Wynne Erica P.

Englatiera
Block AAA

3RD APPRAISAL EXAM

1. Which of the following is the best definition of diabetes mellitus?

a. It is a group of metabolic diseases in which high blood glucose results from defective
insulin secretion or action.
b. It is a disease that causes polyuria and polydipsia.
c. It is a disease characterized by macrovascular and microvascular complications.
d. It is a complex disease of protein and fat metabolism.
2. Which of the following is a risk factor for type 2 diabetes mellitus?
a. Cardiovascular disease
b. Obesity
c. Age younger than 40 years
d. Virus exposure
3. Diabetes is diagnosed when the fasting blood glucose is greater than or equal to 126 mg/dL
(7.0 mmol/L).
4. Which of the following symptoms is most commonly associated with hyperglycemia?
a. Tremor
b. Flank pain
c. Sweating
d. Polyuria
5. Protein in the urine is a sign of which long-term complication of diabetes?
a. Nephropathy
b. Neuropathy
c. Retinopathy
d. Gastroparesis
6. What is the best way for patients to avoid long-term complications of diabetes?
 a. See the doctor for a complete check-up every 6 months.
b. Check feet daily.
c. Maintain blood sugar levels under 126 mg/dL.
d. Follow a strict 1500-calorie diet.
7. Place the steps for mixing insulin in correct sequential order.
a. Draw up cloudy insulin 6
b. Draw up clear insulin 5
c. Roll cloudy vial 1
d. Inject air into cloudy insulin 3
e. Inject air into clear insulin 4
f. Clean vial tops with alcohol 2
8. Type 1 Diabetes Mellitus is characterized by the following. Select all that apply.
a. the beta cells in the pancreas are destroyed or suppressed
b. little or no endogenous insulin
c. increased thirst (polydipsia), increased urination (polyuria), and increased hunger
(polyphagia) resulting are the classic symptoms of diabetes.
d. the most powerful predictor is obesity
e. often have islet cell antibodies
9. Type 2 Diabetes Mellitus is characterized by the following. Select all that apply.
a. the beta cells in the pancreas are destroyed or suppressed
b. little or no endogenous insulin
c. increased thirst (polydipsia), increased urination (polyuria), and increased hunger
(polyphagia) resulting are the classic symptoms of diabetes.
d. the most powerful predictor is obesity
e. often have islet cell antibodies
10. The diagnosis of Prediabetes is confirmed by the following assessment & laboratory
findings. Select all that apply.
a. Fasting plasma glucose 100 to 125 mg/dL (IFG)
 b. oral glucose tolerance test (OGTT) 140 to199 mg/dL (IGT)
c. polyuria, polydipsia, and unexplained weight loss.
d. HbA1C: 5.7%–-6.4%
11. Which of the following are true regarding Gestational Diabetes Mellitus? Select all that
apply.
a. It is a disorder of glucose intolerance that is diagnosed in the postpartum period.
b. Placental hormones and weight gain are contributing factors.
c. High infant birth weight and neonatal hyperglycemia are common complications.
d. Gestational diabetes is a risk factor for the later development of type 2 diabetes.
12. Which of the following comprises the risk factors for Gestational Diabetes Mellitus? Select
all that apply.
a. severe obesity
b. history of gestational diabetes
c. previous offspring weighing more than 9 lb at birth
d. presence of glycosuria
e. strong family history of type 2 diabetes
13. Nurse Juliah is attending a diabetic patient in her unit. As she has her usual morning rounds,
she is more concerned on the following clinical manifestations of hypoglycemia which include
the following. Select all that apply.
a. cold and clammy skin
b. diaphoresis
c. headache
d. abdominal pain
14. This refers to a rise in blood glucose concentration in the early morning hours attributed to
increased growth hormone, cortisol, glucagon, and epinephrine release Dawn effect/Dawn
Phenomenon.
15. A client’s blood gases reflect diabetic acidosis. The nurse should expect:
a. increased pH
b. decreased PO2
 c. Increased PCO2
d. decreased HCO3
16. A client is in diabetic ketoacidosis (DKA) secondary to infection. As the condition
progresses, which of the following symptoms might the nurse see?
a. Kussmaul’s respirations and a fruity odor on the breath
b. Shallow respirations and severe abdominal pain
c. decreased respiration & increased urine output
d. Cheyne-stokes respirations and foul-smelling urine
17. Which of the following statement is INCORRECT about Diabetic Ketoacidosis?
a. Serum osmolality exceeds 320 mOsm/kg
b. Ketones are present in the urine
c. Metabolic acidosis is present with Kussmaul breathing
d. Hypovolemic shock can lead to death if the patient is not promptly treated.
18. The major electrolyte of concern during treatment of DKA is:
a. Sodium
b. bicarbonate
c. Potassium
d. Calcium
19. Severe diabetic ketoacidosis may lead to what electrolyte imbalance/s?
a. hyponatremia
b. hypokalemia
c. hypochloremia
d. hypomagnesemia
d. all of the above
e. a & b & c
20. Obesity is the strongest risk factor for type 2 diabetes.
21. Because type 2 diabetes mellitus is a progressive disease, many (if not most) individuals will
need insulin at some time, either because of increasing insulin resistance or because of β-cell
dysfunction.
a. True b. False
22. It is considered to be the most common complication of hyperglycemic therapy and the most
hazardous hypoglycemia.

23. A client with type 2 diabetes mellitus has a blood glucose level higher than 600 mg/dL and is
complaining of polydipsia, polyuria, weight loss, and weakness. A nurse reviews the physician's
documentation and would expect to note which of the following diagnoses?
a. Hypoglycemia
b. Pheochromocytoma
c. Diabetic ketoacidosis (DKA)
d. Hyperglycemic hyperosmolar syndrome (HHS)
24. A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of
hypoglycemia with exercising. Which statement by the client indicates an inadequate
understanding of the peak action of NPH insulin and exercise?
a. “The best time for me to exercise is after I eat.”
b. “The best time for me to exercise is after breakfast.”
c. “The best time for me to exercise is mid- to late afternoon.”
d. “The best time for me to exercise is after my morning snack.”
25. A patient is diagnosed with type 1 diabetes. The nurse knows that all of the following are
probable clinical characteristics except:
a. ketosis-prone.
b. little endogenous insulin.
c. obesity at diagnoses.
d. younger than 30 years.
26. A nurse went to a patient’s room to do routine vital signs monitoring and found out that the
patient’s bedtime snack was not eaten. This should alert the nurse to check and assess for:
a. elevated serum bicarbonate and decreased blood pH
 b. Signs of hypoglycemia earlier than expected
c. Symptoms of hyperglycemia during the peak time of NPH insulin
d. Sugar in the urine
27. A male nurse is providing a bedtime snack for his patient. This is based on the knowledge
that intermediate-acting insulins are effective for an approximate duration of:
a. 6-8 hours
b. 10-14 hours
c. 14-18 hours
d. 24-28 hours
28. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:
a. blurred vision
b. diaphoresis
c. nausea
d. weakness
29. The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should
expect the following symptoms during an assessment, except:
a. hypoglycemia
b. frequent bruising
c. ketonuria
d. dry mouth
30. The tissue area that provides the fastest absorption rate for regular insulin is believed to be
the:
a. abdominal area.
b. anterior thigh.
c. deltoid area.
d. gluteal site.
31. A child with type 1 diabetes mellitus is brought to an emergency room
by the mother, who states that the child has been complaining of
abdominal pain and has a fruity odor of the breath. Diabetic
ketoacidosis is diagnosed. Anticipating the plan of care, the nurse
prepares to administer:
a. Potassium IV infusion
b. NPH insulin IV infusion
c. 5% dextrose IV infusion
d. Normal saline IV infusion
32. If the patient’s blood glucose level is low, but he or she is not exhibiting any symptoms, the
nurse should:
a. give 2 or 3 glucose tablets to the patient
b. change the present IVF to D5 LR
c. double check he glucose level to ensure that it is correct
d. record the blood glucose level
33. Teenager Clarence, an 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 Clarence is given NPH insulin at 7:30. Meals are served at 8:30, 12:30, and
6:30. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the
hours of:
a. 11:30 and 1:30
b. 1:30 and 7:30
c. 3:30 and 9:30
d. 5: 30 and 10: 30
34. A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations
and tells the nurse he has type 1 diabetes mellitus. Which of the following actions should the
nurse do first?
a. Inject 1 mg of glucagon subcutaneously
b. Administer 50 mL of 50% glucose I.V
c. Give 4 to 6 oz (118 to 177 mL) of orange juice
d. Give the client four to six glucose tablets
35. The non-diabetic client is admitted for a kidney infection that has now turned septic. The
blood sugars have increased from 150 to 225, what is the best answer to give a family member
who is asking why insulin is used?
 a. The client now has type 2 diabetes because of the infection.
b. Insulin is given to control the hypoglycemia.
c. High sugar is common during infection and stress to the body, the insulin will help
lower the sugar until the infection resolves.
d. Insulin administration causes release of the counter- regulatory hormones, thus
decreasing the blood sugar during infection.
36. Possible risk factors associated with type 1 diabetes mellitus include:
a. an autoimmune susceptibility to diabetogenic viruses.
b. environmental factors.
c. the presence of human leukocyte antigen (HLA).
d. all of the above.
37. Clinical manifestations associated with a diagnosis of type 1 diabetes mellitus include all of
the following except:
a. hypoglycemia.
b. hyponatremia.
c. ketonuria.
d. polyphagia.
38. A nurse is assigned to care for a patient who is suspected of having type 2 diabetes mellitus.
Clinical manifestations for which the nurse should assess include:
a. blurred or deteriorating vision.
b. fatigue and muscle cramping.
c. wounds that heal slowly or respond poorly to treatment.
d. all of the above.
39. The nurse should encourage exercise in the management of diabetes, because it:
a. decreases total triglyceride levels.
b. improves insulin utilization.
c. lowers blood glucose.
d. accomplishes all of the above.
40. Self-monitoring of blood glucose is recommended for patients with:
a. abnormal renal glucose thresholds.
b. hypoglycemia without warning symptoms.
c. unstable diabetes.
d. all of the above conditions.
41. The nurse is teaching a client with newly diagnosed Type 1 diabetes about insulin therapy.
Which statement indicates the client needs more teaching concerning insulin therapy?
a. “If I have a headache or start getting nervous, I will drink some orange juice.”
b. “If I pass out at home, a family member should give me a glucagon injection.”
c. “Because I am taking my insulin daily I do not have to adhere to a diabetic diet.”
d. “I will check my blood glucose with my glucometer at least once a day.”
42. The nurse is discussing storage of insulin vials with the client. Which statement indicates the
client understands the teaching concerning the storage of insulin?
a. “I will keep my unopened vials of insulin in the refrigerator.”
b. “I can keep my insulin in the trunk of my car so I will have it at all times.”
c. “It is all right to put my unopened insulin vials in the freezer.”
d. “If I prefill my insulin syringes, I must use them within 1–2 days.”
43. The client diagnosed with Type 2 diabetes is prescribed the sulfonylurea glipizide
(Glucotrol). Which statement by the client would warrant intervention by the nurse?
a. “I have to eat my diabetic diet even if I am taking this medication.”
b. “I will need to check my blood glucose level at least once a day.”
c. “I usually have one glass of wine with my evening meal.”
d. “I do not like to walk every day, but I will if it will help my diabetes.”
44. The client with Type 2 diabetes is admitted into the medical department with a wound on the
left leg that will not heal. The HCP prescribes sliding-scale insulin. The client tells the nurse, “I
don’t want to have to take shots. I take pills at home.” Which statement would be the nurse’s best
response?
a. “If you can’t keep your glucose under control with pills, you must take insulin.”
 b. “You should discuss the insulin order with your HCP because you don’t want to take
it.”
c. “You are worried about having to take insulin. I will sit down and we can talk.”
d. “During illness you may need to take insulin to keep your blood glucose level down.”
45. The nurse is caring for the client diagnosed with Type 2 diabetes. The client is complaining
of a headache, jitteriness, and nervousness. Which action should the nurse implement first?
a. Check the client’s serum blood glucose level.
b. Give the client a glass of orange juice.
c. Determine when the last antidiabetic medication was administered.
d. Assess the client’s blood pressure and apical pulse.
46. Which of the following laboratory test/s confirms the diagnosis of diabetes? Select all that
apply.
a. Casual Plasma glucose test 200 mg/dL
b. Fasting plasma glucose 130 mg/dl
c. Oral glucose tolerance test 150 mg/dL
d. HbA1C/glycated hemoglobin 6 %
47. Which of the following conditions lead to hypoglycemia? Select all that apply.
a. error in insulin dose (above intended dose)
b. sepsis
c. surgery
d. increased exercise
e. steroids
f. alcohol
48. Which medication could mask the clinical manifestations of hypoglycemia?
a. Metoprolol
b. Albuterol
c. Spironolactone
d. Prednisone
49. The nurse knows that an intermediate-acting insulin should reach its “peak” in:
a. 1 to 2 hours.
b. 3 to 4 hours.
c. 4 to 12 hours.
d. 16 to 20 hours.
50. A probable candidate for diabetic management with oral antidiabetic agents is the patient
who is:
a. non–insulin-dependent.
b. stable and not prone to ketosis.
c. unable to be managed by diet alone.
d. characterized by all of the above.
Test 2. Discussion
1. Discuss the essential elements in the patient education concerning foot care.

The essential elements in the patient education concerning foot care includes:

 All patients should be assessed for neuropathy and undergo evaluation of

neurologic status by an experienced examiner using a monofilament. Pressure
areas, such as calluses, or thick toenails should be treated by a podiatrist in
addition to routine trimming of nails.
 Additional aspects of preventive foot care include the following:
o Patients with bony deformities may need custom-made shoes with extra
width or depth. High-risk behaviors, such as walking barefoot, using
heating pads on the feet, wearing open-toed shoes, soaking the feet, and
shaving calluses, should be avoided.
o Drying
o Lubricating the feet
o Taking care not to allow moisture (water or lotion) to accumulate between
the toes
o Reducing risk factors, such as smoking and elevated blood lipids, that
contribute to peripheral vascular disease.
o Avoiding home remedies, over-the-counter agents, and self-medicating to
treat foot problems.
o Blood glucose control is important for avoiding decreased resistance to
infections and for preventing diabetic neuropathy.
o Properly bathing
o Trimming toenails straight across and filing sharp corners to follow the
contour of the toe. If the patient has visual deficits, is unable to reach the
feet because of disability, or has thickened toenails, a podiatrist should cut
the nails.
o Wearing closed-toed shoes that fit well. A podiatrist can provide the
patient with inserts (orthotics) to remove pressure from pressure points on
the foot. New shoes should be broken in slowly (i.e., worn for 1 to 2 hours
 initially, with gradual increases in the length of time worn) to avoid blister
formation.
o Emphasize the importance of never going barefoot. It’s possible that you
could step on something and hurt your feet without being aware of it.
o Instruct patient to maintain proper foot hygiene by ensuring proper
washing and drying of feet every day, using warm water to avoid burns,
and trimming toenails to a natural shape of the nail to prevent cutting your
skin and keep the nails from growing into your skin.
o Instruct patient to protect feet from hot and cold by keeping them away
from heaters and open fires, wearing shoes on hot pavements, and wearing
socks in bed when feeling cold.
o Encourage the patient to avoid crossing legs, wearing garters and tight
socks, and applying lotions containing alcohol.
o Emphasize daily inspection of feet for any cuts, sores, blisters, swelling,
redness, or any other change.
o Encourage the usage of well-fit leather shoes and cotton socks.
o Encourage the patient to have his/her feet checked at least once a year,
preferably three to four times a year, for loss of sensation.
o Encourage easy and foot-friendly activities such as walking, dancing,
riding a bike, or swimming.
o Instruct patient to report any abnormalities immediately and seek prompt
care.
o Encourage the patient to see a podiatrist regularly to help treat foot
problems.
o Urge the patient to quit smoking as this can impair blood circulation which
can worsen foot problems.
o Emphasize management of blood sugar levels which should stay within
normal levels.

2. . Mrs. Evans is a 68-year-old woman with type 2 diabetes who resides in an assisted
living facility. She is on 42 units of NPH insulin every morning.
a. If Mrs. Evans eats her breakfast at 8:00 every morning, when
should she take her insulin?
If Mrs. Evans eats her breakfast at 8:00 every morning, she should
take her insulin not later than 7:30 a.m, because onset is around 30 minutes.
Peaks in about 2 to 3 hours. Therefore, her insulin should usually be taken
about 30 to 60 minutes before her breakfast.

b. At what time of day should she be alert for symptoms of low

blood sugar?
Although Mrs. Evans insulin peaks between 1:30 p.m. and 7:30 p.m.,
she should be alert for low blood sugar at midafternoon to just before supper.
Mrs. Evans chances of having a hypoglycemic episode will be slim once she
has eaten her supper.

c. What could happen if Mrs. Evans has a busy day and misses
her lunch?
If Mrs. Evans misses a meal; this will result to her blood sugar
dropping further. This can increase her risk of having a hypoglycemic
episode.
Missing a meal would only cause her blood sugar levels to be lower
than normal and medication may drop them even more, which can lead to
hypoglycemia. Hypoglycemia can cause shakiness, passing out, or even
going into a coma.

YOU ARE ALL BLESSED IN CHRIST!