Diabetes Mellitus NCLEX Style Questions

Diabetes Mellitus NCLEX Style Questions ScienceMedicineNursing ssandholmTeacher Save Fluid and Electrolytes NCLEX Quest...33 terms Alex_Hassiepen Preview Diabetes Practice Questions 54 terms KJFerrell03Preview Diabetes Mellitus Practice Question...11 terms jackie_dawson Preview Diabet 133 term Cas The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus?

• A 48-year-old woman with a hemoglobin A1C of 8.4%
• A 58-year-old man with a fasting blood glucose of 111 mg/dL
• A 68-year-old woman with a random plasma glucose of 190 mg/dL
• A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
• A 48-year-old woman with a hemoglobin A1C of 8.4%

Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL.The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse?

• "I will discard any insulin bottle that is cloudy in appearance."
• "The best injection site for insulin administration is in my abdomen."
• "I can wash the site with soap and water before insulin administration."
• "I may keep my insulin at room temperature (75o F) for up to a month."
• "I will discard any insulin bottle that is cloudy in appearance."

Intermediate-acting insulin and combination premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (less than 32° F [0° C]).Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.

The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful?

• "I plan to lose 25 pounds this year by following a high-protein diet."
• "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."
• "I should include more fiber in my diet than a person who does not have diabetes."
• "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."
• "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."

The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits.However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes mellitus. High-protein diets are not recommended for weight loss.Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness?

• A 58-year-old patient with diabetic retinopathy
• A 73-year-old patient who takes propranolol (Inderal)
• A 19-year-old patient who is on the school track team
• A 24-year-old patient with a hemoglobin A1C of 8.9%
• A 73-year-old patient who takes propranolol (Inderal)

Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use â- adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful?

• "Smokeless tobacco products decrease the risk of kidney damage."
• "I can help control my blood pressure by avoiding foods high in salt."
• "I should have yearly dilated eye examinations by an ophthalmologist."
• "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."
• "I can help control my blood pressure by avoiding foods high in salt."

Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.

A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse?

• "With type 2 diabetes, the body of the pancreas becomes inflamed."
• "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
• "With type 2 diabetes, the patient is totally dependent on an outside source of insulin."
• "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
• "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."

In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control?

• Prealbumin level
• Urine ketone level
• Fasting glucose level
• Glycosylated hemoglobin level
• Glycosylated hemoglobin level

A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what?

• Chooses a puncture site in the center of the finger pad.
• Washes hands with soap and water to cleanse the site to be used.
• Warms the finger before puncturing the finger to obtain a drop of blood.
• Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.
• Chooses a puncture site in the center of the finger pad

The patient should select a site on the sides of the fingertips, not on the center of the finger pad as this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention?

• Assess patient's perception of what it means to have diabetes.
• Ask the patient to write down current knowledge about diabetes.
• Set goals for the patient to actively participate in managing his diabetes.
• Assume responsibility for all of the patient's care to decrease stress level.
• Assess patient's perception of what it means to have diabetes.

In order for teaching to be effective, the first step is to assess the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include?

• Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease.
• Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.
• Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.
• Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.
• Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.

Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes?

• Excessive thirst
• Gradual weight gain
• Overwhelming fatigue
• Recurrent blurred vision
• Excessive thirst

The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.