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DM Concepts
DM Concepts
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
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. Diaphoresis
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%
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.
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
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