DM-2

Diabetes - Prep-U/Test Bank
Study online at https://quizlet.com/_eqkqlu
1. A client with diabetes melli- A. hypoglycemia

tus is receiving an oral an-
tidiabetic agent. When car- Rationale: The nurse should observe the
ing for this client, the nurse client receiving an oral antidiabetic agent for
should observe for signs of: the signs of hypoglycemia. The time when the
reaction might occur is not predictable and
A. hypoglycemia could be from 30 to 60 minutes to several
B. polyuria hours after the drug is ingested.
C. blurred vision
D. polydipsia
2. A health care provider pre- A. 8:30 AM.

scribes short-acting insulin
for a patient, instructing the Rationale: Short-acting insulin reaches its
patient to take the insulin 20 peak effectiveness 2 to 3 hours after admin-
to 30 minutes before a meal. istration. See Table 30-3 in the text.
The nurse explains to the pa-
tient that Humulin-R taken at
6:30 AM will reach peak ef-
fectiveness by:
A. 8:30 AM.
B. 10:30 AM.
C. 12:30 PM.
D. 2:30 PM.
3. The nurse is taking the his- C. Erectile dysfunction

tory of a client with di-
abetes who is experienc- Rationale: Autonomic neuropathy affects or-
ing autonomic neuropathy. gan functioning. According the American Di-
Which would the nurse ex- abetes Association, up to 50% of men with
pect the client to report? diabetes develop erectile dysfunction when
nerves that promote erection become im-
A. Skeletal deformities paired. Skeletal deformities and soft tissue
B. Paresthesias ulcers may occur with motor neuropathy.
C. Erectile dysfunction Paresthesias are associated with sensory
D. Soft tissue ulceration neuropathy.
4.
1 / 55
During a follow-up visit 3 C. Glycosylated hemoglobin level
months after a new diag-
nosis of type 2 diabetes, a Rationale:
client reports exercising and Glycosylated hemoglobin is a blood test that
following a reduced-calo- reflects the average blood glucose concen-
rie diet. Assessment re- tration over a period of approximately 2 to
veals that the client has 3 months. When blood glucose is elevated,
only lost 1 pound and did glucose molecules attach to hemoglobin in
not bring the glucose-mon- red blood cells. The longer the amount of
itoring record. Which value glucose in the blood remains above normal,
should the nurse measure? the more glucose binds to hemoglobin and
the higher the glycosylated hemoglobin level
A. Fasting blood glucose lev- becomes.
el
B. Glucose via a urine dip-
stick test
C. Glycosylated hemoglobin
level
D. Glucose via an oral glu-
cose tolerance test
5. After being sick for 3 days, A. Serum potassium level

a client with a history of dia-
betes mellitus is admitted to Rationale: The nurse should monitor the
the hospital with diabetic ke- client's potassium level because during pe-
toacidosis (DKA). The nurse riods of acidosis, potassium leaves the cell,
should evaluate which diag- causing hyperkalemia. As blood glucose
nostic test results to prevent levels normalize with treatment, potassium
dysrhythmias? reenters the cell, causing hypokalemia if lev-
els aren't monitored closely. Hypokalemia
A. Serum potassium level places the client at risk for cardiac arrhyth-
B. Serum calcium level mias such as ventricular tachycardia. DKA
C. Serum sodium level has a lesser affect on serum calcium, sodi-
D. Serum chloride level um, and chloride levels. Changes in these
levels don't typically cause cardiac arrhyth-
mias.
6. The nurse is explaining gly- D. Reflects the amount of glucose stored in

cosylated hemoglobin test- hemoglobin over past several months.
2 / 55
ing to a diabetic client. Which
of the following provides the Rationale: Hemoglobin A1c tests reflect the
best reason for this order? amount of glucose that is stored in the he-
moglobin molecule during its life span of 120
A. Provides best information days. This test provides a more accurate pic-
on the body's ability to main- ture of overall glucose control in a client. Gly-
tain normal blood function- cosylated hemoglobin test does not indicate
ing normal blood functioning or nutritional state
B. Best indicator for the nu- of the client. Self-monitoring with a glucome-
tritional state of the client ter is still encouraged in clients who are tak-
C. Is less costly than per- ing insulin or have unstable blood glucose
forming daily blood sugar levels.
test
D. Reflects the amount of
glucose stored in hemo-
globin over past several
months.
7. Health teaching for a patient C. "You should take your insulin after you eat
with diabetes who is pre- breakfast and dinner."
scribed Humulin N, an inter-
mediate NPH insulin, would Rationale: NPH (Humulin N) insulin is an in-
include which of the follow- termediate-acting insulin that has an onset of
ing advice? 2 to 4 hours, a peak effectiveness of 6 to 8
hours, and a duration of 12 to 16 hours. See
A. "Your insulin will begin to Table 30-3 in the text.
act in 15 minutes."
B. "You should expect your
insulin to reach its peak ef-
fectiveness by 12 noon if you
take it at 8:00 AM."
C. "You should take your in-
sulin after you eat breakfast
and dinner."
D. "Your insulin will last 8
hours, and you will need to
take it three times a day."
8.
3 / 55
A client with diabetes mel- A. 1/2 cup fruit juice or regular soft drink
litus has a blood glucose
level of 40 mg/dL. Which Rationale: In a client with hypoglycemia, the
rapidly absorbed carbohy- nurse uses the rule of 15: give 15 g of rapid-
drate would be most effec- ly absorbed carbohydrate, wait 15 minutes,
tive? recheck the blood sugar, and administer an-
other 15 g of glucose if the blood sugar is not
A. 1/2 cup fruit juice or regu- above 70 mg/dL. One-half cup fruit juice or
lar soft drink regular soft drink is equivalent to the recom-
B. 4 oz of skim milk mended 15 g of rapidly absorbed carbohy-
C. 1/2 tbsp honey or syrup drate. Eight ounces of skim milk is equivalent
D. three to five LifeSavers to the recommended 15 g of rapidly absorbed
candies carbohydrate. One tablespoon of honey or
syrup is equivalent to the recommended 15
g of rapidly absorbed carbohydrate. Six to
eight LifeSavers candies is equivalent to the
recommended 15 g of rapidly absorbed car-
bohydrate.
9. A nurse expects to find D. Nervousness, diaphoresis, and confusion

which signs and symptoms
in a client experiencing hy- Rationale: Signs and symptoms associat-
poglycemia? ed with hypoglycemia include nervousness,
diaphoresis, weakness, light-headedness,
A. Polyuria, headache, and confusion, paresthesia, irritability, headache,
fatigue hunger, tachycardia, and changes in speech,
B. Polyphagia and flushed, hearing, or vision. If untreated, signs and
dry skin symptoms may progress to unconscious-
C. Polydipsia, pallor, and irri- ness, seizures, coma, and death. Polydipsia,
tability polyuria, and polyphagia are symptoms as-
D. Nervousness, diaphore- sociated with hyperglycemia.
sis, and confusion
10. A client has been recent- A. polyphagia.

ly diagnosed with type 2
diabetes, and reports con- Rationale: While the needed glucose is being
tinued weight loss despite wasted, the body's requirement for fuel con-
increased hunger and food tinues. The person with diabetes feels hungry
consumption. This condition and eats more (polyphagia). Despite eating
4 / 55
is called: more, he or she loses weight as the body
uses fat and protein to substitute for glucose.
A. polyphagia.
B. polydipsia.
C. polyuria.
D. anorexia.
11. A nurse is teaching a dia- A. Presence of autoantibodies against islet

betic support group about cells
the causes of type 1 dia-
betes. The teaching is deter-
Rationale: There is evidence of an autoim-
mined to be effective when mune response in type 1 diabetes. This is an
the group is able to attribute
abnormal response in which antibodies are
which factor as a cause of directed against normal tissues of the body,
type 1 diabetes? responding to these tissues as if they were
foreign. Autoantibodies against islet cells and
A. Presence of autoantibod- against endogenous (internal) insulin have
ies against islet cells been detected in people at the time of diag-
B. Obesity nosis and even several years before the de-
C. Rare ketosis velopment of clinical signs of type 1 diabetes.
D. Altered glucose metabo-
lism
12. A nurse is preparing a con- A. 100 units of regular insulin in normal saline
tinuous insulin infusion for solution
a child with diabetic ketoaci-
dosis and a blood glucose Rationale: Continuous insulin infusions use
level of 800 mg/dl. Which so- only short-acting regular insulin. Insulin is
lution is the most appropri- added to normal saline solution and admin-
ate at the beginning of thera- istered until the client's blood glucose lev-
py? el falls. Further along in the therapy, a dex-
trose solution is administered to prevent hy-
A. 100 units of regular in- poglycemia.
sulin in normal saline solu-
tion
B. 100 units of neutral pro-
tamine Hagedorn (NPH) in-
sulin in normal saline solu-
tion
5 / 55
C. 100 units of regular in-
sulin in dextrose 5% in water
D. 100 units of NPH insulin in
dextrose 5% in water
13. A patient who is diagnosed C. Need exogenous insulin.

with type 1 diabetes would
be expected to: Rationale: Type 1 diabetes is characterized
by the destruction of pancreatic beta cells
A. Be restricted to an Amer- that require exogenous insulin.
ican Diabetic Association
diet.
B. Have no damage to the
islet cells of the pancreas.
C. Need exogenous insulin.
D. Receive daily doses of a
hypoglycemic agent.
14. A nurse is teaching a client D. "Ketones accumulate in the blood and

recovering from diabetic ke- urine when fat breaks down in the absence of
toacidosis (DKA) about man- insulin. Ketones signal an insulin deficiency
agement of "sick days." The that will cause the body to start breaking
client asks the nurse why down stored fat for energy."
it is important to monitor
the urine for ketones. Which Rationale: Ketones (or ketone bodies) are
statement is the nurse's best by-products of fat breakdown in the absence
response? of insulin, and they accumulate in the blood
and urine. Ketones in the urine signal an
A. "Ketones are formed insulin deficiency and that control of type 1
when insufficient insulin diabetes is deteriorating. When almost no ef-
leads to cellular starvation. fective insulin is available, the body starts to
As cells rupture, they release break down stored fat for energy.
these acids into the blood."
B. "When the body does
not have enough insulin,
hyperglycemia occurs. Ex-
cess glucose is broken down
by the liver, causing acidic
by-products to be released."
6 / 55
C. "Excess glucose in the
blood is metabolized by the
liver and turned into ke-
tones, which are an acid."
D. "Ketones accumulate in
the blood and urine when
fat breaks down in the ab-
sence of insulin. Ketones
signal an insulin deficiency
that will cause the body to
start breaking down stored
fat for energy."
15. The nurse is preparing a B. Insulin production insufficient

presentation for a group of
adults at a local commu- Rationale: Type 2 diabetes is characterized
nity center about diabetes. by insulin resistance or insufficient insulin
Which of the following would production. It is more common in aging
the nurse include as associ- adults, and now accounts for 20% of all newly
ated with type 2 diabetes? diagnosed cases. Type 1 diabetes is more
likely in childhood and adolescence although
A. Onset most common dur- it can occur at any age. It accounts for ap-
ing adolescence proximately 5% to 10% of all diagnosed cas-
B. Insulin production insuffi- es of diabetes. Pre-diabetes can lead to type
cient 2 diabetes.
C. Less common than type 1
diabetes
D. Little to no relation to
pre-diabetes
16. A nurse educates a group A. Control blood glucose levels.

of clients with diabetes mel-
litus on the prevention of Rationale: Controlling blood glucose levels
diabetic nephropathy. Which and any hypertension can prevent or de-
of the following suggestions lay the development of diabetic nephropathy.
would be most important? Drinking plenty of fluids does not prevent dia-
betic nephropathy. Taking antidiabetic drugs
A. Control blood glucose lev- regularly may help to control blood glucose
els. levels, but it is the control of these levels that
7 / 55
B. Drink plenty of fluids. is most important. A high-fiber diet is unrelat-
C. Take the antidiabetic ed to the development of diabetic nephropa-
drugs regularly. thy.
D. Eat a high-fiber diet.
17. The nurse is preparing to ad- A. NPH

minister intermediate-acting
insulin to a patient with dia- Rationale: Intermediate-acting insulins are
betes. Which insulin will the called NPH insulin (neutral protamine Hage-
nurse administer? dorn) or Lente insulin. Lispro (Humalog) is
rapid acting, Iletin II is short acting, and
A. NPH glargine (Lantus) is very long acting.
B. Iletin II
C. Lispro (Humalog)
D. Glargine (Lantus)
18. Which of the following would A. Diet soda

be considered a "free" item
from the exchange list? Rationale: Free items include unsweetened
iced tea, diet soda, and ice water with lemon.
A. Diet soda A green salad is exchanged for 1 vegetable.
B. Green salad A medium apple is 1 fruit; 1 tsp of olive oil is
C. Medium apple 1 fat.
D. 1 tsp olive oil
19. A client is diagnosed with D. Crying whenever diabetes is mentioned

diabetes mellitus. Which as-
sessment finding best sup- Rationale: A client who cries whenever di-
ports a nursing diagnosis ofabetes is mentioned is demonstrating inef-
Ineffective coping related to
fective coping. A recent weight gain and fail-
diabetes mellitus? ure to monitor blood glucose levels would
support a nursing diagnosis of Noncompli-
A. Recent weight gain of 20 ance: Failure to adhere to therapeutic reg-
lb (9.1 kg) imen. Skipping insulin doses during illness
B. Failure to monitor blood would support a nursing diagnosis of Defi-
glucose levels cient knowledge related to treatment of dia-
C. Skipping insulin doses betes mellitus.
during illness
8 / 55
D. Crying whenever diabetes
is mentioned
20. Which type of insulin acts C. Lispro

most quickly?
Rationale: The onset of action of rapid-acting
A. Regular lispro is within 10 to 15 minutes. The on-
B. NPH set of action of short-acting regular insulin
C. Lispro is 30 minutes to 1 hour. The onset of action
D. Glargine of intermediate-acting NPH insulin is 3 to 4
hours. The onset of action of very long-acting
glargine is ~6 hours.
21. Which statement is true C. A glucose challenge test should be per-

regarding gestational dia- formed between 24 and 28 weeks.
betes?
Rationale: A glucose challenge test should
A. It occurs in most pregnan- be performed between 24 and 28 weeks in
cies. women at average risk. It occurs in less than
B. Onset usually occurs in 10% of all pregnancies. Onset usually oc-
the first trimester. curs in the second or third trimester. There is
C. A glucose challenge test an above-normal risk for perinatal complica-
should be performed be- tions.
tween 24 and 28 weeks.
D. There is a low risk for peri-
natal complications.
22. A 16-year-old client newly C. "Your body is using protein and fat for
diagnosed with type 1 dia- energy instead of glucose."
betes has a very low body
weight despite eating regu- Rationale: Persons with type 1 diabetes, par-
lar meals. The client is upset ticularly those in poor control of the condi-
because friends frequent- tion, tend to be thin because when the body
ly state, "You look anorex- cannot effectively utilize glucose for energy
ic." Which statement by the (no insulin supply), it begins to break down
nurse would be the best re- protein and fat as an alternate energy source.
sponse to help this client un- Patients may be underweight at the onset of
derstand the cause of weight type 1 diabetes because of rapid weight loss
loss due to this condition? from severe hyperglycemia. The goal initially
9 / 55
may be to provide a higher-calorie diet to
A. "I will refer you to a dieti- regain lost weight and blood glucose control.
cian who can help you with
your weight."
B. "You may be having undi-
agnosed infections, causing
you to lose extra weight."
C. "Your body is using pro-
tein and fat for energy in-
stead of glucose."
D. "Don't worry about what
your friends think; the carbo-
hydrates you eat are being
quickly digested, increasing
your metabolism."
23. A client with long-standing C. Deficient knowledge (treatment regimen).

type 1 diabetes is admit-
ted to the hospital with un- Rationale: The client should inject insulin be-
stable angina pectoris. After fore, not after, breakfast and dinner — 30
the client's condition stabi- minutes before breakfast for the a.m. dose
lizes, the nurse evaluates the and 30 minutes before dinner for the p.m.
diabetes management regi- dose. Therefore, the client has a knowledge
men. The nurse learns that deficit regarding when to administer insulin.
the client sees the physician By taking insulin, measuring blood glucose
every 4 weeks, injects in- levels, and seeing the physician regularly,
sulin after breakfast and din- the client has demonstrated the ability and
ner, and measures blood glu- willingness to modify his lifestyle as needed
cose before breakfast and at to manage the disease. This behavior elimi-
bedtime. Consequently, the nates the nursing diagnoses of Impaired ad-
nurse should formulate a justment and Defensive coping. Because the
nursing diagnosis of: nurse, not the client, questioned the client's
health practices related to diabetes manage-
A. Impaired adjustment. ment, the nursing diagnosis of Health-seek-
B. Defensive coping. ing behaviors isn't warranted.
C. Deficient knowledge
(treatment regimen).
D. Health-seeking behaviors
(diabetes control).
10 / 55
24. What is the duration of regu- A. 4 to 6 hours

lar insulin?
Rationale: The duration of regular insulin is
A. 4 to 6 hours 4 to 6 hours; 3 to 5 hours is the duration
B. 3 to 5 hours for rapid-acting insulin such as Novolog. The
C. 12 to 16 hours duration of NPH insulin is 12 to 16 hours. The
D. 24 hours duration of Lantus insulin is 24 hours.
25. A 60-year-old client comes B. Increased hunger

to the ED reporting weak-
ness, vision problems, in- Rationale: The classic symptoms of diabetes
creased thirst, increased uri- are the three Ps: polyuria (increased uri-
nation, and frequent infec- nation), polydipsia (increased thirst), and
tions that do not seem polyphagia (increased hunger). Some of the
to heal easily. The physi- other symptoms include tingling, numbness,
cian suspects that the client and loss of sensation in the extremities and
has diabetes. Which classic fatigue.
symptom should the nurse
watch for to confirm the di-
agnosis of diabetes?
A. Numbness
B. Increased hunger
C. Fatigue
D. Dizziness
26. A client with diabetes is re- A. Metformin

ceiving an oral antidiabetic
agent that acts to help the Rationale: Metformin is a biguanide and
tissues use available insulin along with the thiazolidinediones (rosiglita-
more efficiently. Which of the zone and pioglitazone) are categorized as
following agents would the insulin sensitizers; they help tissues use
nurse expect to administer? available insulin more efficiently. Glyburide
and glipizide which are sulfonylureas, and
A. Metformin repaglinide, a meglitinide, are described as
B. Glyburide being insulin releasers because they stimu-
C. Repaglinide late the pancreas to secrete more insulin.
D. Glipizide
11 / 55
27. A client newly diagnosed B. "Ketones will tell us if your body is using
with diabetes mellitus asks other tissues for energy."
why he needs ketone testing
when the disease affects his Rationale: The nurse should tell the client
blood glucose levels. How that ketones are a byproduct of fat metabo-
should the nurse respond? lism and that ketone testing can determine
A. "The spleen releases ke- whether the body is breaking down fat to
tones when your body can't use for energy. The spleen doesn't release
use glucose." ketones when the body can't use glucose.
B. "Ketones will tell us if your Although ketones can damage the eyes and
body is using other tissues kidneys and help the physician evaluate the
for energy." severity of a client's diabetes, these respons-
C. "Ketones can damage es by the nurse are incomplete.
your kidneys and eyes."
D. "Ketones help the physi-
cian determine how serious
your diabetes is."
28. A child is brought into B. Begin fluid replacements.

the emergency department
with vomiting, drowsiness, Rationale: Management of DKA is aimed at
and blowing respirations. correcting dehydration, electrolyte loss, and
The child's parent reports acidosis before correcting the hyperglycemia
that the symptoms have with insulin.
been progressing through-
out the day. The nurse sus-
pects diabetic ketoacidosis
(DKA). Which action should
the nurse take first in the
management of DKA?
A. Give prescribed antiemet-

ics.
B. Begin fluid replacements.
C. Administer prescribed
dose of insulin.
D. Administer bicarbonate to
correct acidosis.
12 / 55
29. A newly admitted client with D. "Destruction of special cells in the pan-
a diagnosis of type 1 dia- creas causes a decrease in insulin produc-
betes asks the nurse what tion. Glucose levels rise because insulin nor-
caused their diabetes. When mally breaks it down."
the nurse is explaining to the
client the etiology of type Rationale: Type 1 diabetes is characterized
1 diabetes, what process by the destruction of pancreatic beta cells,
should the nurse describe? resulting in decreased insulin production,
unchecked glucose production by the liver,
A. "The tissues in your body and fasting hyperglycemia. Also, glucose de-
are resistant to the action rived from food cannot be stored in the liver
of insulin, making the glu- and remains circulating in the blood, which
cose levels in your blood in- leads to postprandial hyperglycemia. Type 2
crease." diabetes involves insulin resistance and im-
B. "Damage to your pan- paired insulin secretion. The body does not
creas causes an increase in "make" glucose.
the amount of glucose that
it releases, and there is not
enough insulin to control it."
C. "The amount of glucose
that your body makes over-
whelms your pancreas and
decreases your production
of insulin."
D. "Destruction of special
cells in the pancreas caus-
es a decrease in insulin
production. Glucose levels
rise because insulin normal-
ly breaks it down."
30. A client with type 2 diabetes C. Underlying problem of insulin resistance

asks the nurse why he can't
have a pancreatic transplant. Rationale: Clients with type 2 diabetes are
Which of the following would not offered the option of a pancreas trans-
the nurse include as a possi- plant because their problem is insulin resis-
ble reason? tance, which does not improve with a trans-
plant. Urologic complications or the need for
A. Increased risk for urologic exocrine enzymatic drainage are not rea-
13 / 55
complications sons for not offering pancreas transplant to
B. Need for exocrine enzy- clients with type 2 diabetes. Any transplant
matic drainage requires lifelong immunosuppressive drug
C. Underlying problem of in- therapy and is not the factor.
sulin resistance
D. Need for lifelong immuno-
suppressive therapy
31. A nurse is teaching a client B. 15 g of carbohydrates.

with diabetes mellitus about
self-management of his con- Rationale: The nurse should instruct the
dition. The nurse should in- client to administer 1 unit of insulin for every
struct the client to adminis- 15 g of carbohydrates.
ter 1 unit of insulin for every:
A. 10 g of carbohydrates.
B. 15 g of carbohydrates.
C. 20 g of carbohydrates.
D. 25 g of carbohydrates.
32. Insulin is a hormone secret- C. Synthesis of glucose from noncarbohy-

ed by the Islets of Langer- drate sources.
hans and is essential for
the metabolism of carbohy- Rationale: Gluconeogenesis refers to the
drates, fats, and protein. The making of glucose from noncarbohydrates.
nurse understands the phys- This occurs mainly in the liver. Its purpose is
iologic importance of gluco- to maintain the glucose level in the blood to
neogenesis, which refers to meet the body's demands.
the:
A. Transport of potassium.
B. Release of glucose.
C. Synthesis of glucose from
noncarbohydrate sources.
D. Storage of glucose as
glycogen in the liver.
33. Which clinical characteristic A. Presence of islet cell antibodies

is associated with type 1 di-
14 / 55
abetes (previously referred Rationale: Individuals with type 1 diabetes
to as insulin-dependent dia- often have islet cell antibodies and are usu-
betes mellitus)? ally thin or demonstrate recent weight loss at
the time of diagnosis. These individuals are
A. Presence of islet cell anti- prone to experiencing ketosis when insulin
bodies is absent and require exogenous insulin to
B. Obesity preserve life.
C. Rare ketosis
D. Requirement for oral hy-
poglycemic agents
34. Health teaching for a patient C. "You should take your insulin after break-
with diabetes who is pre- fast and after dinner."
scribed Humulin N, an inter-
mediate NPH insulin, would Rationale: NPH (Humulin N) insulin is an in-
include which of the follow- termediate-acting insulin that has an onset of
ing advice? 2 to 4 hours, a peak effectiveness of 4 to 12
hours, and a duration of 16 to 20 hours.
A. "Your insulin will begin to
act in 15 minutes."
B. "You should expect your
insulin to reach its peak ef-
fectiveness by 9:00 AM if you
take it at 8:00 AM."
C. "You should take your in-
sulin after breakfast and af-
ter dinner."
D. "Your insulin will last 8
hours, and you will need to
take it three times a day."
35. Which instruction about in- A. "Always follow the same order when draw-
sulin administration should ing the different insulins into the syringe."
a nurse give to a client?
Rationale: The nurse should instruct the
A. "Always follow the same client to always follow the same order when
order when drawing the dif- drawing the different insulins into the syringe.
ferent insulins into the sy- Insulin should never be shaken because the
ringe." resulting froth prevents withdrawal of an ac-
15 / 55
B. "Shake the vials before curate dose and may damage the insulin
withdrawing the insulin." protein molecules. Insulin should never be
C. "Store unopened vials of frozen because the insulin protein molecules
insulin in the freezer at tem- may be damaged. The client doesn't need
peratures well below freez- to discard intermediate-acting insulin if it's
ing." cloudy; this finding is normal.
D. "Discard the intermedi-
ate-acting insulin if it ap-
pears cloudy."
36. Which assessment finding is D. Fruity breath

most important in determin-
ing nursing care for a client Rationale: The rising ketones and acetone in
with diabetes mellitus? the blood can lead to acidosis and be detect-
ed as a fruity odor on the breath. Ketoaci-
A. Respirations of 12 dosis needs to be treated to prevent further
breaths/minute complications such as Kussmaul respirations
B. Cloudy urine (fast, labored breathing) and renal shutdown.
C. Blood sugar 170 mg/dL A blood sugar of 170 mg/dL is not ideal
D. Fruity breath but will not result in glycosuria and/or trigger
the classic symptoms of diabetes mellitus.
Cloudy urine may indicate a UTI.
37. A client with a tentative di- D. Serum osmolarity

agnosis of hyperosmolar hy-
perglycemic nonketotic syn- Rationale: Serum osmolarity is the most im-
drome (HHNS) has a histo- portant test for confirming HHNS; it's also
ry of type 2 diabetes that is
used to guide treatment strategies and deter-
being controlled with an oral
mine evaluation criteria. A client with HHNS
diabetic agent, tolazamide. typically has a serum osmolarity of more than
Which laboratory test is the350 mOsm/L. Serum potassium, serum sodi-
most important for confirm- um, and ABG values are also measured, but
ing this disorder? they aren't as important as serum osmolarity
for confirming a diagnosis of HHNS. A client
A. Serum potassium level with HHNS typically has hypernatremia and
B. Serum sodium level osmotic diuresis. ABG values reveal acidosis,
C. Arterial blood gas (ABG) and the potassium level is variable.
values
D. Serum osmolarity
16 / 55
38. Laboratory studies indicate C. Serum glycosylated hemoglobin (Hb A1c)

a client's blood glucose level
is 185 mg/dl. Two hours haveRationale: Hb A1c is the most reliable in-
passed since the client ate dicator of glucose use because it reflects
breakfast. Which test would blood glucose levels for the prior 3 months.
yield the most conclusive di-
Although a fasting blood glucose test and
agnostic information about a 6-hour glucose tolerance test yield infor-
the client's glucose use? mation about a client's use of glucose, the
results are influenced by such factors as
A. Fasting blood glucose whether the client recently ate breakfast.
test Presence of ketones in the urine also pro-
B. 6-hour glucose tolerance vides information about glucose use but is
test limited in its diagnostic significance.
C. Serum glycosylated he-
moglobin (Hb A1c)
D. Urine ketones
39. Which findings should the C. Polyuria

nurse expect to assess when D. Polydipsia
completing the health histo- E. Polyphagia
ry of a child admitted for pos-
sible type 2 diabetes? Select Rationale: Type 2 diabetes mellitus is char-
all that apply. acterized by a gradual onset and is most
often associated with obesity and not marked
A. Abrupt onset of symp- weight loss. Type 1 diabetes is most often
toms abrupt and associated with marked weight
B. Marked weight loss loss. Polyuria, polydipsia, and polyphagia are
C. Polyuria frequent assessment findings in both types of
D. Polydipsia diabetes mellitus.
E. Polyphagia
40. The nurse has told the D. "This will tell my doctor what my average
14-year-old adolescent with blood glucose level has been over the last 2
diabetes that the doctor to 3 months."
would like to have a hemo-
globin A1C test performed. Rationale: Hemoglobin A1C (HgbA1C) pro-
Which comment by the client vides the physician or nurse practitioner with
indicates that she under- information regarding the long-term control
stands what this test is for? of glucose levels, as it provides an average
17 / 55
of what the blood glucose levels are over a
A. "That is the test that I take 2 to 3-month period. No fasting is required.
after I have fasted for at least Desired levels for children and adolescents
8 hours." 13 to 19 years are less than 7.5%.
B. "The normal level for my
hemoglobin A1C is between
60 to 100 mg/dl."
C. "I monitor my own blood
glucose every day at home.
I don't see why the doctor
would want this done."
D. "This will tell my doctor
what my average blood glu-
cose level has been over the
last 2 to 3 months."
41. After teaching a group of stu- A. diabetic ketoacidosis

dents about endocrine dis-
orders, the instructor de- Rationale: Insulin deficiency, in association
termines that the teach- with increased levels of counterregulatory
ing was successful when hormones (glucagon, growth hormone, cor-
the students identify insulin tisol, catecholamines) and dehydration, is
deficiency, increased levels the primary cause of diabetic ketoacidosis,
of counterregulatory hor- a life-threatening form of metabolic acidosis
mones, and dehydration as that is a frequent complication of diabetes.
the primary cause of which The liver converts triglycerides (lipolysis) to
condition? fatty acids, which in turn change to ketone
bodies. The accumulation and excretion of
A. diabetic ketoacidosis ketone bodies by the kidneys is called ke-
B. ketone bodies tonuria. Glucosuria is glucose that is spilled
C. ketonuria into the urine.
D. glucosuria
42. The nurse is caring for a A. "Regular exercise will help in the regulation
5-year-old child recently di- of my child's blood sugar levels."
agnosed with type 1 dia- D. "The insulin dosages will be directly asso-
betes. When discussing the ciated to my child's carbohydrate ingestion."
care and management of the E. "We need to rotate insulin injection sites to
disorder with the child's par- prevent complications."
18 / 55
ents, which statement(s) in-
dicates understanding? Se- Rationale: When a child has type 1 diabetes,
lect all that apply. there is an absence of insulin to manage the
metabolism of serum glucose. Regular exer-
A. "Regular exercise will cise is helpful in the maintenance of stable
help in the regulation of my serum glucose levels. Carbohydrate inges-
child's blood sugar levels." tion is linked to the amount of insulin that will
B. "If my child's blood glu- be needed in the body. Carbohydrates break
cose remains stable for a few down and the body needs insulin to metabo-
months, my child can move lize the resulting glucose. The rotation of in-
from injections to pills." sulin injection sites is important. Failing to ro-
C. "When my child is ill and tate injection sites can cause a complication,
unable to eat, we will need lipohypertrophy. Type 1 diabetes means that
to hold the insulin until the the body does not have insulin, so injected
child is able to tolerate flu- insulin is needed to manage it. Oral med-
ids." ications are only an option for those having
D. "The insulin dosages will type 2 diabetes. When the child is ill, it is still
be directly associated to my important that the child with diabetes take the
child's carbohydrate inges- prescribed medications.
tion."
E. "We need to rotate in-
sulin injection sites to pre-
vent complications."
43. A 10-year-old child is new- A. 8.5%

ly diagnosed with type 1
diabetes. The child's hemo- Rationale: The goal for hemoglobin A1C in
globin A1C level is being children between the ages of 6 and 12 years
monitored. The nurse deter- is less than 8%. Therefore, a result of 8.5%
mines that additional inter- would indicate that additional intervention is
vention is needed with the needed to achieve the recommended goal.
child based on which result?
A. 8.5%
B. 6.5%
C. 7.5 %
D. 7.0%
44.
19 / 55
A child with type 1 diabetes A. fruity odor on the breath
is brought to the emergency B. decreased level of consciousness
department. The nurse sus- C. poor skin turgor
pects diabetic ketoacidosis
(DKA) based on which as- Rationale: If insulin deficiency persists and
sessment findings? Select ketone bodies continue to be excreted, the
all that apply. child begins to experience stomach pains,
vomiting, and continued weight loss. Dehy-
A. fruity odor on the breath dration quickly develops as DKA progresses.
B. decreased level of con- The degree of dehydration is assessed while
sciousness the child is weighed and examined. Assess-
C. poor skin turgor ment includes examining the mucous mem-
D. increased urine output branes for moistness, the eyeballs for degree
E. quick capillary refill of depression, the skin for turgor, and the
anterior fontanel (fontanelle), if present, for
depression. The child may also show signs
of impending shock: tachypnea, decreased
output, decreased level of consciousness,
slowed capillary refill, and tachycardia. A
late sign of shock in children is hypotension.
DKA is most commonly present in new-on-
set T1DM or during crises in children with
known type 1 diabetes, but it may also be
found in newly diagnosed type 2 diabetes in
the adolescent age group. Kussmaul respi-
rations and changes in mental status may
ensue. The breath develops a fruity odor in
all children with DKA. If the child becomes
somnolent and advances into a coma, these
are ominous signs of cerebral edema.
45. The nurse is interpreting C. insulin

the negative feedback sys-
tem that controls endocrine Rationale: Feedback is seen in endocrine
function. What secretion will systems that regulate concentrations of
the nurse correlate as de- blood components such as glucose. Glu-
creasing while blood glucose from the ingested lactose or sucrose
cose levels decrease? is absorbed in the intestine and the level
of glucose in blood rises. Elevation of blood
20 / 55
A. glucagon glucose concentration stimulates endocrine
B. adrenocorticotropic hor- cells in the pancreas to release insulin. In-
mone sulin has the major effect of facilitating entry
C. insulin of glucose into many cells of the body; as a
D. glycogen result, blood glucose levels fall. When the lev-
el of blood glucose falls sufficiently, the stimu-
lus for insulin release disappears and insulin
is no longer secreted. Glycogen is stored in
the liver and muscles. It is released to provide
energy when the blood glucose levels fall.
Glucagon is also produced by the pancreas.
Its job is to force the liver to release stored
insulin when the body has a need for more
insulin. The adrenocorticotropic hormone is
produced by the anterior pituitary. Its function
is to regulate cortisol. This is needed so the
adrenal glands can function properly. It also
helps the body respond to stress.
46. A child who has type 1 dia- A. Regular insulin

betes mellitus is brought to
the emergency department Rationale: Insulin for diabetic ketoacidosis is
and diagnosed with diabet- given intravenously. Only regular insulin can
ic ketoacidosis. What treat- be administered by this route.
ment would the nurse expect
to administer?
A. Regular insulin
B. Lispro
C. NPH
D. Detemir
47. A child and her parents are B. "Kids can usually be managed with an oral
being seen in the office after agent, meal planning, and exercise."
discharge from the hospital
with a new diagnosis of type Rationale:
2 diabetes. Which statement Treating type 2 diabetes in children may re-
by the nurse is true? quire insulin at the outset if the child is acidot-
ic and acutely ill. More commonly, the child
21 / 55
A. "You are lucky that you did can be managed initially with oral agents,
not have to learn how to give meal planning, and increased activity. Telling
yourself a shot." the child that she is lucky she did not have
B. "Kids can usually be man- to learn how to give a shot might scare her,
aged with an oral agent, meal so it will inhibit her from seeking future health
planning, and exercise." care. The condition will not rectify itself if all
C. "This will rectify itself if orders are followed. A weight-loss program
you follow all of the doctor's might need to be implemented but that is not
directions." always the case.
D. "A weight-loss program
should be implemented and
maintained."
48. The nurse is talking with a D. "This is caused by insulin resistance from
parent of an adolescent who previous pancreatic injury or generalized in-
is newly diagnosed with type fection."
2 diabetes and asks, "How
could this happen? No one Rationale: Type 2 diabetes is now seen in
in our family has diabetes." overweight adolescents as well as those who
What response would be ap- eat a diet high in fats and carbohydrates
propriate? and do not exercise regularly. Pancreatic mal-
function is not a cause of type 2 diabetes.
A. "This is caused by This disorder is not linked to inadequate in-
the pancreas not making gestion of daily calories. This disorder may
enough insulin." have a genetic link, but environmental factors
B. "This disorder usually oc- such as obesity, diet, and exercise can influ-
curs when inadequate calo- ence its development. Type 2 diabetes is a
ries are ingested on a regu- result of insulin resistance in the metabolism
lar basis." of glucose to maintain normal blood glucose
C. "Because this disorder is levels, but it is not associated with infection
genetic, someone in the fam- or a previous pancreatic injury.
ily will eventually develop
the illness."
D. "This is caused by in-
sulin resistance from previ-
ous pancreatic injury or gen-
eralized infection."
49.
22 / 55
The nurse is preparing to ad- A. 0815
minister the child's ordered
lispro (Humalog) insulin at Rationale: The onset of rapid-acting insulins
0800. When will the child's like lispro (Humalog) is within 15 minutes.
blood glucose level begin to The onset of short-acting insulin is 30 to 60
decline? minutes. The onset of intermediate-acting in-
sulin is 1-3 hours, and long-acting insulin's
A. 0815 onset is 1-2 hours.
B. 0845
C. 0900
D. 0930
50. A child presents to C. Type 1 diabetes mellitus

the primary care setting
with enuresis, nocturia, in- Rationale: Signs and symptoms of type 1 di-
creased hunger, weight loss, abetes mellitus include polyuria, polydipsia,
and increased thirst. What polyphagia, enuresis, and weight loss.
does the nurse suspect?
A. Syndrome of inappropri-
ate diuretic hormone
B. Diabetes insipidus
C. Type 1 diabetes mellitus
D. Hypothyroidism
51. The nurse is teaching a B. "My child measures their own medication
group of caregivers of chil- but sometimes doesn't administer the correct
dren diagnosed with dia- amount."
betes. The nurse is explain-
ing insulin shock and the Rationale:
caregivers make the follow- Insulin reaction (insulin shock, hypo-
ing statements. Which state- glycemia) is caused by insulin overload, re-
ment indicates the best un- sulting in too-rapid metabolism of the body's
derstanding of a reason an glucose. This may be attributable to a change
insulin reaction might oc- in the body's requirement, carelessness in
cur? diet (such as failure to eat proper amounts
of food), an error in insulin measurement, or
A. "If my child eats as much excessive exercise.
as their older brother eats
23 / 55
they could have an insulin
reaction."
B. "My child measures their
own medication but some-
times doesn't administer the
correct amount."
C. "My child monitors their
glucose levels to keep them
from going too high."
D. "On the weekends we en-
courage our child to partic-
ipate in lots of sports activ-
ities and stay busy so they
don't have an insulin reac-
tion."
52. A client with type 1 dia- C. The client's insulin levels are inadequate.
betes has told the nurse
that the client's most recent Rationale: Ketones in the urine signal that
urine test for ketones was there is a deficiency of insulin and that con-
positive. What is the nurse's trol of type 1 diabetes is deteriorating. With-
most plausible conclusion holding insulin or eating food would exac-
based on this assessment erbate the client's ketonuria. Metformin will
finding? not cause short-term resolution of hyper-
glycemia.
A. The client should withhold
the next scheduled dose of
insulin.
B. The client should prompt-
ly eat some protein and car-
bohydrates.
C. The client's insulin levels
are inadequate.
D. The client would benefit
from a dose of metformin.
53. A client presents to the clin- A. Fasting plasma glucose greater than or
ic reporting symptoms that equal to 126 mg/dL (7.0 mmol/L)
suggest diabetes. What cri-
24 / 55
teria would support check- Rationale: Criteria for the diagnosis of dia-
ing blood levels for the diag- betes include symptoms of diabetes plus ran-
nosis of diabetes? dom plasma glucose greater than or equal to
200 mg/dL (11.1 mmol/L), or a fasting plasma
A. Fasting plasma glucose glucose greater than or equal to 126 mg/dL
greater than or equal to 126 (7.0 mmol/L).
mg/dL (7.0 mmol/L)
B. Random plasma glucose
greater than 150 mg/dL (8.3
mmol/L)
C. Fasting plasma glucose
mmol/L) on two separate oc-
casions
D. Random plasma glucose
mmol/L)
54. A client newly diagnosed C. Most calories should be derived from car-
with type 2 diabetes is at- bohydrates.
tending a nutrition class.
What general guideline Rationale: For all levels of caloric intake, 50%
should the nurse teach the to 60% of calories should be derived from
clients at this class? carbohydrates, 20% to 30% from fat, and
the remaining 10% to 20% from protein. Low
A. Low fat generally indi- fat does not automatically mean low sugar.
cates low sugar. Dietary animal fat does not need to be elimi-
B. Protein should constitute nated from the diet.
30% to 40% of caloric intake.
C. Most calories should be
derived from carbohydrates.
D. Animal fats should be
eliminated from the diet.
55. A nurse is providing health C. Exercise

education to a teenage client
newly diagnosed with type 1 Rationale: Exercise lowers blood glucose, in-
diabetes mellitus, as well as creases levels of HDLs, and decreases to-
the client's family. The nurse tal cholesterol and triglyceride levels. Low-fat
25 / 55
teaches the client and fam- intake and low levels of stimulation do not
ily nonpharmacologic mea- reduce a client's need for insulin. Adequate
sures that will decrease the sleep is beneficial in reducing stress, but
body's need for insulin. What does not have an effect that is as pronounced
measure provides the great- as that of exercise.
est impact on glucose reduc-
tion?
A. Adequate sleep
B. Low stimulation
C. Exercise
D. Low-fat diet
56. A nurse is caring for a B. 11:30 AM

client with type 1 diabetes.
The client's medication ad- Rationale: Short-acting insulin is called reg-
ministration record includes ular insulin. It is in a clear solution and is
the administration of regu- usually given 15 minutes before a meal or
lar insulin three times dai- in combination with a longer-acting insulin.
ly. Knowing that the client's Earlier administration creates a risk for hypo-
lunch tray will arrive at 11:45 glycemia; later administration creates a risk
AM, when should the nurse for hyperglycemia.
administer the client's in-
sulin?
A. 10:45 AM
B. 11:30 AM
C. 11:45 AM
D. 11:50 AM
57. A client has just been diag- B. A biguanide

nosed with type 2 diabetes.
The health care provider has Rationale: Sulfonylureas exert their primary
prescribed an oral antidia- action by directly stimulating the pancreas to
betic agent that will inhibit secrete insulin, and therefore require a func-
the production of glucose by tioning pancreas to be effective. Biguanides
the liver and thereby aid in inhibit the production of glucose by the liver
the control of blood glucose. and are in used in type 2 diabetes to control
What type of oral antidiabet- blood glucose levels. Thiazolidinediones en-
26 / 55
ic agent did the health care hance insulin action at the receptor site with-
provider prescribe for this out increasing insulin secretion from the beta
client? cells of the pancreas. Alpha-glucosidase in-
hibitors work by delaying the absorption of
A. A sulfonylurea glucose in the intestinal system, resulting in
B. A biguanide a lower postprandial blood glucose level.
C. A thiazolidinedione
D. An alpha-glucosidase in-
hibitor
58. A diabetes nurse educator is A. Do not eliminate insulin when nauseated

teaching a group of clients and vomiting.
with type 1 diabetes about
"sick day rules." What guide- Rationale: The most important issue to teach
line applies to periods of ill-clients with diabetes who become ill is not
ness in a diabetic client? to eliminate insulin doses when nausea and
vomiting occur. Rather, they should take their
A. Do not eliminate insulin usual insulin or oral hypoglycemic agent
when nauseated and vomit- dose, and then attempt to consume frequent,
ing. small portions of carbohydrates. In general,
B. Report elevated glu- blood sugar levels will rise but should be
cose levels greater than 150 reported if they are greater than 300 mg/dL
mg/dL (8.3 mmol/L). (16.6 mmol/L).
C. Eat three substantial
meals a day, if possible.
D. Reduce food intake and
insulin doses in times of ill-
ness.
59. The nurse is discussing B. The fact that clients with diabetes have an
macrovascular complica- elevated risk of myocardial infarction
tions of diabetes with a
client. The nurse would ad- Rationale: Myocardial infarction and stroke
dress what topic during this are considered macrovascular complications
dialogue? of diabetes, while the effects on vision and
kidney function are considered to be mi-
A. The need for frequent eye crovascular.
examinations for clients with
diabetes
27 / 55
B. The fact that clients with
diabetes have an elevated
risk of myocardial infarction
C. The relationship between
kidney function and blood
glucose levels
D. The need to monitor urine
for the presence of albumin
60. A school nurse is teaching D. Lose weight, if obese

a group of high school stu-
dents about risk factors for Rationale: Obesity is a major modifiable risk
diabetes. What action has factor for diabetes. Smoking is not a direct
the greatest potential to re-risk factor for the disease. Eye examinations
duce an individual's risk forare necessary for persons who have been
developing diabetes? diagnosed with diabetes, but they do not
screen for the disease or prevent it. Simi-
A. Have blood glucose levels larly, blood glucose checks do not prevent
checked annually. diabetes.
B. Stop using tobacco in any
form.
C. Undergo eye examina-
tions regularly.
D. Lose weight, if obese
61. A teenage client is brought A. Type 1 diabetes

to the emergency depart-
ment with symptoms of hy- Rationale: Beta cell destruction is the hall-
perglycemia. Based on the mark of type 1 diabetes. Non- insulin-depen-
fact that the pancreatic beta dent diabetes is synonymous with type 2 dia-
cells are being destroyed, betes, which involves insulin resistance and
the client would be diag- impaired insulin secretion, but not beta cell
nosed with what type of dia- destruction. Prediabetes is characterized by
betes? normal glucose metabolism, but a previous
history of hyperglycemia, often during illness
A. Type 1 diabetes or pregnancy.
B. Type 2 diabetes
C. Non-insulin-dependent di-
28 / 55
abetes
D. Prediabetes
62. A client newly diagnosed B. "You do not need to give up alcohol entirely
with type 2 diabetes has but there are potential side effects specific to
been told by their family that clients with diabetes that you should consid-
they can no longer consume er."
alcohol. The client asks the
nurse if abstaining from all Rationale: Clients with diabetes do not need
alcohol is necessary. What is to give up alcoholic beverages entirely. Mod-
the nurse's best response? eration is the key. Moderate intake is no more
than 1 alcoholic beverage (light beer, wine)
A. "You should stop all al- for women and 2 drinks for men daily. Rec-
cohol intake. Alcohol is ab- ommendations include avoiding mixed drinks
sorbed by your body be- and liqueurs because of the possibility of
fore other important nutri- excessive weight gain, elevated glucose lev-
ents and may lead to very els, and hyperlipidemia. Clients should be
high blood glucose levels." aware of potential side effects of alcohol con-
B. "You do not need to give sumption. These include diabetic ketoacido-
up alcohol entirely but there sis and hypoglycemia To combat possible hy-
are potential side effects poglycemia, clients with diabetes should not
specific to clients with dia- consume alcohol on an empty stomach.
betes that you should con-
sider."
C. "You should no longer
consume alcohol since it
causes immediate low blood
glucose levels in diabetic
clients."
D. "You can still consume
alcohol, but limit your con-
sumption to no more than 3
glasses of wine or beer dai-
ly because of the high sugar
content of alcohol."
63. An occupational health B. "Lately, I drink and drink and can't seem to
nurse is screening a group quench my thirst."
of workers for diabetes. What
29 / 55
statement should the nurse Rationale: Classic clinical manifestations of
interpret as being sugges- diabetes include the "three Ps": polyuria,
tive of diabetes? polydipsia, and polyphagia. Lack of interest in
sweet foods, fatigue, and foul-smelling urine
A. "I've always been a fan are not suggestive of diabetes.
of sweet foods, but lately I'm
turned off by them."
B. "Lately, I drink and drink
and can't seem to quench my
thirst."
C. "No matter how much
sleep I get, it seems to take
me hours to wake up."
D. "When I went to the wash-
room the last few days, my
urine smelled odd."
64. A diabetes educator is C. "I will make sure to follow the weight loss
teaching a client about type plan designed by the dietitian."
2 diabetes. The educator rec-
ognizes that the client un- Rationale: Insulin resistance is associated
derstands the primary treat- with obesity; thus the primary treatment of
ment for type 2 diabetes type 2 diabetes is weight loss. Oral antidia-
when the client states: betic agents may be added if diet and exer-
cise are not successful in controlling blood
A. "I read that a pancreas glucose levels. If maximum doses of a single
transplant will provide a cure category of oral agents fail to reduce glu-
for my diabetes." cose levels to satisfactory levels, additional
B. "I will take my oral antidia- oral agents may be used. Some clients may
betic agents when my morn- require insulin on an ongoing basis, or on a
ing blood sugar is high." temporary basis during times of acute psy-
C. "I will make sure to fol- chological stress, but it is not the central com-
low the weight loss plan de- ponent of type 2 treatment. Pancreas trans-
signed by the dietitian." plantation is associated with type 1 diabetes.
D. "I will make sure I call
the diabetes educator when
I have questions about my
insulin."
30 / 55
65. A diabetes nurse educa- D. 50% to 60% of calories from carbohy-
tor is presenting current drates, 20% to 30% from fat, and the remain-
recommendations for lev- ing 10% to 20% from protein
els of caloric intake. What
are the current recommen- Rationale: Currently, the ADA and the Acad-
dations that the nurse would emy of Nutrition and Dietetics (formerly the
describe? American Dietetic Association) recommend
that for all levels of caloric intake, 50% to 60%
A. 10% of calories from car- of calories come from carbohydrates, 20% to
bohydrates, 50% from fat, 30% from fat, and the remaining 10% to 20%
and the remaining 40% from from protein. Low fat does not automatically
protein mean low sugar. Dietary animal fat does not
B. 10% to 20% of calories need to be eliminated from the diet.
from carbohydrates, 20% to
30% from fat, and the remain-
ing 50% to 60% from protein
C. 20% to 30% of calories
D. 50% to 60% of calories
66. An older adult client with D. Fluid and electrolyte replacement

type 2 diabetes is brought
to the emergency depart- Rationale: The overall approach to HHS in-
ment by the client's daugh- cludes fluid replacement, correction of elec-
ter. The client is found to trolyte imbalances, and insulin administra-
have a blood glucose level tion. Antihypertensive medications are not
of 600 mg/dL (33.3 mmol/L). indicated, as hypotension generally accom-
The client's daughter reports panies HHS due to dehydration. Sodium bi-
that the client recently had carbonate is not given to clients with HHS,
a gastrointestinal virus and as their plasma bicarbonate level is usually
has been confused for the normal. Insulin administration plays a less im-
last 3 hours. The diagno- portant role in the treatment of HHS because
sis of hyperglycemic hyper- it is not needed for reversal of acidosis, as in
osmolar syndrome (HHS) is diabetic ketoacidosis (DKA).
31 / 55
made. What nursing action
would be a priority?
A. Administration of antihy-
pertensive medications
B. Administering sodium bi-
carbonate intravenously
C. Reversing acidosis by ad-
ministering insulin
D. Fluid and electrolyte re-
placement
67. A nurse is caring for a client B. Observe the client drawing up and admin-
with type 1 diabetes who is istering the insulin.
being discharged home to-
morrow. What is the best way Rationale: Nurses should assess the client's
to assess the client's ability ability to perform diabetes-related self-care
to prepare and self-adminis- as soon as possible during the hospital-
ter insulin? ization or office visit to determine whether
the client requires further diabetes teach-
A. Ask the client to describe ing. While consulting a home care nurse
the process in detail. is beneficial, an initial assessment should
B. Observe the client draw- be performed during the hospitalization or
ing up and administering the office visit. Nurses should directly observe
insulin. the client performing the skills such as in-
C. Provide a health educa- sulin preparation and infection, blood glucose
tion session reviewing the monitoring, and foot care. Simply questioning
main points of insulin deliv- the client about these skills without actually
ery. observing performance of the skill is not suf-
D. Review the client's first ficient. Further education does not guarantee
hemoglobin A1C result after learning.
discharge.
68. The nurse reviews foot care B. Avoiding foot ulcers may mean the differ-
with an older adult client. ence between institutionalization and contin-
Why would the nurse feel ued independent living.
that foot care is so important
to this client? Rationale: The nurse recognizes that pro-
viding information on the long-term com-
32 / 55
A. An older adult client with plications—especially foot and eye prob-
foot ulcers experiences se- lems—associated with diabetes is important.
vere foot pain due to the di- Avoiding amputation through early detection
abetic polyneuropathy. of foot ulcers may mean the difference be-
B. Avoiding foot ulcers may tween institutionalization and continued inde-
mean the difference between pendent living for the older adult with dia-
institutionalization and con- betes. While the nurse recognizes that hypo-
tinued independent living. glycemia is a dangerous situation and may
C. Hypoglycemia is linked lead to falls, hypoglycemia is not directly con-
with a risk for falls; this risk nected to the importance of foot care. De-
is elevated in older adults crease in circulation is related to vascular
with diabetes. changes and is not associated with drugs
D. Oral antihyperglycemics given for diabetes.
have the possible adverse
effect of decreased circula-
tion to the lower extremities.
69. A diabetic educator is dis- A. "I will not take my insulin on the days when
cussing "sick day rules" with I am sick, but I will certainly check my blood
a newly diagnosed type 1 di- sugar every 2 hours."
abetic. The educator is aware
that the client will require Rationale: The nurse must explain the "sick
further teaching when the day rules" again to the client who plans
client states what? to stop taking insulin when sick. The nurse
should emphasize that the client should take
A. "I will not take my insulin insulin agents as usual and test the blood
on the days when I am sick, sugar and urine ketones every 3 to 4 hours. In
but I will certainly check my fact, insulin-requiring clients may need sup-
blood sugar every 2 hours." plemental doses of regular insulin every 3
B. "If I cannot eat a meal, I to 4 hours. The client should report elevated
will eat a soft food such as glucose levels (greater than 300 mg/dL or
soup, gelatin, or pudding six 16.6 mmol/L, or as otherwise instructed) or
to eight times a day." urine ketones to the health care provider. If
C. "I will call the doctor if I the client is not able to eat normally, the client
am not able to keep liquids should be instructed to substitute with soft
in my body due to vomiting foods such a gelatin, soup, and pudding. If
or diarrhea." vomiting, diarrhea, or fever persists, the client
D. "I will call the doctor if should have an intake of liquids every 30 to
my blood sugar is over 300 60 minutes to prevent dehydration.
33 / 55
mg/dL (16.6 mmol/L) or if I
have ketones in my urine."
70. Which of the following C. A client who adheres closely to a meal plan
clients with type 1 diabetes and meal schedule
is most likely to experience
adequate glucose control? Rationale: The therapeutic goal for diabetes
management is to achieve normal blood glu-
A. A client who skips break- cose levels without hypoglycemia. Therefore,
fast when the glucose read- diabetes management involves constant as-
ing is greater than 220 mg/dL sessment and modification of the treatment
(12.3 mmol/L) plan by health professionals and daily adjust-
B. A client who never de- ments in therapy (possibly including insulin)
viates from the prescribed by clients. For clients who require insulin to
dose of insulin help control blood glucose levels, maintain-
C. A client who adheres ing consistency in the amount of calories and
closely to a meal plan and carbohydrates ingested at meals is essen-
meal schedule tial. In addition, consistency in the approxi-
D. A client who eliminates mate time intervals between meals, and the
carbohydrates from the daily snacks, helps maintain overall glucose con-
intake trol. Skipping meals is never advisable for
person with type 1 diabetes.
71. A pregnant client has been C. The effects of hormonal changes during
diagnosed with gestation- pregnancy
al diabetes. The client is
shocked by the diagnosis, Rationale: Hyperglycemia and eventual ges-
stating that they are consci- tational diabetes develop during pregnancy
entious about their health, because of the secretion of placental hor-
and asks the nurse what mones, which causes insulin resistance. The
causes gestational diabetes. disease is not the result of food intake or
The nurse should explain changes in osmolality.
that gestational diabetes is a
result of what etiologic fac-
tor?
A. Increased caloric intake

during the first trimester
B. Changes in osmolality
34 / 55
and fluid balance
C. The effects of hormonal
changes during pregnancy
D. Overconsumption of car-
bohydrates during the first
two trimesters
72. A medical nurse is aware of D. Middle-aged or older people with either

the need to screen specific type 2 diabetes or no known history of dia-
clients for their risk of hyper- betes
glycemic hyperosmolar syn-
drome (HHS). In what client Rationale: HHS occurs most often in older
population does this syn- clients (50 to 70 years of age) who have no
drome most often occur? known history of diabetes or who have type
2 diabetes. HHS is a serious metabolic disor-
A. Clients who are obese and der resulting from a relative insulin deficiency
who have no known history initiated by an illness that raises the demand
of diabetes for insulin. Obesity does play a role in HHS
B. Clients with type 1 dia- but clients usually have a history of type 2
betes and poor dietary con- diabetes. Clients with type 1 diabetes usual-
trol ly present with DKA (diabetic ketoacidosis).
C. Adolescents with type 2 Adolescents with type 2 have a low incidence
diabetes and sporadic use of of this condition.
antihyperglycemics
D. Middle-aged or older peo-
ple with either type 2 dia-
betes or no known history of
diabetes
73. A nurse is caring for a A. Avoid using the same injection site more
client newly diagnosed with than once in 2 to 3 weeks.
type 1 diabetes. The nurse
is educating the client about
Rationale: To prevent lipodystrophy, the client
self-administration of insulin
should try not to use the same site more than
in the home setting. The once in 2 to 3 weeks. Mixing different types
nurse should teach the client
of insulin in a syringe is acceptable, within
to do what action? specific guidelines, and the needle is usually
inserted at a 90-degree angle. Cleansing the
A. Avoid using the same in- injection site with alcohol is optional.
35 / 55
jection site more than once
in 2 to 3 weeks.
B. Avoid mixing more than
one type of insulin in a sy-
ringe.
C. Cleanse the injection site
thoroughly with alcohol pri-
or to injecting.
D. Inject at a 45-degree an-
gle.
74. A client with type 2 diabetes B. Stress has likely caused an increase in the
normally achieves adequate client's blood sugar levels.
glycemic control through
diet and exercise. Upon be- Rationale: During periods of physiologic
ing admitted to the hospital stress, such as surgery, blood glucose lev-
for a cholecystectomy, how- els tend to increase because levels of
ever, the client has required stress hormones (epinephrine, norepineph-
insulin injections on two oc- rine, glucagon, cortisol, and growth hor-
casions. The nurse would mone) increase. The client's need for insulin
identify what factor most is unrelated to the action of bile. The client's
likely caused this short-term normal routine of nonpharmacological strate-
change in treatment? gies of diet and exercise have been changed
due to the client's admission to the hospi-
A. Alterations in bile metab- tal. Therefore, the client cannot overestimate
olism and release have likely what they cannot control. Electrolyte/ fluid
caused hyperglycemia. balances may have some bearing on glucose
B. Stress has likely caused levels, but stress is the most impactful cause
an increase in the client's of the change happening to this client.
blood sugar levels.
C. The client's efforts did
not control the diabetes us-
ing nonpharmacologic mea-
sures.
D. The client's volatile flu-
id balance surrounding
surgery has likely caused
unstable blood sugars.
36 / 55
75. The health care provider has C. "The cause is not known for sure but it
explained to a client that the is thought to involve elevated blood glucose
client has developed diabet- levels over a period of years."
ic neuropathy in the right
foot. Later that day, the client Rationale: The etiology of neuropathy may
asks the nurse what caus- involve elevated blood glucose levels over
es diabetic neuropathy. What a period of years. High blood sugar (rather
would be the nurse's best re- than fluctuations or variations in blood sug-
sponse? ars) is thought to be responsible. Ketones
and ketoacidosis are not direct causes of
A. "Research has shown neuropathies.
that diabetic neuropathy is
caused by fluctuations in
blood sugar that have gone
on for years."
B. "The cause is not known
for sure but it is thought to
have something to do with
ketoacidosis."
C. "The cause is not known
for sure but it is thought to
involve elevated blood glu-
cose levels over a period of
years."
D. "Research has shown
that diabetic neuropathy is
caused by a combination of
elevated glucose and ketone
levels."
76. A client with type 2 dia- D. Reviewing the client's creatinine and BUN
betes has been managing levels
his blood glucose levels us-
ing diet and metformin. Fol- Rationale: Metformin has the potential to be
lowing an ordered increase nephrotoxic; consequently, the nurse should
in the client's daily dose of monitor the client's kidney function. This drug
metformin, the nurse should does not typically affect clients' neutrophils,
prioritize which of the follow- liver function, or cognition.
ing assessments?
37 / 55
A. Monitoring the client's

neutrophil levels
B. Assessing the client for
signs of impaired liver func-
tion
C. Monitoring the client's lev-
el of consciousness and be-
havior
D. Reviewing the client's cre-
atinine and BUN levels
77. A client with a long-stand- A. Infection

ing diagnosis of type 1 dia-
betes has a history of poor Rationale: Decreased sensations of pain and
glycemic control. The nurse temperature place clients with neuropathy at
recognizes the need to as- increased risk for injury and undetected foot
sess the client for signs and infections. The neurologic changes associat-
symptoms of peripheral neu- ed with peripheral neuropathy do not normal-
ropathy. Peripheral neuropa- ly result in pain, confusion, or impairments in
thy constitutes a risk for urinary function.
what nursing diagnosis?
A. Infection
B. Acute pain
C. Acute confusion
D. Impaired urinary elimina-
tion
78. A client has been brought A. IV administration of 50% dextrose in water

to the emergency depart-
ment by paramedics after be- Rationale: In hospitals and emergency de-
ing found unconscious. The partments, for clients who are unconscious
client's MedicAlert bracelet or cannot swallow, 25 to 50 mL of 50% dex-
indicates that the client has trose in water (D50W) may be administered
type 1 diabetes and the IV for the treatment of hypoglycemia. Five
client's blood glucose is percent dextrose would be inadequate, and
22 mg/dL (1.2 mmol/L). The insulin would exacerbate the client's condi-
nurse should anticipate what tion.
38 / 55
intervention?
A. IV administration of 50%
dextrose in water
B. Subcutaneous adminis-
tration of 10 units of Huma-
log
C. Subcutaneous adminis-
tration of 12 to 15 units of
regular insulin
D. IV bolus of 5% dextrose in
0.45% NaCl
79. A nurse is working for A. Always carry a form of fast-acting sugar.

the summer at a camp for
adolescents with diabetes. Rationale: The following teaching points
When providing information should be included in information provided to
on the prevention and man- the client on how to prevent hypoglycemia:
agement of hypoglycemia, Always carry a form of fast-acting sugar, in-
what action should the nurse crease food prior to exercise, eat a meal or
promote? snack every 4 to 5 hours, and check blood
sugar regularly.
A. Always carry a form of
fast-acting sugar.
B. Perform exercise prior to
eating whenever possible.
C. Eat a meal or snack every
8 hours.
D. Check blood sugar at least
every 24 hours.
80. A nurse is teaching basic D. Recognition of hypoglycemia and hyper-

"survival skills" to a client glycemia
newly diagnosed with type 1
diabetes. What topic should Rationale: It is imperative that newly diag-
the nurse address? nosed clients know the signs and symp-
toms and management of hypo- and hyper-
A. Signs and symptoms of glycemia. The other listed topics are valid
diabetic nephropathy points for education, but are not components
39 / 55
B. Management of diabetic of the client's immediate "survival skills" fol-
ketoacidosis lowing a new diagnosis.
C. Effects of surgery and
pregnancy on blood sugar
levels
D. Recognition of hypo-
glycemia and hyperglycemia
81. A nurse is conducting a A. "If you are going to use up the vial within 1
class on how to self-manage month, it can be kept at room temperature."
insulin regimens. A client
asks how long a vial of in- Rationale: If a vial of insulin will be used
sulin can be stored at room up within 1 month, it may be kept at room
temperature before it "goes temperature.
bad." What would be the
nurse's best answer?
A. "If you are going to use

up the vial within 1 month, it
can be kept at room temper-
ature."
B. "If a vial of insulin will be
used up within 21 days, it
may be kept at room temper-
ature."
C. "If a vial of insulin will be
used up within 2 weeks, it
ature."
D. "If a vial of insulin will
be used up within 1 week, it
ature."
82. A client has received a diag- D. Assess the client's readiness to learn.
nosis of type 2 diabetes. The
diabetes nurse has made Rationale: Before initiating diabetes educa-
contact with the client and tion, the nurse assesses the client's (and
will implement a program of family's) readiness to learn. This must pre-
40 / 55
health education. What is the cede other physiologic assessments (such
nurse's priority action? as BMI) and providing health education.
A. Ensure that the client un-

derstands the basic patho-
physiology of diabetes.
B. Identify the client's body
mass index.
C. Teach the client "survival
skills" for diabetes.
D. Assess the client's readi-
ness to learn.
83. A student with diabetes re- C. Half of a cup of juice, followed by cheese
ports feeling nervous and and crackers
hungry. The school nurse as-
sesses the student and finds Rationale: Initial treatment for hypoglycemia
the child has tachycardia is 15 g concentrated carbohydrate, such as
and is diaphoretic with a two or three glucose tablets, 1 tube glucose
blood glucose level of 50 gel, or 0.5 cup juice. Initial treatment should
mg/dL (2.8 mmol/L). What be followed with a snack including starch and
should the school nurse ad- protein, such as cheese and crackers, milk
minister? and crackers, or half of a sandwich. It is un-
necessary to add sugar to juice, even it if is
A. A combination of protein labeled as unsweetened juice, because the
and carbohydrates, such as fruit sugar in juice contains enough simple
a small cup of yogurt carbohydrate to raise the blood glucose level
B. Two teaspoons of sugar and the additional sugar may result in a sharp
dissolved in a cup of apple rise in blood sugar that will last for several
juice hours.
C. Half of a cup of juice, fol-
lowed by cheese and crack-
ers
D. Half a sandwich with a pro-
tein-based filling
84. A client with a history of B. Maintaining and monitoring the client's flu-
type 1 diabetes has just been id balance
admitted to the critical care
41 / 55
unit (CCU) for diabetic ke- Rationale: In addition to treating hyper-
toacidosis. The CCU nurse glycemia, management of DKA is aimed at
should prioritize what as- correcting dehydration, electrolyte loss, and
sessment during the client's acidosis before correcting the hyperglycemia
initial phase of treatment? with insulin. The nurse should monitor the
client for dysrhythmias, decreased LOC and
A. Monitoring the client for VTE, but restoration and maintenance of fluid
dysrhythmias balance is the highest
B. Maintaining and monitor-
ing the client's fluid balance
C. Assessing the client's lev-
el of consciousness
D. Assessing the client for
signs and symptoms of ve-
nous thromboembolism
85. A client has been living with A. Participation in a support group for per-
type 2 diabetes for several sons with diabetes
years, and the nurse real-
izes that the client is likelyRationale: Participation in support groups is
to have minimal contact with encouraged for clients who have had dia-
the health care system. In or-betes for many years as well as for those
der to ensure that the client who are newly diagnosed. This is more inter-
maintains adequate blood active and instructive than simply consulting
sugar control over the long websites. Weekly telephone contact with an
term, what should the nurse endocrinologist is not realistic in most cases.
recommend? Participation in research trials may or may
not be beneficial and appropriate, depending
A. Participation in a support on clients' circumstances.
group for persons with dia-
betes
B. Regular consultation of
websites that address dia-
betes management
C. Weekly telephone
"check-ins" with an endocri-
nologist
D. Participation in clinical
42 / 55
trials relating to antihyper-
glycemics
86. A client with type 1 diabetes C. Avoid hot-water bottles and heating pads.
mellitus is seeing the nurse
to review foot care. What Rationale: High-risk behaviors, such as walk-
would be a priority instruc- ing barefoot, using heating pads on the
tion for the nurse to give the
feet, wearing open-toed shoes, soaking the
client? feet, and shaving calluses, should be avoid-
ed. Socks should be worn for warmth. Feet
A. Examine feet weekly for should be examined each day for cuts,
redness, blisters, and abra- blisters, swelling, redness, tenderness, and
sions. abrasions. Lotion should be applied to dry
B. Avoid the use of moistur- feet but never between the toes. After a bath,
izing lotions. the client should gently, not vigorously, pat
C. Avoid hot-water bottles feet dry to avoid injury.
and heating pads.
D. Dry feet vigorously after
each bath.
87. The most recent blood work A. Teach the client about actions to slow the
of a client with a long-stand- progression of nephropathy.
ing diagnosis of type 1 di-
abetes has shown the pres- Rationale: Clinical nephropathy eventually
ence of microalbuminuria. develops in more than 85% of people with
What is the nurse's most ap- microalbuminuria. As such, educational inter-
propriate action? ventions addressing this microvascular com-
plication are warranted. Expired insulin does
A. Teach the client about ac- not cause nephropathy, and the client's liver
tions to slow the progres- function is not likely affected. There is no
sion of nephropathy. indication for the use of a fluid challenge.
B. Ensure that the client re-
ceives a comprehensive as-
sessment of liver function.
C. Determine whether the
client has been using ex-
pired insulin.
D. Administer a fluid chal-
43 / 55
lenge and have the test re-
peated.
88. A nurse is assessing a client D. The presence of a tingling sensation

who has diabetes for the
presence of peripheral neu- Rationale: Although approximately half of
ropathy. The nurse should clients with diabetic neuropathy do not have
question the client about symptoms, initial symptoms may include
what sign or symptom that paresthesias (prickling, tingling, or height-
would suggest the possible ened sensation) and burning sensations (es-
development of peripheral pecially at night). Cold and intense pain are
neuropathy? atypical early signs of this complication.
A. Persistently cold feet

B. Pain that does not re-
spond to analgesia
C. Acute pain, unrelieved by
rest
D. The presence of a tingling
sensation
89. A client with diabetes is ask- B. "DKA can be caused by taking too little
ing the nurse what causes insulin."
diabetic ketoacidosis (DKA).
Which of the following is Rationale: Three main causes of DKA are
a correct statement by the decreased or missed dose of insulin, illness
nurse? or infection, and undiagnosed and untreated
diabetes. DKA may be the initial manifesta-
A. "DKA can be caused by tion of type 1 diabetes. For prevention of DKA
taking too much insulin." related to illness, the client should attempt to
B. "DKA can be caused by consume frequent small portions of carbohy-
taking too little insulin." drates. Drinking fluid every hour is important
C. "DKA can happen without to prevent dehydration. Blood glucose and
a cause." urine ketones must be assessed every 3 to
D. "DKA will not happen with 4 hours, and the client should take the usual
type 1 diabetes." dose of insulin.
90. A client is brought to the B. Glycosuria

emergency department. The C. Dehydration
44 / 55
client is a type 2 diabet- E. Hyperglycemia
ic and is experiencing hy-
perglycemic hyperosmolar Rationale: In HHS, persistent hyperglycemia
syndrome (HHS). The nurse causes osmotic diuresis, which results in
should identify what compo- losses of water and electrolytes. To maintain
nents of HHS? Select all that osmotic equilibrium, water shifts from the in-
apply. tracellular fluid space to the extracellular fluid
space. With glycosuria and dehydration, hy-
A. Leukocytosis ponatremia and increased osmolarity occur.
B. Glycosuria Leukocytosis does not take place.
C. Dehydration
D. Hypernatremia
E. Hyperglycemia
91. The nurse is developing a A. Deficient fluid volume related to dehydra-

plan of care for a 7-year-old tion
boy with diabetes insipidus.
What is the priority nursing Rationale: The priority nursing diagnosis
diagnosis? most likely would be deficient fluid volume
related to dehydration, due to a deficiency in
A. Deficient fluid volume re- the secretion of antidiuretic hormone (ADH).
lated to dehydration Excess fluid would result from a disorder that
B. Excess fluid volume relat- leads to water retention, such as syndrome of
ed to edema inappropriate antidiuretic hormone (SIADH).
C. Deficient knowledge relat- Deficient knowledge related to fluid intake
ed to fluid intake regimen regimen is a nursing diagnosis for this child,
D. Imbalanced nutrition, but a secondary one. Imbalanced nutrition,
more than body require- more than body requirements related to ex-
ments related to excess cess weight would be inappropriate for this
weight child since he probably has lost weight sec-
ondary to the fluid loss.
92. The nurse is preparing a A. Developing management and deci-

teaching plan for the fami- sion-making skills
ly and their 6-year-old son
who has just been diag- Rationale: Developing basic management
nosed with diabetes melli- and decision-making skills related to the di-
tus. What would the nurse abetes is the initial goal of the teaching plan
identify as the initial goal for for this child and family. The nurse would have
45 / 55
the teaching plan? provided a basic description of the disorder
after it was diagnosed. Development of a de-
A. Developing management tailed monthly meal plan would come later,
and decision-making skills perhaps after consulting with a nutritionist. It
B. Educating the parents is too soon to expect the boy to administer
about diabetes mellitus type his own insulin.
1
C. Developing a nutritionally
sound, 30-day meal plan
D. Promoting independence
with self-administration of
insulin
93. The nurse is assessing a C. The parents report that their son "can't
13-year-old boy with type drink enough water."
2 diabetes mellitus. What
would the nurse correlate Rationale: Unquenchable thirst (polydipsia)
with disorder? is a common finding associated with diabetes
mellitus, type 1 and 2. However, reports of
A. The parents report that flu-like illness and Kussmaul breathing are
their child had "a cold or flu" more commonly associated with type 1 dia-
recently. betes. Blood pressure is normal with type 1
B. Blood pressure is de- diabetes and elevated with type 2 diabetes.
creased when checking vital
signs.
C. The parents report that
their son "can't drink
enough water."
D. Auscultation reveals
Kussmaul breathing.
94. A child with diabetes reports B. Give 10 to 15 g of a simple carbohydrate.

that he is feeling a little
shaky. Further assessment Rationale: The child is experiencing hypo-
reveals that the child is co- glycemia as evidenced by the assessment
herent but with some slight findings and blood glucose level. Since the
tremors and sweating. A fin- child is coherent, offering the child 10 to 15
gerstick blood glucose level g of a simple carbohydrate would be appro-
is 70 mg/dL. What would the priate. Insulin is not used because the child
46 / 55
nurse do next? is hypoglycemic. A complex carbohydrate
snack would be used after offering the simple
A. Administer a sliding-scale carbohydrate to maintain the glucose level.
dose of insulin. Intramuscular glucagons would be used if the
B. Give 10 to 15 g of a simple child was not coherent.
carbohydrate.
C. Offer a complex carbohy-
drate snack.
D. Administer glucagon in-
tramuscularly.
95. A child with diabetes in- A. Syndrome of inappropriate antidiuretic

sipidus is being treated hormone (SIADH)
with vasopressin. The nurse
would assess the child Rationale: SIADH, although rare in children,
closely for signs and symp- is a potential complication of excessive ad-
toms of which condition? ministration of vasopressin. Thyroid storm
may result from overadministration of
A. Syndrome of inappro- levothyroxine (thyroid hormone replace-
priate antidiuretic hormone ment). Cushing syndrome is associated with
(SIADH) corticosteroid use. Vitamin D toxicity may re-
B. Thyroid storm sult from the use of vitamin D as treatment of
C. Cushing syndrome hypoparathyroidism.
D. Vitamin D toxicity
96. A group of students are re- D. Glargine

viewing information about
the various types of insulin Rationale: Of the insulins listed, glargine
used to treat type 1 dia- (Lantus) has the longest duration of action,
betes. The students demon- that is, 12 to 24 hours. Lispro lasts approxi-
strate understanding of the mately 3 to 5 hours; regular lasts 5 to 8 hours;
information when they iden- and NPH lasts approximately 10 to 16 hours.
tify which of these insulins
as having the longest dura-
tion?
A. Lispro
B. Regular
47 / 55
C. NPH
D. Glargine
97. A 5-year-old child with type B. 8.2%

1 diabetes is brought to the
clinic by his mother for a Rationale: For a child 6 years of age and
follow-up visit after having younger, the target HbA1C level should be
his hemoglobin A1C level less than 8.5% but greater than 7.5%. For
drawn. Which result would children between the ages of 6 and 12 years,
indicate to the nurse that the the target HbA1C level is less than 8%. For
child is achieving long-term children and adolescents between 13 and 19
glucose control? years of age, the target HbA1C level would
be less than 7.5%.
A. 9.0%
B. 8.2%
C. 7.3%
D. 6.9%
98. The nurse is administering C) Between 9 and 11 AM

10 units of NPH insulin to
a child at 8 AM. The nurse Rationale: NPH insulin has an onset of action
would expect this insulin to of 1 to 3 hours, so the drug would begin to act
begin acting at which time? between 9 and 11 AM. A rapid-acting insulin
would begin to act by 8:15 AM; regular insulin
A. By 8:15 AM would begin to act between 8:30 and 9 AM.
B. Between 8:30 and 9 AM No type of insulin would begin acting around
C. Between 9 and 11 AM 12 noon.
D. Around 12 noon
99. The nurse suspects that a C. Diaphoresis

4-year-old with type 1 di- D. Slurred speech
abetes is experiencing hy- F. Tachycardia
poglycemia based on what
findings? Select all that ap- Rationale: Manifestations of hypoglycemia
ply. include behavioral changes, confusion,
slurred speech, belligerence, diaphoresis,
A. Blurred vision tremors, palpitation, and tachycardia. Blurred
B. Dry, flushed skin vision; dry, flushed skin; and fruity breath
C. Diaphoresis odor suggest hyperglycemia.
48 / 55
D. Slurred speech
E. Fruity breath odor
F. Tachycardia
100. A nurse is preparing a pre- C. Deficient decision-making skills

sentation for a group of par- D. Body image conflicts
ents of adolescents diag- E. Struggle for independence
nosed with type 1 diabetes.
What issues would the nurse Rationale: Adolescents are undergoing rapid
need to address? Select all physical, emotional, and cognitive growth.
that apply. Working toward a separate identity from
parents and the demands of diabetic care
A. Self-monitoring of blood can hinder this. This struggle for indepen-
glucose levels dence can lead to nonadherence of the di-
B. Feelings of being different abetic care regimen. Conflicts develop with
C. Deficient decision-making self-management, body image, and peer
skills group acceptance. Teens may acquire the
D. Body image conflicts skills to perform tasks related to diabetic care
E. Struggle for indepen- but may lack decision-making skills needed
dence to adjust treatment plan. Teens do not always
foresee the consequences of their activities.
Self-monitoring of blood glucose levels and
feelings of being different are issues common
to school- age children.
101. The nurse is caring for a A. Imbalanced nutrition: less than body re-
9-year-old client newly di- quirements
agnosed with diabetes. The B. Deficient fluid volume
client has polyuria, polydip- C. Deficient knowledge regarding disease
sia, and weight loss. Which process
nursing diagnoses will the
nurse include in the care Rationale: Polyuria (excessive urination),
plan? Select all that apply. polydipsia (excessive thirst), and weight loss
support the diagnoses of deficient fluid vol-
A. Imbalanced nutrition: less ume and imbalanced nutrition: less than body
than body requirements requirements. Being newly diagnosed with
B. Deficient fluid volume the disease at the age of 9 supports the
C. Deficient knowledge re- diagnosis of deficient knowledge regarding
garding disease process disease process. There is no data to support
49 / 55
D. Noncompliance noncompliance or delayed growth and devel-
E. Delayed growth and development.
opment
102. Diabetes insipidus is a disor- B. Posterior pituitary

der of the
Rationale: The principal disorder of the pos-
A. Anterior pituitary terior pituitary hypo function is diabetes in-
B. Posterior pituitary sipidus
C. Adrenal cortex
D. Adrenal medulla
103. Which sign, when exhibit- C. Increased urination

ed by a hospitalized child,
should the nurse recognize Rationale: The deficiency of antidiuretic hor-
as a characteristic of dia- mone associated with diabetes insipidus
betes insipidus? causes the body to excrete large volumes of
dilute urine
A. Weight gain
B. Increased urine specific
gravity
C. Increased urination
D. Serum sodium level of 130
mEq/L
104. What should the nurse in- C. The child should have free access to water
clude in the teaching plan for and toilet facilities at school
parents of a child with di-
abetes insipidus who is re- Rationale: The childs teachers should be
ceiving DDAVP? aware of the diagnosis and the child should
have access to free water and toilet facili-
A. Increase the dosage of ties at school. DDAVP needs to be given as
DDAVP as the urine specific ordered by the physician. If the parents are
gravity (SG) increases monitoring urine SG at home, they would not
B. Give DDAVP only if urine increase the medication dose for increased
output decreases SG; the physician may order an increased
C. The child should have free dosage for very dilute urine with decreased
access to water and toilet fa- SG. DDAVP needs to be given continuously
cilities at school as ordered by the physician. DDAVP is typi-
50 / 55
D. Cleanse skin before ad- cally given intranasally or by sub cut injection.
ministering the transdermal For nocturnal enuresis, it may be given orally.
patch
105. Type 1 diabetes mellitus is D. Blurred vision

suspected in an adolescent.
Which clinical manifestation Rationale: Dry skin, weight loss, dehydration,
may be present? fatigue, and blurred vision are clinical mani-
festations of type 1 diabetes mellitus
A. Moist skin
B. Weight gain
C. Fluid overload
D. Blurred vision
106. A parents asks the nurse C. Children are better able to manage the
why self-monitoring of blood diabetes
glucose is being recom-
mended for her child with Rationale: Blood glucose self-management
diabetes. The nurse should has improved diabetes management and can
base the explanation on the be successfully by children from the time of
knowledge that diagnosis. Insulin dosages can be adjusted
based on blood sugar results. The ability to
A. It is a less expensive self-test allows the child to balance, diet, ex-
method of testing ercise, and insulin. The parents are partners
B. It is not as accurate as lab- in the process, but the child should be taught
oratory testing how to manage the disease. Blood glucose
C. Children are better able to monitoring is more expensive but provides
manage the diabetes improved management. It is as accurate as
D. The parents are better able lab testing.
to manage the disease
107. What is the best time for A. Two hours after administration
the nurse to assess the
peak effectiveness of subcu- Rationale: The peak action of regular
taneously administered Reg- (short-acting) insulin is 2-3 hours after sub-
ular insulin? cutaneous administration.
A. Two hours after adminis-

tration
51 / 55
B. Four hours after adminis-
tration
C. Immediately after admin-
istration
D. Thirty minutes after ad-
ministration
108. What is the primary concern A. The child's safety

for a 7-year-old child with
type 1 diabetes mellitus who Rationale: Safety is the primary issue. School
asks his mother not to tell personnel need to be aware of the signs
anyone at school that he has and symptoms of hypoglycemia and hyper-
diabetes? glycemia and the appropriate interventions.
A. The child's safety

B. The privacy of the child
C. Development of a sense of
industry
D. Peer group acceptance
109. What is the best nursing ac- C. Give the child a glass of orange juice
tion when a child with type
1 diabetes mellitus is sweat- Rationale: An easily digested carbohydrate is
ing, trembling, and pale? indicated when a child exhibits symptoms of
hypoglycemia. Four ounces of orange juice
A. Offer the child a glass of is an appropriate treatment for the conscious
water child who is exhibiting signs of hypoglycemia.
B. Give the child 5 units Subcutaneous injection of glucagon is used
of regular insulin subcuta- to treat hypoglycemia when the child is un-
neously conscious.
C. Give the child a glass of
orange juice
D. Give the child glucagon
subcutaneously
110. Which sign is the nurse most C. Irritability and serum glucose less than 60
likely to assess in a child mg/dL
with hypoglycemia?
Rationale: Irritability and serum glucose less
52 / 55
A. Urine positive for ketones than 60 mg/dL are neuroglycopenic manifes-
and serum glucose greater tations of hypoglycemia
than 300 mg/dL
B. Normal sensorium and
serum glucose greater than
160 mg/dL
C. Irritability and serum glu-
cose less than 60 mg/dL
D. Increased urination and
serum glucose less than 120
mg/dL
111. When would a child diag- A. During the "honeymoon" phase

nosed with type 1 diabetes
mellitus most likely demon- Rationale: During the honeymoon phase,
strate a decreased need for which may last from a few weeks to a year or
insulin? longer, the child is likely to need less insulin
A. During the "honeymoon"

phase
B. During adolescence
C. During growth spurts
D. During minor illnesses
112. What should a nurse advise B. Substitute simple carbs or calorie-contain-

the parents of a child with ing liquids for solid foods
type 1 diabetes mellitus who
is not eating as a result of a Rationale: A sick-day diet of simple carbs or
minor illness? calorie-containing liquids will maintain nor-
mal serum glucose levels and decrease the
A. Give the child half his reg- risk of hypoglycemia
ular morning dose of insulin
B. Substitute simple carbs
or calorie-containing liquids
for solid foods
C. Give the child plenty of
unsweetened, clear liquids
to prevent dehydration
53 / 55
D. Take the child directly to
the ED
113. Which is the nurse's best re- D. "Give the child an extra 15 to 30 g of
sponse to the parents of a carbohydrate snack before soccer practice."
10-year-old child newly diag-
nosed with type 1 diabetes Rationale: Exercise lowers blood glucose lev-
mellitus who are concerned els. A snack with 15-30 g of carbs before ex-
about the child's continued ercise will decrease the risk of hypoglycemia.
participation in soccer?
A. "Consider the swim team

as an alternative to soccer."
B. "Encourage intellectual
activity rather than participa-
tion in sports."
C. "It is okay to play sports
such as soccer unless the
weather is too hot."
D. "Give the child an extra
15 to 30 g of carbohydrate
snack before soccer prac-
tice."
114. Which comment by a C. Ill be glad when I can take a pill for my
12-year-old with type 1 di- diabetes like my uncle does
abetes indicates deficient
knowledge. Rationale: Children with type 1 diabetes will
require life-long insulin therapy
A. I rotate my insulin injec-
tion sites every time I give
myself an injection
B. I keep records of my glu-
cose levels and insulin sites
and amounts
C. Ill be glad when I can take
a pill for my diabetes like my
uncle does
D. I keep lifesavers in my
54 / 55
school bag in case I have a
low-sugar reaction
55 / 55

DM-2

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

DM-2

Uploaded by

Copyright:

Available Formats

Diabetes - Prep-U/Test Bank

Study online at https://quizlet.com/_eqkqlu

1. A client with diabetes melli- A. hypoglycemia

2. A health care provider pre- A. 8:30 AM.

3. The nurse is taking the his- C. Erectile dysfunction

5. After being sick for 3 days, A. Serum potassium level

6. The nurse is explaining gly- D. Reflects the amount of glucose stored in

9. A nurse expects to find D. Nervousness, diaphoresis, and confusion

10. A client has been recent- A. polyphagia.

11. A nurse is teaching a dia- A. Presence of autoantibodies against islet

13. A patient who is diagnosed C. Need exogenous insulin.

14. A nurse is teaching a client D. "Ketones accumulate in the blood and

15. The nurse is preparing a B. Insulin production insufficient

16. A nurse educates a group A. Control blood glucose levels.

17. The nurse is preparing to ad- A. NPH

18. Which of the following would A. Diet soda

19. A client is diagnosed with D. Crying whenever diabetes is mentioned

20. Which type of insulin acts C. Lispro

21. Which statement is true C. A glucose challenge test should be per-

23. A client with long-standing C. Deficient knowledge (treatment regimen).

24. What is the duration of regu- A. 4 to 6 hours

25. A 60-year-old client comes B. Increased hunger

26. A client with diabetes is re- A. Metformin

28. A child is brought into B. Begin fluid replacements.

A. Give prescribed antiemet-

30. A client with type 2 diabetes C. Underlying problem of insulin resistance

31. A nurse is teaching a client B. 15 g of carbohydrates.

32. Insulin is a hormone secret- C. Synthesis of glucose from noncarbohy-

33. Which clinical characteristic A. Presence of islet cell antibodies

36. Which assessment finding is D. Fruity breath

37. A client with a tentative di- D. Serum osmolarity

38. Laboratory studies indicate C. Serum glycosylated hemoglobin (Hb A1c)

39. Which findings should the C. Polyuria

41. After teaching a group of stu- A. diabetic ketoacidosis

43. A 10-year-old child is new- A. 8.5%

45. The nurse is interpreting C. insulin

46. A child who has type 1 dia- A. Regular insulin

50. A child presents to C. Type 1 diabetes mellitus

55. A nurse is providing health C. Exercise

56. A nurse is caring for a B. 11:30 AM

57. A client has just been diag- B. A biguanide

58. A diabetes nurse educator is A. Do not eliminate insulin when nauseated

60. A school nurse is teaching D. Lose weight, if obese

61. A teenage client is brought A. Type 1 diabetes

66. An older adult client with D. Fluid and electrolyte replacement

A. Increased caloric intake

72. A medical nurse is aware of D. Middle-aged or older people with either

A. Monitoring the client's

77. A client with a long-stand- A. Infection

78. A client has been brought A. IV administration of 50% dextrose in water

79. A nurse is working for A. Always carry a form of fast-acting sugar.

80. A nurse is teaching basic D. Recognition of hypoglycemia and hyper-

A. "If you are going to use

A. Ensure that the client un-

88. A nurse is assessing a client D. The presence of a tingling sensation

A. Persistently cold feet

90. A client is brought to the B. Glycosuria

91. The nurse is developing a A. Deficient fluid volume related to dehydra-

92. The nurse is preparing a A. Developing management and deci-

94. A child with diabetes reports B. Give 10 to 15 g of a simple carbohydrate.

95. A child with diabetes in- A. Syndrome of inappropriate antidiuretic

96. A group of students are re- D. Glargine

97. A 5-year-old child with type B. 8.2%

98. The nurse is administering C) Between 9 and 11 AM