JOANNE BERNADETTE C.

AGUILAR BSN-4

1. Knowing that gluconeogenesis helps to maintain blood glucose 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. The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should
expect the following symptoms during an assessment, except:

A. Hypoglycemia

B. Frequent bruising

C. Ketonuria

D. Dry mouth

3. Question

Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an
individual over the previous three months. Which of the following values is considered a
diagnosis of pre-diabetes?

A. 6.5-7%

B. 5.7-6.4%

C. 5-5.6%

D. >5.6%

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

B. Every other day

C. 1-2 weeks
D. 2-4 weeks

5. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

A. Blurred vision

B. Diaphoresis

C. Nausea

D. Weakness

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 how much of his or her morning dose of
insulin preoperatively?

A. 10-20%

B. 25-40%

C. 50-60%

D. 85-90%

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 male nurse is providing a bedtime snack for his patient. 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. 14-18 hours

D. 24-28 hours

10.A nurse went to a patient’s room to do routine vital signs monitoring and found out that the
patient’s bedtime snack was not eaten. This should alert the nurse to check and assess for:

A. Elevated serum bicarbonate and 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 a 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. It is timed to release programmed doses of regular or NPH insulin into the bloodstream at
specific intervals.

C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in
turn releases the insulin into the bloodstream.
D. It 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 respiration and an increase in pH

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 diabetes mellitus 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 diabetes mellitus. Findings
include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations
of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse?

A. Pulse

B. Blood pressure

C. Respiration

D. Temperature

18. A client with type 1 diabetes mellitus 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 180-200 mg/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

21. When a client is first admitted with hyperglycemic hyperosmolar non ketotic syndrome
(HHNS), the nurse’s priority is to provide:

A. Oxygen

B. Carbohydrates

C. Fluid replacement

D. Dietary instruction

22.The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse
should expect. Select all that apply.

A. Thirst

B. Palpitations

C. Diaphoresis

D. Slurred speech

E. Hyperventilation

23.When a client is experiencing diabetic ketoacidosis, the insulin that would be administered is:

A. Human NPH insulin

B. Human regular insulin

C. Insulin lispro injection

D. Insulin glargine injection

24. The nurse recognizes that additional teaching is necessary when the client who is learning
alternative site testing (AST) for glucose monitoring says:

A. “I need to rub my forearm vigorously until warm before testing at this site.”

B. “The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”

C. “I have to make sure that my current glucose monitor can be used at an alternate site.”
D. “Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.”

25. A 44-year-old woman with type 1 diabetes comes to the emergency department due to
abdominal pain accompanied by nausea and vomiting. The patient had a history of chronic back
pain due to a motor accident 20 years ago. Her situation renders her unable to work and pay for
the increasing price of insulin, which has doubled during the last five years. The patient doesn’t
have medical coverage or insurance; therefore, she rations her insulin intake, making her unable
to follow her prescribed therapeutic regimen for her diabetes. Because of her situation, the client
is at high risk of developing diabetic ketoacidosis. As her nurse, which of the following
symptoms would you anticipate the client to exhibit? Select all that apply.

A. Fruity odor breath

B. Deep and labored respirations

C. Blurred vision

D. Increased urination

E. Increased thirst

F. Fatigue

G. Blood glucose level of 60 mg/dL

H. Dehydration

I. Respiratory rate of 8 bpm

J. Hypernatremia

K. Metabolic alkalosis

PART #2
1. A client’s blood gases reflect diabetic acidosis. The nurse should expect:

A. Increased pH

B. Decreased PO2

C. Increased PCO2

D. Decreased HCO3

2.The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:
A. Inhibits gluconeogenesis

B. Stimulates the release of insulin

C. Increases blood glucose levels

D. Provides more storage of glucose.

3. A client with type 1 diabetes mellitus has a fingerstick glucose level of 258mg/dl at bedtime.
An order for sliding scale insulin exists. The nurse should:

A. Call the physician

B. Encourage the intake of fluids

C. Administer the insulin as ordered

D. Give the client 1/2 c. of orange juice

4. The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to
administer these drugs using one (1) syringe.

Tip: Identify the steps in this procedure by listing them in priority order, simply drag and drop
the choices below.

a. Inject air equal to NPH dose into NPH vial

b. Inject air equal to regular dose into regular dose

c. Invert regular insulin bottle and withdraw regular insulin dose

d. Invert NPH vial and withdraw NPH dose

5.The nurse is teaching a client regarding the administration of insulin as part of the discharge
plan. Which of the following insulin has the most rapid onset of action?

A. insulin regular (Humulin R)

B. lispro (Admelog)

C. glargine (Toujeo)

D. insulin NPH (Humulin N)

6. A client with diabetes mellitus states, “I cannot eat big meals; I prefer to snack throughout the
day.” The nurse should carefully explain that:

A. Regulated food intake is basic to control

B. Salt and sugar restriction is the main concern

C. Small, frequent meals are better for digestion

D. Large meals can contribute to a weight problem

7. A client with diabetes mellitus has an above-knee amputation because of severe peripheral
vascular disease, Two days following surgery, when preparing the client for dinner, it is the
nurse’s primary responsibility to:

A. Check the client’s serum glucose level

B. Assist the client out of bed to the chair

C. Place the client in a High-Fowler's position

D. Ensure that the client’s residual limb is elevated

8. Which of the following nursing interventions should be taken for a client who complains of
nausea and vomits one hour after taking his glyburide (DiaBeta)?

A. Give glyburide again

B. Give subcutaneous insulin and monitor blood glucose

C. Monitor blood glucose closely, and look for signs of hypoglycemia

D. Monitor blood glucose, and assess for signs of hyperglycemia

9. Which of the following chronic complications is associated with diabetes?

A. Dizziness, dyspnea on exertion, and coronary artery disease

B. Retinopathy, neuropathy, and coronary artery disease

C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts

D. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias

10. Rotating injection sites when administering insulin prevents which of the following
complications?

A. Insulin edema

B. Insulin lipodystrophy

C. Insulin resistance
D. Systemic allergic reactions

11. Which of the following methods of insulin administration would be used in the initial
treatment of hyperglycemia in a client with diabetic ketoacidosis?

A. Subcutaneous

B. Intramuscular

C. IV bolus only

D. IV bolus, followed by continuous infusion

12. Insulin forces which of the following electrolytes out of the plasma and into the cells?

A. Calcium

B. Magnesium

C. Phosphorus

D. Potassium

13. Which of the following causes of Hyperglycaemic Hyperosmolar Non-Ketotic Syndrome

(HHNS) is most common?

A. Insulin overdose

B. Removal of the adrenal gland

C. Undiagnosed, untreated hyperpituitarism

D. Undiagnosed, untreated diabetes mellitus

14. A client is in diabetic ketoacidosis (DKA) secondary to infection. As the condition

progresses, which of the following symptoms might the nurse see?

A. Kussmaul’s respirations and a fruity odor on the breath

B. Shallow respirations and severe abdominal pain

C. Decreased respiration and increased urine output

D. Cheyne-stokes respirations and foul-smelling urine

15. Clients with type 1 diabetes may require which of the following changes to their daily routine
during periods of infection?

A. No changes
B. Less insulin

C. More insulin

D. Oral antidiabetic agents

16. Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol what this
means. What is the best response by the nurse? Select all that apply.

A. "Your alpha cells should be able to secrete insulin, but cannot."

B. "The exocrine function of your pancreas is to secrete insulin."

C. "Without insulin, you will develop ketoacidosis (DKA)."

D. "The endocrine function of your pancreas is to secrete insulin."

E. "It means your pancreas cannot secrete insulin."

17. Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse
AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the
nurse reveal? Select all that apply.

A. The nurse could have given the insulin subcutaneously.

B. The nurse should have contacted the physician.

C. The nurse should have used regular insulin (Humulin R).

D. The nurse used the correct insulin.

E. The nurse could have given the insulin intramuscularly.

18. Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best
assessment of the nurse reveal?

A. The client will be very thirsty.

B. The client will complain of nausea.

C. The client will need to urinate.

D. The client will have moist clammy skin.

19. A clinical instructor teaches a class for the public about diabetes mellitus. Which individual
does the nurse assess as being at the highest risk for developing diabetes?

A. The 50-year-old client who does not get any physical exercise
B. The 56-year-old client who drinks three glasses of wine each evening

C. The 42-year-old client who is 50 pounds overweight

D. The 38-year-old client who smokes one pack of cigarettes per day

20. A patient was recently diagnosed with type 1 diabetes mellitus and received insulin. Which
laboratory test will the nurse assess?

A. Potassium

B. AST (aspartate aminotransferase)

C. Serum amylase

D. Sodium

21. Jansen is receiving metformin (Glucophage). What will be the best plan of the nurse with
regard to patient education with this drug? Select all that apply.

A. It stimulates the pancreas to produce more insulin.

B. It must be taken with meals.

C. It decreases sugar production in the liver.

D. It inhibits the absorption of carbohydrates.

E. It reduces insulin resistance.

22. Serafica who has diabetes mellitus type 1 is found unresponsive in the clinical setting. Which
nursing action is a priority?

TIP: To arrange all answers in the correct order, simply drag and drop the choices below.

a.Treat the client for hypoglycemia.

b. Call the physician STAT.

c. Assess the vital signs.

d.Call a code.

e. Incorrect

23.Serge who has diabetes mellitus is taking oral agents and is scheduled for a diagnostic test
that requires him to be NPO. What is the best plan of the nurse with regard to giving the client
his oral medications?
A. Administer the oral agents immediately after the test.

B. Notify the diagnostic department and request orders.

C. Notify the physician and request orders.

D. Administer the oral agents with a sip of water before the test.

24. A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can’t just
take pills instead. What is the best response by the nurse?

A. "Insulin must be injected because it needs to work quickly."

B. "Insulin can't be in a pill because it is destroyed in stomach acid."

C. "Have you talked to your doctor about taking pills instead?"

D. "I know it is tough, but you will get used to the shots soon."

25.Nurse Andy has finished teaching a client with diabetes mellitus how to administer insulin.
He evaluates the learning has occurred when the client makes which statement?

A. "I should check my blood sugar immediately prior to the administration."

B. "I should provide direct pressure over the site following the injection."

C. "I should use the abdominal area only for insulin injections."

D. "I should only use a calibrated insulin syringe for the injections."

PART#3
1. Question

Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that
she likes to have a glass of wine with dinner. What will the best plan of the nurse for client
education include?

A. The alcohol could cause pancreatic disease.

B. The alcohol could cause serious liver disease.

C. The alcohol could predispose you to hypoglycemia.

D. The alcohol could predispose you to hyperglycemia.

2. Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes
mellitus. When will the nurse administer this medication?

A. When the client is eating

B. Thirty minutes before meals

C. Fifteen minutes before meals

D. When the meal trays arrive on the floor

3.Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse
Matt notes the client’s additional insulin vials are not refrigerated. What is the best action by the
nurse at this time?

A. Instruct the client to label each vial with the date when opened.

B. Tell the client there is no need to keep additional vials.

C. Have the client place the insulin vials in the refrigerator.

D. Have the client discard the vials.

4. During the morning rounds, Nurse AJ accompanied the physician in every patient’s room. The
physician writes orders for the client with diabetes mellitus. Which order would the nurse
validate with the physician?

A. Use Humalog insulin for sliding scale coverage.

B. Metformin (Glucophage) 1000 mg per day in divided doses.

C. Administer regular insulin 30 minutes prior to meals.

D. Lantus insulin 20U BID.

5. Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning
has occurred when the client makes which statement?

A. "My cells have increased their receptors, but there is enough insulin."

B. "My peripheral cells have increased sensitivity to insulin."

C. "My beta cells cannot produce enough insulin for my cells."

6. The principal goals of therapy for older patients who have poor glycemic control are:
A. Enhancing the quality of life.

B. Decreasing the chance of complications.

C. Improving self-care through education.

7. Which of the following is accurate pertaining to physical exercise and type 2 diabetes
mellitus?

A. Physical exercise can slow the progression of type 2 diabetes mellitus.

B. Strenuous exercise is beneficial when blood glucose is high.

C. Patients who take insulin and engage in strenuous physical exercise might experience
hyperglycemia.

D. Adjusting insulin regimen allows for safe participation in all forms of exercise.

8. Harry is a diabetic patient who is experiencing a reaction to alternating periods of nocturnal

hypoglycemia and hyperglycemia. The patient might be manifesting which of the following?

A. Uncontrolled diabetes

B. Somogyi phenomenon

C. Brittle diabetes

D. Diabetes insipidus

9. Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus
type 2. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting
glyburide (Micronase), is to:

A. Induce hypoglycemia by decreasing insulin sensitivity.

B. Improve insulin sensitivity and decrease hyperglycemia.

C. Stimulate the beta cells of the pancreas to secrete insulin.

D. Decrease insulin sensitivity by enhancing glucose uptake.

10. Rosemary has been taking glargine (Lantus) to treat her condition. One of the benefits of
glargine (Lantus) insulin is its ability to:

A. Release insulin rapidly throughout the day to help control basal glucose.

B. Release insulin evenly throughout the day and control basal glucose levels.
C. Simplify the dosing and better control blood glucose levels during the day.

D. Cause hypoglycemia with other manifestations of other adverse reactions.

11. A 50-year-old widower is admitted to the hospital with a diagnosis of diabetes mellitus and
complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia. The
gerontology nurse should anticipate which of the following secondary medical diagnoses?

A. Impaired glucose tolerance

B. Gestational diabetes mellitus

C. Pituitary tumor

D. Pancreatic tumor

12. An older woman with diabetes mellitus visits the clinic concerning her condition. Which of
the following symptoms might an older woman with diabetes mellitus complain?

A. Anorexia

B. Pain intolerance

C. Weight loss

D. Perineal itching

13. Gregory is a 52-year-old man identified as high-risk for diabetes mellitus. Which laboratory
test should a nurse anticipate a physician would order for him? Select all that apply.

A. Fasting Plasma Glucose (FPG)

B. Two-hour Oral Glucose Tolerance Test (OGTT)

C. Glycosylated hemoglobin (HbA1C)

D. Fingerstick glucose three times daily

E. Urinalysis and urine culture

14. According to the National Diabetes Statistics Report, diabetes remains one of the leading
causes of death in the United States since 2010. Which of the following factors are risks for the
development of diabetes mellitus? Select all that apply.

A. Age over 45 years

B. Overweight with a waist/hip ratio >1

C. Having a consistent HDL level above 40 mg/dl

D. Maintaining a sedentary lifestyle

E. Polycystic ovary syndrome

15. During a visit to the hospital, the student nurses are asked which of the following persons
would most likely be diagnosed with diabetes mellitus. They are correct if they answered a 44-
year-old:

A. Caucasian woman.

B. Asian woman.

C. African-American woman.

D. Hispanic male.

16. An ailing 70-year-old woman with a diagnosis of type 2 diabetes mellitus has been ill with
pneumonia. The client’s intake has been very poor, and she is admitted to the hospital for
observation and management as needed. What is the most likely problem with this patient?

A. Insulin resistance has developed.

B. Diabetic ketoacidosis is occurring.

C. Hypoglycemia unawareness is developing.

D. Hyperglycemic hyperosmolar nonketotic syndrome.

17. After suffering an acute MI, a client with a history of type 1 diabetes is prescribed metoprolol
(Lopressor) I.V. Which nursing interventions are associated with I.V. administration of
metoprolol? Select all that apply.

A. Monitor glucose levels closely.

B. Monitor for heart block and bradycardia.

C. Monitor blood pressure closely.

D. Mix the drug in 50 ml of dextrose 5% in water and infuse over 30 minutes.

E. Be aware that the drug is not compatible with morphine.

18. When reviewing the urinalysis report of a client with newly diagnosed diabetes mellitus, the
nurse would expect which urine characteristics to be abnormal? Select all that apply.
A. Amount.

B. Odor.

C. pH.

D. Specific gravity.

E. Glucose level.

F. Ketone bodies.

19. The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart
failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness,
and confusion. The client complains of headache and nausea. Based on the serum laboratory
results below, how would the nurse interpret the client’s acid-base balance?

Lab Results:

pH: 7.34

HCO3-: 19 mEq/L

PaCO2: 35 mm Hg

PaO2: 88 mm Hg

Potassium: 5.3 mEq/L

Chloride: 102 mEq/L

Calcium: 10.4 mg/dl

Anion gap: 30 mEq/L

A. Metabolic alkalosis.

B. Metabolic acidosis.

C. Respiratory acidosis.
D. Respiratory alkalosis.

20, which client would have the following treatment goals: fluid replacement, vasopressin
replacement, and correction of underlying intracranial pathology?

A. The client with diabetes mellitus.

B. The client with diabetes insipidus.

C. The client with diabetic ketoacidosis.

D. The client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion.

21. During the lecture, the clinical instructor tells the students that 50% to 60% of daily calories
should come from carbohydrates. What should the nurse say about the types of carbohydrates
that can be eaten?

A. Try to limit simple sugars to between 10% and 20% of daily calories.

B. Simple carbohydrates are absorbed more rapidly than complex carbohydrates.

C. Simple sugars cause a rapid spike in glucose levels and should be avoided.

22. At the time Cherrie Ann found out that the symptoms of diabetes were caused by high levels
of blood glucose, she decided to break the habit of eating carbohydrates. With this, the nurse
would be aware that the client might develop which of the following complications?

A. Retinopathy

B. Atherosclerosis

C. Glycosuria

D. Acidosis

23. Joko has recently been diagnosed with type 1 Diabetes Mellitus and asks nurse Jessica for
help formulating a nutrition plan. Which of the following recommendations would the nurse
make to help the client increase calorie consumption to offset absorption problems?

A. Eat small meals with two or three snacks throughout the day to keep blood glucose levels
steady

B. Increase the consumption of simple carbohydrates

C. Eating small meals with two or three snacks may be more helpful in maintaining blood
glucose levels than three large meals.

D. Skip meals to help lose weight

24. Billy is being asked concerning his health in the emergency department. When obtaining a
health history from a patient with acute pancreatitis, the nurse asks the patient specifically about
the history of:

A. Alcohol use

B. Cigarette smoking

C. Diabetes mellitus

D. High-protein diet

25. Nurse Shey is educating a pregnant client who has gestational diabetes. Which of the
following statements should the nurse make to the client? Select all that apply.

A. Cakes, candies, cookies, and regular soft drinks should be avoided.

B. Gestational diabetes increases the risk that the mother will develop diabetes later in life.

C. Gestational diabetes usually resolves after the baby is born.

D. Insulin injections may be necessary.

E. The mother should strive to gain no more weight during pregnancy.

F. The baby will likely be born with diabetes.

PART#4
1. The goal of preprandial blood glucose for those with type 1 diabetes mellitus is:

A. <80 mg/dl

B. <130 mg/dl

C. <180 mg/dl

D. >8%

2. The guidelines for carbohydrate counting as medical nutrition therapy for diabetes mellitus
includes all of the following, except:
A. Flexibility in types and amounts of foods consumed

B. Unlimited intake of total fat, saturated fat, and cholesterol

C. Including adequate servings of fruits, vegetables, and the dairy group

D. Applicable to with either Type 1 or Type 2 diabetes mellitus

3. The nurse working in the physician’s office is reviewing lab results on the clients seen that
day. One of the clients who has classic diabetic symptoms had an eight-hour fasting plasma
glucose (FPG) test done. The nurse realizes that diagnostic criteria developed by the American
Diabetes Association for diabetes include classic diabetic symptoms plus which of the following
fasting plasma glucose levels?

A. Higher than 106 mg/dl

B. Higher than 126 mg/dl

C. Higher than 140 mg/dl

D. Higher than 160 mg/dl

4. When taking a health history, the nurse screens for manifestations suggestive of diabetes type
1. Which of the following manifestations are considered the primary manifestations of type 1
diabetes mellitus and would be most suggestive and require follow-up investigation?

A. Excessive intake of calories, rapid weight gain, and difficulty losing weight

B. An increase in three areas: thirst, intake of fluids, and hunger

C. Poor circulation, wound healing, and leg ulcers

D. Lack of energy, weight gain, and depression

5. The nurse is working with an overweight client who has a high-stress job and smokes. This
client has just received a diagnosis of type 2 diabetes mellitus and has just been started on an oral
hypoglycemic agent. Which of the following goals for the client which if met, would be most
likely to lead to an improvement in insulin efficiency to the point the client would no longer
require oral hypoglycemic agents?

A. Comply with medication regimen 100% for 6 months

B. Quit the use of any tobacco products by the end of three months
C. Lose a pound a week until the weight is within the normal range for height and exercise 30
minutes daily

D. Practice relaxation techniques for at least five minutes five times a day for at least five months

6. During a visit to a community, the nurse will recommend routine screening for diabetes when
the person has one or more of seven risk criteria. Which of the following persons that the nurse
comes in contact with most needs to be screened for diabetes based on the seven risk criteria?

A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl

B. A woman who is at 90% of standard body weight after delivering an eight-pound baby

C. A middle-aged Caucasian male

D. An older client who is hypotensive

7. A client was brought to the emergency room with complaints of slurring of speech, vomiting,
dry mucosa, and dry skin turgor. Lab tests showing serum sodium 125 mEq/L and serum blood
glucose of 350 mg/dL. Nurse Sophie will anticipate the physician to initially order which of the
following intravenous solutions?

A. 10% dextrose in water (D10W)

B. 0.9% normal saline solution

C. 5% dextrose in water (D5W)

D. 0.45% normal saline solution

8. You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent.
The client mentions that he usually has a couple of beers each night and takes an aspirin each day
to prevent heart attack and/or strokes. Which of the following responses would be best on the
part of the nurse?

A. As long as you only drink two beers and take one aspirin, this should not be a problem

B. The aspirin is alright but you need to give up drinking any alcoholic beverages

C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of
hypoglycemia

D. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug

9. Which of the following, if stated by the nurse, is correct about Hyperglycemic Hyperosmolar
Nonketotic Syndrome (HHNS)?
A. “This syndrome occurs mainly in people with type 1 diabetes.”

B. “It has a higher mortality rate than diabetic ketoacidosis.”

C. “The client with HHNS is in a state of overhydration.”

D. “This condition develops very rapidly.”

10. Nurse Robedee is teaching an underweight and emaciated client about the proper
methods/techniques when giving insulin. Which one of the following shows a proper technique?

A. Pinch the skin up and use a 90-degree angle

B. Use a 45-degree angle with the skin pinched up

C. Massage the area of injection after injecting the insulin

D. Warm the skin with a warm towel or washcloth prior to the injection

11. Nurse Pira is explaining to the client about type 2 diabetes mellitus. Risk factors of such
condition include all of the following, except:

A. Advanced age

B. Physical inactivity

C. Obesity

D. Smoking

12. Blood sugar is well controlled when Hemoglobin A1C is:

A. Below 5.7%

B. Between 12%-15%

C. Less than 180 mg/dL

D. Between 90 and 130 mg/dL

13. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by
the liver?

A. Alpha-glucosidase inhibitors

B. Biguanides
C. Meglitinides

D. Sulfonylureas

14. A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations
and tells the nurse he has type 1 diabetes mellitus. Which of the following actions should the
nurse do first?

A. Inject 1 mg of glucagon subcutaneously

B. Administer 50 mL of 50% glucose I.V

C. Give 4 to 6 oz (118 to 177 mL) of orange juice

D. Give the client four to six glucose tablets

15. Which insulin can be administered through continuous intravenous infusion?

A. insulin glargine (Lantus)

B. insulin aspart (Novolog)

C. insulin detemir (Levemir)

D. insulin Afrezza

E. regular insulin (Novolin R)

16. A medication nurse is about to give insulin to a patient with diabetes mellitus. Upon
reviewing the medications of the patient, which of the following would cause a further decrease
in the blood glucose level of the patient?

A. hydrochlorothiazide (Microzide)

B. levothyroxine (Synthroid)

C. carvedilol (Coreg)

D. hydrocortisone (SoluCortef)

17. Tony is a night shift nurse who is assigned to a patient whose glucose levels remain normal
at bedtime but experiences hypoglycemia at 3 am and hyperglycemia at 7 am. The patient is
likely experiencing what kind of complication of insulin therapy?

A. Insulin resistance

B. Dawn phenomenon
C. Insulin lipohypertrophy

D. Somogyi phenomenon

18. A nurse is caring for a client admitted with diabetic retinopathy. Which of the following
would the nurse expect to note on the assessment of this client:

A. Blurred or distorted vision

B. Flashes of lights or floaters

C. Sudden loss of vision

D. All of the above

19. A patient received 6 units of regular insulin three (3) hours ago. The nurse would be MOST
concerned if which of the following was observed?

A. Kussmaul respirations and diaphoresis

B. Anorexia and lethargy

C. Diaphoresis and trembling

D. Headache and polyuria

20. Mr. Wesley is newly diagnosed with Type I DM and is being seen by the home health nurse.
The doctor’s orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and
check blood sugar QID. When the nurse visits the patient at 5 pm, the nurse observes the man
performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to
be:

A. Anxiety, paleness, and pulse of 110 bpm

B. Lethargic with hot dry skin and rapid deep respirations

C. Alert and cooperative with BP of 130/80 mm Hg and respirations of 12 breaths per minute

D. Short of breath, with distended neck veins and bounding pulse of 96 bpm

21. Give Regular insulin by continuous I.V. infusion at 20 units/hr. The solution is 250 ml NS
with 100 units of Regular insulin. What rate on the infusion pump will deliver the correct dose?
Fill in the blank.

22. Question
Your patient has had the following intake: 2 ½ cups of coffee (240 mL/cup), 11.5 oz of grape
juice, ¾ qt of milk, 320 mL of diet coke, 1 ¼ L of D5W IV and 2 oz of grits. What will you
record as the total intake in mL for this patient? Fill in the blank.

23. A health care provider prescribed ondansetron (Zofran) 8 mg p.o. T.i.d to a patient with Type
1 diabetes mellitus with complaints of vomiting.; Available stock of Zofran in a 100 ml bottle
labeled 4 mg/tsp.; How many ml will the nurse administer for each dose? Fill in the blank.

24. Your patient has had the following intake: 8 oz glasses of iced tea, 4 oz cartons of grape
juice, ¾ pt of ice cream, 32 oz of juice, 1 ½ L of D5W IV and 6 oz of cottage cheese. What will
you record as the total intake in mL for this patient? Fill in the blank.

25. Question

A patient was recently discharged after being hospitalized due to type 1 diabetes mellitus and
was given ergocalciferol (Vitamin D) 225,000 units PO daily. The patient have on hand
ergocalciferol in 50,000 unit tablets. How many tablet(s) should the patient take? Fill in the
blank.

ANSWER

Part#1

1. d
2. a
3. b
4. c
5. b
6. d
7. c
8. b
9. c
10. b
11. b
12. a
13. a
14. d
15. a
16. a
17. d
18. a
 19. a
20. a
21. c
22. bcd
23. b
24. b
25. abcdefh

PART#2

1. d
2. c
3. c
4. d
5. b
6. a
7. a
8. c
9. b
10. b
11. d
12. d
13. d
14. a
15. c
16. cde
17. bc
18. d
19. c
20. a
21. bce
22. a
23. c
24. b
25. b
PART#3

1. c
2. a
3. c
4. d
5. d
6. d
7. a
8. b
9. c
10. b
11. d
12. d
13. ab
14. abde
15. c
16. d
17. abc
18. abef
19. b
20. b
21. a
22. d
23. c
24. a
25. abcd

PART#4

1. b
2. b
3. b
4. b
5. c
6. a
7. b
8. c
9. b
10. b
11. d
12. a
13. b
14. c
15. e
16. c
17. d
18. d
19. c
20. a
21. 50ml/hr
22. 3,265ml
23. 10ml
24. 3,195ml
25. 4.5 tablets