NCLEX Questions Diabetes

NCLEX Questions – Diabetes 1.A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction is included in the plan?a.Soak feet in hot water b.Avoid using a mild soap on the feet c.Apply a moisturizing lotion to dry feet but not between the toes d.Always have a podiatrist cut you toenails; never cut them yourself

Answer: C

Rationale: The client is instructed to used a moisturizing lotion on the feet and to avoid applying the lotion between the toes. The client should be instructed not to soak the feet and should avoid hot water to prevent burns. The client may cut the toenails straight across and even with the toe itself and would consult a podiatrist if the toenails were thick or hard to cut or if vision were poor. The client should be instructed to wash the feet daily with a mild soap.

2.A client is brought to the emergency room in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse would immediately prepare to initiate which of the following anticipated physician’s order?a.Endotracheal intubation b.100 units of NPH insulin c.Intravenous infusion of normal saline d.Intravenous infusion of sodium bicarbonate

Answer: C

Rationale: The primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels.Intubation and mechanical ventilation are not required to treat HHNS 3.An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump.a.Is timed to release programmed doses of regular or NPH insulin into the bloodstream while regularly monitoring blood glucose levels b.Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels c.Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream This study source was downloaded by 100000869267694 from CourseHero.com on 08-02-2023 16:13:28 GMT -05:00 https://www.coursehero.com/file/43894993/52459198-Diabetes-NCLEX-Questions-2-Anwsers-1docx/

d.Gives a small continuous dose of regular insulin subcutaneously and the client can self-administer a bolus with an additional dose from the pump before each meal

Answer: D

Rationale: An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

4.A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the following concepts?a.Always keep insulin vials refrigerated b.Ketones in the urine signify a need for less insulin c.Increase the amount of insulin before unusual exercise d.Systematically rotate insulin injections within one anatomic site

Answer: D

Rationale: Insulin doses should not be adjusted nor increased before unusual exercise. If ketones are found in the urine, it possibly may indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. Injection sites should be rotated systematically within one anatomic site.

5.A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency room. Which finding would a nurse expect to note as confirming this diagnosis?a.Comatose state b.Decreased urine output c.Increased respirations and an increase in pH d.Elevated blood glucose level and low plasma bicarbonate level

Answer: D

Rationale: In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul’s respirations would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.

6.A nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which of the following symptoms develops?a.Polyuria b.Shakiness c.Blurred vision This study source was downloaded by 100000869267694 from CourseHero.com on 08-02-2023 16:13:28 GMT -05:00 https://www.coursehero.com/file/43894993/52459198-Diabetes-NCLEX-Questions-2-Anwsers-1docx/

d.Fruity breath odor

Answer: B

Rationale: Shakiness is a sign of hypoglycemia and would indicate the need for food or glucose. A fruity breath odor, blurred vision, and polyuria are signs of hyperglycemia.

7.A client with diabetes mellitus demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The appropriate intervention to decrease the client’s anxiety is

to:

a.Administer a sedative b.Convey empathy, trust and respect toward the client c.Ignore the signs and symptoms of anxiety so that they will soon disappear d.Make sure that the client knows all the correct medical terms to understand what is happening.

Answer: B

Rationale: The appropriate intervention is to address the client’s feelings related to the anxiety.Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client’s anxious feelings. A client will not relate to medical terms, particularly when anxiety exits.

8.A nurse provides instructions to a client newly diagnosed with type 1 diabetes. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the

client states:

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 physician if my blood glucose level is higher than 250mg/dL.”

Answer: D

Rationale: During illness, the client should monitor blood glucose levels and should notify the physician if the level is higher than 250 mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the physician’s advice and are usually adjusted based on blood glucose levels, not urinary glucose readings.

9.A client is admitted t a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intraveneous infusion of regular insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level in now 240 mg/dL. The nurse would next prepare to administer which of the following: a.Ampule of 5% dextrose b.NPH insulin subcutaneously c.Intravenous fluids containing 5% dextrose d.Phenytoin (Dilantin) for the prevention of seizure This study source was downloaded by 100000869267694 from CourseHero.com on 08-02-2023 16:13:28 GMT -05:00 https://www.coursehero.com/file/43894993/52459198-Diabetes-NCLEX-Questions-2-Anwsers-1docx/

Answer: C

Rationale: During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and 5% dextrose is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. NPH insulin is not used to treat DKA. Fifty percent dextrose is used to treat hypoglycemia. Phenytoin (Dilantin) is not a usual treatment measure for DKA.

10.A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification?a.Polyuria b.Diaphoresis c.Hypertension d.Increased pulse rate

Answer: A

Rationale: Classic symptoms of hypeglycemia include polydipsia, polyuria, and plyphagia. Options b, c, and d are not signs of hyperglycemia.

11.A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia.

The priority nursing diagnosis would be:

a.Fluid volume deficient b.Family processes, dysfunctional

c.Nutrition: less than body requirements, imbalanced

d.Knowledge, deficient: disease process and treatment

Answer: A

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 dieresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options b, c, and d are not related specifically to the subject of the question.

12.A 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 36 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 physician because of these symptoms.” Answer: A This study source was downloaded by 100000869267694 from CourseHero.com on 08-02-2023 16:13:28 GMT -05:00 https://www.coursehero.com/file/43894993/52459198-Diabetes-NCLEX-Questions-2-Anwsers-1docx/