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Diabetes Mellitus

1. In addition to promoting the transport of glucose from the blood in the cell,
insulin also.
a. enhances the breakdown of adipose tissue for energy
b. stimulates hepatic glycogenolysis and gluconeogenesis
c. prevents the transport of triglycerides into adipose tissue
d. accelerates the transport of amino acids into cells and their synthesis into protein
2. Complete the following statements.
a. Tissues that require insulin for glucose transport are ____________________ &
______________ tissues.
b. In type I diabetes, the bodys own _______________ cells are attacked and
c. Four hormones released that are counter-regulatory to insulin are
________________, ________________, __________________ and _________________.
3. Indicate whether the following mechanisms of diabetes mellitus are characteristic
of the pathophysiology of type I (1) or type II (2) diabetes.
_____a. Insulin resistance

-cell secretory exhaustion

_____c. Inherited defect in insulin receptors

_____d. Immune mediated
_____e. Genetic predisposition
_____f. Inappropriate glucose production by the liver
_____g. -cell destruction
_____h. Altered production of adipokines
_____i. Compensatory increased insulin production
_____j. Exposure to a virus
4. Describe the process that occurs to cause the following classic diabetes
a. polyuria
b. polydipsia

c. polyphagia
5. Which of the following patients would a nurse plan to teach how to prevent or
delay the development of diabetes?
a. A 62-y/o obese white man
b. An obese 50-y/o Hispanic women
c. A child whose father has type I diabetes
d. A 34-y/o women whose parents both have type II diabetes
6. Priority Decision: When caring for a patient with metabolic syndrome, the
nurse gives the highest priority to teaching the patient about:
a. maintaining a normal weight
b. performing daily aerobic exercise
c. eliminating red meat from the diet
d. monitoring the blood glucose periodically
7. During routine health screening, a patient is found to have fasting plasma
glucose (FPG) of 132 mg/dL. At a follow-up visit, a diagnosis of diabetes would be
made based on (select all that apply).
a. glucosuria of 3+
b. an A1C of 7.5%
c. A FPG of 136 mg/dL
d. a random blood glucose of 136 mg/dL
e. a 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL
8. The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has
a. diabetes
b. impaired fasting glucose
c. impaired glucose tolerance
d. elevated glycosylated hemoglobin (Hb)

9. A 52-y/o patient admitted to the hospital with vomiting and diarrhea has a fasting
blood sugar (FBS) of 512 mg/dL and an arterial pH of 7.38. He is diagnosed with
diabetes mellitus and treated with insulin and IV fluids. The nurse recognizes that it
most likely that this patient
a. will require insulin treatment only during stress
b. is demonstrating the abrupt onset of type I diabetes
c. will require long-term insulin therapy to control the diabetes
d. has enough endogenous insulin to prevent diabetic ketoacidosis with the
10. When teaching the patient with diabetes about insulin administration, the nurse
instructs the patient to
a. pull back on the plunger after inserting the needle to check for blood return
b. clean the skin at the injection site with an alcohol swab before each injection
c. consistently use the same size of the appropriate strength insulin syringe to avoid
dosing errors
d. rotate injection sites from arms to thighs to abdomen with each injection to
prevent lipodystrophies
11. A patient with type I diabetes uses 20 U of 70/30 neutral protamine Hagedorn
(NPH/regular) in the morning and at 6:00 pm. When teaching the patient about this
regimen, the nurse stresses that
a. hypoglycemia is most likely to occur before the noon meal
b. a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia
c. flexibility in foot intake is possible because insulin is available 24 hr/day
d. pre-meal glucose checks are required to determine needed changes in daily
12. Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly
diagnosed type I diabetes. The nurse knows that when lispro insulin is used, it
should be administered
a. only once a day
b. 1 hour before meals
c. 30 to 45 minutes before meals
d. at mealtime or within 15 minutes of meals

13. A diabetic patient is learning to mix regular insulin and NPH insulin in the same
syringe. The nurse determines that additional teaching is needed when the patient
a. withdraws the NPH dose into the syringe first
b. injects air equal to the NPH dose into the syringe first
c. removes any air bubbles after withdrawing the first insulin
d. adds air equal to the insulin dose into the regular vial and withdraws the first
14. Delegation Decision: The following interventions are planned for a diabetic
patient. Which intervention can the nurse delegate to nursing assistive personnel
a. Discuss complications of diabetes
b. Check that the bath water is not too hot
c. Check the patients technique for drawing up insulin
d. Teach the patient to use the glucometer for in-home glucose monitoring
15. The home care nurse should intervene to correct a patient whose insulin
administration includes
a. warming a prefilled refrigerated syringe in the hands before administration
b. storing syringes prefilled with NPH and regular insulin needle-up in the
c. placing the insulin bottle currently in use in a small container on the bathroom
d. mixing an evening dose of regular insulin with insulin glargine in one syringe for
16. The major advantage of using an insulin pump is that
a. tight glycemic control can be maintained
b. errors in insulin dosing are less likely to occur
c. complications of insulin therapy are prevented
d. frequent blood glucose monitoring is unnecessary
17. A patient taking insulin has recorded fasting glucose levels above 200 mg/dL on
awakening for the last five mornings. The nurse advises the patient to

a. increase the evening insulin dose to prevent dawn phenomenon

b. use a single-dose insulin regimen with an intermediate-acting insulin
c. monitor the glucose level at bedtime between 2:OO and 4:00 am and on arising
d. decrease the evening insulin dosage to prevent night hypoglycemia and the
Somogyi effect

18. One of the disadvantages of using oral antidiabetic agents compared with the
use of insulin is that
a. hypoglycemic episodes are more common and prolonged than with the use of
b. more frequent blood glucose monitoring is necessary to evaluate the effect of
oral antidiabetic agents
c. patients may assume that their diabetes is not serious and that dietary
modifications and meal scheduling are not important
d. the use of other medications may cause interactions, potentiating the glucoselowering effect of oral antidiabetic agents
19. Match the following oral glucose-lowering agents with their descriptions
(answers may be used more than once)
1. sulfonylurea
2. meglitinide
3. biguanide
4. -glucosidase inhibitor
5. thiazolidinediones
_____a. Decrease endogenous glucose production
_____b. Should be taken within 30 minutes of each meal
_____c. Decreases glycogenolysis
_____d. Enhance cell sensitivity to insulin
_____e. Rapid- and short-acting release of insulin from the pancreas
_____f. Delays glucose absorption from the gastrointestinal (GI) tract
_____g. Stimulates production and release of insulin and enhances cellular sensitivity
to insulin
_____h. Increases glucose uptake, especially in muscles

_____i. Primary effect is decreased glucose production by liver

_____j. Effectiveness measured by 2-hour postprandial glucose
_____k. Taken with the first bite of each meal
_____l. Not used in patients with heart failure

20. Priority Decision: The nurse is assessing a newly admitted diabetic patient.
Which of these observations should be addressed as a priority by the nurse?
a. Bilateral numbness of both hands
b. Stage II pressure ulcer on the right heel
c. Rapid respirations with deep inspiration
d. Areas of lumps and dents on the abdomen
21. In nutritional management of all types of diabetes, it is important for the patient
a. eat regular meals at regular times
b. restrict calories to promote moderate weight loss
c. eliminate sucrose and other simple sugars from the diet
d. limit saturated fat intake to 30% of dietary calorie intake
22. Goals of nutritional therapy for the patient with type II diabetes include
maintenance of
a. ideal body weight
b. normal serum glucose and lipid levels
c. a special diabetic diet using dietetic foods
d. five small meals per day with a bedtime snack
23. To prevent hyperglycemia or hypoglycemia with exercise, the nurse teaches the
patient using glucose-lowering agents that exercise should be undertaken
a. only after a 10- to 15-g carbohydrate snack is eaten
b. about 1 hour after eating, when blood glucose levels are rising
c. when glucose monitoring reveals that the blood glucose is in the normal range
d. when blood glucose levels are high because exercise always has a hypoglycemic

24. The nurse assesses the diabetic patients technique of self-administration of

blood glucose (SMBG) 3 months after initial instruction. An error in the performance
of SMBG noted by the nurse that requires intervention is
a. doing the SMBG before and after exercising
b. puncturing the finger on the side of the finger pad
c. cleaning the puncture site with alcohol before the puncture
d. holding the hand down for a few minutes before the puncture
25. A nurse working in an outpatient clinic plans a screening program for diabetes.
Recommendations for screening would include
a. OGTT for all minority populations every year
b. FPG for all individuals at 45 and then every 3 years
c. testing all people under the age of 21 for islet cell antibodies
d. testing for type II diabetes only in overweight or obese individuals
26. A patient with diabetes calls the clinic because she is experiencing nausea and
flulike symptoms. The nurse advise the patient to
a. administer the usual insulin dosage
b. hold fluid intake until the nausea subsides
c. come to the clinic immediately for evaluation and treatment
d. monitor the blood glucose every 1 to 2 hours and call if the glucose rises over
150 mg/dL
27. Ketoacidosis occurs as a complication of diabetes when
a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids
b. the glucose level becomes so high that osmotic diuresis promotes fluid and
electrolyte loss
c. an insulin deficit causes the body to metabolize large amounts of fatty acids
rather than glucose for energy
d. the patient skips meals after taking insulin, leading to rapid metabolism of
glucose and breakdown of fats for energy
28. Number in sequence from 1 to 8 the process of potassium imbalance in diabetic
ketoacidosis (DKA)
_____ a. Treatment with insulin increases glucose metabolism and decrease fat
_____ b. Decreased H ions in the blood

_____ c. K from the cells moves into blood in exchange for H ions
_____ d. Movement of K back into the cells
_____ e. K excreted in urine with osmotic diuresis
_____ f. Increased serum K concentration
_____ g. total body K deficit
_____ h. Increased H ions present in form of acidic ketones and acetone

29. List five signs and symptoms that are present in diabetic ketoacidosis (DKA) that
are not seen in hyperglycemic hyperosmolar syndrome (HHS)
30. The treatment of DKA and HHS differs primarily in that
a. DKA requires administration of bicarbonate to correct acidosis
b. K replacement is not necessary in management of HHS
c. HHS requires grater fluid replacement to correct the dehydration
d. administration of glucose is withheld in HHS until the blood glucose reaches a
normal level
31. Indicate whether the following characteristics are associated with Hypoglycemia
(1), hyperglycemia (2) or both (3)
_____ a. slurred speech and irritability
_____ b. headache
_____ c. nausea and vomiting
_____ d. too much exercise without food
_____ e. increased dietary intake
_____ f. cold, clammy skin
_____ g. precipitated by stress
_____ h. changes in vision

32. The nurse is alerted to the possibility of hypovolemic shock occurring in the
patient with HHS by the presence of
a. an increase in central venous pressure (CVP)
b. deep, rapid respirations
c. a change from polyuria to oliguria
d. depressed ST segment and T waves on cardiac monitoring
33. A diabetic patient is found unconscious at home and a family member calls the
clinic. After determining that no glucometer is available, the nurse advises the
family member to
a. try to arouse the patient to drink some orange juice
b. administer 10U of regular insulin subcutaneously
c. call for an ambulance to transport the patient to medical facility
d. administer glucagon 1mg intramuscularly (IM) or subcutaneously
34. Two days following a self-managed hypoglycemic episode at home, the patient
tells the nurse that his blood glucose levels since the episode have been between
80 and 90 mg/dL. The best response by the nurse is
a. that is good range for your glucose levels.
b. you should call your HCP because you need to have your insulin increased
c. that level is too low in view of your recent hypoglycemia and you should
increase your food intake:
d. you should only take half your insulin dosage for the next few days to get your
glucose level back to normal
35. In diabetes, atherosclerotic disease affecting the cerebrovascular,
cardiovascular and peripheral vascular systems
a. can be prevented by tight glucose control
b. occurs with higher frequency and earlier onset than in the nondiabetic population
c. is caused by the hyperinsulinemia related to insulin resistance common in type II
d. cannot be modified by reduction of risk factors such as smoking, obesity and high
fat intake
36. Following the teaching of foot care to a diabetic patient, the nurse determines
that additional instructions is needed when the patients says
a. I should wash my feet daily with soap and warm water

b. I should always wear shoes to protect my feet from injury

c. If my feet are cold, I should wear socks instead of using a heating pad
d. Ill know if I have sores or lesions on my feet because they will be painful

37. A 72-y/o woman is diagnosed with diabetes. The nurse recognizes that
management of diabetes in the older adult
a. does not require as tight glucose control as in younger diabetics
b. is usually not treated unless the patient becomes severely hyperglycemic
c. does not include treatment with insulin because of limited dexterity and vision
d. usually requires that a younger family member be responsible for care of the
38. Match the following characteristics as they relate to complications of diabetes
(answers may be used more than once)
1. Microvascular
2. Macrovascular
3. Autonomic neuropathy
4. Sensory neuropathy
_____ a. male impotence
_____ b. damage to small vessels that supply the renal glomeruli
_____ c. related to altered lipid metabolism of diabetes
_____ d. micro-aneurysms and destruction of retinal capillaries
_____e. atrophy of small muscles of the hands and feet
_____ f. capillary and arteriole membrane thickening specific to diabetes
_____ g. pain and paresthesia of the legs
_____ h. ulceration and amputation of the lower extremities
_____ i. foot ulcers without patient feeling pain
_____ j. delayed gastric emptying

_____ k. ischemic heart disease

_____ l. painless myocardial infarction

1. D
2. a. skeletal muscle, adipose; b. pancreatic beta (); c. cortisol, epinephrine,
glucagon, growth hormone; d. type I
3. a. 2

b. 2

c. 2

d. 1

e. 1

f. 2

g. 1

h. 2

i. 2

j. 1

4. a. high glucose levels cause loss of glucose in urine w/osmotic diuresis; b.

thirst caused by fluid loss of polyuria; c. cellular starvation from lack of
glucose and use of fat and protein for energy
5. d
6. a
7. b,c
8. c
9. d
10. c
11. b
12. d
13. a
14. b
15. d
16. a
17. c
18. c

19. a. 5 b. 2 c. 1 d. 1 e. 2 f. 4 g. 1 h. 3 i. 3 j. 4 k. 4 l. 5
20. c
21. a
22. b
23. b
24. c
25. b
26. a
27. c
28. a. 5

b. 6 c. 2

d. 7

e. 4

f. 3 g. 8 h. 1

29. a. kussmauls respirations; b. ketonuria; c. sweet, fruity odor to breath; d.

decrease arterial pH (acidosis) e. ketonemia
30. c
31. a. 1

b. 3

c. 2

d. 1

e. 2

f. 1 g. 2

h. 3

32. c
33. d
34. a
35. b
36. d
37. a
38. a. 3 b. 1 c. 2 d. 1

e. 4

f. 1 g. 4 h. 2 i. 4

j. 3 k. 2

l. 3