Diabetes Mellitus

1
Diabetes Mellitus

• Practice Questions

2

• The client, an 18-year old female, comes to the
  clinic with a wound on her left lower leg that
  has not healed for 2 weeks. Which disease process
  would the nurse suspect that the client
  developed?
• Type 1 DM
• Type 2 DM
• Gestational DM
• Secondary DM

3

• The client diagnosed with Type 1 DM has a
  glycosylated Hgb (A1C) of 8.1. Which
  interpretation should the nurse make based on
  this result?
• This result is below normal levels
• This result is within acceptable range
• This result is above recommended levels
• This result is dangerously high

4

• The nurse administered 28 units of Humulin N, an
  intermediate acting insulin, to a client
  diagnosed with Type 1 DM at 1700. Which action
  should the nurse implement?
• Determine how much food the client ate at lunch
• Perform a glucometer reading at 0700
• Ensure the client eats a bedtime snack
• Offer the client protein after administering
  insulin

5

• The client diagnosed with Type 1 DM is receiving
  Humalog, a rapid-acting insulin, by sliding
  scale. The order reads blood glucose level lt150,
  give 0 units 151-200, give 3 units 201-250,
  give 6 units gt251, contact MD. The clients BS
  is 189 mg/dL.
• How much insulin should you administer?_________
• What is the most important follow-up assessment
  for this patient and when? ____________________

6

• The nurse is completing an admission assessment
  for a 76 year old client with Type 2 DM that must
  be controlled with 70/30 combination insulin.
  Which intervention should be included in the plan
  of care?
• Assess the clients ability to read small print
• Monitor the clients coagulation studies
• Teach the client how to perform a HgbA1C test
  daily
• Instruct the client to check the feet weekly.

7

• The client with Type 2 DM controlled with
  biguanide oral diabetic medication is scheduled
  for a computed tomography with contrast of the
  abdomen to evaluate pancreatic function. Which
  intervention should the nurse implement?
• Provide a high fat diet 24 hours prior to test
• Hold the biguanide medication for 48 hours to
  test
• Obtain an informed consent for the test
• Administer pancreatic enzymes prior to test

8

• The diabetic educator is teaching a class on
  diabetes Type 1 and is discussing sick-day
  rules. Which interventions should the educator
  include in the discussion?
• Take diabetic medication even if unable to eat
  the clients normal diabetic diet
• If unable to eat, drink liquids equal to clients
  normal caloric intake
• It is not necessary to notify health care
  provider if ketones are present in urine
• Test blood glucose levels frequently and test
  urine for ketones once a day and keep a record

9

• The client received 10 units of Humulin R, a fast
  acting insulin, at 0700. At 1030, the unlicensed
  nursing assistant tells the nurse the client has
  a headache and is asking for his lunch tray early
  because he is feeling very hungry. Which action
  should the nurse implement first?
• Order the clients lunch tray from the kitchen
  and give it to him early
• Have the client drink 8 ounces of orange juice
• Go to the clients room and assess the client for
  hypoglycemia
• Prepare to administer 1 amp of 50 Dextrose
  intravenously
• Instruct the nursing assistant to obtain a blood
  glucose level

10

• The client diagnosed with Type 1 DM is found
  lying unconscious on the floor of the bathroom.
  Which intervention should the nurse implement
  first?
• Notify the physician
• Check the serum glucose level
• Administer 50 dextrose IVP
• Move the client to the ICU

11

• The nurse is discussing ways to prevent DKA with
  the client diagnosed with Type 1 DM. Which
  instruction would be most important to discuss
  with the client?
• Refer the client to American Diabetes Association
• Do not take any over the counter medications
• Take the prescribed insulin even when unable to
  eat because of illness
• Be sure to get you annual flu and pneumonia
  vaccines

12

• The goal of treatment with hypoglycemic agents is
  the maintenance of stable blood glucose levels to
  prevent the acute complications of hypoglycemia
  and hyperglycemia, and the long-term
  complications associated with hyperglycemia. Your
  patient will initially be taking Humulin
  N/Humulin R 70/30 insulin subcutaneously q a.m.,
  a sliding-scale dose of regular insulin
  subcutaneously before lunch and dinner, and
  Humulin N insulin at bedtime.
• Which statement made by a client indicates that
  she correctly understands self-administration of
  insulin?
• A) "My daily dose of 70/30 insulin is based on
  how much I ate the day before."B) "The amount of
  short-acting insulin I take every day is based on
  my blood sugar readings."C) "I should store my
  insulin in the refrigerator and remove it thirty
  minutes before I need it."D) "I will alternate
  my injection sites from leg to abdomen each day
  to avoid overuse."

  11.
13

• An hour before the next dose of sliding-scale
  insulin is scheduled, the client tells the nurse,
  "I guess Im really nervous about giving myself
  insulin injections. Look how shaky and sweaty I
  am.
•   What is the priority nursing action?
• A) Obtain Laras vital signs.B) Check Laras
  blood glucose.C) Assure Lara that she will be
  able to give herself the injections.D) Offer to
  bring Lara an orange so she can practice giving
  injections.

13
14

• After discharge, Lara is scheduled for a
  follow-up evaluation at the outpatient clinic. A
  glycosylated Hgb level is drawn, and the results
  were 11.
• Which statement by Lara reflects understanding of
  glycosylated Hgb?
• A) "The results of the test are probably high,
  because I was not fasting before my blood was
  drawn this morning."B) "The results of my test
  are probably high, because I went to a party
  last night and did not follow my diet."C) "I
  know that I need to check my glycosolated Hgb
  before each meal and at bedtime, but I dont
  always have time."D) "At least I won't have
  this done again for 3 months. I will really work
  at following my diet between now
• and then."

21.
15

• Lara tells the nurse that her 15-year-old sister
  had a fasting blood glucose test last week,
  because she felt that she had some of the same
  symptoms that Lara had before being diagnosed
  with diabetes. Lara states her sister's results
  were 135 mg/dl.
• How should the nurse respond?
• A) "She needs a second test performed before a
  diagnosis is made."B) "Since her value is high,
  it sounds like both of you have diabetes."C)
  "Her value is low and indicates that she does not
  have diabetes."D) "She is too young to develop
  Type 1 diabetes. She may have Type 2."

• 22.

16

• Lara talks to the nurse about what to do if she
  gets sick. She states, "It just doesnt make
  sense to take my insulin when I feel sick,
  knowing I wont want to eat anything."
• How should the nurse respond?
• A) "You are right. You should not take your
  insulin if you are feeling sick."B) "Take only
  sliding-scale insulin, not your regular dose, if
  you are feeling sick."C) "Being sick increases
  your blood sugar. Taking your usual insulin dose
  is important."D) "When you are sick, you should
  test your urine and only take insulin if ketones
  are present."

23.
17

• Which finding indicates that Lara is experiencing
  a complication of diabetes?
• A) Burning sensation in her toes.B) Visual
  acuity of 60/20.C) Lack of protein in her
  urine.D) Blood pressure of 110/60.

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