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1. The nurse is assessing a group of patients with pre-diabetes. Which of the following
should the nurse include in the teaching plan regarding pre-diabetes?
1.
2.
3.
4.
Correct Answer: The person with pre-diabetes has an increased risk of heart disease.
Rationale: The individual with pre-diabetes is at risk for cardiovascular disease. Fluids
are not restricted in pre-diabetes. While individuals with poorly managed diabetes are at
risk for retinopathy, the pre-diabetic is not at risk for diabetes, but does not have or
necessarily develop macular degeneration. A client with pre-diabetes may not always
develop diabetes, and not all diabetics require insulin.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 1
2. The nurse teaches a group of patients that type 1 diabetes involves which of the
following etiologies?
1.
2.
3.
4.
Autoimmune disorder
Infectious disorder
Inflammatory disorder
Drug induced disorder
3. The nurse is teaching a client about fasting blood glucose levels and an oral glucose
tolerance test. Which of the following should be included in the teaching?
Correct Answer: You must fast before each of the tests for 8 to 10 hours.
Rationale: A fasting blood glucose level requires the client to fast for 8 to 12 hours prior
to the test. A glucose tolerance test involves both a fasting blood glucose level and
ingesting a known quantity of glucose with measurement of the blood glucose at , 1,
and 2 hours. Fasting for 8 hours and then eating a large meal describes a postprandial
blood glucose test. The normal value for fasting glucose is 60 to 100 mg/dL. The normal
result of a 2-hour glucose tolerance test should be a value of <140 mg/dL.
Cognitive Level: Application
Nursing Process: Planning
Client Need: Health Promotion and Maintenance
LO: 1
5. When caring for a client with new-onset diabetes, which of the following diagnostic
tests supports this diagnosis?
1.
2.
3.
4.
6. When teaching the client with diabetes about long-term management, the nurse
emphasizes which of the following?
Select all that apply.
1.
2.
3.
4.
5.
Correct Answer:
1. Have an eye examination yearly.
2. Have the urine checked for microalbuminuria.
3. Consult the provider to plan an exercise program.
Rationale: Have an eye examination yearly. The client with diabetes should have a
yearly dilated eye examination to check for retinopathy. Have the urine checked for
microalbuminuria. Microalbuminuria may warn of early diabetic nephropathy. Consult
the provider to plan an exercise program. Exercise will help maintain lower glucose
levels. Check your urine for ketones daily. There is no need to check the urine for
ketones when well; fingerstick glucose levels are done before meals. Measure your
blood pressure daily. There is no indication of instability and need to measure the blood
pressure daily.
Cognitive Level: Analysis
Nursing Process: Planning
Client Need: Health Promotion and Maintenance
LO: 2
7. The nurse is teaching a group of students about pre-diabetes and diabetes. Which of
the following is correct about the pathophysiology of pre-diabetes as compared to
diabetes?
1. The patient with pre-diabetes has a fasting glucose level between 101 and 125
on at least two occasions.
2. The patient with diabetes presents with a random glucose level of 75 mg/dl at
any time of day.
3. The patient with pre-diabetes will complain of polydypsia, polyuria, and
polyphagia.
4. The patient with pre-diabetes experiences weight loss and dehydration.
Correct Answer: The patient with prediabetes has a fasting glucose level between 101 and
125 on at least two occasions.
Rationale: Diagnostic criteria for pre-diabetes includes fasting glucose level between 101
and 125 on at least two occasions. A blood glucose level of 75 mg/dL is normal and
therefore not associated with diabetes. The symptoms of polydypsia, polyuria, and
polyphasia are present in diabetics with hyperglycemia, not pre-diabetics. Weight loss
and dehydration are associated with hyperglycemia and/or DKA, and therefore are not
part of the pre-diabetes syndrome.
Cognitive Level: Analysis
Nursing Process: Implementation
Client Need: Physiologic Integrity
LO: 3
8. The nurse is screening a group of patients for metabolic syndrome. Which of the
following findings are present in metabolic syndrome?
Select all that apply.
1.
2.
3.
4.
5.
Correct Answer:
1. Fasting glucose of 187 mg/dL
2. Triglyceride levels 325 mg/dL
3. Blood pressure 166/84
4. Abdominal obesity
Rationale: Fasting glucose of 187 mg/dL. Metabolic syndrome is present when three or
more of the following are present: blood pressure >135/85, triglycerides > 150 mg/dL,
low HDL, abdominal obesity or fasting glucose >100 mg/dL. Triglyceride levels 325
mg/dL. Metabolic syndrome is present when three or more of the following are present:
blood pressure >135/85, triglycerides > 150 mg/dL, low HDL, abdominal obesity or
fasting glucose >100 mg/dL. Blood pressure 166/84. Metabolic syndrome is present
when three or more of the following are present: blood pressure >135/85, triglycerides >
150 mg/dL, low HDL, abdominal obesity or fasting glucose >100 mg/dL. Abdominal
obesity. Metabolic syndrome is present when three or more of the following are present:
blood pressure >135/85, triglycerides > 150 mg/dL, low HDL, abdominal obesity or
fasting glucose >100 mg/dL. Swelling of thighs and lower extremities. Swelling of
lower extremities may be associated with poor venous return, CHF, hypoalbuminemia, or
other disorders.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 3
Correct Answer:
1. Develop an exercise plan with your health care provider.
2. Consume a diet high in fruits and vegetables.
Rationale: Develop an exercise plan with your health care provider. Exercise will help
avoid obesity and attain/maintain normal weight, a risk factor for type 2 diabetes.
Consume a diet high in fruits and vegetables. A Mediterranean diet high in
monounsaturated fat, fresh vegetables, and fruit, as well as exercise, is indicated. Try to
attain a target body weight 10% lower than your suggested weight. Moderate weight
loss is indicated, not radical weight loss. Increase your calories and decrease your
intake of saturated fats. Because obesity is a risk factor, caloric intake is usually
decreased, not increased. Follow a low-residue diet. A low-residue diet is
contraindicated; a diet high in fiber moderates blood glucose levels.
Cognitive Level: Analysis
Nursing Process: Planning
Client Need: Health Promotion and Maintenance
LO: 3
10. When caring for a male client with diabetes, the nurse assesses for which of the
following chronic complications of diabetes?
1.
2.
3.
4.
Erectile dysfunction
Hypoglycemia
Icteric sclera
Diabetic ketoacidosis
11. When caring for the patient with diabetes, which of the following acute complications
requires immediate intervention?
1.
2.
3.
4.
Correct Answer: The patient presents with vomiting, abdominal pain, and flushing.
Rationale: Vomiting, flushed and dry skin, abdominal pain, and acetone odor to the breath
are symptoms of diabetic ketoacidosis (DKA), which, if untreated, leads to severe
dehydration and acidosis. Burning in the lower extremities may indicate diabetic
neuropathy, a chronic complication of diabetes that can be treated, but not necessarily
immediately. Decreased visual acuity is a chronic complication of diabetes due to
retinopathy, macular degeneration, or cataracts. A creatinine of 1.1 mg/dL is normal and
does not represent a complication of diabetes.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 4
12. The nurse teaches the client that he has been placed on an ACE inhibitor to prevent
which of the following complications of diabetes?
1.
2.
3.
4.
Kidney damage
Hypotensive crisis
Neurogenic bladder
Infections
14. For which of the following clients would the nurse develop a plan of care to discuss
risk factors for developing pre-diabetes and diabetes?
1.
2.
3.
4.
15. The community health nurse is performing diabetes screening. Which of the
following groups of individuals is at highest risk for the development of type 2 diabetes?
1.
2.
3.
4.
Native Americans
Children and adolescents
Caucasian Americans
Asians living in the Far East
16. The nurse is providing health education for a group of clients with type 2 diabetes.
Which of the following risk factors should be included in the teaching plan?
1.
2.
3.
4.
5.
Overweight
Family history
Sedentary lifestyle
Picky eater
Large hip-to-abdomen ratio
Correct Answer:
1. Overweight
2. Family history
3. Sedentary lifestyle
Rationale: Overweight. The typical risks for developing type 2 diabetes include being
overweight. Family history. The typical risks for developing type 2 diabetes include
family members with diabetes. Sedentary lifestyle. The typical risks for developing type
2 diabetes include a sedentary lifestyle. Picky eater. There is no indication that being a
picky eater is related to diabetes. Large hip-to-abdomen ratio. The diabetic is typically
apple shaped, with a larger abdomen-to-hip ratio.
Cognitive Level: Analysis
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 6
17. The public health nurse plans a teaching program for senior citizens on modifying
risk factors in their lifestyle to decrease risk of developing type 2 diabetes mellitus.
Which of the following would the nurse not include in the teaching plan?
1.
2.
3.
4.
Genetic predisposition
Hypertension
Physical inactivity
Obesity
18. When caring for the patient with type 1 diabetes, the nurse includes which of the
following in the plan of care?
1. Administer insulin lispro or aspart immediately prior to the meal.
2. Administer oral hypoglycemic medications hour prior to meals.
3. Observe for hypoglycemia approximately to 1 hour after injecting NPH
insulin.
4. Avoid insulin if the patient reports an allergy to sulfa drugs.
Correct Answer: Administer insulin lispro or aspart immediately prior to the meal.
Rationale: Insulin lispro and aspart are rapid-acting insulins; the meal should be prepared
prior to injecting the insulin. Oral hypoglycemics are not used in the care of type 1
diabetics. The peak action of NPH, an intermediate-acting insulin, is 4 to 10 hours; the
peak action of insulin is when hypoglycemia is most likely to occur. Sulfonylurea oral
agents may cause cross sensitivity and hypersensitivity in people with sulfa allergy.
Cognitive Level: Analysis
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 6
19. The nurse should include which of the following in the teaching plan related to diet
for the patient with diabetes?
1.
2.
3.
4.
20. The nurse is responding to a client with diabetes about incorporating an occasional
alcoholic beverage into the meal plan with the providers permission. Which of the
following indicates the client understands the teaching?
1. If I drink alcohol, I should have only one alcohol-containing beverage daily.
2. Alcoholic beverages will raise my blood glucose and I will need more
insulin.
3. If I have a mixed drink, my blood glucose may drop.
4. I should take a vitamin supplement on the days I consume alcohol.
Rationale: One alcohol-containing beverage for women or two for men is considered a
moderate and acceptable intake of alcohol. Blood glucose is not acutely affected with
alcohol consumption; mixed with carbohydrates such as in a mixed drink, blood glucose
levels may rise. Vitamin supplements do not provide additional medical benefits to
diabetics whether they consume alcohol or not.
Cognitive Level: Application
Nursing Process: Evaluation
Client Need: Health Promotion and Maintenance
LO: 7
21. The nurse teaches the patient with diabetes or pre-diabetes that exercise is especially
important for which of the following reasons?
Select all that apply.
1.
2.
3.
4.
22. When developing a plan of care regarding exercise for clients with diabetes, the nurse
emphasizes which of the following?
1.
2.
3.
4.
23. Which of the following outcomes for a type 2 diabetic indicates the clients exercise
program has been effective?
1.
2.
3.
4.
24. When assessing the patient with diabetes for complications, it is especially important
for the nurse to pay attention to:
1.
2.
3.
4.
Creatinine.
Albumin.
Potassium.
Sclera.
25. When developing the plan of care for a patient who has been newly diagnosed with
diabetes, which of the following points is of highest priority?
1.
2.
3.
4.
Correct Answer: Hunger and irritability may indicate low blood glucose.
Rationale: Untreated hypoglycemia may lead to brain damage, and therefore is the
highest priority for teaching. Cutting the toenails straight across and proper foot care is
taught, but is not the priority. Alcohol and sweets may be incorporated into the diabetic
diet prescription in moderation.
Cognitive Level: Application
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 9
26. When teaching a client about the signs and symptoms of diabetes, which response
indicates more teaching is necessary?
1.
2.
3.
4.
Rationale: Coarse hair is not a typical symptom of diabetes. Signs and symptoms of
diabetes include polydypsia, polyuria, polyphagia, fatigue, and more frequent infections,
including UTIs.
Cognitive Level: Analysis
Nursing Process: Evaluation
Client Need: Physiological Integrity
LO: 9
27. When caring for the client with diabetic ketoacidosis (DKA), it is essential to include
which of the following interventions in the plan of care?
1.
2.
3.
4.
28. Which of the following nursing diagnoses is of highest priority for the client
presenting with hyperosmolar hyperglycemic syndrome (HHS)?
29. When caring for the client with diabetic ketoacidosis (DKA), the nurse monitors the
blood urea nitrogen (BUN) level for which of the following reasons?
1.
2.
3.
4.
30. The nurse teaches the patient with diabetes that he is particularly prone to injury that
may lead to amputation of the lower extremities due to which of the following?
Select all that apply.
1. Loss of protective sensation may lead to ulceration and infection.
2. The patient with diabetes is at risk for impaired tissue perfusion secondary to
peripheral arterial disease.
3. Taking insulin increases the likelihood of developing atherosclerotic disease.
4. Patients with hemoglobin A1C greater than 4 are at risk for gangrene.
5. Individuals with diabetes are particularly prone to arthritis.
Correct Answer:
1. Loss of protective sensation may lead to ulceration and infection.
2. The patient with diabetes is at risk for impaired tissue perfusion secondary to
peripheral arterial disease.
Rationale: Loss of protective sensation may lead to ulceration and infection. Poor
blood flow (PAD) may cause gangrene and decreased sensation may allow an injury to go
unobserved and infection such as osteomyelitis may develop, requiring amputation. The
patient with diabetes is at risk for impaired tissue perfusion secondary to peripheral
arterial disease. Clients with diabetes are prone to atherosclerotic disease and peripheral
neuropathy; these process decrease blood flow to the lower extremities and cause lack of
sensation. Taking insulin increases the likelihood of developing atherosclerotic
disease. Taking insulin promotes glycemic control and decreases risk of vascular
complications. Patients with hemoglobin A1C greater than 4 are at risk for gangrene.
The target for hemoglobin A1C should be below 7. Individuals with diabetes are
particularly prone to arthritis. Arthritis is not a risk factor for injury and PAD leading
to amputation.
Cognitive Level: Analysis
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 10
31. When assessing a 65-year-old patient with diabetes, which of the following
assessment findings requires notification of the health care provider?
1.
2.
3.
4.
32. When caring for a group of clients with diabetes, the nurse recognizes that which of
the following is at highest risk for peripheral arterial disease?
1.
2.
3.
4.