1. Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:
a. Document weight changes because of fatty acid mobilization
b. Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation
c. Protect the patient from sources of infection because of decreased cellular protein deposits
d. Do all of the above
2. Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:
3. The lowest fasting plasma glucose level suggestive of a diagnosis of DM is:
4. Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every:
a. Third day
c. 2-3 weeks
d. 2-4 weeks
5. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:
a. Blurred vision
6. Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:
a. Integumentary inspection for the presence of brown spots on the lower extremities
b. Observation for paleness of the lower extremities
c. Observation for blanching of the feet after the legs are elevated for 60 seconds
d. Palpation for increased pulse volume in the arteries of the lower extremities
7. The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively:
8. Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:
a. 1130 and 1330
b. 1330 and 1930
c. 1530 and 2130
d. 1730 and 2330
9. A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of:
a. 6-8 hours
b. 10-14 hours
c. 16-20 hours
d. 24-28 hours
10. Albert refuses his bedtime snack. This should alert the nurse to assess for:
a. Elevated serum bicarbonate and a decreased blood pH.
b. Signs of hypoglycemia earlier than expected.
c. Symptoms of hyperglycemia during the peak time of NPH insulin.
d. Sugar in the urine
11. A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:
a. 2-4 hours after administration
b. 6-14 hours after administration
c. 16-18 hours after administration
d. 18-24 hours after administration
12. An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:
a. Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.
b. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.
c. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.
d. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.
13. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?
a. Elevated blood glucose level and a low plasma bicarbonate
b. Decreased urine output
c. Increased respirations and an increase in pH
d. Comatose state
14. A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to:
a. Administer a sedative
b. Make sure the client knows all the correct medical terms to understand what is happening.
c. Ignore the signs and symptoms of anxiety so that they will soon disappear
d. Convey empathy, trust, and respect toward the client.
15. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be:
a. High risk for deficient fluid volume
b. Deficient knowledge: disease process and treatment
c. Imbalanced nutrition: less than body requirements
d. Disabled family coping: compromised.
16. A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:
a. Administer regular insulin intravenously
b. Administer 5% dextrose intravenously
c. Correct the acidosis
d. Apply an electrocardiogram monitor.
17. A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse?
18. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise?
a. “The best time for me to exercise is every afternoon.”
b. “The best time for me to exercise is right after I eat.”
c. “The best time for me to exercise is after breakfast.”
d. “The best time for me to exercise is after my morning snack.”
19. A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?
a. Prednisone (Deltasone)
b. Atenolol (Tenormin)
c. Phenelzine (Nardil)
d. Allopurinol (Zyloprim)
20. Glucose is an important molecule in a cell because this molecule is primarily used for:
a. Extraction of energy
b. Synthesis of protein
c. Building of genetic material
d. Formation of cell membranes.