DIABETES MELLITUS ( QUESTION)

1. An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks
the nurse about the functioning of the pump, the nurse bases the response on which information
about the pump.
A. It is timed to release programmed doses of either short-duration or NPH insulin into the
bloodstream at specific intervals.
B. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly
monitoring blood glucose levels.
C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This
releases insulin into the bloodstream.
D. It administers a small continuous dose of short-duration insulin subcutaneously. The client
can self-administer an additional bolus dose from the pump before each meal.

Answer: D. It administers a small continuous dose of short-duration insulin subcutaneously. The

client can self-administer an additional bolus dose from the pump before each meal.
Rationale: An insulin pump provides a small continuous dose of short-duration (rapid-or short-
acting) insulin subcutaneously throughout the day and night. The client can self-administer an
additional bolus dose from the pump before each meal as needed. Short-duration insulin is used
in an insulin pump. An external pump is not attached surgically to the pancreas.

2. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency
department. Which findings support this diagnosis? Select all that apply.
A. Increase in pH
B. Comatose state
C. Deep, rapid breathing
D. Decreased urine output
E. Elevated blood glucose level

Answer: B. Comatose state, C. Deep, rapid breathing, E. Elevated blood glucose level
Rationale: Because of the profound deficiency of insulin associated with DKA, glucose cannot
be used for energy, and the body breaks down fat as a secondary source of energy. Ketones,
which are acid byproducts of fat metabolism, build up, and the client experiences a metabolic
ketoacidosis. High serum glucose contributes to an osmotic diuresis, and the client becomes
severely dehydrated. If untreated, the client will become comatose due to severe dehydration,
acidosis, and electrolyte imbalance. Kussmaul’s respirations, the deep rapid breathing associated
with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic
state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client
will experience severe hyperglycemia. Option A is incorrect because, in acidosis, the pH would
be low. Option D is incorrect because a high serum glucose will result in an osmotic diuresis and
the client will experience polyuria.
3. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia
and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form
of glucose should be taken if which symptom or symptoms develop? Select all that apply.
A. Polyuria
B. Shakiness
C. Palpitations
D. Blurred vision
E. Lightheadedness
F. Fruity breath odor

Answer: B. Shakiness, C. Palpitations, E. Lightheadedness

Rationale: Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia
and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath
odor are manifestations of hyperglycemia.

4. A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for
the treatment of hyperglycemia. What is the appropriate intervention to decrease the client’s
anxiety?
A. Administer a sedative.
B. Convey empathy, trust, and respect toward the client.
C. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear.
D. Make sure that the client is familiar with the correct medical terms to promote understanding
of what is happening.

Answer: B. Convey empathy, trust, and respect toward the client.

Rationale: Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate
intervention is to address the client’s feelings related to the anxiety. Administering a sedative is
not the most appropriate intervention and does not address the source of the client’s anxiety. The
nurse should not ignore the client’s anxious feelings. Anxiety needs to be managed before
meaningful client education can occur.

5. The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The
nurse recognizes an accurate understanding of measures to prevent diabetic ketoacidosis when
the client makes which statement?
A. “I will stop taking my insulin if I’m too sick to eat.”
B. “I will decrease my insulin dose during times of illness.”
C. “I will adjust my insulin dose according to the level of glucose in my urine.”
D. “I will notify my health care provider (HCP) if my blood glucose level is higher than 250
mg/dL (14.2 mmol/L).”

Answer: D. “I will notify my health care provider (HCP) if my blood glucose level is higher
than 250 mg/dL (14.2 mmol/L).”
Rationale: During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic
ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically
decreased caloric intake. As part of sick day management, the client with diabetes should
monitor blood glucose levels and should notify the health care provider if the level is higher than
250 mg/dL(14.2 mmol/L). Insulin should never be stopped. In fact, insulin may need to be
increased during times of illness. Doses should not be adjusted without the health care provider’s
advice and are usually adjusted based on blood glucose levels, not urinary glucose readings.
6. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial
blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of
short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose
level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer
which medication?
A. An ampule of 50% dextrose
B. NPH insulin subcutaneously
C. IV fluids containing dextrose
D. Phenytoin for the prevention of seizures

Answer: C. IV fluids containing dextrose

Rationale: Emergency management of DKA focuses on correcting fluid and electrolyte
imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious
consequences, including hypoglycemia and cerebral edema, can occur. During the management
of DKA, when the blood glucose level falls to 250 to 300 mg/dL (14.2 to 17.1 mmol/L), the IV
infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of
about 250 mg/dL (14.2 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose
is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual
treatment measure for DKA.

7. The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of
complications. Which sign or symptom, if exhibited in the client, indicates that the client is at
risk for chronic complications of diabetes if the blood glucose is not adequately managed?
A. Polyuria
B. Diaphoresis
C. Pedal edema
D. Decreased respiratory rate

Answer: A. Polyuria
Rationale: Chronic hyperglycemia, resulting from poor glycemic control, contributes to the
microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of
hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in
hypoglycemia. Hypoglycemia is an acute complication of diabetes mellitus; however, it does not
predispose a client to the chronic complications of diabetes mellitus. Therefore, option B can be
eliminated because this finding is characteristic of hypoglycemia. Options C and D are not
associated with diabetes mellitus.
8. The nurse is preparing a plan of care for a client with diabetes mellitus who has
hyperglycemia. The nurse places priority on which client problem?
A. Lack of knowledge
B. Inadequate fluid volume
C. Compromised family coping
D. Inadequate consumption of nutrients

Answer: B. Inadequate fluid volume

Rationale: An increased blood glucose level will cause the kidneys to excrete the glucose in the
urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis
leading to dehydration. This fluid loss must be replaced when it becomes severe. Options A, C,
and D are not related specifically to the information in the question.

9. The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client
relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for
the last 24 hours. Which additional statement by the client indicates a need for further teaching?
A. “I need to stop my insulin.”
B. “I need to increase my fluid intake.”
C. “I need to monitor my blood glucose every 3 to 4 hours.”
D. “I need to call the health care provider (HCP) because of these symptoms.”

Answer: A. “I need to stop my insulin.”

Rationale: When a client with diabetes mellitus is unable to eat normally because of illness, the
client still should take the prescribed insulin or oral medication. The client should consume
additional fluids and should notify the HCP. The client should monitor the blood glucose level
every 3 to 4 hours. The client should also monitor the urine for ketones during illness.

10. The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings
include a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), a temperature of 101 °F (38.3
°C), a pulse of 102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72
mm Hg. Which finding would be the priority concern to the nurse?
A. Pulse
B. Respiration
C. Temperature
D. Blood pressure

Answer: C. Temperature
Rationale: In the client with type 2 diabetes mellitus, an elevated temperature may indicate
infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client
with type 2 diabetes mellitus. The other findings are within normal limits.
11. The nurse is teaching a client how to mix regular insulin and NPH insulin in the same
syringe. Which action, if performed by the client, indicates the need for further teaching?
A. Withdraws the NPH insulin first
B. Withdraws the regular insulin first
C. Injects air into NPH insulin vial first
D. Injects an amount of air equal to the desired dose of insulin into each vial

Answer: A. Withdraws the NPH insulin first

Rationale: When preparing a mixture of short-acting insulin, such as regular insulin, with
another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence
will avoid contaminating the vial of short-acting insulin with insulin of another type. Options B,
C, and D identify correct actions for preparing NPH and short-acting insulin.

12. The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking
Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin.
The nurse should tell the client to take which action?
A. Freeze the insulin.
B. Refrigerate the insulin.
C. Store the insulin in a dark, dry place.
D. Keep the insulin at room temperature

Answer: B. Refrigerate the insulin.

Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials
should not be frozen. When stored unopened under refrigeration, insulin can be used up to the
expiration date on the vial. Options 1, 3, and 4 are incorrect.

13. Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client
that which food items are most acceptable to consume while taking this medication? Select all
that apply.
A. Alcohol
B. Red meats
C. Whole-grain cereals
D. Low-calorie desserts
E. Carbonated beverages

Answer: B. Red meats, C. Whole-grain cereals, E. Carbonated beverages

Rationale: When alcohol is combined with glimepiride, a disulfiram-like reaction may occur.
This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the
hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol
consumption while taking this medication. Low-calorie desserts should also be avoided. Even
though the calorie content may be low, carbohydrate content is most likely high and can affect
the blood glucose. The items in options B, C, and E are acceptable to consume.
14. A client with diabetes mellitus visits a health care clinic. The client’s diabetes mellitus
previously had been well controlled with glyburide daily, but recently the fasting blood glucose
level has been 180 to 200 mg/dL (10.2 to 11.4 mmol/L). Which medication, if added to the
client’s regimen, may have contributed to the hyperglycemia?
A. Prednisone
B. Atenolol
C. Phenelzine
D. Allopurinol

Answer: A. Prednisone
Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and
potassium supplements. Option B, a beta-blocker, and option C, a monoamine oxidase inhibitor,
have their own intrinsic hypoglycemic activity. Option D decreases urinary excretion of
sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

15. A client with diabetes mellitus is told that amputation of the leg is necessary to sustain life.
The client is agitated and tells the nurse, “This is all my health care provider’s fault. I have done
everything I’ve been asked to do!” Which nursing interpretation is best for this situation?
A. An expected coping mechanism
B. An ineffective defense mechanism
C. A need to notify the hospital lawyer
D. An expression of guilt on the part of the client

Answer: A. An expected coping mechanism

Rationale: The nurse needs to be aware of the effective and ineffective coping mechanisms that
can occur in a client when a loss is anticipated. The expression of anger is known to be a normal
response to impending loss, and the anger may be directed toward the self, God or other spiritual
beings, or caregivers. Notifying the hospital lawyer is inappropriate. Guilt may or may not be a
component of the client’s feelings, and the data in the question do not indicate that guilt is
present.

16. The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N
insulin. Which statement indicates to the nurse that the client understood the discharge teaching?
A. “I should keep the insulin in the cabinet during the day only.”
B. “I know I have to keep my insulin in the refrigerator at all times.”
C. “I can store the open insulin bottle in the kitchen cabinet for 1 month.”
D. “The best place for my insulin is on the windowsill, but in the cupboard is just as good.”

Answer: C. “I can store the open insulin bottle in the kitchen cabinet for 1 month.”
Rationale: An insulin vial in current use can be kept at room temperature for 1 month without
significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options A, B,
and D are incorrect.
17. Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common
side effect that the nurse should include in the client’s teaching plan?
A. Weight gain
B. Hypoglycemia
C. Flushing and palpitations
D. Gastrointestinal disturbances

Answer: D. Gastrointestinal disturbances

Rationale: The most common side effect of metformin is gastrointestinal disturbances, including
decreased appetite, nausea, and diarrhea. These generally subside over time. This medication
does not cause weight gain; clients lose an average of 7 to 8 lb (3.2 to 3.6 kg) because the
medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the
most common side effect. Flushing and palpitations are not specifically associated with this
medication.

18. Angiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with
diabetes mellitus to reduce vascular changes and possibly prevent or delay development of:
A. Chronic obstructive pulmonary disease.
B. Pancreatic cancer.
C. Renal failure.
D. Cerebrovascular accident.

Answer: C. Renal failure.

Rationale: Renal failure frequently results from the vascular changes associated with diabetes
mellitus. ACE inhibitors increase renal blood flow and are effective in decreasing diabetic
nephropathy. Chronic obstructive pulmonary disease is not a complication of diabetes, nor is it
prevented by ACE inhibitors. Pancreatic cancer is neither prevented by ACE inhibitors nor
considered a complication of diabetes. Cerebrovascular accident is not directly prevented by
ACE inhibitors, although management of hypertension will decrease vascular disease.

19. A client with diabetes mellitus comes to the clinic for a regular 3-month follow-up
appointment. The nurse notes several small bandages covering cuts on the client’s hands. The
client says, “I’m so clumsy. I’m always cutting my finger cooking or burning myself on the
iron.” Which of the following responses by the nurse would be most appropriate?
A. “Wash all wounds in isopropyl alcohol.”
B. “Keep all cuts clean and covered.”
C. “Why don’t you have your children do the cooking and ironing?”
D. “You really should be fine as long as you take your daily medication.

Answer: B. “Keep all cuts clean and covered.”

Rationale: Proper and careful first-aid treatment is important when a client with diabetes has a
skin cut or laceration. The skin should be kept supple and as free of organisms as possible.
Washing and bandaging the cut will accomplish this. Washing wounds with alcohol is too
caustic and drying to the skin. Having the children help is an unrealistic suggestion and does not
educate the client about proper care of wounds. Tight control of blood glucose levels through
adherence to the medication regimen is vitally important; however, it does not mean that careful
attention to cuts can be ignored.

20. The client with diabetes mellitus says, “If I could just avoid what you call carbohydrates in
my diet, I guess I would be okay.” The nurse should base the response to this comment on the
knowledge that diabetes affects the metabolism of which of the following?
A. Carbohydrates only.
B. Fats and carbohydrates only.
C. Protein and carbohydrates only.
D. Proteins, fats, and carbohydrates.

Answer: D. Proteins, fats, and carbohydrates.

Rationale: Diabetes mellitus is a multifactorial, systemic disease associated with problems in the
metabolism of all food types. The client’s diet should contain appropriate amounts of all three
nutrients, plus adequate minerals and vitamins.