NCLEX Questions: Type I Diabetes

NCLEX Questions: Type I Diabetes

mary_g_mcdaniel Save Diabetes Mellitus NCLEX Style Ques...Teacher 36 terms ssandholmPreview Thyroid Disorders NCLEX Questions...12 terms erin_colmenero Preview Cushings/Addison's Practice Questi...44 terms alexisvu99Preview SIADH 10 terms flor The nurse is teaching a group of young adults regarding nonmodifiable risk factors for the development of type 1 diabetes mellitus. Which attendee statement indicates a need for further​ instruction? (Select all that​ apply.)

• "Type 1 diabetes mellitus is caused by exposure to processing of metals and​ proteins."
• "Type 1 diabetes mellitus can be passed on from one recessive gene from one​ parent."
• "I can develop type 1 diabetes mellitus from bacterial​ infections."
• "There are genes such as the​ HLA-DR3 and​ HLA-DR4 genes that can cause type 1 diabetes​ mellitus."
• "Type 1 diabetes mellitus can be caused by exposure to excessive heat and​ temperatures."

Answer: A, B, C, E

The individual with type 1 diabetes mellitus usually inherits the risk factor for the disorder from each parent. Environmental factors such as cold weather and exposure to a virus also contribute to the development of type 1 diabetes mellitus. The genes​ HLA-DR3 and​ HLA-DR4 have been identified in people with type 1 diabetes mellitus. Exposure to processing of metals contributes to the development of cirrhosis.A young client is admitted for lethargy and weight loss. Which clinical manifestation supports the​ nurse's suspicion of diagnosis of type 1 diabetes​ mellitus? (Select all that​ apply.)

• Glucosuria
• Weight gain
• Polyuria
• Fever
• Blurred vision

Answer: A, C, E

Rationale: Manifestations of type 1 diabetes mellitus are caused by the lack of insulin to transport glucose into the cells for energy. The resulting hyperglycemia leads to​ polyuria, glucosuria, and blurred vision. Polyuria occurs because water is drawn into the general​ circulation, increasing renal blood flow. Once the blood glucose exceeds the renal​ threshold, which is 180​ mg/dL, glucose will spill into the urine. Blurred vision is caused by swelling of the lenses of the eyes in response to increased fluid volume. Clients with type 1 diabetes mellitus usually lose​ weight, because proteins and fats are metabolized for energy and water is lost in the urine. In​ addition, clients with type 1 diabetes mellitus are frequently unable to develop a fever when cellular fuel stores are depleted because of a lack of insulin.

A teacher sends a child to the school nurse due to frequent thirst and urination. Upon​ assessment, the nurse suspects the child has type 1 diabetes mellitus. Which question should the nurse ask to gain data to support this​ suspicion?

• "How is your​ appetite?"
• "Have you noticed any bruises on your​ legs?"
• "Do you play outside a​ lot?"

D ​"When did you last see your healthcare​ provider?"

Answer: A

​Rationale: Polydipsia,​ polyuria, and polyphagia are the three hallmark signs of type 1 diabetes mellitus.​ Therefore, the nurse would ask about the​ child's appetite. Playing outside is not related to the onset of type 1 diabetes mellitus. Asking when the child last saw the healthcare provider is irrelevant to the current situation. Bruising to the legs can be from injuries or​ leukemia, not type 1 diabetes mellitus.The nurse is teaching the parents of a child with a new diagnosis of type 1 diabetes mellitus. Which information should the nurse include regarding the pathophysiology of the​ disease?

• Beta cells need help producing insulin.
• Delta cell destruction causes type 1 diabetes mellitus.
• Hyperglycemia happens when​ 50% of alpha cells are damaged.
• Beta cells are destroyed.

Answer: D

​Rationale: Type 1 diabetes mellitus has a slow onset and symptoms are not evident until​ 80-90% of beta cells are​ destroyed, causing hyperglycemia. Beta cells are functional and need medication to help with insulin production in type 2 diabetes mellitus. Hyperglycemia happens from beta cell​ destruction, not alpha or delta cell destruction.The nurse is working a health fair and teaching the public about risk factors for type 1 diabetes mellitus. Which ethnicity would the nurse include as having the highest risk in the United​ States?

• Hispanic
• Caucasian American
• Asian American
• African American

Answer: B

​Rationale: Caucasian Americans have a higher risk of developing type 1 diabetes mellitus than Asian​ Americans, African​ Americans, or Hispanics.The nurse is conducting discharge teaching with a client who has been newly diagnosed with type 1 diabetes mellitus. Which statement from the client indicates the need for additional​ teaching?

• "I need to stay hydrated during the​ day."

B ​"It is important to test my blood sugar at least four times a​ day."

• "I need to be alert for​ infections."

D ​"As long as​ I'm in my​ house, I can walk​ barefoot."

Answer: D

Rationale: Clients with diabetes should always wear shoes to protect their feet from injury. The client should be alert for infection or​ injuries, stay well​ hydrated, and test the blood sugar four times a day.

The nurse is caring for a child diagnosed with type 1 diabetes mellitus. The nurse should teach the child and parents that insulin dosing is based on which​ item?

• Age
• Weight
• Urine output
• Diet

Answer: D

​Rationale: Insulin dose is based on​ diet, specifically carbohydrate intake. Insulin dose is not based on​ weight, age, or urine output.Which finding in the medical record indicates a client has good control of type 1 diabetes​ mellitus?

• Fasting blood sugar 200​ mg/dL
• Hemoglobin A1C​ 5.4%
• Blood pressure​ 150/90 mmHg
• Free of amputations

Answer: B

Rationale: The finding that the client is maintaining a hemoglobin A1C of less than​ 6.5% indicates good diabetic control over the past 3 months.The client not having amputations indicates good peripheral​ circulation, but it does not indicate good disease management. Blood pressure of​ 150/90 mmHg is​ elevated, but it does not indicate good diabetes control. The fasting blood sugar should be under 125​ mg/dL. The finding of 200​ mg/dL is elevated.The nurse is teaching a group of clients newly diagnosed with type 1 diabetes mellitus. Which information should the nurse include in the​ teaching?

• "Schedule regular ophthalmology​ visits."
• "Have routine pedicures​ performed."
• "Take beta blockers daily to control blood​ pressure."
• "Monitor blood glucose levels​ weekly."

Answer: A

​Rationale: The client with type 1 diabetes mellitus is at high risk for retinal damage.​ Therefore, the nurse would teach the client to schedule regular ophthalmology visits to monitor vision. The nurse would not encourage the client to have regular pedicures due to possible injury that can occur from macrovascular and microvascular deficits. Blood glucose levels should be monitored several times a​ day, not once a week. The client would be prescribed​ angiotensin-converting enzyme​ (ACE) inhibitors to protect the kidneys from vascular damage.Which statement made by a client with type 1 diabetes mellitus indicates an understanding of instruction provided regarding disease​ management? (Select all that​ apply.)

• "I should obtain blood glucose levels prior to each insulin​ injection."
• "I should maintain my hemoglobin A1C levels at or below​ 8%."
• "I should count calories consumed to determine insulin needs for each​ day."
• "I should administer insulin during the day in multiple​ injections."
• "I should trim my toenails at an angle to prevent cutting the​ skin."

Answer: A, D

Rationale: For better blood glucose​ control, the healthcare provider would instruct the client to administer insulin throughout the day in multiple injections and to obtain blood glucose levels prior to each injection. Hemoglobin A1C levels should be below​ 6.5%. The client should be instructed to count​ carbohydrates, not calories. Toenails should be cut straight across with a clipper and the edges and corners smoothed with an emery board. If the client is unable to see his feet or reach them​ easily, someone else can trim his nails. If the nails are very thick or​ ingrown, if toes​ overlap, or if circulation is​ poor, then a podiatrist should cut the​ client's toenails.

The nurse is caring for a child who is hospitalized for the treatment of diabetic ketoacidosis​ (DKA). The​ child's parents ask why their child is receiving potassium. Which response by the nurse is​ accurate?

• "Potassium is administered to treat​ acidosis."
• "Potassium is administered to treat cerebral​ edema."
• "Potassium is administered to decrease blood glucose​ levels."
• "Potassium is administered to treat​ hypokalemia."

Answer: D

​Rationale: Potassium is administered to treat hypokalemia.​ Insulin, not​ potassium, is administered to decrease blood glucose levels. Sodium​ bicarbonate, not​ potassium, is administered to treat acidosis.​ Mannitol, not​ potassium, is administered to treat cerebral edema.A client with type 1 diabetes mellitus is being taught to monitor her blood glucose level. Which factor affecting accurate glucose monitoring should the nurse include in the​ instruction? (Select all that​ apply.)

• Medication overdoses
• Low hematocrit level
• Creatinine level
• High hematocrit level
• White blood cell​ (WBC) count

Answer: A, B, D

​Rationale: Factors that affect accurate glucose monitoring include medication​ overdoses, a low hematocrit​ level, and a high hematocrit level.The WBC count and creatinine levels do not affect accurate glucose monitoring.The nurse is providing teaching to a client with a new diagnosis of type 1 diabetes mellitus. The nurse should instruct the client about incorporating which treatment to help manage the​ disease? (Select all that​ apply.)

• Medication
• Exercise
• Daily weight checking
• Nutrition
• Fluid restriction

Answer: A, B, D

Clients with type 1 diabetes mellitus are treated with​ exercise, nutrition, and medication. Fluid restriction and daily weight checking are not part of the treatment plan for clients with type 1 diabetes mellitus.The nurse is teaching a child with type 1 diabetes mellitus and his family about sick day guidelines. Which statement by the family indicates successful​ teaching?

• "We will test for ketones when the blood glucose level reaches 160​ mg/dL."
• "We will test for ketones when the blood glucose level reaches 200​ mg/dL."
• "We will test for ketones when the blood glucose level reaches 180​ mg/dL."
• "We will test for ketones when the blood glucose level reaches 240​ mg/dL."

Answer: D

​Rationale: Blood glucose levels of 160​ mg/dL, 180​ mg/dL, and 200​ mg/dL are​ elevated, but they would not require testing for ketones. Once the blood glucose level exceeds 240​ mg/dL, the child and family should test the urine for ketones.