Diabetes NCLEX-Style Questions

Diabetes NCLEX-Style Questions ScienceMedicineNursing Xianinsacto Save Diabetes Mellitus NCLEX Style Ques...Teacher 36 terms ssandholmPreview Fluid and Electrolytes NCLEX Quest...33 terms Alex_Hassiepen Preview NCLEX Lung Assessment 36 terms nhyder12Preview NCLEX 48 terms Xiu 1. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes

• the patient is totally dependent on an outside source of insulin.
• there is decreased insulin secretion and cellular resistance to insulin that is produced.
• the immune system destroys the pancreatic insulin-producing cells.
• the insulin precursor that is secreted by the pancreas is not activated by the liver.

B Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body's needs or the cells do not respond to the insulin appropriately. The other information describes the physiology of type 1 diabetes.Cognitive Level: Application Text Reference: p. 1255 Nursing Process: Implementation NCLEX: Physiological Integrity

• A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient

about

• use of low doses of regular insulin.
• self-monitoring of blood glucose.
• oral hypoglycemic medications.
• maintenance of a healthy weight.

D Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.Cognitive Level: Application Text Reference: p. 1255 Nursing Process: Planning NCLEX: Physiological Integrity

• During a diabetes screening program, a patient tells the nurse, "My mother died of complications of type 2 diabetes. Can I inherit diabetes?"

The nurse explains that

• as long as the patient maintains normal weight and exercises, type 2 diabetes can be prevented.
• the patient is at a higher than normal risk for type 2 diabetes and should have periodic blood glucose level testing.
• there is a greater risk for children developing type 2 diabetes when the father has type 2 diabetes.
• although there is a tendency for children of people with type 2 diabetes to develop diabetes, the risk is higher for those with type 1 diabetes.

B Rationale: Offspring of people with type 2 diabetes are at higher risk for developing type 2 diabetes. The risk can be decreased, but not prevented, by maintenance of normal weight and exercising. The risk for children of a person with type 1 diabetes to develop diabetes is higher when it is the father who has the disease. Offspring of people with type 2 diabetes are more likely to develop diabetes than offspring of those with type 1 diabetes.Cognitive Level: Application Text Reference: p. 1256 Nursing Process: Implementation NCLEX: Physiological Integrity

• A program of weight loss and exercise is recommended for a patient with impaired fasting glucose (IFG). When teaching the patient about the

reason for these lifestyle changes, the nurse will tell the patient that

• the high insulin levels associated with this syndrome damage the lining of blood vessels, leading to vascular disease.
• although the fasting plasma glucose levels do not currently indicate diabetes, the glycosylated hemoglobin will be elevated.
• the liver is producing excessive glucose, which will eventually exhaust the ability of the pancreas to produce insulin, and exercise will

normalize glucose production.

• the onset of diabetes and the associated cardiovascular risks can be delayed or prevented by weight loss and exercise.

D Rationale: The patient with IFG is at risk for developing type 2 diabetes, but this risk can be decreased with lifestyle changes. Glycosylated hemoglobin levels will not be elevated in IFG and the Hb A1C test is not included in prediabetes testing. Elevated insulin levels do not cause the damage to blood vessels that can occur with IFG. The liver does not produce increased levels of glucose in IFG.Cognitive Level: Application Text Reference: p. 1255 Nursing Process: Implementation NCLEX: Physiological Integrity

• When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question should the nurse ask?
• "Have you lost any weight lately?"
• "Do you crave fluids containing sugar?"
• "How long have you felt anorexic?"
• "Is your urine unusually dark-colored?"

A Rationale: Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar- containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.Cognitive Level: Application Text Reference: pp. 1255, 1258 Nursing Process: Assessment NCLEX: Physiological Integrity

• During a clinic visit 3 months following a diagnosis of type 2 diabetes, the patient reports following a reduced-calorie diet. The patient has not

lost any weight and did not bring the glucose-monitoring record. The nurse will plan to obtain a(n)

• fasting blood glucose level.
• urine dipstick for glucose.
• glycosylated hemoglobin level.
• oral glucose tolerance test.

C Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been diagnosed.Cognitive Level: Application Text Reference: pp. 1258-1259 Nursing Process: Planning NCLEX: Physiological Integrity

• A patient who has just been diagnosed with type 2 diabetes is 5 ft 4 in (160 cm) tall and weighs 182 pounds (82 kg). A nursing diagnosis of

imbalanced nutrition: more than body requirements is developed. Which patient outcome is most important for this patient?

• The patient will have a diet and exercise plan that results in weight loss.
• The patient will state the reasons for eliminating simple sugars in the diet.
• The patient will have a glycosylated hemoglobin level of less than 7%.
• The patient will choose a diet that distributes calories throughout the day.

C Rationale: The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes are also appropriate but are not as high in priority.Cognitive Level: Application Text Reference: p. 1273 Nursing Process: Planning NCLEX: Physiological Integrity

• A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a

swimming class every day at 1:00 PM. The clinic nurse teaches the patient to

• delay eating the noon meal until after the swimming class.
• increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the swimming class.
• time the morning insulin injection so that the peak occurs while swimming.
• check glucose level before, during, and after swimming.

D Rationale: The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising.Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.Cognitive Level: Application Text Reference: p. 1269

Nursing Process: Implementation

NCLEX: Health Promotion and Maintenance

• A patient with type 1 diabetes has received diet instruction as part of the treatment plan. The nurse determines a need for additional

instruction when the patient says,

• "I may have an occasional alcoholic drink if I include it in my meal plan."
• "I will need a bedtime snack because I take an evening dose of NPH insulin."
• "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia."
• "I may eat whatever I want, as long as I use enough insulin to cover the calories."

D Rationale: Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.Cognitive Level: Application Text Reference: p. 1268 Nursing Process: Evaluation NCLEX: Physiological Integrity

• A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The patient tells the nurse, "I hate to

exercise! Can't I just follow the diet to keep my glucose under control?" The nurse teaches the patient that the major purpose of exercise for diabetics is to

• increase energy and sense of well-being, which will help with body image.
• facilitate weight loss, which will decrease peripheral insulin resistance.
• improve cardiovascular endurance, which is important for diabetics.
• set a successful pattern, which will help in making other needed changes.

B Rationale: Exercise is essential to decrease insulin resistance and improve blood glucose control. Increased energy, improved cardiovascular endurance, and setting a pattern of success are secondary benefits of exercise, but they are not the major reason.Cognitive Level: Application Text Reference: p. 1269 Nursing Process: Implementation NCLEX: Physiological Integrity

• The nurse has been teaching the patient to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the

patient that indicates a need for additional instruction is,

• "I need to rotate injection sites among my arms, legs, and abdomen each day."
• "I will buy the 0.5-ml syringes because the line markings will be easier to see."
• "I should draw up the regular insulin first after injecting air into the NPH bottle."
• "I do not need to aspirate the plunger to check for blood before I inject the insulin."

A Rationale: Rotating sites is no longer necessary because all insulin is now purified human insulin, and the risk for lipodystrophy is low. The other patient statements are accurate and indicate that no additional instruction is needed.Cognitive Level: Application Text Reference: p. 1262

Nursing Process: Evaluation

NCLEX: Health Promotion and Maintenance