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: <150, give 0 units; 151-200, give 3 units; 201-250, give 6 units; >251, contact MD. The client’s 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 client’s ability to read small print • Monitor the client’s 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 client’s normal diabetic diet • If unable to eat, drink liquids equal to client’s 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 client’s lunch tray from the kitchen and give it to him early • Have the client drink 8 ounces of orange juice • Go to the client’s 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 I’m really nervous about giving myself insulin injections. Look how shaky and sweaty I am.“   What is the priority nursing action? A) Obtain Lara’s vital signs.B) Check Lara’s 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 don’t 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 doesn’t make sense to take my insulin when I feel sick, knowing I won’t 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.