Chapter 38: Care of Patients With Diabetes and Hypoglycemia: Multiple Choice

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Chapter 38: Care of Patients with Diabetes and Hypoglycemia

MULTIPLE CHOICE
1. The nurse explains to a newly diagnosed type 1 diabetic that the beta cells can no
longer produce adequate insulin because:
a. they are inhibited by pituitary disorder.
b. an allergic response has altered their response to hyperglycemia.
c. alpha cells have proliferated in the islets of Langerhans.
d. the bodys immune system has destroyed them.
ANS: D
In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are
destroyed by an autoimmune reaction.
DIF: Cognitive Level: Comprehension REF: 857 OBJ: 1 (clinical)
TOP: Type 1 Diabetes Mellitus (DM): Etiology
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. The nurse uses a visual aid to demonstrate that among diabetics, type 2 diabetics
comprise up to _____% of all known cases.
a. 70
b. 75
c. 80
d. 95
ANS: D
Type 2 diabetics comprise 90% to 95% of all known cases.
DIF: Cognitive Level: Comprehension REF: 857 OBJ: 1 (theory)
TOP: Type 2 Diabetes Mellitus: Incidence
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
3. The nurse recognizes a need for further information when a young woman with
gestational diabetes says:
a. Gestational diabetes results from the hormonal changes of pregnancy.
b. I will need to exercise regularly and lose weight to reduce my risk of becoming a diabetic
c. Ill be free of diabetes when this baby is born.
d. The baby will have to be monitored for hypoglycemia during my pregnancy.
ANS: C
Of the women who have gestational diabetes, 5% to 10% go on to develop type 2
diabetes.
DIF: Cognitive Level: Application REF: 857-858 OBJ: 2 (theory)
TOP: Gestational Diabetes: Risks KEY: Nursing Process Step: Evaluation
4. A patient asks the nurse if stress can be a potential cause of type 2 diabetes. What
should be included in the response provided by the nurse?
Stress decreases the number of alpha cells in the pancreas, thus increasing the workload o
a. cells.
b. Periods of stress cause increases in glycogen production by the adrenal cortex.
c. Stress is directly associated with decreased insulin tolerance.
d. The inhibition of beta cells to glucose is increased in periods of stress.
ANS: B
Stress stimulates the adrenal cortex to release glucocorticoids, which can cause
hyperglycemia.
DIF: Cognitive Level: Application REF: 858 OBJ: 2 (theory)
TOP: Diabetes Mellitus: Metabolic Risks
5. The nurse counsels the 30-year-old woman with type 2 diabetes who is overweight
and noncompliant that control of diabetes would most improve if she were to:
a. lose weight.
b. take more Glucophage.
c. eat a high-protein diet.
d. take insulin.
ANS: A
Type 2 diabetes is prevalent in the obese. Of the known cases, 80% of them are
overweight. Loss of weight decreases hyperglycemia.
TOP: Diabetes Mellitus: Modifiable Risks
6. The patient inquires about the significance of islet cell antibodies. The nurses most
informative response is that islet cell antibodies:
a. will cause beta cells to quit producing insulin, resulting in diabetes mellitus (DM).
b. protect beta cells from viral attack.
c. increase production of insulin from beta cells.
d. decrease the size of the pancreas.
ANS: A
The antibodies cause beta cells to quit production of insulin.
TOP: Diabetes Mellitus: Islet Cell Antibodies
7. The nurse reinforces the American Diabetes Associations recommendation that all
people over age 45, especially if overweight, monitor themselves for diabetes by:
a. having regularly scheduled fasting blood glucose level testing.
b. adhering to weight reduction diets.
c. exercising regularly.
d. using stress reduction techniques.
ANS: A
The ADA recommends screening with a fasting blood glucose. The other options are
helpful with controlling diabetes but do not monitor for diabetes.
TOP: ADA Recommendations: Screening
8. A patient recently diagnosed with type 1 diabetes mellitus questions the nurse about
her increased thirst level. What should be included in the response by the nurse?
a. Diabetes results in a lack of protein absorption causing reduced amino acids, resulting in
b. Elevated levels of blood glucose pull cellular water into circulating volume.
c. Thirst results from the bodys increased loss of fluids through polyuria.
d. Appetites of both food and water signal the changes of diabetes.
ANS: B
Polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling
intracellular fluid into the circulating volume.
DIF: Cognitive Level: Application REF: 859 OBJ: 2 (clinical)
TOP: Polydipsia: Pathophysiology KEY: Nursing Process Step: Assessment
9. The nurse is caring for a patient who was hospitalized with ketosis. The nurse
recognizes that the patient correctly understands the phenomenon when she reports
what about the condition?
a. I had taken too much insulin to decrease my bodys levels of glucose.
b. The condition resulted when my body tried to break down and use my stores of fats.
c. When my blood glucose goes over 150 mg/dL, I am at risk for this condition.
d. I was exercising too much and had too sharp reductions in my blood glucose level.
ANS: B
Persons with type 1 diabetes are more prone to a serious complication, ketosis,
associated with an excess production of ketone bodies, leading to ketoacidosis
(metabolic acidosis). When the glucose level gets too high the body attempts to
metabolize fats for energy, and the result is a buildup of ketone bodies.
TOP: Ketosis: Etiology KEY: Nursing Process Step: Implementation

10. At 2:00 AM, the CNA reports that a patient with type 1 diabetes is extremely wet
with perspiration, is cool to the touch, and is complaining of hunger. The nurse
should:
a. give insulin by sliding scale based on glucometer reading.
b. notify the night supervisor of the patients deteriorating condition.
c. give 6 ounces of orange juice.
d. ambulate the patient in the hall to use up excess glucose with exercise.
ANS: C
Hypoglycemia is a common complication of type 1 diabetes mellitus. Most often it is
a response to either too large a dose of insulin or too much exercise in relation to the
amount of food eaten. Symptoms of hypoglycemia include tremulousness, hunger,
headache, pallor, sweating, palpitations, blurred vision, and weakness. Management
includes providing a source of quick-acting carbohydrate/glucose. Insulin is used to
manage hyperglycemia, not hypoglycemia. The patients condition is likely easily
managed by the interventions noted and will not warrant notification of the
supervisor. The patient will not benefit from exercise as he has limited serum glucose.
TOP: Hypoglycemia: Nursing Interventions
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
11. The nurse would anticipate laboratory values from a patient in ketoacidosis to
reveal:
a. increased blood urea nitrogen (BUN).
b. normal or decreased CO2.
c. increased arterial pH.
d. decreased glucose.
ANS: A
Diabetic ketoacidosis results when the body attempts to metabolize protein and fats,
which results in high BUN readings. The CO2 should be normal or low depending on
the effectiveness of Kussmauls respirations. The arterial pH will be low, and there
will be high glucose, which the diabetic patient cannot use.
DIF: Cognitive Level: Analysis REF: 859 OBJ: 5 (clinical)
TOP: Ketoacidosis: Laboratory Values KEY: Nursing Process Step: Assessment
12. The patient comes to the emergency room with dry hot skin, fruity breath, and
deep respirations and is complaining of abdominal pain. The nurse interprets these
signs and symptoms as:
a. an insulin reaction.
b. ketoacidosis.
c. rebound hyperglycemia.
d. hypoglycemia.
ANS: B
All the signs and symptoms mentioned are characteristics of ketoacidosis. An insulin
reaction may be referred to as hypoglycemia. The symptoms of hypoglycemia:
tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and
weakness. Rebound hyperglycemia, also known as the Somogyi effect, follows a
period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body
secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects
of low blood sugar. The patient may report nightmares and night sweats along with
morning elevated serum glucose; if the patient increases the insulin dose, it worsens
the problem.
TOP: Ketoacidosis: Indicators KEY: Nursing Process Step: Assessment
13. The nurse is aware that diabetics are prone to infection, which can be attributed to:
a. high glucose levels.
b. atherosclerotic vascular changes.
c. deficient protein reserve.
d. inadequacy of blood cell production.
ANS: B
People with diabetes are prone to infection, delayed healing, and vascular diseases.
Poor control of diabetes makes the person prone to develop an infection. The
propensity for infection is thought to be partly a result of decreased normal function of
leukocytes and abnormal phagocyte function. Another contributing factor to infection
and delayed healing probably is decreased blood supply to the tissues because of
atherosclerotic changes in the blood vessels. An impaired blood supply means a
deficit in the protective cells brought by the blood to a site of injury.
TOP: Diabetes Mellitus: Infections KEY: Nursing Process Step: Assessment
14. The nurse notes that the HbA1c level of an assigned patient demonstrated a drop
from 9.4% to 5.4%. What inference can best be made about this patient?
a. The patient is demonstrating improved control of hyperglycemia over the last several mon
b. The patient has been less compliant with the prescribed treatment regimen.
c. The patient is experiencing a reduction in insulin sensitivity.
d. The patient has less need for insulin.

ANS: A
HbA1c is a diagnostic assessment used to review blood glucose levels retrospectively.
A reduction in the value indicates improved glucose control by the patient. There is no
evidence of insulin sensitivity. The need for insulin is not decreased in this patient.
TOP: Type 1 DM: HbA1c KEY: Nursing Process Step: Evaluation
15. The nurse cautions that the technique of tight control of hyperglycemia is not
recommended for the older adult because the older adult:
a. may not be able to test and administer sliding-scale insulin.
b. is at a lower risk for hyperglycemia.
c. is prone to cardiovascular problems resultant from hypoglycemia.
d. has an unstable metabolic rate.
ANS: C
Hypoglycemia is a complication of the tight control method of controlling
hyperglycemia. Older adults experience hypoglycemia more quickly than do younger
people, and the elderly are more prone to hypoglycemic episodes. The older adult may
progress to dangerously low levels of blood glucose before signs and symptoms are
obvious. Severe hypoglycemia in the older adult can precipitate myocardial infarction,
angina, stroke, or seizures. For this reason, tight control may not be the best thing for
the older adult.
TOP: Tight Control of Hyperglycemia: Older Adult
16. The diet of the diabetic is geared toward adequate nutrition and:
a. control of weight.
b. exclusion of all sweets.
c. increase in fats for energy.
d. avoidance of all fast foods.
ANS: A
The much less stringent diet of the diabetic is focused on adequate nutrition and
weight and cholesterol control. The newer diets allow for some sweets and some fast
foods. Fats are not adequate sources of energy. Fat intake should be limited to reduce
complications related to weight gain and cardiovascular concerns.
TOP: Diabetes Mellitus: Diet KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance
17. The patient takes his NovoLog 70-30 at 7:00 AM. The nurse suggests the best time
to schedule exercise would be at:
a. 7:30 AM before peak action of insulin.
b. 10:00 AM at peak action of insulin.
c. 1:00 PM after peak action of insulin.
d. any time after injection.
ANS: C
Exercise should occur after peak action time to prevent hypoglycemia. NovoLog is a
rapid-acting insulin that peaks 1 to 3 hours after administration.
TOP: Exercise: Schedule KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
18. The nurse is discussing insulin administration with an assigned patient. The patient
reports that she prefers to use only certain sites for insulin injections. The patient
questions why rotation of the sites is important. What response by the nurse is most
appropriate?
a. Rotating your injection sites will help to reduce your risk of infection.
b. If you do not rotate injection sites you are at risk for an erratic absorption of your medicat
c. Unsightly fatty tumors can develop when you do not adequately rotate injection sites.
d. Failing to rotate injection sites will improve your ability prevent an insulin reaction.
ANS: B
Insulin injections are rotated within one body area to enhance absorption. Patients are
given charts showing the places on the arms, legs, buttocks, and abdomen where
insulin can be injected. Patients should be encouraged to keep a daily record of
injection sites to help remember which sites have been used and to avoid the problem
of altered or erratic absorption, which is a complication associated with overuse of a
single site. The most important way to reduce the incidence of infection is to wash the
hands before insulin administration and to avoid reusing syringes. Fatty tumors are
not complications of overuse of a single injection site. The term insulin reaction refers
to hypoglycemia. Hypoglycemia is not directly associated with the failure to rotate
injection sites.
TOP: Insulin Injection: Site Rotation KEY: Nursing Process Step: Implementation
19. A long-term diabetic patient reports that the physician has told him he has the early
symptoms of cardiovascular disease. The nurse correctly understands that diabetes
predisposes the patient to cardiovascular complications for which reason?
The periods of hyperglycemia that result in diabetes damage the basement membrane cau
a. atherosclerosis.
b. Hypoglycemic periods result in increased release of cortisol resulting in hypertension.

c. Insulin constricts the cardiovascular vessels.
d. Diabetes causes a decrease in the bodys ability to digest fats by the pancreas.
ANS: A
Periods of hyperglycemia cause thickening of the vessels, chiefly the basement
membrane (thin layer of connective tissue under the epithelium). The vessels of the
retina, renal glomeruli, peripheral nerves, muscles, and skin are affected. Larger
vessels also are affected, predisposing the patient to atherosclerosis and vascular
occlusion. Two out of three people with diabetes die prematurely from heart attack or
stroke.
TOP: Cardiovascular Complications: Etiology
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance
20. The nurse is caring for a patient who is experiencing problems with maintaining
glycemic control at night and during the early morning hours. The nurse correctly
recognizes that:
a. hyperglycemia is produced from counterregulatory hormones.
b. hyperglycemia of dawn phenomenon does not react to insulin.
c. hypoglycemia quickly follows the dawn phenomenon.
d. hyperglycemia of dawn phenomenon is not changed by food intake.
ANS: A
Dawn phenomenon is produced in the morning by the circadian release of growth
hormones, epinephrine, and glucagon during the night.
TOP: Diabetes Mellitus: Dawn Phenomenon
KEY: Nursing Process Step: Assessment
21. A patient with type 1 diabetes mellitus is preparing for a moderate 30-minute
exercise period. Which action best indicates understanding of condition management?
a. The patient reduces insulin use during days when exercise periods are planned.
b. The patient administers insulin after exercise rather than before exercise.
c. The patient eats a high-carbohydrate snack before the exercise period.
d. The patient consumes a simple carbohydrate snack after 30 minutes of activity.
ANS: D
During moderate exercise (such as brisk walking, bowling, or vacuuming), 5 g of
simple carbohydrate should be consumed at the end of 30 minutes and at 30-minute
intervals during the continued activity. (A food example with 5 g of simple
carbohydrate is 1 tsp honey.)

TOP: Increasing Food During Exercise KEY: Nursing Process Step: Evaluation
22. The nurse is reviewing the patients prescribed insulin regimen. The nurse notes
that the physician has ordered a long-lasting insulin. Which medication will best meet
this criteria?
a. Lantus
b. NovoLog
c. Humalog
d. Regular
ANS: A
Lantus is a long-lasting insulin. It may be administered only one time per day.
NovoLog and Humalog are both rapid-onset insulin preparations. Regular insulin is
classified as a short-acting insulin.
TOP: Table 38-3 Common Types of Insulin: Onset, Peak, and Duration of Action
KEY: Nursing Process Step: Evaluation
MULTIPLE RESPONSE
23. The nurse explains that genetic factor(s) that increase(s) the risk of a person
developing diabetes mellitus include: (Select all that apply.)
a. the number of relatives who have diabetes mellitus.
b. whether the relatives are related on the maternal side.
c. whether the relatives are male.
d. the genetic closeness of the relatives.
e. severity of the relatives disease.
ANS: A, D, E
Neither the gender nor the family side of the relationship is significant.
TOP: Diabetes Mellitus: Genetic Etiology
24. The nurse is aware that among the microbiologic factor(s) that may cause diabetes
mellitus are: (Select all that apply.)
a. hepatitis B.
b. coxsackievirus.
c. influenza virus.
d. chickenpox.
e. mumps.
ANS: B, C, E
Coxsackievirus, mumps, and influenza are suspected to be the virus-related causes of
diabetes mellitus.
TOP: Diabetes Mellitus: Microbiologic Etiology
KEY: Nursing Process Step: Assessment
25. The nurse is aware that the weight loss experienced by type 1 diabetics is
attributed to: (Select all that apply.)
a. loss of body fluid.
b. insulin intolerance.
c. metabolization of body fats.
d. stress of disease.
e. altered diet.
ANS: A, C
Weight loss in type 1 diabetics can be attributed to loss of body fluids and
metabolization of fats.
TOP: Diabetes Mellitus: Weight Loss KEY: Nursing Process Step: Assessment
26. The nurse outlines the criteria for tight control of hyperglycemia as: (Select all that
apply.)
a. glucose testing two times a day.
b. insulin injections three times a day based on glucometer readings.
c. fasting glucose remaining within normal limits.
d. maintaining normal weight for height and age.
e. maintaining cholesterol within normal limits.
ANS: B, C, D, E
Patients attempting tight control follow an intensive therapy plan of blood glucose
testing and insulin injections, three or more times a day, or they use an insulin pump.
The protocol for control of diabetes mellitus is highly individualized and depends on
the type of diabetes a person has, age, general state of health, ability to follow the
prescribed regimen, and acceptance of responsibility for managing the illness, along
with a host of other factors.
TOP: Diabetes Mellitus: Tight Control KEY: Nursing Process Step: Implementation
27. When discussing exercise programs with the diabetic, the nurse should stress that
the patient should: (Select all that apply.)
a. delay the exercise program until glucose is under control.
b. check glucose after exercise.
c. have a quick source of glucose available while exercising.
d. begin slowly and build up to 30 to 45 minutes.
e. use abdomen only for injection site for insulin.
ANS: A, C, D, E
All options should be observed by the diabetic who exercises except the patient
should check the glucose level before exercise rather than after.
TOP: Diabetes Mellitus: Exercise KEY: Nursing Process Step: Implementation
28. The nurse is caring for a patient suspected of having ketoacidosis. What early
manifestation(s) may be noted with this condition? (Select all that apply.)
a. Fruity breath
b. Polyuria
c. Nausea
d. Thirst
e. Sunken eyes
ANS: A, B, D
Ketoacidosis is a complication associated with type 1 diabetes. Some of the earliest
symptoms may be polyuria, fatigue, anorexia, abdominal pain, and a fruity smell to
the breath. Later signs and symptoms will include sunken eyes as a result of excessive
dehydration. Nausea is not associated with ketoacidosis.
DIF: Cognitive Level: Analysis REF: 861 OBJ: 4 (theory)
TOP: Types of Diabetes: Characteristics KEY: Nursing Process Step: Assessment
29. The nurse is observing a patient administer insulin. Which observation indicates
the need for further instruction? (Select all that apply.)
a. The patient uses a 90-degree angle to administer the injection.
b. The patient cleans the injection site with alcohol before the injection.
c. The patient rubs the injection site after administration of the insulin injection.
d. The patient draws up the cloudy insulin and then the clear insulin.
e. The patient shakes the insulin bottle before administration.
ANS: C, D, E
When administering insulin the site is cleaned with alcohol before the injection but
not after. Rubbing will alter the rate of absorption. When mixing two types of insulin
the clear should be drawn into the syringe first. This prevents contamination of the
second vial. Shaking the bottle can damage the solution. The bottle should be gently
rolled between the palms of the hands.
TOP: Patient Teaching: Guidelines for Subcutaneous Insulin Injection
KEY: Nursing Process Step: Evaluation
COMPLETION
30. The nurse explains that the three cardinal signs of type 1 diabetes mellitus are
__________, __________, and __________.
ANS:
polydipsia, polyphagia, polyuria
polydipsia, polyuria, polyphagia
polyphagia, polyuria, polydipsia
polyphagia, polydipsia, polyuria
polyuria, polydipsia, polyphagia
polyuria, polyphagia, polydipsia
The three Pspolydipsia, polyphagia, and polyuriaare the cardinal signs of diabetes.
TOP: Type 1 Diabetes Mellitus: Cardinal Signs
MATCHING
The nurse associates the type of diabetes with the characteristics that may be seen
with the specific disease. Match the type of diabetes with the symptoms that are
associated with it. (The options may be used once, more than once, or not at all.)
a. Type 1
b. Type 2
c. Gestational
d. Prediabetes
31. Weight loss and exercise can delay onset of diabetes
32. Occurs during pregnancy
33. Adult onset
34. Little or no endogenous insulin
35. Threat of renal, retinal, and neurologic complications
36. Rarely develops ketosis
31. ANS: D DIF: Cognitive Level: Analysis REF: 857
OBJ: 1 (theory) TOP: Types of Diabetes: Characteristics

32. ANS: C DIF: Cognitive Level: Analysis REF: 857
33. ANS: B DIF: Cognitive Level: Analysis REF: 857
34. ANS: A DIF: Cognitive Level: Analysis REF: 857
35. ANS: A DIF: Cognitive Level: Analysis REF: 857
36. ANS: B DIF: Cognitive Level: Analysis REF: 857

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Chapter 38: Care of Patients with Diabetes and Hypoglycemia

TOP: Ketosis: Etiology KEY: Nursing Process Step: Implementation

d. The patient has less need for insulin.

b. Hypoglycemic periods result in increased release of cortisol resulting in hypertension.

DIF: Cognitive Level: Analysis REF: 875 OBJ: 1 (clinical)

MSC: NCLEX: Health Promotion and Maintenance

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