peak time. It may not be 3 p.m. as stated in answer C. Answer D is incorrect because there is no need to save the dessert until bedtime.
  43. B. Weight gain
  44. A. “Always follow the same order when drawing the different insulins into the syringe.” The client should be instructed always to follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin also should never be frozen because the insulin protein molecules may be damaged. Intermediate-acting insulin is normally cloudy.
  45. B. Cyclosporine
  46. B. FALSE
  47. A. Sulfonylureas . A functioning pancreas is necessary for sulfonylureas to be effective.
  48. B. hypoglycemic
  49. D. Nonstress testing is performed weekly until 32 weeks’ gestation. For most clients with type 1 diabetes mellitus, nonstress testing is done weekly until 32 weeks’ gestation and twice a week to assess fetal well-being.
  50. B. hyperosmolar hyperglycemic noketotic coma 
  51. A. Do not mix the drug with other insulins . Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.
  52. D. Hypotension
  53. B. At least three times a week . Diabetic clients must exercise at least three times a week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a week wouldn’t achieve these goals. Exercising more than three times a week, although beneficial, would exceed the minimum requirement.
  54. C. They debride the wound and promote healing by secondary intention. For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by secondary intention. Moist, transparent dressings contain exudate and provide a moist wound environment. Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort. Dry sterile dressings protect the wound from mechanical trauma and promote healing.
  55. C. short-acting only. Continuous subcutaneous insulin regimen uses a basal rate and boluses of short-acting insulin. Multiple daily injection therapy uses a combination of short-acting and intermediate or long-acting insulins.
  56. C. More insulin. During periods of infection or illness, patients with Type 1 diabetes may need even more insulin to compensate for increased blood glucose levels.
  57. B. “Sometimes when I put my shoes on I don’t know where my toes are.” Peripheral neuropathy can lead to lack of sensation in the lower extremities. Clients do not feel pressure and/or pain and are at high risk for skin impairment.
  58. A. Renin 
  59. A. Diabetic ketoacidosis 
  60. B. early prenatal medical care. A review of dietary modifications is important once the woman is pregnant. However, it is not of primary importance when considering pregnancy. Pregnancy makes metabolic control of diabetes more difficult. It is essential that the client start prenatal care early so that potential complications can be controlled or minimized by the efforts of the client and health care team. The alternative of adoption is not necessary just because the client is a diabetic. Many diabetic women have pregnancies with successful outcomes if they receive good care. While there is some risk to the pregnant diabetic woman, it is not considered a major health risk. The greater risk is to the fetus.
  61. B. Retinopathy
  62. D. Fever 
  63. D. Projectile vomiting 
  64. B. “I’ll probably need my daily insulin dose raised.” The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. As a result of placental maturation and placental production of lactogen, insulin requirements begin increasing in the second trimester and may double or quadruple by the end of pregnancy. The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. Insulin doses depend on blood glucose levels. Finger sticks for glucose levels must be continued.
  65. D. Suggest referral to a sex counselor or other appropriate professional. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client’s care. The nurse doesn’t normally provide sex counseling. Therefore, providing time for privacy and providing support for the spouse or significant other are important, but not as important as referring the client to a sex counselor.
  66. A. Accurate dose delivery. These devices are more accurate because they are easily to used and have improved adherence in insulin regimens by young people because the medication can be administered discreetly.
  67. A. Can control blood glucose through diet and exercise . Oral hypoglycemic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful. Individuals with Type 2 diabetes are usually obese at diagnosis. Individuals with Type 2 diabetes rarely demonstrate ketosis, except in stress or infection. Individuals with Type 2 diabetes do not demonstrate islet cell antibodies.
  68. A. Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision. When blood glucose levels are well controlled, the potential for complications of diabetes is reduced.
  69. B. FALSE
  70. A. Glucagon 

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